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Question 1
Correct
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Cardiac muscle and skeletal muscle are alike, but there are a few key variations. Which of the following is NOT a characteristic of skeletal muscle but is a characteristic of cardiac muscle?Â
Your Answer: The presence of intercalated discs
Explanation:Cardiac muscle is striated, and the sarcomere is the contractile unit, similar to skeletal muscle. Contracture is mediated by the interaction of calcium, troponins, and myofilaments, much as it occurs in skeletal muscle. Cardiac muscle, on the other hand, differs from skeletal muscle in a number of ways.In contrast to skeletal muscle cells, cardiac myocytes have a nucleus in the middle of the cell and sometimes two nuclei. The cells are striated because the thick and thin filaments are arranged in an orderly fashion, although the arrangement is less well-organized than in skeletal muscle.Intercalated discs, which work similarly to the Z band in skeletal muscle in defining where one cardiac muscle cell joins the next, are a very significant component of cardiac muscle.Adherens junctions and desmosomes, which are specialized structures that hold the cardiac myocytes together, are formed by the transverse sections. The lateral sections produce gap junctions, which join the cytoplasm of two cells directly, allowing for rapid action potential conduction. These critical properties allow the heart to contract in a coordinated manner, allowing for more efficient blood pumping.Cardiac myocytes have the ability to create their own action potentials, which is referred to as myogenic’. They can depolarize spontaneously to initiate a cardiac action potential. Pacemaker cells, as well as the sino-atrial (SA) and atrioventricular (AV) nodes, control this.The Purkinje cells and the cells of the bundle of His are likewise capable of spontaneous depolarization. While the bundle of His is made up of specialized myocytes, it’s vital to remember that Purkinje cells are not myocytes and have distinct characteristics. They are larger than myocytes, with fewer filaments and more gap junctions than myocytes. They conduct action potentials more quickly, allowing the ventricles to contract synchronously.Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.Comparison of skeletal and cardiac muscle:Skeletal muscle Cardiac muscleStriation Striated but arrangement less organised Multiple nuclei located peripherally Usually single nucleus (but can be two), located centrallyDiscs None Intercalated discsNo Gap junctions Gap junctions No Pacemaker PacemakerElectrical stimulation: Nervous system (excitation) Pacemaker (excitation)
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 2
Correct
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A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.Which drug is least likely to have caused his hypokalaemia?
Your Answer: Spironolactone
Explanation:Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 3
Incorrect
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What is the partial pressure of oxygen if it makes up 20.9 percent of the ambient air composition and the atmospheric pressure of ambient air is 760 mmHg?
Your Answer: 300 mmHg
Correct Answer: 159 mmHg
Explanation:Ambient air is atmospheric air in its natural state. Ambient air is typically 78.6% nitrogen and 20.9% oxygen. The extra 1% is made up of carbon, helium, methane, argon and hydrogen. The partial pressure of any gas can be calculated using this formula: P = atmospheric pressure (760 mmHg) x percent content in the mixture. Atmospheric pressure is the sum of all of the partial pressures of the atmospheric gases added together: The formula for atmospheric pressure is: Patm = PN2 + PO2 + PH2O + PCO2. The atmospheric pressure is known to be 760 mmHg. The partial pressures of the various gases can be estimated to have partial pressures of approximately 597.4 mmHg for nitrogen, 158.8 mm Hg for oxygen, and 7.6 mmHg for argon.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 4
Incorrect
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A 56-year-old man presents with pneumonia 8 days after being admitted for an open fracture of his tibia and fibula. Upon history taking and observation, it was established that he has no known drug allergies, has coarse left basal crackles and evidence of consolidation in the left lower lobe based on his chest X-ray.Which of the following antibacterial agents would be the most appropriate to prescribe according to the latest NICE guidelines?
