Amk Practice Questions - Childhood, Adolescence, Young Adult

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Amk Practice Questions - Childhood, Adolescence, Young Adult - Quiz

It’s time to answer some Amk Practice Questions – Childhood, Adolescence, Young Adult are all topics under the microscope in this quiz as we offer a handful of scenarios and see if you can tell us what happens next. How much do you know? Let’s find out.


Questions and Answers
  • 1. 

    Martin Richards, 23, arrives in A & E intoxicated with a lacerated wrist after putting his fist through a window during a fight. On inspection you find a clean but apparently deep 2cm long transverse laceration on the palmar aspect of the wrist, 2cm proximal to the wrist crease. Martin complains of numbness over the lateral aspect of the palm. He has a full range of movement in the affected hand.What is the most likely nerve to have been damaged?

    • A.

      Palmar cutaneous branch of median nerve

    • B.

      Lateral cutaneous nerve of forearm

    • C.

      Superficial branch of radial nerve

    • D.

      Cutaneous branch of ulnar nerve

    • E.

      Medial cutaneous nerve of forearm

    Correct Answer
    A. Palmar cutaneous branch of median nerve
    Explanation
    The most likely nerve to have been damaged in this scenario is the palmar cutaneous branch of the median nerve. This is because the laceration is on the palmar aspect of the wrist, which is innervated by this specific branch of the median nerve. The numbness over the lateral aspect of the palm also suggests damage to this nerve. The other options are not as likely because they do not specifically innervate the palmar aspect of the wrist or cause numbness in the lateral aspect of the palm.

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  • 2. 

    A 26 year old rugby player presents to his GP. He tells you that whilst he was playing a game at the weekend he felt his shoulder 'give way', although it did not remain out of joint. He has come to see you today as he is experiencing a tingling sensation on the lateral aspect of his upper arm. On examination he has an area of numbness over the lateral aspect of the deltoid and is having trouble abducting his shoulder.Which structure has been damaged?

    • A.

      Axillary nerve

    • B.

      Musculocutaneous nerve

    • C.

      Posterior interosserous nerve

    • D.

      Long throacic nerve

    • E.

      Radial nerve

    Correct Answer
    A. Axillary nerve
    Explanation
    The tingling sensation on the lateral aspect of the upper arm, along with the numbness over the lateral aspect of the deltoid and difficulty in shoulder abduction, suggests damage to the axillary nerve. The axillary nerve innervates the deltoid muscle and the skin over the lateral aspect of the upper arm. Injury to this nerve can occur during trauma or shoulder dislocation, leading to weakness and sensory changes in the affected area. The other nerves listed do not innervate the deltoid muscle or the specific area described in the question.

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  • 3. 

    You see Darren Clark, 34, who slipped on ice going to his car and hit his elbow. His elbow is swollen and painful to move. Plain film radiogaphy shows that he has a fracture of his olecranon.During your neurovascular assesment you note that Darren has tingling and pain in his 4th and 5th digits.Which nerve would you suspect Darren has damaged?

    • A.

      Ulnar

    • B.

      Radial

    • C.

      Median

    • D.

      Axillary

    • E.

      Musculocutaneous

    Correct Answer
    A. Ulnar
    Explanation
    Based on the information provided, Darren has a fracture of his olecranon, which is the bony prominence of the ulna at the elbow. The tingling and pain in his 4th and 5th digits suggest damage to the ulnar nerve, which innervates these digits. Therefore, the correct answer is ulnar.

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  • 4. 

    Following an attempt to self harm, a 14 year old girl is admitted to the emergeny department with a series of mostly superficial lacerations on the dorsal aspect of her left forearm. However, one laceration is particularly deep. It is 2cm lateral to the medial epicondyle of her humerus, 2cm distal to her ante cubital fossa and approx. 4cm long with no foreign bodies. She complains of numbness in her thumb, index, middle and part of her ring finger. She is unable to fully flex thumb, index or middle fingers.Which is the most likely nerve to have been damaged?

    • A.

      Median nerve

    • B.

      Medial cutaneous nerve of forearm

    • C.

      Cutaneous branch of median nerve

    • D.

      Ulnar nerve

    • E.

