00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 25-year-old female visits her GP complaining of weight loss, fatigue, and night...

    Incorrect

    • A 25-year-old female visits her GP complaining of weight loss, fatigue, and night sweats that have been ongoing for the past 2 months. During the examination, the GP discovers cervical and axillary lymphadenopathy and hepatosplenomegaly. The patient is referred to the hospital for further investigation, which includes a biopsy of her cervical lymph nodes.

      The biopsy report reveals the presence of Reed-Sternberg cells. These cells belong to the same lineage as which of the following cells?

      Your Answer: Monocytes

      Correct Answer: NK cells

      Explanation:

      Common lymphoid progenitor cells give rise to NK cells, as well as B-cells and T-cells. The biopsy of the patient in this case reveals Reed-Sternberg cells, indicating Hodgkin’s lymphoma, a cancer of B-cells. Platelets, monocytes, basophils, and erythrocytes, on the other hand, are derived from common myeloid progenitor cells.

      Haematopoiesis: The Generation of Immune Cells

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

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

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

    • This question is part of the following fields:

      • Haematology And Oncology
      19.6
      Seconds
  • Question 2 - A medical research team is analyzing the expression levels of numerous genes concurrently...

    Incorrect

    • A medical research team is analyzing the expression levels of numerous genes concurrently to identify Single Nucleotide Polymorphisms (SNPs) in breast cancer.

      Which molecular method would be the most suitable?

      Your Answer: Flow cytometry

      Correct Answer: Microarray

      Explanation:

      Microarrays are utilized for the simultaneous profiling of gene expression levels of numerous genes to investigate different diseases and treatments. These arrays consist of grids of thousands of DNA sequences arranged on glass or silicon. The chip is then hybridized with DNA or RNA probes, and a scanner is used to detect the relative amounts of complementary binding.

      Overview of Molecular Biology Techniques

      Molecular biology techniques are essential tools used in the study of biological molecules such as DNA, RNA, and proteins. These techniques are used to detect and analyze these molecules in various biological samples. The most commonly used techniques include Southern blotting, Northern blotting, Western blotting, and enzyme-linked immunosorbent assay (ELISA).

      Southern blotting is a technique used to detect DNA, while Northern blotting is used to detect RNA. Western blotting, on the other hand, is used to detect proteins. This technique involves the use of gel electrophoresis to separate native proteins based on their 3-D structure. It is commonly used in the confirmatory HIV test.

      ELISA is a biochemical assay used to detect antigens and antibodies. This technique involves attaching a colour-changing enzyme to the antibody or antigen being detected. If the antigen or antibody is present in the sample, the sample changes colour, indicating a positive result. ELISA is commonly used in the initial HIV test.

      In summary, molecular biology techniques are essential tools used in the study of biological molecules. These techniques include Southern blotting, Northern blotting, Western blotting, and ELISA. Each technique is used to detect specific molecules in biological samples and is commonly used in various diagnostic tests.

    • This question is part of the following fields:

      • General Principles
      11.8
      Seconds
  • Question 3 - Mrs. Johnson presents to her GP with pain in her left eye and...

    Incorrect

    • Mrs. Johnson presents to her GP with pain in her left eye and a strange feeling that something is bothering her eye. After a corneal reflex test, it is observed that the corneal reflex on the left is impaired, specifically due to a lesion affecting the nerve serving as the afferent limb of the pathway.

      What is the name of the nerve that serves as the afferent limb of the corneal pathway, detecting stimuli?

      Your Answer: Oculomotor nerve

      Correct Answer: Ophthalmic branch of the trigeminal nerve

      Explanation:

      The corneal reflex pathway involves the detection of stimuli by the ophthalmic branch of the trigeminal nerve, which then travels to the trigeminal ganglion. The brainstem, specifically the trigeminal nucleus, detects this signal and sends signals to both the left and right facial nerve. This causes the orbicularis oculi muscle to contract, resulting in a bilateral blink. The oculomotor nerve, on the other hand, innervates the extraocular muscles responsible for eye movement and does not provide any sensory function.

      Cranial nerves are a set of 12 nerves that emerge from the brain and control various functions of the head and neck. Each nerve has a specific function, such as smell, sight, eye movement, facial sensation, and tongue movement. Some nerves are sensory, some are motor, and some are both. A useful mnemonic to remember the order of the nerves is Some Say Marry Money But My Brother Says Big Brains Matter Most, with S representing sensory, M representing motor, and B representing both.

      In addition to their specific functions, cranial nerves also play a role in various reflexes. These reflexes involve an afferent limb, which carries sensory information to the brain, and an efferent limb, which carries motor information from the brain to the muscles. Examples of cranial nerve reflexes include the corneal reflex, jaw jerk, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and reflexes of the cranial nerves is important in diagnosing and treating neurological disorders.

    • This question is part of the following fields:

      • Neurological System
      13.8
      Seconds
  • Question 4 - A 32-year-old man with a submandibular gland stone is undergoing excision of the...

    Incorrect

    • A 32-year-old man with a submandibular gland stone is undergoing excision of the submandibular gland. The incision is sited transversely approximately 4 cm below the mandible. After incising the skin, platysma and deep fascia which of the following structures is most likely to be encountered.

      Your Answer: Facial artery

      Correct Answer: Facial vein

      Explanation:

      When accessing the submandibular gland, the facial vein and submandibular lymph nodes are the structures that are most easily visible. The gland is divided into a superficial and deep part by the mylohyoid muscle. The facial artery runs along the surface of the gland and can be seen in a groove. It then passes between the gland and the mandible before emerging on the face. During surgery, the facial vein is encountered first as the incision is made 4 cm below the mandible to prevent damage to the marginal mandibular nerve.

      Anatomy of the Submandibular Gland

      The submandibular gland is located beneath the mandible and is surrounded by the superficial platysma, deep fascia, and mandible. It is also in close proximity to various structures such as the submandibular lymph nodes, facial vein, marginal mandibular nerve, cervical branch of the facial nerve, deep facial artery, mylohyoid muscle, hyoglossus muscle, lingual nerve, submandibular ganglion, and hypoglossal nerve.

      The submandibular duct, also known as Wharton’s duct, is responsible for draining saliva from the gland. It opens laterally to the lingual frenulum on the anterior floor of the mouth and is approximately 5 cm in length. The lingual nerve wraps around the duct, and as it passes forward, it crosses medial to the nerve to lie above it before crossing back, lateral to it, to reach a position below the nerve.

      The submandibular gland receives sympathetic innervation from the superior cervical ganglion and parasympathetic innervation from the submandibular ganglion via the lingual nerve. Its arterial supply comes from a branch of the facial artery, which passes through the gland to groove its deep surface before emerging onto the face by passing between the gland and the mandible. The anterior facial vein provides venous drainage, and the gland’s lymphatic drainage goes to the deep cervical and jugular chains of nodes.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      14.5
      Seconds
  • Question 5 - During a radical neck dissection, at what age would division of which of...

    Incorrect

    • During a radical neck dissection, at what age would division of which of the following fascial layers expose the ansa cervicalis?

      Your Answer: Prevertebral fascia

      Correct Answer: Pretracheal fascia

      Explanation:

      To access the ansa cervicalis, one must cut through the pretracheal fascia on the posterolateral side of the thyroid gland. This nerve is located in front of the carotid sheath. However, it should be noted that the pre vertebral fascia is situated further back and cannot be reached by dividing the investing layer of fascia.

      The ansa cervicalis is a nerve that provides innervation to the sternohyoid, sternothyroid, and omohyoid muscles. It is composed of two roots: the superior root, which branches off from C1 and is located anterolateral to the carotid sheath, and the inferior root, which is derived from the C2 and C3 roots and passes posterolateral to the internal jugular vein. The inferior root enters the inferior aspect of the strap muscles, which are located in the neck, and should be divided in their upper half when exposing a large goitre. The ansa cervicalis is situated in front of the carotid sheath and is an important nerve for the proper functioning of the neck muscles.

    • This question is part of the following fields:

      • Respiratory System
      14
      Seconds
  • Question 6 - A carpal tunnel release results in median nerve damage. Which muscles will be...

    Correct

    • A carpal tunnel release results in median nerve damage. Which muscles will be impacted by this in the patient?

      Your Answer: Abductor pollicis brevis

      Explanation:

      Only the abductor pollicis brevis is innervated by the median nerve, while the other muscles are innervated by different nerves. It is important to be careful not to confuse the terms adductor and abductor when discussing muscle innervation.

      Abductor Pollicis Brevis: Anatomy and Function

      The abductor pollicis brevis is a muscle located in the palm of the hand. It originates from the flexor retinaculum, scaphoid, and trapezium bones and inserts into the radial side of the proximal phalanx of the thumb via a short tendon. The muscle is innervated by the recurrent branch of the median nerve in the palm.

      The main function of the abductor pollicis brevis is to abduct the thumb at the carpometacarpal and metacarpophalangeal joints. This causes the thumb to move anteriorly at right angles to the plane of the palm and to rotate medially, which is useful for activities such as typing. When the thumb is fully abducted, there is an angulation of around 30 degrees between the proximal phalanx and the metacarpal.

      Abduction of the thumb involves medial rotation of the metacarpal, and the abductor pollicis brevis is used along with the opponens pollicis in the initial stages of thumb opposition. Overall, the abductor pollicis brevis plays an important role in the movement and function of the thumb.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      14.8
      Seconds
  • Question 7 - A 50-year-old woman presents with two months of lower back pain. The pain...

    Incorrect

    • A 50-year-old woman presents with two months of lower back pain. The pain worsens during prolonged periods of sitting and shoots down her left leg. She is still able to perform all of her usual activities but has noticed that she has been catching her left foot on stairs when walking.

      On examination, power is normal in all myotomes of the right leg. In the left leg, dorsiflexion is slightly weak. The sensation is intact to touch and pin-prick on the right leg but there is a subjective loss of sensation along the sole of the left foot. Reflexes are normal. Hip abduction is assessed, which shows reduced power on the left compared to the right.

      An MRI is organised to assess for pathology.

      What spinal level corresponds to the symptoms?

      Your Answer: First lumbar vertebrae (L1)

      Correct Answer: Fifth lumbar vertebrae (L5)

      Explanation:

      Understanding Prolapsed Disc and its Features

      A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

      Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

      The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      30.7
      Seconds
  • Question 8 - A 65-year-old man presents to the hospital with a 3-day history of headaches....

    Correct

    • A 65-year-old man presents to the hospital with a 3-day history of headaches. He has a medical history of type 2 diabetes mellitus and hypertension.

      During the examination, it is observed that his left pupil is constricted with enophthalmos and ptosis of the left eyelid. However, the right side of his face appears to be unaffected.

      What could be the probable reason for this patient's symptoms?

      Your Answer: Carotid artery dissection

      Explanation:

      Carotid artery dissection is the likely cause of the patient’s Horner’s syndrome, which presents with ptosis, enophthalmos, and miosis. This syndrome occurs when there is damage to the cervical sympathetic chain, resulting in the loss of sympathetic innervation to the head and neck. The patient’s history of hypertension and headache further support this diagnosis.

      Facial nerve schwannoma is an incorrect diagnosis, as it would present with facial nerve palsy rather than Horner’s syndrome.

      Microvascular oculomotor nerve palsy is also an incorrect diagnosis, as it typically presents with complete ptosis and an eye that is turned outwards and downwards, without pupil dilatation.