Your Answer: Co-amoxiclav
Correct Answer: Ciprofloxacin
Explanation:The current NICE guidelines for hospital-acquired pneumonia are as follow:- First-choice oral antibiotic if non‑severe symptoms or signs, and not at higher risk of resistance (guided by microbiological results when available): co-amoxiclav- Alternative oral antibiotics if non‑severe symptoms or signs, and not at higher risk of resistance, for penicillin allergy or if co‑amoxiclav unsuitable (based on specialist microbiological advice and local resistance data): doxycycline, cefalexin, co-trimoxazole, levofloxacin- First-choice intravenous antibiotics if severe symptoms or signs (for example, symptoms or signs of sepsis) or at higher risk of resistance (based on specialist microbiological advice and local resistance data): piperacillin with tazobactam, ceftazidime, ceftriaxone, cefuroxime, meropenem, ceftazidime with avibactam, levofloxacin- Antibiotics to be added if suspected or confirmed methicillin-resistant Staphylococcus aureus infection (dual therapy with a first-choice intravenous antibiotic): vancomycin, teicoplanin, linezolid
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 5
Incorrect
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A 42-year-old woman with a history of hyposplenism arrives at the Emergency Department sick and feverish. A complete set of bloods, including a peripheral blood film, is organised.On a hyposplenic blood film, which of the following features is LEAST likely to be seen?
Your Answer: Macrocytosis
Correct Answer: Teardrop cells
Explanation:The collection of abnormalities found in these patients is referred to as a hyposplenic film.The following features can be seen on hyposplenic blood films:Howell-Jolly bodiesHeinz’s bodiesTarget cellsRBCs with nuclei on occasionLymphocytosisMacrocytosisAcanthocytesTeardrop cells, also known as dacrocytes, are named for their teardrop-shaped shape. Dacrocytosis is a condition in which a large number of these cells are present. Myelofibrosis and beta thalassemia major both have dacrocytes, but hyposplenism does not.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 6
Incorrect
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Which anatomical structure is divided following an emergency department anterolateral thoracotomy?
Your Answer: Internal mammary artery
Correct Answer: Latissimus dorsi
Explanation:Thoracotomy describes an incision made in the chest wall to access the contents of the thoracic cavity. Thoracotomies typically can be divided into two categories; anterolateral thoracotomies and posterolateral thoracotomies. These can be further subdivided into supra-mammary and infra-mammary and, of course, further divided into the right or left chest. Each type of incision has its utility given certain circumstances.A scalpel is used to sharply divide the skin along the inframammary crease overlying the fifth rib. Electrocautery is then used to divide the pectoralis major muscle and serratus anterior muscle. Visualization of the proper operative field can be achieved with the division and retraction of the latissimus dorsi. Either the fourth or fifth intercostal space is then entered after the division of intercostal muscles above the rib to ensure the preservation of the neurovascular bundle. Once the patient is properly secured to the operating table, the ipsilateral arm is raised and positioned anteriorly and cephalad to rest above the head. The incision is started along the inframammary crease and extended posterolaterally below the tip of the scapula. It is then extended superiorly between the spine and the edge of the scapula, a short distance. The trapezius muscle and the subcutaneous tissues are divided with electrocautery. The serratus anterior and latissimus dorsi muscles are identified and can be retracted. The intercostal muscles are then divided along the superior border of the ribs, and the thoracic cavity is accessed.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 7
Incorrect
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Which of the following corticosteroids has the most potent mineralocorticoid effect:
Your Answer: Dexamethasone
Correct Answer: Fludrocortisone
Explanation:Fludrocortisone has the most potent mineralocorticosteroid activity, making it ideal for mineralocorticoid replacement in adrenal insufficiency.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 8
Incorrect
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A 59-year-old man is complaining of pain in his perineal area, a recent onset of urinary frequency and urgency, fever, chills, and muscle aches. He has a long history of nocturia and terminal dribbling. On rectal examination you find an exquisitely tender prostate.Which of these antibacterial agents would be most appropriate in this case?