      Superficial branch of radial nerve

    Correct Answer
    A. Median nerve
    Explanation
    The most likely nerve to have been damaged in this scenario is the median nerve. The location and characteristics of the deep laceration suggest that it is in close proximity to the median nerve. The symptoms reported by the patient, including numbness in the thumb, index, middle, and part of the ring finger, as well as the inability to fully flex the thumb, index, and middle fingers, are consistent with median nerve injury.

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  • 5. 

    Mrs Anderson, a 45 year old secretary, comes to see her GP. She has been experiencing a sensation of tingling and numbness and aching in the palmar surface of the lateral three and a half digits of her right hand. She also has diminished sensation in these areas, These syptoms are aggravated when she has been typing for long periods of time, and are worse at night.On examination, the symptoms are worsened by placing the backs of her hands together, and by hyperextension of her wrist.Which of the following is most likely to be causing these symptoms?

    • A.

      Dupuytren's contracture

    • B.

      Ulnar nerve compression

    • C.

      Radial nerve compression

    • D.

      De Quervain's Tenosynovitis

    • E.

      Carpal Tunnel Syndrome

    Correct Answer
    E. Carpal Tunnel Syndrome
    Explanation
    The patient's symptoms of tingling, numbness, aching, and diminished sensation in the palmar surface of the lateral three and a half digits of her right hand, aggravated by typing for long periods and worse at night, are consistent with Carpal Tunnel Syndrome. The exacerbation of symptoms when placing the backs of her hands together and hyperextending her wrist further supports this diagnosis. Carpal Tunnel Syndrome is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist, which can be exacerbated by repetitive hand movements such as typing.

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  • 6. 

    Ellie James is a 59 year old woman who has come to see you, her GP, because of numbness in the thumb, index and middle finger of her left hand. It began 12 months ago and occured at night. In the morning she found herself having to move her arms around to get rid of the numbness. More recently she has had numbness during the day, tingling and pain in a similar distribution.You perform Tinnel's and Phalen's tests and make a diagnosis of Carpal Tunell Syndrome.Which neurovascular structure is being compressed and causing her symptoms?

    • A.

      Median nerve

    • B.

      Ulnar nerve

    • C.

      Radial nerve

    • D.

      Radial artery

    • E.

      Ulnar artery

    Correct Answer
    A. Median nerve
    Explanation
    The correct answer is the median nerve. Carpal Tunnel Syndrome is a condition where the median nerve, which runs through the carpal tunnel in the wrist, becomes compressed or squeezed. This compression leads to symptoms such as numbness, tingling, and pain in the thumb, index, and middle fingers. The fact that the symptoms started in the thumb, index, and middle finger and have worsened over time is consistent with the diagnosis of Carpal Tunnel Syndrome.

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  • 7. 

    The biceps brachii, coracobrachialis and the brachialis muscles are innervated by which structure?

    Correct Answer
    musculocutaneous nerve
    Explanation
    The biceps brachii, coracobrachialis, and brachialis muscles are innervated by the musculocutaneous nerve. This nerve arises from the brachial plexus and provides motor innervation to these muscles, allowing for flexion of the elbow joint. Additionally, the musculocutaneous nerve also supplies sensory innervation to the skin on the lateral aspect of the forearm.

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  • 8. 

    The triceps brachii and anconeus muscles are innervated by which structure?

    Correct Answer
    radial nerve
    Explanation
    The triceps brachii and anconeus muscles are innervated by the radial nerve. The radial nerve is a major nerve in the arm that supplies motor innervation to the muscles that extend the elbow joint. It also provides sensory innervation to the skin on the back of the arm and forearm. Therefore, the radial nerve is responsible for the contraction and movement of the triceps brachii and anconeus muscles.

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  • 9. 

    What is the main role of the serratus anterior muscle?

    Correct Answer
    protracts scapula and holds it against the throacic wall
    Explanation
    The main role of the serratus anterior muscle is to protract the scapula, which means it pulls the scapula forward and away from the spine. Additionally, it helps to hold the scapula against the thoracic wall, providing stability and support to the shoulder joint.

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  • 10. 

    The serratous anterior is innervated by which structure?