      Uncal herniation is another incorrect diagnosis, as it can cause an oculomotor nerve palsy with pupillary involvement, but typically presents with a ‘down and out’ facing eye, rather than Horner’s syndrome.

      Horner’s syndrome is a condition characterized by several features, including a small pupil (miosis), drooping of the upper eyelid (ptosis), a sunken eye (enophthalmos), and loss of sweating on one side of the face (anhidrosis). The cause of Horner’s syndrome can be determined by examining additional symptoms. For example, congenital Horner’s syndrome may be identified by a difference in iris color (heterochromia), while anhidrosis may be present in central or preganglionic lesions. Pharmacologic tests, such as the use of apraclonidine drops, can also be helpful in confirming the diagnosis and identifying the location of the lesion. Central lesions may be caused by conditions such as stroke or multiple sclerosis, while postganglionic lesions may be due to factors like carotid artery dissection or cluster headaches. It is important to note that the appearance of enophthalmos in Horner’s syndrome is actually due to a narrow palpebral aperture rather than true enophthalmos.

    • This question is part of the following fields:

      • Neurological System
      32.4
      Seconds
  • Question 9 - A 78-year-old woman has been diagnosed with acute myeloid leukaemia (AML). During an...

    Incorrect

    • A 78-year-old woman has been diagnosed with acute myeloid leukaemia (AML). During an MDT meeting, it was decided that her first-line treatment will involve chemotherapy. The chosen drug is an antimetabolite that acts as a pyrimidine antagonist, inhibiting DNA polymerase and interfering with DNA synthesis.

      What chemotherapy drug is most likely being prescribed based on the above mechanism of action?

      Your Answer: Allopurinol

      Correct Answer: Cytarabine

      Explanation:

      Cytarabine is a medication used in chemotherapy to treat acute myeloid leukaemia (AML). It works by interfering with DNA synthesis during the S-phase of the cell cycle and inhibiting DNA polymerase.

      Allopurinol is a medication that inhibits xanthine oxidase, which prevents the production of uric acid. It is commonly used to treat gout, but can also be used to prevent hyperuricaemia in high-grade lymphoma and leukaemia before chemotherapy treatment.

      Methotrexate works by inhibiting dihydrofolate reductase and thymidylate synthesis. It is used to treat rheumatoid arthritis and various types of cancer.

      Ondansetron is an anti-emetic medication that is used to prevent nausea during chemotherapy treatment. It works by selectively blocking serotonin receptors (5-HT3) in the chemoreceptor trigger zone (CTZ) of the medulla.

      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
      18.7
      Seconds
  • Question 10 - Samantha is a 42-year-old woman with a lengthy history of alcohol misuse. She...

    Incorrect

    • Samantha is a 42-year-old woman with a lengthy history of alcohol misuse. She visits her physician complaining of ongoing abdominal discomfort, steatorrhea, and weight loss. There is no jaundice present. Tests indicate an increased lipase level and a normal amylase level. An ERCP is performed to examine the biliary system and pancreas.

      What is the most probable finding in the pancreas during the ERCP?

      Your Answer: A pancreatic abscess

      Correct Answer: 'Chain of lakes' appearance

      Explanation:

      Chronic pancreatitis can be diagnosed based on several factors, including alcohol abuse, elevated lipase levels, and normal amylase levels. An ERCP can confirm the diagnosis by revealing the characteristic chain of lakes appearance of the dilated and twisted main pancreatic duct. The absence of systemic symptoms makes a pancreatic abscess or necrosis unlikely, while a normal or absent pancreas is highly improbable.

      Understanding Chronic Pancreatitis

      Chronic pancreatitis is a condition characterized by inflammation that can affect both the exocrine and endocrine functions of the pancreas. While alcohol excess is the leading cause of this condition, up to 20% of cases are unexplained. Other causes include genetic factors such as cystic fibrosis and haemochromatosis, as well as ductal obstruction due to tumors, stones, and structural abnormalities.

      Symptoms of chronic pancreatitis include pain that worsens 15 to 30 minutes after a meal, steatorrhoea, and diabetes mellitus. Abdominal x-rays and CT scans are used to detect pancreatic calcification, which is present in around 30% of cases. Functional tests such as faecal elastase may also be used to assess exocrine function if imaging is inconclusive.

      Management of chronic pancreatitis involves pancreatic enzyme supplements, analgesia, and antioxidants. While there is limited evidence to support the use of antioxidants, one study suggests that they may be beneficial in early stages of the disease. Overall, understanding the causes and symptoms of chronic pancreatitis is crucial for effective management and treatment.

    • This question is part of the following fields:

      • Gastrointestinal System
      20.2
      Seconds
  • Question 11 - A 29-year-old woman goes into labour following an uncomplicated pregnancy. During delivery, the...

    Correct

    • A 29-year-old woman goes into labour following an uncomplicated pregnancy. During delivery, the baby is found to be in a breech position and there is insufficient time for a C-section. What is the condition that poses the greatest risk to the newborn?

      Your Answer: Developmental dysplasia of the hip

      Explanation:

      Developmental dysplasia of the hip is more likely to occur in babies who were in a breech presentation during pregnancy. Neonatal hypoglycaemia can be a risk for babies born to mothers with gestational diabetes or those who are preterm or small for their gestational age. Asymmetrical growth restriction, where a baby’s head circumference is on a higher centile than their weight or abdominal circumference, is often caused by uteroplacental dysfunction, such as pre-eclampsia or maternal smoking.

      Developmental dysplasia of the hip (DDH) is a condition that affects 1-3% of newborns and is more common in females, firstborn children, and those with a positive family history or breech presentation. It used to be called congenital dislocation of the hip (CDH). DDH is more often found in the left hip and can be screened for using ultrasound in infants with certain risk factors or through clinical examination using the Barlow and Ortolani tests. Other factors to consider include leg length symmetry, knee level when hips and knees are flexed, and restricted hip abduction in flexion. Ultrasound is typically used to confirm the diagnosis, but x-rays may be necessary for infants over 4.5 months old. Management options include the Pavlik harness for younger children and surgery for older ones. Most unstable hips will stabilize on their own within 3-6 weeks.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      16.3
      Seconds
  • Question 12 - A 39-year-old man comes to the emergency department with his wife who reports...

    Correct

    • A 39-year-old man comes to the emergency department with his wife who reports that he is exhibiting unusual behavior. According to her, he has been experiencing a progressively severe headache for the past three days. He vomited once this morning, and there is no history of head injury. Bilateral papilloedema is present on ophthalmoscopy. Although he scores a GCS of 15, his speech is sometimes slurred and confused. A CT scan of the head reveals a mass on the right side, near the midline in the anterior parietal lobe. The lateral and third ventricles are significantly dilated, indicating a blockage in the flow of cerebrospinal fluid (CSF). What structure does CSF from the third ventricle typically flow into the fourth ventricle through?

      Your Answer: Cerebral aqueduct

      Explanation:

      The cerebral aqueduct is the correct answer.

      The interventricular foramina allow the two lateral ventricles to drain into the third ventricle, which is located in the midline between the thalami of the two hemispheres. The third ventricle communicates with the fourth ventricle via the cerebral aqueduct (of Sylvius).

      CSF flows from the third ventricle into the fourth ventricle through the cerebral aqueduct (of Sylvius). From the fourth ventricle, CSF can leave through one of four openings: the median aperture (foramen of Magendie), either of the two lateral apertures (foramina of Luschka), or the central canal at the obex.

      The patient in the question is showing symptoms of raised intracranial pressure, which can be caused by various factors, including mass lesions and neoplasms. In this case, a mass is blocking the normal flow of CSF through the ventricular system, leading to an increase in intracranial pressure.

      Cerebrospinal Fluid: Circulation and Composition

      Cerebrospinal fluid (CSF) is a clear, colorless liquid that fills the space between the arachnoid mater and pia mater, covering the surface of the brain. The total volume of CSF in the brain is approximately 150ml, and it is produced by the ependymal cells in the choroid plexus or blood vessels. The majority of CSF is produced by the choroid plexus, accounting for 70% of the total volume. The remaining 30% is produced by blood vessels. The CSF is reabsorbed via the arachnoid granulations, which project into the venous sinuses.

      The circulation of CSF starts from the lateral ventricles, which are connected to the third ventricle via the foramen of Munro. From the third ventricle, the CSF flows through the cerebral aqueduct (aqueduct of Sylvius) to reach the fourth ventricle via the foramina of Magendie and Luschka. The CSF then enters the subarachnoid space, where it circulates around the brain and spinal cord. Finally, the CSF is reabsorbed into the venous system via arachnoid granulations into the superior sagittal sinus.

      The composition of CSF is essential for its proper functioning. The glucose level in CSF is between 50-80 mg/dl, while the protein level is between 15-40 mg/dl. Red blood cells are not present in CSF, and the white blood cell count is usually less than 3 cells/mm3. Understanding the circulation and composition of CSF is crucial for diagnosing and treating various neurological disorders.

    • This question is part of the following fields:

      • Neurological System
      30.8
      Seconds
  • Question 13 - A 22-year-old individual is brought to the medical team on call due to...

    Incorrect

    • A 22-year-old individual is brought to the medical team on call due to fever, neck stiffness, and altered Glasgow coma scale. The medical team suspects acute bacterial meningitis.

      What would be the most suitable antibiotic option for this patient?

      Your Answer: Cefuroxime and amoxicillin

      Correct Answer: Cefotaxime

      Explanation:

      Empirical Antibiotic Treatment for Acute Bacterial Meningitis

      Patients aged 16-50 years presenting with acute bacterial meningitis are most likely infected with Neisseria meningitidis or Streptococcus pneumoniae. The most appropriate empirical antibiotic choice for this age group is cefotaxime alone. However, if the patient has been outside the UK recently or has had multiple courses of antibiotics in the last 3 months, vancomycin may be added due to the increase in penicillin-resistant pneumococci worldwide.

      For infants over 3 months old up to adults of 50 years old, cefotaxime is the preferred antibiotic. If the patient is under 3 months or over 50 years old, amoxicillin is added to cover for Listeria monocytogenes meningitis, although this is rare. Ceftriaxone can be used instead of cefotaxime.

      Once the results of culture and sensitivity are available, the antibiotic choice can be modified for optimal treatment. Benzylpenicillin is usually first line, but it is not an option in this case. It is important to choose the appropriate antibiotic treatment to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Neurological System
      11.7
      Seconds
  • Question 14 - A 25 year old woman comes to the clinic with a lump in...

    Correct

    • A 25 year old woman comes to the clinic with a lump in her left breast. She mentions that she has noticed it for about 3 months and is worried because it hasn't disappeared. During the physical examination, a 1.5cm lump is found in the left breast. It is smooth, movable, and not attached to the skin. There are no changes in the nipple or skin. What is the probable diagnosis?

      Your Answer: Fibroadenoma

      Explanation:

      The most frequent breast lumps in women aged 15-25 are fibroadenomas. These lumps are usually firm, mobile, and less than 3 cm in size. They are not a cause for concern and typically disappear within a few years.

      Fat necrosis is a condition that occurs after breast trauma, such as a sports injury or core needle biopsy. The affected area may be tender and show bruising. However, it usually resolves on its own and is unlikely to persist for an extended period.

