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173,465,726 | false | 20 | null | 6,495,189 | null | false | [] | null | 17,563 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The triquetrum bone is too medial to be the bone broken in this question. The anatomical snuffbox occupies the lateral aspect of the hand (remember in anatomical position, the arm is supinated) and therefore tenderness in this area could not be explained by a triquetrum fracture.",
"id": "10025827",
"label": "c",
"name": "Triquetrum fracture",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The examination findings show marked tenderness in the anatomical snuffbox and pain when \"telescoping\" the thumb. This, paired with an injury sustained from falling on an outstretched hand is a classic presentation of a scaphoid fracture. These are clinically important as the scaphoid bone has a retrograde blood supply, meaning it is at risk of avascular necrosis if not managed promptly.",
"id": "10025825",
"label": "a",
"name": "Scaphoid fracture",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The ulna is not typically fractured when falling on an outstretched hand. It is more likely to be fractured by direct impact or falling on a flexed elbow. It is not characterised by tenderness in the anatomical snuffbox or on axial loading of the thumb.",
"id": "10025829",
"label": "e",
"name": "Ulna fracture",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst a distal radius (Colle's) fracture commonly results from falling onto an outstretched hand, it would not explain the tenderness in the anatomical snuffbox or on axial loading of the thumb.",
"id": "10025828",
"label": "d",
"name": "Distal radius fracture",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The pisiform bone is too medial to be the bone broken in this question. The anatomical snuffbox occupies the lateral aspect of the hand (remember in anatomical position, the arm is supinated) and therefore tenderness in this area could not be explained by a pisiform fracture.",
"id": "10025826",
"label": "b",
"name": "Pisiform fracture",
"picture": null,
"votes": 2
}
],
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"name": "Scaphoid fractures",
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"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
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"question": "A 22 year old female presents to A&E with a painful, swollen wrist and hand. She was out riding her bike earlier that day when she slipped and fell to the floor on an outstretched left hand. On examination, she has marked tenderness in the region between the extensor pollicis longus tendon and the extensor pollicis brevis and adductor pollicis longus tendon. She also reports pain upon axial loading of the thumb.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
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"totalVotes": 81,
"typeId": 1,
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173,465,727 | false | 21 | null | 6,495,189 | null | false | [] | null | 17,564 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The corticobulbar tracts terminate in the cranial nerves and are not associated with neurological changes in the lower limbs. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.",
"id": "10025833",
"label": "d",
"name": "Tectospinal tract",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The lateral spinothalamic tract is responsible for carrying sensory information relating to pain and temperature. By contrast, lower limb deficits in vibration sensation and proprioception, in combination with the severe vitamin B12 deficiency, are more in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.",
"id": "10025834",
"label": "e",
"name": "Lateral spinothalamic tract",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The dorsal columns carry sensory fibres for vibration and proprioception, which are impaired in the neurological examination of this patient. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with subacute combined degeneration of the spinal cord which affected the dorsal column.",
"id": "10025830",
"label": "a",
"name": "Dorsal column",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The corticobulbar tracts terminate in the cranial nerves and are not associated with neurological changes in the lower limbs. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.",
"id": "10025831",
"label": "b",
"name": "Corticobulbar tracts",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The reticulospinal tracts are responsible for voluntary movements and muscle tone, and are not associated with neurological changes in the lower limbs. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.",
"id": "10025832",
"label": "c",
"name": "Reticulospinal tracts",
"picture": null,
"votes": 2
}
],
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"__typename": "Concept",
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"demo": null,
"entitlement": null,
"id": "5864",
"name": "Subacute combined degeneration of the spinal cord",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "Dorsal column",