Your Answer: Co-amoxiclav for 28 days
Correct Answer: Ciprofloxacin for 14 days
Explanation:An acute focal or diffuse suppurative inflammation of the prostate gland is called acute bacterial prostatitis.According to the National Institute for Health and Care Excellence (NICE), acute prostatitis should be suspected in a man presenting with:A feverish illness of sudden onset which may be associated with rigors, arthralgia, or myalgia; Irritative urinary voiding symptoms; acute urinary retention; perineal or suprapubic pain and an exquisitely tender prostate on rectal examination.Treatment of acute prostatitis as recommended by NICE and the BNFare:Ciprofloxacin or ofloxacin for 14 daysAlternatively, trimethoprim can be used. Duration of treatment is still 14 days
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 9
Incorrect
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Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?
Your Answer: The corticospinal tracts
Correct Answer: The lateral spinothalamic tract
Explanation:The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 10
Correct
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What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 11
Incorrect
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C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:
Your Answer: IL-3
Correct Answer: IL-6
Explanation:Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 12
Correct
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Regarding dermatophytes, which of the following statement is CORRECT:
Your Answer: Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings.
Explanation:Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings depending on the site of infection. The lesions of ringworm typically have a dark outer ring with a pale centre. Tinea capitis is ringworm affecting the head and scalp. Spread is via direct skin contact. Treatment is usually topical, oral antifungals are reserved for refractory infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 13
Incorrect
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Question 14
Incorrect
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A 23-year-old student presents to the emergency department with a terrible headache, photophobia, and a fever. On her lower limbs, you see a non-blanching purpuric rash. In the department, a lumbar puncture is conducted. What do you think you'll notice on Gram stain:
Your Answer: Gram positive streptococcus
Correct Answer: Gram negative diplococci
Explanation:Bacterial meningitis and septicaemia are most commonly caused by meningococcal bacteria. The Gram-negative diplococci Neisseria Meningitidis causes meningitis. Gram stain and culture of CSF identify the etiologic organism, N meningitidis. In bacterial meningitis, Gram stain is positive in 70-90% of untreated cases, and culture results are positive in as many as 80% of cases.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 15
Incorrect
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An 80-year-old female complains of chest pain characteristic of angina. A dose of glyceryl trinitrate (GTN) is administered that resolves the chest pain rapidly. Which ONE of the following is released on the initial metabolism of GTN?
Your Answer: Nitric oxide
Correct Answer: Nitrite ions
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine. Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are: 1. Glyceryl trinitrate 2. Isosorbide dinitrate The nitrate drugs are metabolized in the following steps: 1. Release Nitrite ions (NO2-), which are then converted to nitric oxide (NO) within cells. 2. NO activates guanylyl cyclase, which causes an increase in the intracellular concentration of cyclic guanosine-monophosphate (cGMP) in vascular smooth muscle cells. 3. Relaxation of vascular smooth muscle.Although nitrates are potent coronary vasodilators, their principal benefit in the management of angina results from a predominant mechanism of venous dilation:- Bigger veins hold more blood- Takes blood away from the left ventricle- Lowers LVEDV (preload), LA pressure- Less pulmonary oedema → improved dyspnoea
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Incorrect
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All of the following predisposes to lithium toxicity in patients taking long-term therapy EXCEPT:
Your Answer: Co-administration of diuretics
Correct Answer: Hypernatraemia
Explanation:A common complication of long term lithium therapy results in most cases of lithium intoxication. It is caused by reduced excretion of the drug which can be due to several factors including deterioration of renal function, dehydration, hyponatraemia, infections, and co-administration of diuretics or NSAIDs or other drugs that may interact.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 17
Incorrect
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A 55-year-old male diabetic patient presents to the Emergency Room complaining of severe chest pain. His medical record shows that he had coronary angioplasty one week ago, during which he was administered abciximab. Which of the following haematological diseases has a similar mechanism of action to this drug?