      Overview of Benign Breast Lesions

      Benign breast lesions are non-cancerous growths that can occur in the breast tissue. There are several types of benign breast lesions, each with their own unique features and treatment options.

      Fibroadenomas are one of the most common types of benign breast lesions, accounting for 12% of all breast masses. They develop from a whole lobule and are typically mobile, firm breast lumps. While they do not increase the risk of malignancy, surgical excision is usually recommended if the lesion is larger than 3 cm. Phyllodes tumors, a rare type of fibroadenoma, should be widely excised or removed with a mastectomy if the lesion is large.

      Breast cysts are another common type of benign breast lesion, with 7% of all Western females presenting with one. They usually present as a smooth, discrete lump and may be aspirated. However, if the cyst is blood-stained or persistently refills, it should be biopsied or excised.

      Sclerosing adenosis, radial scars, and complex sclerosing lesions can cause mammographic changes that mimic carcinoma. However, they are considered a disorder of involution and do not increase the risk of malignancy. Biopsy is recommended, but excision is not mandatory.

      Epithelial hyperplasia is a disorder that consists of increased cellularity of the terminal lobular unit, and atypical features may be present. Those with atypical features and a family history of breast cancer have a greatly increased risk of malignancy and may require surgical resection.

      Fat necrosis can occur in up to 40% of cases and usually has a traumatic cause. Physical features may mimic carcinoma, but imaging and core biopsy can help diagnose the lesion.

      Duct papillomas usually present with nipple discharge and may require microdochectomy if they are large. However, they do not increase the risk of malignancy.

      Overall, benign breast lesions can have varying presentations and treatment options. It is important to consult with a healthcare provider to determine the best course of action for each individual case.

    • This question is part of the following fields:

      • Reproductive System
      15.5
      Seconds
  • Question 15 - A 30-year-old man arrived at the emergency department following a syncopal episode during...

    Incorrect

    • A 30-year-old man arrived at the emergency department following a syncopal episode during a game of basketball. He is typically healthy with no prior medical history, but he does mention experiencing occasional palpitations, which he believes may be due to alcohol or caffeine consumption. Upon further inquiry, he reveals that his father passed away suddenly at the age of 40 due to a heart condition. What is the underlying pathophysiological alteration in this patient?

      Your Answer: Ventricular septal defect

      Correct Answer: Asymmetric septal hypertrophy

      Explanation:

      When a young patient presents with symptoms of syncope and chest discomfort, along with a family history of hypertrophic cardiomyopathy (HOCM), it is important to consider the possibility of this condition. Asymmetric septal hypertrophy and systolic anterior movement (SAM) of the anterior leaflet of the mitral valve on echocardiogram or cMR are supportive of HOCM. This condition is caused by a genetic defect in the beta-myosin heavy chain protein gene. While Brugada syndrome may also be a consideration, it is not listed as a possible answer due to its underlying mechanism of sodium channelopathy.

      Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder that affects muscle tissue and is inherited in an autosomal dominant manner. It is caused by mutations in genes that encode contractile proteins, with the most common defects involving the ÎČ-myosin heavy chain protein or myosin-binding protein C. HOCM is characterized by left ventricle hypertrophy, which leads to decreased compliance and cardiac output, resulting in predominantly diastolic dysfunction. Biopsy findings show myofibrillar hypertrophy with disorganized myocytes and fibrosis. HOCM is often asymptomatic, but exertional dyspnea, angina, syncope, and sudden death can occur. Jerky pulse, systolic murmurs, and double apex beat are also common features. HOCM is associated with Friedreich’s ataxia and Wolff-Parkinson White. ECG findings include left ventricular hypertrophy, non-specific ST segment and T-wave abnormalities, and deep Q waves. Atrial fibrillation may occasionally be seen.

    • This question is part of the following fields:

      • Cardiovascular System
      24.3
      Seconds
  • Question 16 - A 45-year-old woman has been found to carry a BRCA 1 mutation. Besides...

    Correct

    • A 45-year-old woman has been found to carry a BRCA 1 mutation. Besides breast cancer, what other type of cancer is she most susceptible to developing?

      Your Answer: Ovarian cancer

      Explanation:

      It is more probable for individuals with a history of colorectal cancer to develop a second colorectal cancer. However, the risk of developing other types of cancer is only slightly elevated and does not warrant screening.

      Genetic Conditions and Their Association with Surgical Diseases

      Li-Fraumeni Syndrome is an autosomal dominant genetic condition caused by mutations in the p53 tumour suppressor gene. Individuals with this syndrome have a high incidence of malignancies, particularly sarcomas and leukaemias. The diagnosis is made when an individual develops sarcoma under the age of 45 or when a first-degree relative is diagnosed with any cancer below the age of 45 and another family member develops malignancy under the age of 45 or sarcoma at any age.

      BRCA 1 and 2 are genetic conditions carried on chromosome 17 and chromosome 13, respectively. These conditions are linked to developing breast cancer with a 60% risk and an associated risk of developing ovarian cancer with a 55% risk for BRCA 1 and 25% risk for BRCA 2. BRCA2 mutation is also associated with prostate cancer in men.

      Lynch Syndrome is another autosomal dominant genetic condition that causes individuals to develop colonic cancer and endometrial cancer at a young age. 80% of affected individuals will get colonic and/or endometrial cancer. High-risk individuals may be identified using the Amsterdam criteria, which include three or more family members with a confirmed diagnosis of colorectal cancer, two successive affected generations, and one or more colon cancers diagnosed under the age of 50 years.

      Gardners syndrome is an autosomal dominant familial colorectal polyposis that causes multiple colonic polyps. Extra colonic diseases include skull osteoma, thyroid cancer, and epidermoid cysts. Desmoid tumours are seen in 15% of individuals with this syndrome. Due to colonic polyps, most patients will undergo colectomy to reduce the risk of colorectal cancer. It is now considered a variant of familial adenomatous polyposis coli.

      Overall, these genetic conditions have a significant association with surgical diseases, and early identification and management can help reduce the risk of malignancies and other associated conditions.

    • This question is part of the following fields:

      • Haematology And Oncology
      5.6
      Seconds
  • Question 17 - A young adult comes to your clinic to inquire about their tuberculosis vaccination...

    Correct

    • A young adult comes to your clinic to inquire about their tuberculosis vaccination history. You administer a Mantoux test and after three days, you observe a positive reaction. What category of hypersensitivity reaction has occurred?

      Your Answer: Type IV

      Explanation:

      The tuberculin skin reaction, also known as the Mantoux test, is an instance of a type IV hypersensitivity reaction, which is characterized by delayed onset. The clinician must wait for 2-3 days before examining the skin for any reaction. Various types of hypersensitivity reactions are outlined below.

      Classification of Hypersensitivity Reactions

      Hypersensitivity reactions are classified into four types according to the Gell and Coombs classification. Type I, also known as anaphylactic hypersensitivity, occurs when an antigen reacts with IgE bound to mast cells. This type of reaction is commonly seen in atopic conditions such as asthma, eczema, and hay fever. Type II hypersensitivity occurs when cell-bound IgG or IgM binds to an antigen on the cell surface, leading to autoimmune conditions such as autoimmune hemolytic anemia, ITP, and Goodpasture’s syndrome. Type III hypersensitivity occurs when free antigen and antibody (IgG, IgA) combine to form immune complexes, leading to conditions such as serum sickness, systemic lupus erythematosus, and post-streptococcal glomerulonephritis. Type IV hypersensitivity is T-cell mediated and includes conditions such as tuberculosis, graft versus host disease, and allergic contact dermatitis.

      In recent times, a fifth category has been added to the classification of hypersensitivity reactions. Type V hypersensitivity occurs when antibodies recognize and bind to cell surface receptors, either stimulating them or blocking ligand binding. This type of reaction is seen in conditions such as Graves’ disease and myasthenia gravis. Understanding the classification of hypersensitivity reactions is important in the diagnosis and management of these conditions.

    • This question is part of the following fields:

      • General Principles
      6.1
      Seconds
  • Question 18 - A 27-year-old man presents to the Emergency Department following a car accident. He...

    Incorrect

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

      Which function is most likely impacted in this patient?

      Your Answer: Plantar flexion of foot

      Correct Answer: Dorsiflexion of foot

      Explanation:

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

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

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      21.4
      Seconds
  • Question 19 - A 10-year-old boy is brought to the doctor with developmental delay and seizure...

    Incorrect

    • A 10-year-old boy is brought to the doctor with developmental delay and seizure attacks since the age of 8. He displays abnormal behavior, ataxia, unusual laughing, intellectual disability, and mandibular prognathism. Genomic testing reveals a deletion in the 15q11-q13 chromosome, leading to a diagnosis of Angelman syndrome (AS). Which cellular activity is most likely to be impaired due to dysfunctional expression of the ubiquitin-protein ligase E3A gene on chromosome 15?

      Your Answer: Translation of RNA into proteins

      Correct Answer: Proteasomal degradation of proteins

      Explanation:

      The function of the mitochondrion is primarily aerobic respiration.

      The peroxisome is the only organelle that carries out the catabolism of very long-chain fatty acids and amino acids.

      The rough endoplasmic reticulum is responsible for protein folding.

      The ribosome translates RNA into proteins.

      Functions of Cell Organelles

      The functions of major cell organelles can be summarized in a table. The rough endoplasmic reticulum (RER) is responsible for the translation and folding of new proteins, as well as the manufacture of lysosomal enzymes. It is also the site of N-linked glycosylation. Cells such as pancreatic cells, goblet cells, and plasma cells have extensive RER. On the other hand, the smooth endoplasmic reticulum (SER) is involved in steroid and lipid synthesis. Cells of the adrenal cortex, hepatocytes, and reproductive organs have extensive SER.

      The Golgi apparatus modifies, sorts, and packages molecules that are destined for cell secretion. The addition of mannose-6-phosphate to proteins designates transport to lysosome. The mitochondrion is responsible for aerobic respiration and contains mitochondrial genome as circular DNA. The nucleus is involved in DNA maintenance, RNA transcription, and RNA splicing, which removes the non-coding sequences of genes (introns) from pre-mRNA and joins the protein-coding sequences (exons).

      The lysosome is responsible for the breakdown of large molecules such as proteins and polysaccharides. The nucleolus produces ribosomes, while the ribosome translates RNA into proteins. The peroxisome is involved in the catabolism of very long chain fatty acids and amino acids, resulting in the formation of hydrogen peroxide. Lastly, the proteasome, along with the lysosome pathway, is involved in the degradation of protein molecules that have been tagged with ubiquitin.

    • This question is part of the following fields:

      • General Principles
      13.8
      Seconds
  • Question 20 - A 50-year-old male presents to his primary care physician with complaints of edema...

    Incorrect

    • A 50-year-old male presents to his primary care physician with complaints of edema around his eyes and ankles. Upon further inquiry, he reports having foamy urine and is diagnosed with hypertension. The physician suggests that a biopsy of the affected organ would be the most informative diagnostic tool.

      Considering the organ most likely involved in his symptoms, what would be the optimal approach for obtaining a biopsy?

      Your Answer: Posteriorly, mid-scapular line, above the iliac crest

      Correct Answer: Posteriorly, inferior to the 12 rib and adjacent to the spine

      Explanation:

      The safest way to access the kidneys is from the patient’s back, as they are retroperitoneal structures. Attempting to access them from the front or side would involve passing through the peritoneum, which increases the risk of infection. The kidneys are located near the spine and can be accessed below the 12th rib.