    Correct Answer
    long throacic nerve
    Explanation
    The serratus anterior muscle is innervated by the long thoracic nerve. This nerve originates from the brachial plexus and supplies motor innervation to the serratus anterior muscle. The serratus anterior muscle is responsible for protracting and stabilizing the scapula, allowing for movements such as pushing and punching. Damage to the long thoracic nerve can result in winging of the scapula, causing weakness and impaired function of the serratus anterior muscle.

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  • 11. 

    The trapezius muscle is innervated by which structure?

    Correct Answer
    accessory nerve
    Explanation
    The trapezius muscle is innervated by the accessory nerve. The accessory nerve, also known as the cranial nerve XI, is responsible for controlling the movement of the trapezius muscle. This muscle plays a significant role in the movement and stability of the shoulder and neck. Damage or dysfunction of the accessory nerve can lead to weakness or paralysis of the trapezius muscle, resulting in difficulty with shoulder movement and posture.

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  • 12. 

    The latissimus dorsi muscle is innervated by which structure?

    Correct Answer
    thoracodorsal nerve
    Explanation
    The latissimus dorsi muscle is innervated by the thoracodorsal nerve. This nerve originates from the posterior cord of the brachial plexus and supplies motor innervation to the latissimus dorsi muscle. It is responsible for the movement and control of the muscle, allowing it to perform actions such as extension, adduction, and medial rotation of the arm.

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  • 13. 

    The deltoid muscle is innervated by which structure?

    Correct Answer
    axillary nerve
    Explanation
    The deltoid muscle is innervated by the axillary nerve. This nerve originates from the brachial plexus and supplies motor innervation to the deltoid muscle, which is located in the shoulder. The axillary nerve also provides sensory innervation to the skin over the deltoid muscle.

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  • 14. 

    The supraspinatus and infraspinatus muscles are innervated by which structure?

    Correct Answer
    suprascapular nerve
    Explanation
    The supraspinatus and infraspinatus muscles are innervated by the suprascapular nerve. This nerve originates from the upper trunk of the brachial plexus and passes through the suprascapular notch to reach these muscles. It provides motor innervation to these muscles, allowing them to contract and perform their respective functions. Damage or compression of the suprascapular nerve can result in weakness or paralysis of the supraspinatus and infraspinatus muscles, leading to shoulder dysfunction and pain.

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  • 15. 

    The teres minor muscle is innervated by which structure?

    Correct Answer
    axillary nerve
    Explanation
    The teres minor muscle is innervated by the axillary nerve. This nerve is a branch of the brachial plexus and supplies motor innervation to the teres minor muscle, as well as the deltoid muscle. It also provides sensory innervation to the skin over the deltoid muscle. Damage to the axillary nerve can lead to weakness or paralysis of the teres minor muscle, resulting in decreased shoulder stability and limited range of motion.

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  • 16. 

    Name the bones of the wrist. Where do you start naming from?

    Correct Answer
    scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate, hamate. Start naming from proximal lateral to proximal medial, then distal medial to distal lateral
    Explanation
    The bones of the wrist are named starting from the proximal lateral side and moving towards the proximal medial side. After that, the naming continues from the distal medial side to the distal lateral side. The correct order of the bones is scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate, and hamate.

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  • 17. 

    Describe the positions of innervation by nerves C3-T4.

  • 18. 

    Wrist drop is a classical sign of damage to which nerve?

    Correct Answer
    radial
    Explanation
    Wrist drop is a classical sign of damage to the radial nerve. The radial nerve is responsible for providing motor function to the muscles that extend the wrist and fingers. Damage to this nerve can result in weakness or paralysis of these muscles, causing the wrist to drop and making it difficult to extend the hand and fingers.

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  • 19. 

    In the hand, which muscles does the ulnar nerve supply?

    Correct Answer
    none
    Explanation
    The ulnar nerve does not supply any muscles in the hand. It primarily innervates the muscles of the forearm and some of the intrinsic muscles of the hand. However, it does provide sensory innervation to the little finger and part of the ring finger, as well as the skin on the back of the hand along the ulnar side.

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  • 20. 

    List the 4 stages of bone repair.