"highlights": [],
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"question": "A 65 year old male presents to A& after a fall, with a 6-month history of general health deterioration, increased fatigue, unsteadiness, and leg tingling.\n \n\n \n \n\nA neurological examination reveals:\n \n \n\n* Diminished vibration sense in the lower limbs bilaterally\n* Diminished proprioception in the lower limbs bilaterally\n* Slight weakness of the lower limbs bilaterally (power 3/5)\n* Intact pain and temperature sensation throughout\n \n \n\nSome blood tests are done and relevant results are as follows:\n \n \n| | | |\n| -------------- | :-------: | --------------- |\n| Haemoglobin | 110 g/L | (M) 130 - 170, (F) 115 - 155 | \n| Mean Cell Haemoglobin (MCH)| 36 pg | 27 - 33 |\n| Mean Cell Volume (MCV) | 104 fL | 80 - 96 |\n| Serum Vitamin B12 | 55 ng/L | 160 - 925 |\n \n\n* Intrinsic factor antibody positive\n \n \n\nWhich of the following neurological tracts are most likely to be implicated in this pati",
"sbaAnswer": [
"a"
],
"totalVotes": 77,
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173,465,728 | false | 22 | null | 6,495,189 | null | false | [] | null | 17,565 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst the pons does contain the spinothalamic tracts responsible for pain and temperature sensation, this is not the most site of the lesion likely given the patient's history of spinal trauma.",
"id": "10025839",
"label": "e",
"name": "Pons",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst peripheral neuropathy would be an appropriate differential for bilateral sensory changes in a distal limb for a patient with type 2 diabetes, this is not the most likely explanation. The recent spinal trauma and absence of pain and temperature sensation are consistent with damage to the lateral spinothalamic tracts.",
"id": "10025836",
"label": "b",
"name": "Peripheral nerves",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The lateral spinothalamic tracts are responsible for pain and temperature sensation, both of which are impaired in this patient. They can be damaged following spinal injury, and individuals with spinothalamic tract damage often present with burns.",
"id": "10025835",
"label": "a",
"name": "Lateral spinothalamic tracts",
"picture": null,
"votes": 58
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patient did not present with any cerebellar signs. These can be remembered with the mnemonic DANISH (Dysmetria and dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia). In this case, the recent spinal trauma and absence of pain and temperature sensation are consistent with damage to the lateral spinothalamic tracts.",
"id": "10025837",
"label": "c",
"name": "The cerebellum",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The dorsal column tracts are responsible for proprioception and vibration sense, both of which are intact in this vignette. The recent spinal trauma and absence of pain and temperature sensation are consistent with damage to the lateral spinothalamic tracts.",
"id": "10025838",
"label": "d",
"name": "Dorsal column",
"picture": null,
"votes": 8
}
],
"comments": [],
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"__typename": "Concept",
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5828",
"name": "Spinothalamic tracts",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
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"question": "A 60 year old man presents to A&E after sustaining burns to both of his feet. He had not noticed the temperature of his bath when he got in it. On examination, as well as second-degree burns to the plantar aspects of both feet, he also has impaired sensation of pain bilaterally. His sensation of fine touch, vibration and proprioception is intact.\n\nThe patient had a recent hospital admission after sustaining a traumatic spinal cord injury, but was discharged the previous week. Other than the spinal cord injury he has a past medical history of type 2 diabetes mellitus, but takes no regular medications.\n\nWhich of the following is the most likely location of the pathology?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
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173,465,729 | false | 23 | null | 6,495,189 | null | false | [] | null | 17,566 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, the abducens nerve (CN VI) is responsible for innervating the lateral rectus muscle of the eye. CN VI palsy results in horizontal diplopia when attempting to abduct the affected eye.",
"id": "10025841",
"label": "b",
"name": "CN VI",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient is presenting with a facial nerve (CN VII) palsy. The facial nerve is responsible for motor innervation of the muscles of facial expression, as well as lacrimation and taste from the anterior 2/3 of the tongue.",
"id": "10025840",
"label": "a",
"name": "CN VII",
"picture": null,
"votes": 60
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, the trigeminal nerve (CN V) is responsible for facial sensation and innervation of the muscles of mastication. Damage to this cranial nerve can cause trigeminal neuralgia, loss of facial sensation and loss of the corneal reflex.",