      The retroperitoneal structures are those that are located behind the peritoneum, which is the membrane that lines the abdominal cavity. These structures include the duodenum (2nd, 3rd, and 4th parts), ascending and descending colon, kidneys, ureters, aorta, and inferior vena cava. They are situated in the back of the abdominal cavity, close to the spine. In contrast, intraperitoneal structures are those that are located within the peritoneal cavity, such as the stomach, duodenum (1st part), jejunum, ileum, transverse colon, and sigmoid colon. It is important to note that the retroperitoneal structures are not well demonstrated in the diagram as the posterior aspect has been removed, but they are still significant in terms of their location and function.

    • This question is part of the following fields:

      • Gastrointestinal System
      17.2
      Seconds
  • Question 21 - In a 70 Kg person, what percentage of the entire body fluid will...

    Incorrect

    • In a 70 Kg person, what percentage of the entire body fluid will be provided by plasma?

      Your Answer: 65%

      Correct Answer: 5%

      Explanation:

      Understanding the Physiology of Body Fluid Compartments

      Body fluid compartments are essential components of the human body, consisting of intracellular and extracellular compartments. The extracellular compartment is further divided into interstitial fluid, plasma, and transcellular fluid. In a typical 70 Kg male, the intracellular compartment comprises 60-65% of the total body fluid volume, while the extracellular compartment comprises 35-40%. The plasma volume is approximately 5%, while the interstitial fluid volume is 24%. The transcellular fluid volume is approximately 3%. These figures are only approximate and may vary depending on the individual’s weight and other factors. Understanding the physiology of body fluid compartments is crucial in maintaining proper fluid balance and overall health.

    • This question is part of the following fields:

      • Renal System
      9.2
      Seconds
  • Question 22 - As a junior doctor in orthopaedic surgery, you are tasked with evaluating a...

    Incorrect

    • As a junior doctor in orthopaedic surgery, you are tasked with evaluating a 42-year-old woman who is scheduled for surgery tomorrow to repair an open radial fracture resulting from a bike accident. The patient has a medical history of severe psoriasis, gastro-oesophageal reflux disease, polycystic ovary syndrome, and depression. Routine blood tests were ordered before the surgery, and the results are surprising:

      - Bilirubin: 17 ”mol/L (normal range: 3 - 17)
      - ALP: 89 u/L (normal range: 30 - 100)
      - ALT: 354 u/L (normal range: 3 - 40)
      - ÎłGT: 61 u/L (normal range: 8 - 60)
      - Albumin: 34 g/L (normal range: 35 - 50)

      Which medication is most likely responsible for this abnormality?

      Your Answer: Omeprazole

      Correct Answer: Methotrexate

      Explanation:

      Hepatotoxicity is a potential side effect of using Methotrexate to treat severe psoriasis. The use of combined oral contraceptive pills may increase the risk of venous thromboembolism and breast cancer. Fluoxetine may cause serotonin syndrome, while morphine can lead to respiratory depression and overdose, both of which are serious risks.

      Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

      Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5 mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

      It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      29.8
      Seconds
  • Question 23 - A 20-year-old man experienced recurrent episodes of breathlessness and palpitations lasting approximately 20...

    Correct

    • A 20-year-old man experienced recurrent episodes of breathlessness and palpitations lasting approximately 20 minutes and resolving gradually. No unusual physical signs were observed. What is the probable cause of these symptoms?

      Your Answer: Panic attacks

      Explanation:

      Likely Diagnosis for Sudden Onset of Symptoms

      When considering the sudden onset of symptoms, drug abuse is an unlikely cause as the symptoms are short-lived and not accompanied by other common drug abuse symptoms. Paroxysmal SVT would present with sudden starts and stops, rather than a gradual onset. Personality disorder and thyrotoxicosis would both lead to longer-lasting symptoms and other associated symptoms. Therefore, the most likely diagnosis for sudden onset symptoms would be panic disorder. It is important to consider all possible causes and seek medical attention to properly diagnose and treat any underlying conditions.

    • This question is part of the following fields:

      • Cardiovascular System
      15.9
      Seconds
  • Question 24 - A 22-year-old university student with a history of primary sclerosing cholangitis presents to...

    Incorrect

    • A 22-year-old university student with a history of primary sclerosing cholangitis presents to the gastroenterologists with symptoms suggestive of ulcerative colitis. She has been experiencing bloody diarrhoea and fatigue for the past three months, with an average of seven bowel movements per day. Her medical history includes a childhood hepatitis A infection and an uncomplicated appendicectomy three years ago. She also has a family history of hepatocellular carcinoma.

      During examination, stage 1 haemorrhoids and a scar over McBurney's point are noted. Given her medical history, which condition warrants annual colonoscopy in this patient?

      Your Answer: Family history of hepatocellular carcinoma

      Correct Answer: Primary sclerosing cholangitis

      Explanation:

      Annual colonoscopy is recommended for individuals who have both ulcerative colitis and PSC.

      Colorectal Cancer Risk in Ulcerative Colitis Patients

      Ulcerative colitis patients have a significantly higher risk of developing colorectal cancer compared to the general population. The risk is mainly related to chronic inflammation, and studies report varying rates. Unfortunately, patients with ulcerative colitis often experience delayed diagnosis, leading to a worse prognosis. Lesions may also be multifocal, further increasing the risk of cancer.

      Several factors increase the risk of colorectal cancer in ulcerative colitis patients, including disease duration of more than 10 years, pancolitis, onset before 15 years old, unremitting disease, and poor compliance to treatment. To manage this risk, colonoscopy surveillance is recommended, and the frequency of surveillance depends on the patient’s risk stratification.

      Patients with lower risk require a colonoscopy every five years, while those with intermediate risk require a colonoscopy every three years. Patients with higher risk require a colonoscopy every year. The risk stratification is based on factors such as the extent of colitis, the severity of active endoscopic/histological inflammation, the presence of post-inflammatory polyps, and family history of colorectal cancer. Primary sclerosing cholangitis or a family history of colorectal cancer in first-degree relatives aged less than 50 years also increase the risk of cancer. By following these guidelines, ulcerative colitis patients can receive appropriate surveillance and management to reduce their risk of developing colorectal cancer.

    • This question is part of the following fields:

      • Gastrointestinal System
      34.6
      Seconds
  • Question 25 - A 16-year-old boy presents to his GP with a 5-month history of passing...

    Incorrect

    • A 16-year-old boy presents to his GP with a 5-month history of passing frequent watery diarrhoea, up to 6 times a day. He reports occasional passage of mucus mixed with his stool and has experienced a weight loss of around 9kg. An endoscopy and biopsy are performed, revealing evidence of granuloma formation.

      What is the probable diagnosis?

      Your Answer: Coeliac disease

      Correct Answer: Crohn’s disease

      Explanation:

      The presence of granulomas in the gastrointestinal tract is a key feature of Crohn’s disease, which is a chronic inflammatory condition that can affect any part of the digestive system. The combination of granulomas and clinical history is highly indicative of this condition.

      Coeliac disease, on the other hand, is an autoimmune disorder triggered by gluten consumption that causes villous atrophy and malabsorption. However, it does not involve the formation of granulomas.

      Colonic tuberculosis, caused by Mycobacterium tuberculosis, is another granulomatous condition that affects the ileocaecal valve. However, the granulomas in this case are caseating with necrosis, and colonic tuberculosis is much less common than Crohn’s disease.

      Endoscopy and biopsy are not necessary for diagnosing irritable bowel syndrome, as they are primarily used to rule out other conditions. Biopsies in irritable bowel syndrome would not reveal granuloma formation.

      Ulcerative colitis, another inflammatory bowel disease, is characterized by crypt abscesses, pseudopolyps, and mucosal ulceration that can cause rectal bleeding. However, granulomas are not present in this condition.

      Inflammatory bowel disease (IBD) is a condition that includes two main types: Crohn’s disease and ulcerative colitis. Although they share many similarities in terms of symptoms, diagnosis, and treatment, there are some key differences between the two. Crohn’s disease is characterized by non-bloody diarrhea, weight loss, upper gastrointestinal symptoms, mouth ulcers, perianal disease, and a palpable abdominal mass in the right iliac fossa. On the other hand, ulcerative colitis is characterized by bloody diarrhea, abdominal pain in the left lower quadrant, tenesmus, gallstones, and primary sclerosing cholangitis. Complications of Crohn’s disease include obstruction, fistula, and colorectal cancer, while ulcerative colitis has a higher risk of colorectal cancer than Crohn’s disease. Pathologically, Crohn’s disease lesions can be seen anywhere from the mouth to anus, while ulcerative colitis inflammation always starts at the rectum and never spreads beyond the ileocaecal valve. Endoscopy and radiology can help diagnose and differentiate between the two types of IBD.

    • This question is part of the following fields:

      • Gastrointestinal System
      15.7
      Seconds
  • Question 26 - A 20-year-old woman currently completing her exams presents to her GP with fatigue...

    Correct

    • A 20-year-old woman currently completing her exams presents to her GP with fatigue and generalised weakness. She has also noted that her skin and the whites of her eyes appear yellow. The GP suspects the patient may have Gilbert’s syndrome and orders liver function tests to determine the patient’s baseline liver function. The GP advises the patient that no treatment is necessary for this condition.

      Reference range
      Bilirubin 3 - 17 ”mol/L
      ALP 30 - 100 u/L
      ALT 3 - 40 u/L
      ÎłGT 8 - 60 u/L
      Albumin 35 - 50 g/L
      LDH 100 - 190 U/L

      What set of results would be expected from this patient?

      Your Answer: Bilirubin 40 umol/l, ALT 15 U/L, LDH 160 U/L, GGT 25 U/L

      Explanation:

      Jaundice becomes visible when bilirubin levels exceed 35 umol/l. Therefore, the correct option is the one with a bilirubin level of 40 umol/l, as this is typically the range where jaundice becomes visible. Furthermore, all other liver function values in this option are within the normal range. The other options are incorrect because they have bilirubin levels that are too low to cause visible jaundice, and the liver function results are usually normal in cases of Gilbert’s syndrome.

      Understanding Bilirubin and Its Role in Jaundice

      Bilirubin is a chemical by-product that is produced when red blood cells break down heme, a component found in these cells. This chemical is also found in other hepatic heme-containing proteins like myoglobin. The heme is processed within macrophages and oxidized to form biliverdin and iron. Biliverdin is then reduced to form unconjugated bilirubin, which is released into the bloodstream.

      Unconjugated bilirubin is bound to albumin in the blood and then taken up by hepatocytes, where it is conjugated to make it water-soluble. From there, it is excreted into bile and enters the intestines to be broken down by intestinal bacteria. Bacterial proteases produce urobilinogen from bilirubin within the intestinal lumen, which is further processed by intestinal bacteria to form urobilin and stercobilin and excreted via the faeces. A small amount of bilirubin re-enters the portal circulation to be finally excreted via the kidneys in urine.

      Jaundice occurs when bilirubin levels exceed 35 umol/l. Raised levels of unconjugated bilirubin may occur due to haemolysis, while hepatocyte defects, such as a compromised hepatocyte uptake of unconjugated bilirubin and/or defective conjugation, may occur in liver disease or deficiency of glucuronyl transferase. Raised levels of conjugated bilirubin can result from defective excretion of bilirubin, for example, Dubin-Johnson Syndrome, or cholestasis.