Your Answer: Von Willebrand disease
Correct Answer: Glanzmann’s thrombasthenia
Explanation:Abciximab is glycoprotein IIb/IIIa receptor antagonist that decreases aggregation of platelets by prevent their cross-linking. In Glanzmann’s thrombasthenia there are low levels of these same receptors leading to decreased bridging of platelets as fibrinogen cannot attach. There is increased bleeding time both in this disease and when there is use of abciximab.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 18
Incorrect
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A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?
Your Answer: Type 1 diabetes mellitus
Correct Answer: Cranial diabetes insipidus
Explanation:Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes. The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus. By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone. Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output. Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 19
Incorrect
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During quiet respiration, position of the right oblique fissure can be marked by a line drawn on the thoracic wall that:
Your Answer: Begins at the spinous process of T6, crosses the fifth intercostal space laterally and follows the contour of rib 7 anteriorly.
Correct Answer: Begins at the spinous process of T4, crosses the fifth intercostal space laterally and follows the contour of rib 6 anteriorly.
Explanation:During quiet respiration, the approximate position of the right oblique fissure can be marked by a line on the thoracic wall that begins at the spinous process of vertebra T4, crosses the fifth intercostal space laterally and then follows the contour of rib 6 anteriorly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Correct
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When an elderly dehydrated patient is moved from a supine to a standing position, her heart rate increases. Which of the following accounts for the increase in heart rate upon standing:
Your Answer: Decreased venous return
Explanation:On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 21
Incorrect
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A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?
Your Answer: Malignant hypertension
Correct Answer: None of the other options
Explanation:Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:Coronary artery disease (CAD) Coronary artery disease (CAD) Second stage of labourHypertension that is uncontrolledSevere Ventricular arrhythmias
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 22
Correct
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A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis on indwelling metal work and no known drug allergies. He has had a recent skin swab that has cultured MRSA and MRSA infection is suspected.Which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.
Your Answer: Vancomycin
Explanation:In the majority of patients the commonest causative organism for osteomyelitis isStaphylococcus aureus.Salmonella spp. are the commonest cause in patients with sickle cell disease.Other bacteria that can cause osteomyelitis include:Enterobacter spp.Group A and B streptococcusHaemophilus influenzaeThe current recommendations by NICE and the BNF on the treatment of osteomyelitis are:Flucloxacillin first-lineConsider adding fusidic acid or rifampicin for initial 2 weeksIf penicillin allergic use clindamycinIf MRSA is suspected use vancomycinSuggested duration of treatment is 6 weeks for acute infection
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 23
Correct
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Regarding skeletal muscle, which of the following best describes the Z-line:
Your Answer: A line dividing muscle fibres into sarcomeres
Explanation:Each muscle fibre is divided at regular intervals along its length into sarcomeres separated by Z-lines. The sarcomere is the functional unit of the muscle.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 24
Incorrect
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Parasympathetic preganglionic neurons originate in which of the following locations:
Your Answer: Ventral horn of spinal cord segments - C7 - T12
Correct Answer: Brainstem and pelvic splanchnic nerves
Explanation:Parasympathetic preganglionic neurones originate in the brainstem from which they run in cranial nerves III, VII, IX and X and also from the second and third sacral segments of the spinal cord. Parasympathetic preganglionic neurones release acetylcholine into the synapse, which acts on cholinergic nicotinic receptors on the postganglionic fibre. Parasympathetic peripheral ganglia are generally found close to or within their target, whereas sympathetic peripheral ganglia are located largely in two sympathetic chains on either side of the vertebral column (paravertebral ganglia), or in diffuse prevertebral ganglia of the visceral plexuses of the abdomen and pelvis. Parasympathetic postganglionic neurones release acetylcholine, which acts on cholinergic muscarinic receptors.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 25
Incorrect
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Regarding the extensor carpi ulnaris muscle, which of the following statements is true?
Your Answer: It assists with the abduction of the hand at the wrist joint
Correct Answer: It receives its blood supply from the ulnar artery
Explanation:Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 26
Incorrect
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A 40-year-old male presents to your clinic complaining of a cough with bloody sputum for the past three months. He has also had fever, night sweats, and has noticed some weight loss over the past three months.Which ONE of the following statements regarding this disease is correct?