"id": "10025842",
"label": "c",
"name": "CN V",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, the vestibulocochlear nerve (CN VIII) is responsible for hearing and balance. Patients with damage to this cranial nerve commonly present with hearing loss and vertigo.",
"id": "10025843",
"label": "d",
"name": "CN VIII",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The hypoglossal nerve (CN XII) is responsible for tongue movement; a lesion in CN XII would present with tongue deviation to the side of the lesion, as well as tongue wasting.",
"id": "10025844",
"label": "e",
"name": "CN XII",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4303",
"name": "Facial nerve palsy",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
},
"topicId": 141,
"totalCards": null,
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"highlights": [],
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"question": "A 33 year old man presents to the GP as his friends noticed some changes to the appearance of his face. On examination, he has left-sided ptosis, loss of the nasolabial fold and drooping of the left side of the mouth. Motor function on the right side of his face is intact. Sensation is unaffected bilaterally\n\nWhich of the following cranial nerves is most likely implicated in this presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
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173,465,730 | false | 24 | null | 6,495,189 | null | false | [] | null | 17,567 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The substantia nigra includes two pathways, intrinsic and extrinsic, which together are responsible for the initiation of movement. The neurons within these pathways are dopaminergic, not serotonergic.",
"id": "10025846",
"label": "b",
"name": "Serotonergic cells of the substantia nigra",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The main location of pathology in Parkinson's disease is the substantia nigra, located within the basal ganglia.",
"id": "10025849",
"label": "e",
"name": "Dopaminergic cells of the medulla oblongata",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Damage to neuronal myelin sheaths is not specifically implicated in Parkinson's disease. The myelin sheath is wrapped around the axon and allows action potentials to be conducted at a faster pace. Damage to the myelin sheath in the central nervous system is seen in conditions such as multiple sclerosis.",
"id": "10025848",
"label": "d",
"name": "Myelin sheath of the central nervous system",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Whilst the exact cause of Parkinson's disease is unclear, it is believed to be caused by the loss of dopaminergic neurons in the substantia nigra of the basal ganglia. Functions of the basal ganglia include the initiation of movement, motor learning and motor control.",
"id": "10025845",
"label": "a",
"name": "Dopaminergic cells of the substantia nigra",
"picture": null,
"votes": 79
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The main location of pathology in Parkinson's is the substantia nigra, located within the basal ganglia.",
"id": "10025847",
"label": "c",
"name": "Dopaminergic cells of the cerebellum",
"picture": null,
"votes": 1
}
],
"comments": [],
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"__typename": "Concept",
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"typeId": 7
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"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5865",
"name": "Parkinsonism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"topicId": 141,
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"question": "A 72 year old male attends neurology clinic regarding a new diagnosis of Parkinson's disease. The patient has been having recurrent falls and his wife has noticed he moves a lot slower than he used to, and has developed a tremor that is worse on the right-hand side. On examination, the patient demonstrates 'cog wheel' rigidity and a 'pill-rolling' tremor of the right hand.\n\nWhich of the following neuronal subtypes are lost in Parkinson's disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 81,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,731 | false | 25 | null | 6,495,189 | null | false | [] | null | 17,568 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The abducens nerve (CN VI) innervates the lateral rectus muscle. Patients with sixth nerve palsy present with diplopia that is worse in the horizontal plane.",
"id": "10025853",
"label": "d",
"name": "CN VI",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, the olfactory nerve (CN I) is responsible for smell. Patients with damage to this cranial nerve may experience a change or lack of their sense of smell.",
"id": "10025854",
"label": "e",
"name": "CN I",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The trochlear nerve (CN IV) controls the superior oblique muscle. Damage to this cranial nerve presents with diplopia that is worse in the vertical plane, classically experienced when reading or going downstairs.",
"id": "10025852",
"label": "c",