      Cholestasis can result from a wide range of pathologies, which can be largely divided into physical causes, for example, gallstones, pancreatic and cholangiocarcinoma, or functional causes, for example, drug-induced, pregnancy-related and postoperative cholestasis. Understanding bilirubin and its role in jaundice is important in diagnosing and treating various liver and blood disorders.

    • This question is part of the following fields:

      • Gastrointestinal System
      30.9
      Seconds
  • Question 27 - A 50-year-old patient presents for a routine checkup. During a neurological assessment, it...

    Correct

    • A 50-year-old patient presents for a routine checkup. During a neurological assessment, it is discovered that the patient has sensory loss in their middle finger. Which specific dermatome is responsible for this sensory loss?

      Your Answer: C7

      Explanation:

      The middle finger is where the C7 dermatome is located.

      Understanding Dermatomes: Major Landmarks and Mnemonics

      Dermatomes are areas of skin that are innervated by a single spinal nerve. Understanding dermatomes is important in diagnosing and treating various neurological conditions. The major dermatome landmarks are listed in the table above, along with helpful mnemonics to aid in memorization.

      Starting at the top of the body, the C2 dermatome covers the posterior half of the skull, resembling a cap. Moving down to C3, it covers the area of a high turtleneck shirt, while C4 covers the area of a low-collar shirt. The C5 dermatome runs along the ventral axial line of the upper limb, while C6 covers the thumb and index finger. To remember this, make a 6 with your left hand by touching the tip of your thumb and index finger together.

      Moving down to the middle finger and palm of the hand, the C7 dermatome is located here, while the C8 dermatome covers the ring and little finger. The T4 dermatome is located at the nipples, while T5 covers the inframammary fold. The T6 dermatome is located at the xiphoid process, and T10 covers the umbilicus. To remember this, think of BellybuT-TEN.

      The L1 dermatome covers the inguinal ligament, while L4 covers the knee caps. To remember this, think of being Down on aLL fours with the number 4 representing the knee caps. The L5 dermatome covers the big toe and dorsum of the foot (except the lateral aspect), while the S1 dermatome covers the lateral foot and small toe. To remember this, think of S1 as the smallest one. Finally, the S2 and S3 dermatomes cover the genitalia.

      Understanding dermatomes and their landmarks can aid in diagnosing and treating various neurological conditions. The mnemonics provided can help in memorizing these important landmarks.

    • This question is part of the following fields:

      • Neurological System
      9.3
      Seconds
  • Question 28 - A 26-year-old female is undergoing examination for an atypical cyst on her left...

    Incorrect

    • A 26-year-old female is undergoing examination for an atypical cyst on her left ovary. Her AFP levels are elevated. Upon biopsy, the following report is obtained:

      Biopsy report: Schiller-Duval bodies are present

      What type of ovarian tumor has developed in this patient?

      Your Answer: Krukenberg tumour

      Correct Answer: Yolk sac tumour

      Explanation:

      Schiller-Duval bodies seen on histology are a characteristic feature of yolk sac tumor, making it a pathognomonic finding.

      1. Incorrect. Yolk sac tumor would not present with diffuse sheets, nests, and cords of large uniform tumor cells like testicular seminoma.

      2. Incorrect. Call-Exner bodies are not present in yolk sac tumor.

      3. Incorrect. Yolk sac tumor is not a metastasis from a diffuse-type gastric adenocarcinoma, which would have a signet cell histology appearance.

      4. Incorrect. Yolk sac tumor contains tissues from all three germ layers, including ectodermal, mesodermal, and endodermal tissues.

      5. Correct. Schiller-Duval bodies are a unique feature of yolk sac tumor, and it also secretes AFP.

      Types of Ovarian Tumours

      There are four main types of ovarian tumours, including surface derived tumours, germ cell tumours, sex cord-stromal tumours, and metastasis. Surface derived tumours are the most common, accounting for around 65% of ovarian tumours, and include the greatest number of malignant tumours. These tumours can be either benign or malignant and include serous cystadenoma, serous cystadenocarcinoma, mucinous cystadenoma, mucinous cystadenocarcinoma, and Brenner tumour. Germ cell tumours are more common in adolescent girls and account for 15-20% of tumours. These tumours are similar to cancer types seen in the testicle and can be either benign or malignant. Examples include teratoma, dysgerminoma, yolk sac tumour, and choriocarcinoma. Sex cord-stromal tumours represent around 3-5% of ovarian tumours and often produce hormones. Examples include granulosa cell tumour, Sertoli-Leydig cell tumour, and fibroma. Metastatic tumours account for around 5% of tumours and include Krukenberg tumour, which is a mucin-secreting signet-ring cell adenocarcinoma resulting from metastases from a gastrointestinal tumour.

    • This question is part of the following fields:

      • Reproductive System
      13.3
      Seconds
  • Question 29 - A 75-year-old male is admitted to the ICU with a fever, headache, vomiting,...

    Correct

    • A 75-year-old male is admitted to the ICU with a fever, headache, vomiting, and a Glasgow Coma Scale score of 13. The medical team suspects herpes simplex encephalitis and orders an MRI while starting the appropriate treatment. What is the likely mechanism of action of the drug administered?

      Your Answer: Competitively inhibits viral DNA polymerases

      Explanation:

      acyclovir is a highly specific antiviral agent that targets viral DNA polymerase with greater affinity than cellular DNA polymerase. It works by incorporating into the DNA and causing chain termination due to the missing 2′ and 3′ carbons. To become active, acyclovir must first be converted to acyclovir monophosphate by the virus-specific enzyme thymidine kinase (TK), and then to its active triphosphate form by human enzymes. acyclovir is effective against most herpesvirus species.

      Penicillins prevent peptidoglycan cross-linking by binding to penicillin-binding-proteins, leading to cell lysis and making them bactericidal. They can be given with ÎČ-lactamase inhibitors to prevent antibiotic breakdown, such as co-amoxiclav (amoxicillin with clavulanic acid).

      Quinolones are topoisomerase inhibitors that inhibit DNA synthesis and are bactericidal. However, they can cause tendon rupture as a side effect.

      Aminoglycosides bind to the 30S subunit, causing mRNA misreading. Gentamicin is an example used to treat various bacterial infections, but it can cause ototoxicity and nephrotoxicity.

      Macrolides like clindamycin bind to the 50S subunit, inhibiting translocation. Clindamycin is primarily used to treat anaerobic infections caused by susceptible anaerobic bacteria, including dental, respiratory, skin, and soft tissue infections, as well as peritonitis.

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

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

    • This question is part of the following fields:

      • General Principles
      22.2
      Seconds
  • Question 30 - What is the name of the bacterium that produces toxins and causes food...

    Correct

    • What is the name of the bacterium that produces toxins and causes food poisoning with vomiting as the main symptom, specifically from rice consumption?

      Your Answer: Bacillus cereus

      Explanation:

      Bacterial Causes of Food Poisoning

      Food poisoning can be caused by various bacteria, including Bacillus cereus, Staphylococcus aureus, Campylobacter, Yersinia, and E. coli. Bacillus cereus is known for secreting an exotoxin into rice, particularly rice that has been kept warm for a long time, causing vomiting within 1-6 hours of ingestion. Staphylococcus aureus, on the other hand, tends to infect meat and eggs and causes similar symptoms.

      Campylobacter, Yersinia, and E. coli, on the other hand, cause diarrhea (with or without vomiting) after an incubation period of 1-4 days. While all three can cause bloody diarrhea, it is less common with Campylobacter and does not occur with all strains of E. coli. In most cases, these infections resolve on their own without the need for antibiotics. However, if the diarrhea persists, Campylobacter may be treated with a macrolide.

      Overall, it is important to be aware of the various bacterial causes of food poisoning and take necessary precautions to prevent contamination and ensure safe food consumption.

    • This question is part of the following fields:

      • Microbiology
      9.2
      Seconds
  • Question 31 - In which cell types can mesenchymal pluripotent stem cells undergo differentiation? ...

    Incorrect

    • In which cell types can mesenchymal pluripotent stem cells undergo differentiation?

      Your Answer: Mesenchymal progenitor cells

      Correct Answer: Osteoblasts, adipocytes and chondrocytes

      Explanation:

      Mesenchymal Stem Cells: A Versatile Type of Connective Tissue

      The mesenchyme is a type of connective tissue that originates from the embryonic mesoderm and is composed of undifferentiated cells. During fetal development, these mesenchymal stem cells differentiate into various types of adult cells, including osteoblasts, adipocytes, and chondrocytes. Mesenchymal stem cells have a remarkable ability to self-renew, making them a valuable resource for regenerative medicine.

      Osteoblasts are cells that generate bone tissue, while adipocytes are responsible for storing fat in the body. Chondrocytes, on the other hand, produce cartilage, which is essential for maintaining healthy joints. These three cell types are the primary products of mesenchymal stem cells.

      It’s important to note that the other answer options are incorrect because they don’t arise from mesenchymal stem cells. Mesenchymal stem cells are a versatile type of connective tissue that holds great promise for treating a wide range of medical conditions.

    • This question is part of the following fields:

      • Clinical Sciences
      12.3
      Seconds
  • Question 32 - From which of the following structures does the posterior cruciate ligament originate? ...

    Incorrect

    • From which of the following structures does the posterior cruciate ligament originate?

      Your Answer: Posterior intercondylar area of tibia

      Correct Answer: Anterior intercondylar area of tibia

      Explanation:

      The attachment point of the anterior cruciate ligament is the anterior intercondylar area of the tibia. From there, it extends in a posterolateral direction and inserts into the posteromedial aspect of the lateral femoral condyle.

      The knee joint is the largest and most complex synovial joint in the body, consisting of two condylar joints between the femur and tibia and a sellar joint between the patella and femur. The degree of congruence between the tibiofemoral articular surfaces is improved by the presence of the menisci, which compensate for the incongruence of the femoral and tibial condyles. The knee joint is divided into two compartments: the tibiofemoral and patellofemoral compartments. The fibrous capsule of the knee joint is a composite structure with contributions from adjacent tendons, and it contains several bursae and ligaments that provide stability to the joint. The knee joint is supplied by the femoral, tibial, and common peroneal divisions of the sciatic nerve and by a branch from the obturator nerve, while its blood supply comes from the genicular branches of the femoral artery, popliteal, and anterior tibial arteries.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      11.2
      Seconds
  • Question 33 - Mrs. Green is a 64-year-old woman with colon cancer. She is undergoing adjuvant...

    Incorrect

    • Mrs. Green is a 64-year-old woman with colon cancer. She is undergoing adjuvant chemotherapy, however in the past six months has suffered four deep vein thrombosis (DVT) events, despite being optimally anticoagulated with the maximum dose of dabigatran. On one occasion she suffered a DVT during treatment with dalteparin (a low molecular weight heparin). She has been admitted with symptoms of another DVT.

      What is the recommended treatment for her current DVT?