    Correct Answer
    formation of fracture haematoma, fibrocartilaginous callous formation, bony callous formation, bone remodelling
    Explanation
    The 4 stages of bone repair are as follows:
    1. Formation of fracture hematoma: After a bone fracture, blood vessels are damaged and bleed, leading to the formation of a blood clot or hematoma at the site of the fracture.
    2. Fibrocartilaginous callus formation: In this stage, fibroblasts and chondroblasts migrate to the fracture site and produce a soft callus made of fibrous tissue and cartilage. This callus helps stabilize the fracture and provides a framework for new bone growth.
    3. Bony callus formation: Osteoblasts, which are bone-forming cells, invade the soft callus and begin to produce spongy bone. This bony callus gradually replaces the fibrocartilaginous callus, further stabilizing the fracture.
    4. Bone remodeling: In the final stage, the newly formed bone undergoes remodeling, where it is reshaped and strengthened according to the mechanical stresses placed upon it. This process can take several months to years to complete.

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  • 21. 

    What is a compound fracture?

    Correct Answer
    broken ends of the bone protrude through the skin
    Explanation
    A compound fracture refers to a type of fracture where the broken ends of the bone protrude through the skin. This is considered a severe and serious injury as it exposes the bone to the external environment, increasing the risk of infection and complicating the healing process. Immediate medical attention is required to clean the wound, realign the bone, and prevent further damage or complications.

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  • 22. 

    What is a Pott's fracture?

    Correct Answer
    fracture of distal end of lateral leg bone with serious injury of distal tibial articulation
    Explanation
    A Pott's fracture refers to a fracture of the distal end of the lateral leg bone (fibula) along with a serious injury to the distal tibial articulation. This type of fracture typically occurs as a result of an ankle sprain or twisting injury, where the force applied to the ankle causes the fibula to break and the tibia to be displaced. The injury involves both bones of the lower leg and can result in significant pain, swelling, and difficulty with weight-bearing. Treatment usually involves immobilization with a cast or splint, and in some cases, surgery may be required to realign the bones.

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  • 23. 

    What is a Colles' fracture?

    Correct Answer
    fracture of distal end of radius in which distal fragment is displaced posteriorly
    Explanation
    A Colles' fracture refers to a specific type of fracture that occurs in the distal end of the radius bone in the forearm. In this fracture, the distal fragment of the radius bone is displaced posteriorly, or towards the back of the body. This displacement is a characteristic feature of Colles' fracture and helps differentiate it from other types of fractures in the same area.

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  • 24. 

    Which hormone is responsible for the 'growth spurt' during puberty?

    Correct Answer
    growth hormone
    Explanation
    During puberty, the body goes through a rapid growth phase known as the 'growth spurt'. This is primarily driven by the secretion of growth hormone. Growth hormone is produced by the pituitary gland and stimulates the growth of bones, muscles, and tissues in the body. It plays a crucial role in increasing height, promoting the development of secondary sexual characteristics, and overall physical growth during puberty.

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  • 25. 

    Growth hormone doesn't act directly on the target cells. What does?

    Correct Answer
    somatomedins
    Explanation
    Somatomedins, also known as insulin-like growth factors (IGFs), act as mediators between growth hormone and target cells. When growth hormone is released from the pituitary gland, it stimulates the liver to produce somatomedins. These somatomedins then bind to specific receptors on target cells, triggering various growth-promoting effects. Therefore, while growth hormone initiates the process, it is the somatomedins that directly act on the target cells to exert their growth-promoting effects.

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  • 26. 

    What is responsible for the short stature of African pygmies?

    Correct Answer
    lack of most potent somatomedin
    Explanation
    The short stature of African pygmies is attributed to the lack of the most potent somatomedin. Somatomedins, also known as insulin-like growth factors (IGFs), play a crucial role in the regulation of growth and development. They are produced in response to the release of growth hormone from the pituitary gland. Without the presence of the most potent somatomedin, the growth process is hindered, resulting in shorter stature.

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  • 27. 

    Growth hormone excess in childhood (before epiphyseal plates have sealed) leads to which condition?