Your Answer: Miliary tuberculosis refers to tuberculosis that affects the spine
Correct Answer: It can be diagnosed using the Ziehl-Neelson stain
Explanation:Tuberculosis is an infection caused by the microorganism Mycobacterium tuberculosis. TB can affect any organ system in the body, but it most commonly affects the lungs, followed by the lymph nodes. Option Tuberculosis is spread by the faecal-oral route: It is spread by inhalation of droplet nuclei. There are different methods to diagnose a tuberculosis infection. 1) Direct Microscopy: The organisms are visualised using Ziehl-Neelsen or Auramine staining. This is the quickest method to establish a diagnosis and start treatment.2) Culture: M. tuberculosis can be grown on Lowenstein-Jensen or Ogawa mediums, but it can take up to 8 weeks; therefore, ZN staining is also performed to start treatment immediately. Option There are several types of vaccine currently available: The BCG vaccine is the only vaccine approved to prevent TB and is administered at birth. Option Miliary tuberculosis refers to tuberculosis that affects the spine: Miliary tuberculosis refers to a tuberculosis infection disseminated throughout the body’s organ systems via the blood or lymphatics. Pott’s disease is extrapulmonary TB that affects the spine. It usually affects the lower thoracic and upper lumbar regions.Option A Ghon focus typically appears at the apex of a lung: The Ghon focus is a primary sign of TB that forms in the lung of previously unaffected patients. It typically occurs in the mid or lower zones of the lung.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 27
Correct
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Which of the following nerves is responsible for the symptoms of a patient who presented with ophthalmic herpes zoster and a few vesicles on the nose?
Your Answer: Trigeminal nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve. The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 28
Incorrect
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A 60-year-old female is referred to the Oncology clinic due to the presence of lumps in her neck. There is a non-tender enlargement of several groups of cervical lymph nodes on examination. She is sent for a lymph node biopsy. The results show the presence of lymphoma cells, but there are no Reed-Sternberg cells. Which one is most appropriate for this case out of the following diagnoses?
Your Answer: Chronic lymphocytic leukaemia
Correct Answer: Non-Hodgkin’s lymphoma
Explanation:Non-Hodgkin’s Lymphoma (NHL) causes neoplastic transformation of both B cell (85%) and T cell (15%) lines. The most common presentation is with enlarged, rubbery, painless lymph nodes. The patient may also have B symptoms which consist of night sweats, weight loss and fevers. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs. The presence of Reed-Sternberg cells characterises Hodgkin’s lymphoma. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.The following are recognised risk factors for NHL:Chromosomal translocations and molecular rearrangementsEpstein-Barr virus infectionHuman T-cell leukaemia virus type-1 (HTLV-1)Hepatitis CCongenital and acquired immunodeficiency statesAutoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis
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This question is part of the following fields:
- Haematology
- Pathology
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Question 29
Correct
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A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes. The lymph from the testes will drain to which of the following nodes?
Your Answer: Para-aortic lymph nodes
Explanation:Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.The scrotum is the one which drains into the nearby superficial inguinal nodes.The glans penis and clitoris drains into the deep inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 30
Incorrect
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Which of the following statements is correct with regards to immunoglobulin?
Your Answer: Immunoglobulin molecules are composed of 4 identical light chains.
Correct Answer: The isotype of immunoglobulin is determined by the heavy chain.
Explanation:The composition of immunoglobulin molecules is two identical heavy and two identical light chains. These chains are linked by disulphide bridges and are each have highly variable regions which give the immunoglobulin its specificity. In addition, they have constant regions and there is virtual complete correspondence in amino acid sequence in all antibodies of a given isotype. Five isotypes of immunoglobulin exist – these are IgG, IgA, IgM, IgE and IgD. They are determined by the heavy chain (gamma, alpha, mu, epsilon or delta respectively). The light chains are either kappa or lambda.
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This question is part of the following fields:
- Immune Responses
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