      Your Answer: Prescribe Thrombo-Embolic Deterrent (TED) stockings

      Correct Answer: Insert an inferior vena caval filter

      Explanation:

      For patients with recurrent venous thromboembolic disease, an inferior vena cava filter may be considered. This is particularly relevant for patients with cancer who have experienced multiple DVTs despite being fully anticoagulated. Before considering an inferior vena cava filter, alternative treatments such as increasing the target INR to 3-4 for long-term high-intensity oral anticoagulant therapy or switching to LMWH should be considered. This recommendation is in line with NICE guidelines on the diagnosis, management, and thrombophilia testing of venous thromboembolic diseases. Prescribing apixaban, increasing the dose of dabigatran off-license, or prescribing Thrombo-Embolic Deterrent (TED) stockings are not appropriate solutions for this patient. Similarly, initiating end-of-life drugs and preparing the family is not indicated based on the clinical description provided.

      Management of Pulmonary Embolism

      Pulmonary embolism (PE) is a serious condition that requires prompt management. The National Institute for Health and Care Excellence (NICE) updated their guidelines on the management of venous thromboembolism (VTE) in 2020, with some key changes. One of the significant changes is the recommendation to use direct oral anticoagulants (DOACs) as the first-line treatment for most people with VTE, including those with active cancer. Another change is the increasing use of outpatient treatment for low-risk PE patients, determined by a validated risk stratification tool.

      Anticoagulant therapy is the cornerstone of VTE management. The guidelines recommend using apixaban or rivaroxaban as the first-line treatment for PE, followed by LMWH, dabigatran, edoxaban, or a vitamin K antagonist (VKA) if necessary. For patients with active cancer, DOACs are now recommended instead of LMWH. The length of anticoagulation depends on whether the VTE was provoked or unprovoked, with treatment typically lasting for at least three months. Patients with unprovoked VTE may continue treatment for up to six months, depending on their risk of recurrence and bleeding.

      In cases of haemodynamic instability, thrombolysis is recommended as the first-line treatment for massive PE with circulatory failure. Other invasive approaches may also be considered where appropriate facilities exist. Patients who have repeat pulmonary embolisms, despite adequate anticoagulation, may be considered for inferior vena cava (IVC) filters. However, the evidence base for IVC filter use is weak, and further studies are needed.

    • This question is part of the following fields:

      • Cardiovascular System
      32
      Seconds
  • Question 34 - A 67-year-old man arrives at the Emergency Department with a swollen, red, and...

    Correct

    • A 67-year-old man arrives at the Emergency Department with a swollen, red, and hot first metatarsophalangeal joint. The diagnosis is an acute gout attack. What substance in the joint space is responsible for causing gout?

      Your Answer: Monosodium urate

      Explanation:

      When joint aspiration is performed in cases of gout, the presence of needle-shaped monosodium urate crystals that are negatively birefringent can be observed under polarised light. The acute manifestation of gout often involves the first metatarsophalangeal joint, which is commonly referred to as podagra. Gout is caused by elevated levels of uric acid, which results in the accumulation of monosodium urate crystals in and around the joints. Pseudogout, a similar condition, is caused by the deposition of calcium pyrophosphate. In rheumatoid arthritis, a collection of fibrous tissue known as a pannus may be observed within affected joints, while osteoarthritis may present with bony projections called osteophytes. A diet that is high in purines, such as red meat, liver, and beer, may increase the likelihood of developing gout.

      Understanding Gout: Symptoms and Diagnosis

      Gout is a type of arthritis that causes inflammation and pain in the joints. Patients experience episodes of intense pain that can last for several days, followed by periods of no symptoms. The acute episodes usually reach their peak within 12 hours and can affect various joints, with the first metatarsophalangeal joint being the most commonly affected. Swelling and redness are also common symptoms of gout.

      If left untreated, repeated acute episodes of gout can lead to joint damage and chronic joint problems. To diagnose gout, doctors may perform synovial fluid analysis to look for needle-shaped, negatively birefringent monosodium urate crystals under polarised light. Uric acid levels may also be checked once the acute episode has subsided, as they can be high, normal, or low during the attack.

      Radiological features of gout include joint effusion, well-defined punched-out erosions with sclerotic margins, and eccentric erosions. Unlike rheumatoid arthritis, gout does not cause periarticular osteopenia. Soft tissue tophi may also be visible.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      7.4
      Seconds
  • Question 35 - An 85-year-old man presents to the hospital with complaints of breathlessness at rest....

    Incorrect

    • An 85-year-old man presents to the hospital with complaints of breathlessness at rest. He has a medical history of type 2 diabetes and hypertension, for which he takes metformin, lisinopril, and metoprolol. He also smokes five cigarettes a day. On examination, he has a heart rate of 100 bpm, blood pressure of 128/90 mmHg, and a respiratory rate of 26 with oxygen saturation of 88% on 2l/minute. He has a regular, slow rising pulse, an ejection systolic murmur, crepitations at both lung bases, and oedema at the ankles and sacrum.

      What investigation is most crucial for his immediate management?

      Your Answer: D-dimers

      Correct Answer: Electrocardiogram

      Explanation:

      Managing Pulmonary Edema from Congestive Cardiac Failure

      Pulmonary edema from congestive cardiac failure requires prompt investigation and management. The most crucial investigation is an ECG to check for a possible silent myocardial infarction. Even if the ECG is normal, a troponin test may be necessary to rule out a NSTEMI. Arterial blood gas analysis is also important to guide oxygen therapy. Additionally, stopping medications such as metformin, lisinopril, and metoprolol, and administering diuretics can help manage the condition.

      It is likely that the patient has aortic stenosis, which is contributing to the cardiac failure. However, acute management of the valvular disease will be addressed separately. To learn more about heart failure and its management, refer to the ABC of heart failure articles by Millane et al. and Watson et al.

    • This question is part of the following fields:

      • Cardiovascular System
      29.7
      Seconds
  • Question 36 - During an on-call shift, you are reviewing the blood results of a 72-year-old...

    Incorrect

    • During an on-call shift, you are reviewing the blood results of a 72-year-old man. He was admitted with abdominal pain and has a working diagnosis of acute cholecystitis. He is currently on intravenous cefuroxime and metronidazole, awaiting further surgical review. His blood results are as follows:

      Hb 115 g/L : (115 - 160)
      Platelets 320* 109/L (150 - 400)
      WBC 18.2* 109/L (4.0 - 11.0)
      Na+ 136 mmol/L (135 - 145)
      K+ 6.9 mmol/L (3.5 - 5.0)
      Urea 14.8 mmol/L (2.0 - 7.0)
      Creatinine 225 ”mol/L (55 - 120)
      CRP 118 mg/L (< 5)

      Bilirubin 15 ”mol/L (3 - 17)
      ALP 410 u/L (30 - 100)
      ALT 32 u/L (3 - 40)
      Albumin 39 g/L (35 - 50)

      You initiate treatment with intravenous calcium gluconate, salbutamol nebulisers, and furosemide. On discussion with the renal team, they recommend additional treatment with calcium resonium.

      What is the mechanism of action of calcium resonium?

      Your Answer: It shifts potassium from the extracellular to the intracellular compartment

      Correct Answer: It increases potassium excretion by preventing enteral absorption

      Explanation:

      The correct answer is that calcium resonium increases potassium excretion by preventing enteral absorption. This is achieved through cation ion exchange, where the resin exchanges potassium for Ca++ in the body. The onset of action is usually 2-12 hours when taken orally and longer when administered rectally. It is important to note that calcium resonium does not act on the Na+/K+-ATPase pump, which is the mechanism of action for drugs like digoxin. Additionally, it does not shift potassium from the extracellular to the intracellular compartment, which is the mechanism of action for salbutamol nebulisers. Lastly, calcium resonium does not stabilise the cardiac membrane, which is the action of calcium gluconate.

      Managing Hyperkalaemia: A Step-by-Step Guide

      Hyperkalaemia is a serious condition that can lead to life-threatening arrhythmias if left untreated. To manage hyperkalaemia, it is important to address any underlying factors that may be contributing to the condition, such as acute kidney injury, and to stop any aggravating drugs, such as ACE inhibitors. Treatment can be categorised based on the severity of the hyperkalaemia, which is classified as mild, moderate, or severe based on the patient’s potassium levels.

      ECG changes are also important in determining the appropriate management for hyperkalaemia. Peaked or ‘tall-tented’ T waves, loss of P waves, broad QRS complexes, and a sinusoidal wave pattern are all associated with hyperkalaemia and should be evaluated in all patients with new hyperkalaemia.

      The principles of treatment modalities for hyperkalaemia include stabilising the cardiac membrane, shifting potassium from extracellular to intracellular fluid compartments, and removing potassium from the body. IV calcium gluconate is used to stabilise the myocardium, while insulin/dextrose infusion and nebulised salbutamol can be used to shift potassium from the extracellular to intracellular fluid compartments. Calcium resonium, loop diuretics, and dialysis can be used to remove potassium from the body.

      In practical terms, all patients with severe hyperkalaemia or ECG changes should receive emergency treatment, including IV calcium gluconate to stabilise the myocardium and insulin/dextrose infusion to shift potassium from the extracellular to intracellular fluid compartments. Other treatments, such as nebulised salbutamol, may also be used to temporarily lower serum potassium levels. Further management may involve stopping exacerbating drugs, treating any underlying causes, and lowering total body potassium through the use of calcium resonium, loop diuretics, or dialysis.

    • This question is part of the following fields:

      • Renal System
      25.5
      Seconds
  • Question 37 - What is the obligate intracellular pathogen that can cause respiratory and genital tract...

    Correct

    • What is the obligate intracellular pathogen that can cause respiratory and genital tract infections?

      Your Answer: Chlamydia species

      Explanation:

      The obligate intracellular pathogen that can cause respiratory and genital tract infections is Chlamydia trachomatis.

      Chlamydia trachomatis is a bacterium that can cause a variety of infections in humans, including respiratory infections such as pneumonia and genital tract infections such as urethritis, cervicitis, and pelvic inflammatory disease (PID). It is transmitted through sexual contact and can also be transmitted from mother to newborn during childbirth, leading to neonatal conjunctivitis and pneumonia.

    • This question is part of the following fields:

      • Microbiology
      11.5
      Seconds
  • Question 38 - Sarah is a 63-year-old woman who has been experiencing gradual visual changes for...

    Incorrect

    • Sarah is a 63-year-old woman who has been experiencing gradual visual changes for the past 2 years. Recently, she has noticed a decline in her peripheral vision and has been running into objects.

      During the examination, her eyes do not appear red. Ophthalmoscopy reveals bilateral cupping with a cup to disc ratio of 0.8. Tonometry shows a pressure of 26mmHg in her left eye and 28mmHg in her right eye.

      After trying brinzolamide, latanoprost, and brimonidine, which were not well tolerated due to side effects, what is the mechanism of action of the best alternative medication?

      Your Answer: Decrease uveoscleral outflow

      Correct Answer: Decrease aqueous humour production

      Explanation:

      Timolol, a beta blocker, is an effective treatment for primary open-angle glaucoma as it reduces the production of aqueous humor in the eye. This condition is caused by a gradual increase in intraocular pressure due to poor drainage within the trabecular meshwork, resulting in gradual vision loss. The first-line treatments for primary open-angle glaucoma include beta blockers, prostaglandin analogues, carbonic anhydrase inhibitors, and alpha-2-agonists. However, if a patient is unable to tolerate carbonic anhydrase inhibitors, prostaglandin analogues, or alpha-2-agonists, beta blockers like timolol are the remaining option. Carbonic anhydrase inhibitors reduce aqueous humor production, prostaglandin analogues increase uveoscleral outflow, and alpha-2-agonists have a dual action of reducing humor production and increasing outflow. It is important to note that increasing aqueous humor production and reducing uveoscleral outflow are not effective treatments for glaucoma.