    Correct Answer
    gigantism
    Explanation
    Excess growth hormone in childhood, before the epiphyseal plates have sealed, can cause gigantism. Gigantism is a condition characterized by excessive growth and height, as the bones continue to elongate. This occurs due to the overproduction of growth hormone by the pituitary gland. The excess hormone stimulates the growth of the long bones, resulting in abnormal growth and a significantly taller stature than average. It is important to identify and treat gigantism early to prevent further complications and ensure proper growth and development.

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  • 28. 

    Growth hormone excess in adolescence (after epiphyseal plates have sealed) leads to which condition?

    Correct Answer
    acromegaly
    Explanation
    Growth hormone excess in adolescence, after the epiphyseal plates have sealed, leads to the condition known as acromegaly. This condition is characterized by the excessive growth of bones and tissues, especially in the hands, feet, and face. It occurs when the pituitary gland produces an excessive amount of growth hormone, usually due to a tumor in the gland.

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  • 29. 

    Other than growth hormones, which 4 hormones are essential for normal growth?

    Correct Answer
    thyroid hormone, insulin, oestrogen, androgens
    Explanation
    Thyroid hormone, insulin, oestrogen, and androgens are essential for normal growth. The thyroid hormone regulates metabolism and plays a crucial role in growth and development. Insulin is responsible for regulating blood sugar levels and promoting the uptake of nutrients necessary for growth. Oestrogen is important for bone growth and development, especially during puberty. Androgens, such as testosterone, are involved in the growth and development of secondary sexual characteristics in both males and females. These four hormones work together to ensure proper growth and development in the body.

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  • 30. 

    How is paracetamol metabolised and why could an overdose be potentially harmful?

    Correct Answer
    some oxidised to benzoquinoneimine. combines with glutathione and is metabolised to compounds that are safely excreted. Comes a point where stores of glutathione all used up so benzoquinoneimine can attach to liver protein and cause liver damage
    Explanation
    Paracetamol is metabolized in the body through oxidation, forming a compound called benzoquinoneimine. This compound then combines with glutathione, another molecule in the body, and is further metabolized into compounds that can be safely excreted. However, when an overdose of paracetamol is taken, the stores of glutathione in the body can become depleted. This depletion of glutathione allows the benzoquinoneimine to attach to liver proteins, leading to liver damage. Therefore, an overdose of paracetamol can be potentially harmful due to the depletion of glutathione and subsequent liver damage.

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  • 31. 

    What is the drug name and drug type of the first-line anti-depressant treatment.

    Correct Answer
    selective serotonin re-uptake inhibitor. fluoxetine
    Explanation
    The drug name of the first-line anti-depressant treatment is fluoxetine, and it belongs to the drug type known as selective serotonin re-uptake inhibitors. Selective serotonin re-uptake inhibitors work by increasing the levels of serotonin in the brain, which helps to improve mood and alleviate symptoms of depression. Fluoxetine is commonly prescribed as an effective treatment for depression and is widely used as a first-line option due to its safety and efficacy profile.

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  • 32. 

    Give a named example of a trycyclic antidepressant.

    Correct Answer
    amitriptaline
    Explanation
    Amitriptyline is a tricyclic antidepressant commonly used to treat depression and other mood disorders. It works by increasing the levels of certain chemicals in the brain, such as serotonin and norepinephrine, which helps improve mood and relieve symptoms of depression. Amitriptyline is also sometimes used to treat chronic pain conditions, such as fibromyalgia. It is important to note that tricyclic antidepressants like amitriptyline may have side effects and should be used under the guidance of a healthcare professional.

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  • 33. 

    What is the drug type and give a named example of antidepressants used as a second line treatment.

    Correct Answer
    serotonin noradrenaline re-uptake inhibitors. tramadol
    Explanation
    The drug type mentioned in the answer is serotonin noradrenaline re-uptake inhibitors (SNRIs). SNRIs are a class of antidepressant medications that work by increasing the levels of serotonin and norepinephrine in the brain. Tramadol, on the other hand, is not an SNRI but rather an opioid pain medication. It is not typically used as a second-line treatment for depression.

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  • 34. 

    What would an obstructive lung disease do to FVC and FEV1?

