Amk Practice Questions - Childhood, Adolescence, Young Adult

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.