      Primary open-angle glaucoma is a type of optic neuropathy that is associated with increased intraocular pressure (IOP). It is classified based on whether the peripheral iris is covering the trabecular meshwork, which is important in the drainage of aqueous humour from the anterior chamber of the eye. In open-angle glaucoma, the iris is clear of the meshwork, but the trabecular network offers increased resistance to aqueous outflow, causing increased IOP. This condition affects 0.5% of people over the age of 40 and its prevalence increases with age up to 10% over the age of 80 years. Both males and females are equally affected. The main causes of primary open-angle glaucoma are increasing age and genetics, with first-degree relatives of an open-angle glaucoma patient having a 16% chance of developing the disease.

      Primary open-angle glaucoma is characterised by a slow rise in intraocular pressure, which is symptomless for a long period. It is typically detected following an ocular pressure measurement during a routine examination by an optometrist. Signs of the condition include increased intraocular pressure, visual field defect, and pathological cupping of the optic disc. Case finding and provisional diagnosis are done by an optometrist, and referral to an ophthalmologist is done via the GP. Final diagnosis is made through investigations such as automated perimetry to assess visual field, slit lamp examination with pupil dilatation to assess optic nerve and fundus for a baseline, applanation tonometry to measure IOP, central corneal thickness measurement, and gonioscopy to assess peripheral anterior chamber configuration and depth. The risk of future visual impairment is assessed using risk factors such as IOP, central corneal thickness (CCT), family history, and life expectancy.

      The majority of patients with primary open-angle glaucoma are managed with eye drops that aim to lower intraocular pressure and prevent progressive loss of visual field. According to NICE guidelines, the first line of treatment is a prostaglandin analogue (PGA) eyedrop, followed by a beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eyedrop as a second line of treatment. Surgery or laser treatment can be tried in more advanced cases. Reassessment is important to exclude progression and visual field loss and needs to be done more frequently if IOP is uncontrolled, the patient is high risk, or there

    • This question is part of the following fields:

      • Neurological System
      26.4
      Seconds
  • Question 39 - A 23-year-old woman presents to the gastroenterology clinic with a 6-month history of...

    Incorrect

    • A 23-year-old woman presents to the gastroenterology clinic with a 6-month history of cramping abdominal pain and weight loss. She reports looser bowel motions and opening her bowels 2-4 times per day. There is no history of fever or vomiting. During the examination, the physician observes 4 oral mucosal ulcers. Mild tenderness is noted in the right iliac fossa. An endoscopy is ordered.

      What are the expected endoscopy findings for this patient's most likely diagnosis?

      Your Answer: Pseudopolyps

      Correct Answer: Cobble-stoned appearance

      Explanation:

      This patient has been diagnosed with Crohn’s disease, which is characterized by a long history of abdominal pain, weight loss, and diarrhea. Unlike ulcerative colitis, which only affects the colon, Crohn’s disease can affect any part of the gastrointestinal tract. In this case, oral mucosal ulceration is also present. The classic cobblestone appearance on endoscopy is due to deep ulceration in the gut mucosa with skip lesions in between.

      On the other hand, loss of haustra is a finding seen in chronic ulcerative colitis on fluoroscopy. The chronic inflammatory process in the mucosal and submucosal layers of the colon can cause luminal narrowing, resulting in a drainpipe colon that is shortened and narrowed. In UC, shallow ulceration occurs in the mucosa, with spared mucosa giving rise to the appearance of polyps, also known as pseudopolyps. These can cause bloody diarrhea.

      Inflammatory bowel disease (IBD) is a condition that includes two main types: Crohn’s disease and ulcerative colitis. Although they share many similarities in terms of symptoms, diagnosis, and treatment, there are some key differences between the two. Crohn’s disease is characterized by non-bloody diarrhea, weight loss, upper gastrointestinal symptoms, mouth ulcers, perianal disease, and a palpable abdominal mass in the right iliac fossa. On the other hand, ulcerative colitis is characterized by bloody diarrhea, abdominal pain in the left lower quadrant, tenesmus, gallstones, and primary sclerosing cholangitis. Complications of Crohn’s disease include obstruction, fistula, and colorectal cancer, while ulcerative colitis has a higher risk of colorectal cancer than Crohn’s disease. Pathologically, Crohn’s disease lesions can be seen anywhere from the mouth to anus, while ulcerative colitis inflammation always starts at the rectum and never spreads beyond the ileocaecal valve. Endoscopy and radiology can help diagnose and differentiate between the two types of IBD.

    • This question is part of the following fields:

      • Gastrointestinal System
      18.4
      Seconds
  • Question 40 - An 80-year-old man with symptoms of intermittent claudication needs to have his ankle...

    Correct

    • An 80-year-old man with symptoms of intermittent claudication needs to have his ankle brachial pressure indices checked. However, the dorsalis pedis artery cannot be felt. What tendinous structure, located medially, could aid in its identification?

      Your Answer: Extensor hallucis longus tendon

      Explanation:

      The dorsalis pedis artery is located lateral to the extensor hallucis longus tendon.

      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
      18.5
      Seconds
  • Question 41 - A young woman presents with a claw-like appearance of her right hand. She...

    Correct

    • A young woman presents with a claw-like appearance of her right hand. She is subsequently diagnosed with cubital tunnel syndrome. Which nerve has been affected?

      Your Answer: Ulnar nerve

      Explanation:

      The symptoms displayed in this presentation are indicative of cubital tunnel syndrome, which occurs when the ulnar nerve is damaged as it passes through the medial epicondyle. This nerve is responsible for innervating the intrinsic muscles of the hand, and its damage can result in a claw-like appearance of the affected hand’s ulnar side. None of the other nerves listed would cause this specific symptom, as they do not innervate the same muscles.

      If the median nerve were damaged, it would result in an inability to abduct and oppose the thumb due to paralysis of the thenar muscles.

      Damage to the axillary nerve would affect the deltoid muscle, leading to dysfunction in arm abduction.

      Impaired biceps brachii muscle function, affecting arm flexion, would result from damage to the musculocutaneous nerve.

      Paralysis of the extensor muscles, leading to a wrist drop, would be caused by damage to the radial nerve.

      Understanding Cubital Tunnel Syndrome

      Cubital tunnel syndrome is a condition that occurs when the ulnar nerve is compressed as it passes through the cubital tunnel. This can cause tingling and numbness in the fourth and fifth fingers, which may start off as intermittent but eventually become constant. Over time, patients may also experience weakness and muscle wasting. Pain is often worse when leaning on the affected elbow, and there may be a history of osteoarthritis or prior trauma to the area.

      Diagnosis of cubital tunnel syndrome is usually made based on clinical features, but nerve conduction studies may be used in selected cases. Management of the condition involves avoiding aggravating activities, undergoing physiotherapy, and receiving steroid injections. In resistant cases, surgery may be necessary. By understanding the symptoms and treatment options for cubital tunnel syndrome, patients can take steps to manage their condition and improve their quality of life.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      6
      Seconds
  • Question 42 - A 30-year-old woman visits her doctor complaining of coryzal symptoms that have been...

    Correct

    • A 30-year-old woman visits her doctor complaining of coryzal symptoms that have been present for three days. She reports feeling slightly fatigued, having a sore throat, runny nose, and dry cough. She has been using over-the-counter medications to alleviate her symptoms. Her vital signs are within normal limits except for a temperature of 38.4ÂșC.

      What cytokine is most likely responsible for her elevated temperature?

      Your Answer: Interleukin-1

      Explanation:

      Interleukin-1, also known as IL-1, is a cytokine produced by macrophages that plays an important role in acute inflammation and inducing fever during infections. IL-2, produced by T helper 1 cells, stimulates the growth and development of various immune cells to combat infections. IL-4, produced by T helper 2 cells, activates B cells and helps differentiate CD4+ T cells into T helper 2 cells to fight infections. IL-8, also produced by macrophages, is responsible for neutrophil chemotaxis, which is crucial in the acute inflammatory response. IL-10, produced by both macrophages and T helper 2 cells, is an anti-inflammatory cytokine that inhibits cytokine production from T helper 1 cells.

      Overview of Cytokines and Their Functions

      Cytokines are signaling molecules that play a crucial role in the immune system. Interleukins are a type of cytokine that are produced by various immune cells and have specific functions. IL-1, produced by macrophages, induces acute inflammation and fever. IL-2, produced by Th1 cells, stimulates the growth and differentiation of T cell responses. IL-3, produced by activated T helper cells, stimulates the differentiation and proliferation of myeloid progenitor cells. IL-4, produced by Th2 cells, stimulates the proliferation and differentiation of B cells. IL-5, also produced by Th2 cells, stimulates the production of eosinophils. IL-6, produced by macrophages and Th2 cells, stimulates the differentiation of B cells and induces fever. IL-8, produced by macrophages, promotes neutrophil chemotaxis. IL-10, produced by Th2 cells, inhibits Th1 cytokine production and is known as an anti-inflammatory cytokine. IL-12, produced by dendritic cells, macrophages, and B cells, activates NK cells and stimulates the differentiation of naive T cells into Th1 cells.

      In addition to interleukins, there are other cytokines with specific functions. Tumor necrosis factor-alpha, produced by macrophages, induces fever and promotes neutrophil chemotaxis. Interferon-gamma, produced by Th1 cells, activates macrophages. Understanding the functions of cytokines is important in developing treatments for various immune-related diseases.

    • This question is part of the following fields:

      • General Principles
      10.5
      Seconds
  • Question 43 - A 60-year-old woman presents to her physician complaining of upper abdominal pain, fatigue,...

    Incorrect

    • A 60-year-old woman presents to her physician complaining of upper abdominal pain, fatigue, and unintentional weight loss over the past 4 months. During the physical examination, a mass is palpated in the epigastric region. The doctor suspects gastric cancer and refers the patient for an endoscopy. What type of cell would confirm the diagnosis?

      Your Answer: Mucous

      Correct Answer: Signet ring

      Explanation:

      The patient is diagnosed with gastric adenocarcinoma, which is a type of cancer that originates in the stomach lining. The presence of signet ring cells in the biopsy is a concerning feature, indicating an aggressive form of adenocarcinoma.

      Chief cells are normal cells found in the stomach lining and are not indicative of any pathology in this case.

      Megaloblast cells are abnormally large red blood cells that are not expected to be present in a gastric biopsy. They are typically associated with conditions such as leukaemia.

      Merkel cells are benign cells found in the skin that play a role in the sensation of touch.

      Mucous cells are normal cells found in the stomach lining that produce mucus.

      Gastric cancer is a relatively uncommon type of cancer, accounting for only 2% of all cancer diagnoses in developed countries. It is more prevalent in older individuals, with half of patients being over the age of 75, and is more common in males than females. Several risk factors have been identified, including Helicobacter pylori infection, atrophic gastritis, certain dietary habits, smoking, and blood group. Symptoms of gastric cancer can include abdominal pain, weight loss, nausea, vomiting, and dysphagia. In some cases, lymphatic spread may result in the appearance of nodules in the left supraclavicular lymph node or periumbilical area. Diagnosis is typically made through oesophago-gastro-duodenoscopy with biopsy, and staging is done using CT. Treatment options depend on the extent and location of the cancer and may include endoscopic mucosal resection, partial or total gastrectomy, and chemotherapy.