    Correct Answer
    unchanged FVC, decreased FEV1
    Explanation
    An obstructive lung disease would cause a decrease in FEV1, which is the forced expiratory volume in one second. This is because the airways become narrowed, making it difficult for air to flow out of the lungs quickly. However, FVC, which is the forced vital capacity, would remain unchanged. FVC measures the total amount of air that can be forcefully exhaled after taking a deep breath, and it is not affected by the narrowing of the airways in obstructive lung diseases. Therefore, while FEV1 decreases, FVC remains the same.

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  • 35. 

    What would a restrictive lung disease do to FVC and FEV1?

    Correct Answer
    both reduced in proportion to each other
    Explanation
    A restrictive lung disease would cause both Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) to be reduced in proportion to each other. This means that the total amount of air a person can forcefully exhale in one second (FEV1) and the total amount of air they can forcefully exhale after taking a deep breath (FVC) would both be decreased, and the reduction in FEV1 would be proportional to the reduction in FVC. This is because in restrictive lung diseases, the lungs are unable to fully expand and there is a decrease in lung volume, leading to a decrease in both FVC and FEV1.

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  • 36. 

    Is emphysema an obsructive or restrictive lung disease?

    Correct Answer
    obstructive
    Explanation
    Emphysema is classified as an obstructive lung disease because it causes a narrowing of the airways and reduces the ability of the lungs to exhale properly. This narrowing is due to the destruction of the air sacs in the lungs, which leads to the loss of elasticity and collapse of the airways. As a result, the flow of air in and out of the lungs is obstructed, making it difficult for individuals with emphysema to breathe out fully. Restrictive lung diseases, on the other hand, involve a decrease in lung volume and a restriction of lung expansion, which is not the case with emphysema.

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  • 37. 

    Is pneumonia an obsructive or restrictive lung disease?

    Correct Answer
    obstructive
    Explanation
    Pneumonia is not an obstructive or restrictive lung disease. Pneumonia is an infection that causes inflammation in the air sacs of the lungs, leading to symptoms such as cough, fever, and difficulty breathing. It is not characterized by the airflow limitation seen in obstructive lung diseases like asthma or chronic obstructive pulmonary disease (COPD), nor does it involve the decreased lung compliance seen in restrictive lung diseases like pulmonary fibrosis. Therefore, the given answer is incorrect.

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  • 38. 

    Is asthma an obsructive or restrictive lung disease?

    Correct Answer
    obstructive
    Explanation
    Asthma is classified as an obstructive lung disease. This is because it causes the airways to become inflamed and narrowed, making it difficult for air to flow in and out of the lungs. This obstruction leads to symptoms such as wheezing, shortness of breath, and coughing. Restrictive lung diseases, on the other hand, are characterized by reduced lung expansion and decreased lung volume, which is not the case with asthma.

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  • 39. 

    Is bronchitis an obsructive or restrictive lung disease?

    Correct Answer
    obstructive
    Explanation
    Bronchitis is classified as an obstructive lung disease because it causes inflammation and narrowing of the airways, leading to difficulty in breathing. In bronchitis, the airways become obstructed due to excessive mucus production and inflammation, making it harder for air to flow in and out of the lungs. This obstruction results in symptoms such as coughing, wheezing, and shortness of breath. Restrictive lung diseases, on the other hand, involve a decrease in lung volume or expansion, which is not the case with bronchitis.

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  • 40. 

    Is fibrosis an obstructive or restrictive lung disease?

    Correct Answer
    restrictive
    Explanation
    Fibrosis is classified as a restrictive lung disease. Restrictive lung diseases are characterized by a decrease in lung volume, making it difficult for the lungs to expand fully. In the case of fibrosis, there is excessive scarring or fibrous tissue formation in the lungs, which leads to a loss of elasticity and reduces lung compliance. This results in a restriction of airflow and impaired lung function.

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  • 41. 

    Chest wall movement is reduced on the left side, no mediastinal displacement, dull percussiv note, bronchial breath sounds, increased vocal resonance and fine crackles point to which one of the following?

    • A.

      Left pneumothorax

    • B.

      Left sided consolidation

    • C.

      Fibrosis

    • D.

      Left pleural effusion

    • E.

      Right pleural effusion

    Correct Answer
    B. Left sided consolidation
    Explanation
    The combination of reduced chest wall movement on the left side, dull percussion note, bronchial breath sounds, increased vocal resonance, and fine crackles suggests left-sided consolidation. Consolidation refers to the accumulation of fluid or solid material in the lungs, which can occur due to conditions such as pneumonia or lung infection. These findings indicate that there is a localized area of lung tissue that has become solidified, leading to the observed clinical signs.

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  • 42. 

    Chest wall movement is reduced on the left side, mediastinal displacement to the right, stony dull percussive note, reduced or absent breath sounds, reduced or absent vocal resonance point to which one of the following?

    • A.

      Left pneumothorax

    • B.

      Left sided consolidation

    • C.

      Fibrosis

    • D.

      Left sided pleural effusion

    • E.

      Right sided pleural effusion

    Correct Answer
    D. Left sided pleural effusion
    Explanation
    The given symptoms of reduced chest wall movement on the left side, mediastinal displacement to the right, stony dull percussive note, and reduced or absent breath sounds and vocal resonance are indicative of a left-sided pleural effusion. Pleural effusion refers to the accumulation of fluid in the pleural space, which can cause compression of the lung and displacement of the mediastinum. The stony dull percussive note and reduced or absent breath sounds and vocal resonance are consistent with the presence of fluid in the pleural space.

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  • 43. 

    A patient who has been diagnosed with emphysema is submitted to a number of lung function tests. Which of the following would you expect to be reduced?

    • A.

      Functional residual capacity

    • B.

      Vital capacity

    • C.

      Lung compliance

    • D.

      Residual volume

    • E.

      Total lung capacity

    Correct Answer
    B. Vital capacity
    Explanation
    In emphysema, the walls of the alveoli in the lungs are damaged, causing them to lose their elasticity. This leads to the collapse of the air sacs during expiration, resulting in air trapping and reduced lung function. Vital capacity is the maximum amount of air a person can exhale after taking a deep breath, and it is reduced in emphysema due to the loss of lung elasticity. Therefore, in a patient with emphysema, a reduction in vital capacity would be expected.

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  • 44. 

    A patient comes to see you at the GP surgery for a review of her asthma. She is 33 years old and has been asthmatic for 10 years. She tells you she currently uses her salbutamol inhaler (short acting beta-2 agonist) up to 4 times a day and takes the max dose of her Qvar inhaler but still regularly feels wheezy.Which medication would you now prescribe in addition?

    • A.

      Oral steroids

    • B.

      Theophylline

    • C.

      Ipratropium bromide

    • D.

      Leukotriene receptor antagonist

    • E.

      Long acting beta-2 agonist

    Correct Answer
    E. Long acting beta-2 agonist
    Explanation
    In this scenario, the patient is experiencing persistent symptoms of wheeziness despite using her salbutamol inhaler and the maximum dose of Qvar inhaler. This indicates that her asthma is not well controlled and requires additional medication. Long-acting beta-2 agonists (LABAs) are recommended as an add-on therapy in such cases. LABAs provide a long-lasting bronchodilator effect, helping to relax and open up the airways. This can improve asthma symptoms and reduce the need for rescue medication like salbutamol. Therefore, prescribing a long-acting beta-2 agonist would be an appropriate choice to improve the patient's asthma control.

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  • 45. 

    Katie, an 8 year old school girl, comes to see her GP with a history of wheezing and coughing. These symptoms occure in cold weather and after exercise but not everyday.As a result of peak flow measurement over 2 weeks and exercise tests a diagnosis of asthma is made.What is the most appropriate first step in the management of childhood asthma?

    • A.

      Leukotriene receptor antagonist

    • B.

      Short acting beta 2 agonist

    • C.

      Oral corticosteroids

    • D.

      Inhaled corticosteroids

    • E.

      Long acting beta 2 agonist

    Correct Answer
    B. Short acting beta 2 agonist
    Explanation
    The most appropriate first step in the management of childhood asthma is to prescribe a short-acting beta 2 agonist. This medication helps to relieve acute symptoms of wheezing and coughing by relaxing the airway muscles. It is commonly used as a rescue medication for asthma attacks or as a preventive measure before exercise. In this case, since the symptoms occur in cold weather and after exercise, a short-acting beta 2 agonist would be the most suitable initial treatment option.