    • This question is part of the following fields:

      • Gastrointestinal System
      16.5
      Seconds
  • Question 44 - You opt to obtain an arterial blood gas from the radial artery. Where...

    Incorrect

    • You opt to obtain an arterial blood gas from the radial artery. Where should the needle be inserted to obtain the sample?

      Your Answer: Mid point of the inguinal ligament

      Correct Answer: Mid inguinal point

      Explanation:

      The femoral artery can be located using the mid inguinal point, which is positioned halfway between the anterior superior iliac spine and the symphysis pubis.

      Understanding the Anatomy of the Femoral Triangle

      The femoral triangle is an important anatomical region located in the upper thigh. It is bounded by the inguinal ligament superiorly, the sartorius muscle laterally, and the adductor longus muscle medially. The floor of the femoral triangle is made up of the iliacus, psoas major, adductor longus, and pectineus muscles, while the roof is formed by the fascia lata and superficial fascia. The superficial inguinal lymph nodes and the long saphenous vein are also found in this region.

      The femoral triangle contains several important structures, including the femoral vein, femoral artery, femoral nerve, deep and superficial inguinal lymph nodes, lateral cutaneous nerve, great saphenous vein, and femoral branch of the genitofemoral nerve. The femoral artery can be palpated at the mid inguinal point, making it an important landmark for medical professionals.

      Understanding the anatomy of the femoral triangle is important for medical professionals, as it is a common site for procedures such as venipuncture, arterial puncture, and nerve blocks. It is also important for identifying and treating conditions that affect the structures within this region, such as femoral hernias and lymphadenopathy.

    • This question is part of the following fields:

      • Gastrointestinal System
      15.9
      Seconds
  • Question 45 - Which vessel is the first to branch from the external carotid artery? ...

    Correct

    • Which vessel is the first to branch from the external carotid artery?

      Your Answer: Superior thyroid artery

      Explanation:

      Here is a mnemonic to remember the order in which the branches of the external carotid artery originate: Some Attendings Like Freaking Out Potential Medical Students. The first branch is the superior thyroid artery, followed by the ascending pharyngeal, lingual, facial, occipital, post auricular, and finally the maxillary and superficial temporal arteries.

      Anatomy of the External Carotid Artery

      The external carotid artery begins on the side of the pharynx and runs in front of the internal carotid artery, behind the posterior belly of digastric and stylohyoid muscles. It is covered by sternocleidomastoid muscle and passed by hypoglossal nerves, lingual and facial veins. The artery then enters the parotid gland and divides into its terminal branches within the gland.

      To locate the external carotid artery, an imaginary line can be drawn from the bifurcation of the common carotid artery behind the angle of the jaw to a point in front of the tragus of the ear.

      The external carotid artery has six branches, with three in front, two behind, and one deep. The three branches in front are the superior thyroid, lingual, and facial arteries. The two branches behind are the occipital and posterior auricular arteries. The deep branch is the ascending pharyngeal artery. The external carotid artery terminates by dividing into the superficial temporal and maxillary arteries within the parotid gland.

    • This question is part of the following fields:

      • Cardiovascular System
      7.6
      Seconds
  • Question 46 - Which of the following is not a risk factor for developing tuberculosis? ...

    Correct

    • Which of the following is not a risk factor for developing tuberculosis?

      Your Answer: Amiodarone

      Explanation:

      There are several factors that increase the risk of developing active tuberculosis, including having silicosis, chronic renal failure, being HIV positive, undergoing solid organ transplantation with immunosuppression, engaging in intravenous drug use, having a haematological malignancy, receiving anti-TNF treatment, or having undergone a previous gastrectomy.

      Types of Tuberculosis

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

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

    • This question is part of the following fields:

      • General Principles
      10.6
      Seconds
  • Question 47 - A 25-year-old woman complains of pain in the medial aspect of her thigh....

    Correct

    • A 25-year-old woman complains of pain in the medial aspect of her thigh. Upon investigation, a large ovarian cyst is discovered. Which nerve is most likely being compressed as the underlying cause of her discomfort?

      Your Answer: Obturator

      Explanation:

      The cutaneous branch of the obturator nerve is often not present, but it is known to provide sensation to the inner thigh. If there are large tumors in the pelvic area, they may put pressure on this nerve, causing pain that spreads down the leg.

      Anatomy of the Obturator Nerve

      The obturator nerve is formed by branches from the ventral divisions of L2, L3, and L4 nerve roots, with L3 being the main contributor. It descends vertically in the posterior part of the psoas major muscle and emerges from its medial border at the lateral margin of the sacrum. After crossing the sacroiliac joint, it enters the lesser pelvis and descends on the obturator internus muscle to enter the obturator groove. The nerve lies lateral to the internal iliac vessels and ureter in the lesser pelvis and is joined by the obturator vessels lateral to the ovary or ductus deferens.

      The obturator nerve supplies the muscles of the medial compartment of the thigh, including the external obturator, adductor longus, adductor brevis, adductor magnus (except for the lower part supplied by the sciatic nerve), and gracilis. The cutaneous branch, which is often absent, supplies the skin and fascia of the distal two-thirds of the medial aspect of the thigh when present.

      The obturator canal connects the pelvis and thigh and contains the obturator artery, vein, and nerve, which divides into anterior and posterior branches. Understanding the anatomy of the obturator nerve is important in diagnosing and treating conditions that affect the medial thigh and pelvic region.

    • This question is part of the following fields:

      • Neurological System
      7
      Seconds
  • Question 48 - Which one of the following forms the medial wall of the femoral canal?...

    Incorrect

    • Which one of the following forms the medial wall of the femoral canal?

      Your Answer: Sartorius

      Correct Answer: Lacunar ligament

      Explanation:

      It is important to differentiate between the femoral canal and the femoral triangle, particularly during exams when time is limited.

      Understanding the Femoral Canal

      The femoral canal is a fascial tunnel located at the medial aspect of the femoral sheath. It contains both the femoral artery and femoral vein, with the canal lying medial to the vein. The borders of the femoral canal include the femoral vein laterally, the lacunar ligament medially, the inguinal ligament anteriorly, and the pectineal ligament posteriorly.

      The femoral canal plays a significant role in allowing the femoral vein to expand, which facilitates increased venous return to the lower limbs. However, it can also be a site of femoral hernias, which occur when abdominal contents protrude through the femoral canal. The relatively tight neck of the femoral canal places these hernias at high risk of strangulation, making it important to understand the anatomy and function of this structure. Overall, understanding the femoral canal is crucial for medical professionals in diagnosing and treating potential issues related to this area.

    • This question is part of the following fields:

      • Gastrointestinal System
      7
      Seconds
  • Question 49 - A pregnant woman at 14 weeks gestation arrives at the emergency department after...

    Incorrect

    • A pregnant woman at 14 weeks gestation arrives at the emergency department after experiencing an epileptiform seizure preceded by deja vu. Her blood pressure is 130/80 mmHg and 24-hour urine protein is 100 mg, but there is no indication of fetal growth restriction. What is the probable diagnosis?

      Your Answer: Pre-eclampsia

      Correct Answer: Temporal lobe epilepsy

      Explanation:

      Temporal lobe epilepsy is commonly associated with deja vu, as the hippocampus in the temporal lobe plays a role in memory. The only other possible condition is eclampsia, as pre-eclampsia does not involve seizures and absence seizures are more frequent in children. However, eclampsia is not the correct diagnosis in this case as the patient does not have hypertension, her proteinuria is not significant (which is typically over 300 mg/24 hours), and there is no evidence of fetal growth restriction. Although this last point is not always present in eclampsia, it is a potential indicator.

      Epilepsy Classification: Understanding Seizures

      Epilepsy is a neurological disorder that affects millions of people worldwide. The classification of epilepsy has undergone changes in recent years, with the new basic seizure classification based on three key features. The first feature is where seizures begin in the brain, followed by the level of awareness during a seizure, which is important as it can affect safety during a seizure. The third feature is other features of seizures.

      Focal seizures, previously known as partial seizures, start in a specific area on one side of the brain. The level of awareness can vary in focal seizures, and they can be further classified as focal aware, focal impaired awareness, and awareness unknown. Focal seizures can also be classified as motor or non-motor, or having other features such as aura.

      Generalized seizures involve networks on both sides of the brain at the onset, and consciousness is lost immediately. The level of awareness in the above classification is not needed, as all patients lose consciousness. Generalized seizures can be further subdivided into motor and non-motor, with specific types including tonic-clonic, tonic, clonic, typical absence, and atonic.

      Unknown onset is a term reserved for when the origin of the seizure is unknown. Focal to bilateral seizure starts on one side of the brain in a specific area before spreading to both lobes, previously known as secondary generalized seizures. Understanding the classification of epilepsy and the different types of seizures can help in the diagnosis and management of this condition.

    • This question is part of the following fields:

      • Neurological System
      14.6
      Seconds
  • Question 50 - A 25-year-old female presents to the emergency department with complaints of shortness of...

    Correct

    • A 25-year-old female presents to the emergency department with complaints of shortness of breath that started 2 hours ago. She has no medical history. The results of her arterial blood gas (ABG) test are as follows:

      Normal range
      pH: 7.49 (7.35 - 7.45)
      pO2: 12.2 (10 - 14)kPa
      pCO2: 3.4 (4.5 - 6.0)kPa
      HCO3: 22 (22 - 26)mmol/l
      BE: +2 (-2 to +2)mmol/l

      Her temperature is 37ÂșC, and her pulse is 98 beats/minute and regular. Based on this information, what is the most likely diagnosis?

      Your Answer: Anxiety hyperventilation

      Explanation:

      The patient is exhibiting symptoms and ABG results consistent with respiratory alkalosis. However, it is important to conduct a thorough history and physical examination to rule out any underlying pulmonary pathology or infection. Based on the patient’s history, anxiety-induced hyperventilation is the most probable cause of her condition.

      Respiratory Alkalosis: Causes and Examples

      Respiratory alkalosis is a condition that occurs when the blood pH level rises above the normal range due to excessive breathing. This can be caused by various factors, including anxiety, pulmonary embolism, CNS disorders, altitude, and pregnancy. Salicylate poisoning can also lead to respiratory alkalosis, but it may also cause metabolic acidosis in the later stages. In this case, the respiratory centre is stimulated early, leading to respiratory alkalosis, while the direct acid effects of salicylates combined with acute renal failure may cause acidosis later on. It is important to identify the underlying cause of respiratory alkalosis to determine the appropriate treatment. Proper management can help prevent complications and improve the patient’s overall health.

    • This question is part of the following fields:

      • Respiratory System
      33.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology And Oncology (1/3) 33%
General Principles (4/6) 67%
Neurological System (4/8) 50%
Musculoskeletal System And Skin (5/10) 50%
Respiratory System (1/2) 50%
Gastrointestinal System (1/9) 11%
Reproductive System (1/2) 50%
Cardiovascular System (2/5) 40%
Renal System (0/2) 0%
Microbiology (2/2) 100%
Clinical Sciences (0/1) 0%
Passmed