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  • 46. 

    A 6 year old boy is admitted to A&E because of acute exacerbation of his asthma. Pulse rate 120, resps 36. He is barrel chested and using accessory muscles to breathe. He is breathless, wheezing and only talking in short sentences. GCS is 14. Widespread wheeze heard on ascultation of chest. Peak expiratory flow rate is 46% of predicted and O2 sats are 94% on air.What aspect of this patient's presentation is most concerning?

    • A.

      Peak expiratory flow rate

    • B.

      O2 sats

    • C.

      Use of accessory muscles

    • D.

      Respiratory rate

    • E.

      Wheeze on ascultation

    Correct Answer
    A. Peak expiratory flow rate
    Explanation
    The most concerning aspect of this patient's presentation is the peak expiratory flow rate. A peak expiratory flow rate of 46% of predicted indicates severe airflow obstruction, which is a significant concern in asthma exacerbation. It suggests that the patient is experiencing a significant reduction in lung function and may be at risk for respiratory failure. This finding, along with the other symptoms such as barrel chest, use of accessory muscles, and wheezing, indicates that the patient's asthma is poorly controlled and requires urgent intervention.

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  • 47. 

    Managing an asthma attack. High flow O2 administered and a large bore IV cannula inserted. What is the next most important step in managing the patient?

    • A.

      Administer nebulised salbutamol

    • B.

      Send for VQ scan

    • C.

      Oral prednisolone

    • D.

      IV heparin

    • E.

      Send for chest xray

    Correct Answer
    A. Administer nebulised salbutamol
    Explanation
    The next most important step in managing the patient is to administer nebulised salbutamol. Nebulised salbutamol is a bronchodilator medication that helps to relax and open up the airways, which is crucial in managing an asthma attack. This medication is commonly used to relieve symptoms such as wheezing, shortness of breath, and chest tightness. By administering nebulised salbutamol, the patient's breathing can be improved, and their asthma symptoms can be alleviated. This step takes priority over other options such as sending for VQ scan, oral prednisolone, IV heparin, or sending for a chest x-ray, as the immediate focus should be on addressing the acute respiratory distress caused by the asthma attack.

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  • 48. 

    Katie is 4 years old and her asthma is currently being treated with a short acting beta 2 agonist. She has been more breathless at school recently and her father wants her asthma to be more cotrolled, What is the next step in the management of this patient.

    • A.

      Add an inhaled steroid

    • B.

      Add an oral steroid

    • C.

      Maintain present treatment

    • D.

      Add an inhaled long acting beta 2agonist

    • E.

      Monitor with peak flow readings

    Correct Answer
    A. Add an inhaled steroid
    Explanation
    The next step in the management of this patient would be to add an inhaled steroid. This is because Katie's asthma is not well controlled with the current treatment of a short-acting beta 2 agonist. Inhaled steroids are recommended as a controller medication for asthma, as they help reduce airway inflammation and prevent asthma symptoms. By adding an inhaled steroid, it is likely that Katie's asthma symptoms will be better controlled, reducing her breathlessness at school.

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  • 49. 

    An asthmatic presents in A&E in acute respiratory distress. What's the most appropriate primary intervention on admission of this patient?

    • A.

      IV hydrocortisone 200mg

    • B.

      Nebulised salbutamol 5mg every 15-30 mins as required

    • C.

      Allow patient to self medicate using their own 'blue' inhaler

    • D.

      O2 therapy at highest flow rate available

    • E.

      IV magnesium sulphate 1.2-2g every 20 mins as required

    Correct Answer
    D. O2 therapy at highest flow rate available
    Explanation
    The most appropriate primary intervention on admission of an asthmatic patient in acute respiratory distress is O2 therapy at the highest flow rate available. This is because in acute respiratory distress, the priority is to ensure adequate oxygenation to the patient's lungs. O2 therapy helps to increase the oxygen levels in the blood, relieving the respiratory distress. Other interventions such as IV hydrocortisone, nebulised salbutamol, self-medication with a 'blue' inhaler, and IV magnesium sulfate may also be necessary in the management of asthma, but O2 therapy takes precedence in the initial treatment.

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