"name": "CN IV",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct - this presentation is consistent with a third nerve palsy, caused by damage to the oculomotor nerve (CN III). CN III innervates most of the ocular muscles, except the superior oblique and lateral rectus muscles which are innervated by CN IV and CN VI respectively. In third nerve palsy, the superior oblique and lateral rectus muscles are the only functioning ocular muscles. Their unopposed activity pulls the eye into a characteristic 'down and out' resting position of the eye.",
"id": "10025850",
"label": "a",
"name": "CN III",
"picture": null,
"votes": 63
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The optic nerve (CN II) is responsible for vision. A CN II lesion would present with visual loss, rather than problems with eye movements.",
"id": "10025851",
"label": "b",
"name": "CN II",
"picture": null,
"votes": 0
}
],
"comments": [],
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"demo": null,
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"id": "3970",
"name": "Isolated cranial nerve palsies affecting the eye",
"status": null,
"topic": {
"__typename": "Topic",
"id": "141",
"name": "Neurology",
"typeId": 7
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"topicId": 141,
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"question": "A 60 year old man presents to A&E after his sister notices that the appearance of his eyes has changed. The patient also notes some double vision and pain behind the right eye since waking up that morning. On examination, the patient's right eye is fixed in a downward, lateral position. There is also ptosis and fixed pupil dilatation. His visual acuity is intact in both eyes. There is no sensory loss or weakness throughout the rest of his body.\n\nWhich of the following cranial nerves is most likely implicated in the patient's presentation?",
"sbaAnswer": [
"a"
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173,465,732 | false | 26 | null | 6,495,189 | null | false | [] | null | 17,569 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, low BMI and low body weight are risk factors for osteoporosis rather than obesity.",
"id": "10025858",
"label": "d",
"name": "High BMI is a risk factor",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There is a decrease in bone mineral density in osteoporosis, caused by osteoclast activity exceeding osteoblast activity. If there were higher osteoblast activity, we would expect an increase in bone bone mineral density rather than a reduction.",
"id": "10025857",
"label": "c",
"name": "Osteoblast activity exceeds osteoclast activity",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Osteoclasts are responsible for bone resorption whilst osteoblasts are responsible for bone growth. These two cells usually work together to maintain healthy bones. However, in osteoporosis, osteoclast activity exceeds osteoblast activity, thus reducing bone mineral density. This increases an individual's risk of fractures as the less-dense bone fractures more easily.",
"id": "10025855",
"label": "a",
"name": "Osteoclast activity exceeds osteoblast activity",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Osteoclasts and osteoblasts are responsible for bone resorption and bone remodelling respectively. In osteoporosis, the bone is less dense meaning it is being resorbed at a faster rate than it is being remodelled. Therefore, an increase in osteoclast activity compared to osteoblast is a factor in the development of osteoporosis.",
"id": "10025859",
"label": "e",
"name": "Osteoporosis occurs independent of osteoclast and osteoblast activity",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There is a decrease in bone mineral density in osteoporosis which increases an individual's risk of fractures.",
"id": "10025856",
"label": "b",
"name": "Increase in bone mineral density",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4208",
"name": "Osteoporosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4208,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17569",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 71 year old woman is reviewed by the bone health team following a hospital admission for a right neck of femur fracture. She undergoes a DEXA scan, which identifies osteoporosis.\n\nWhich of the following is a feature of osteoporosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 84,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,733 | false | 27 | null | 6,495,189 | null | false | [] | null | 17,570 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The Achilles tendon inserts at the calcaneus bone, specifically the calcaeneal tuberosity. The navicular bone contains a tuberosity for the insertion of the part of the tibialis posterior tendon.",
"id": "10025862",
"label": "c",
"name": "Navicular bone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The Achilles tendon inserts at the calcaneus bone, specifically the calcaneal tuberosity, not at the tibia.",
"id": "10025864",
"label": "e",
"name": "Tibia",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The Achilles tendon inserts at the calcaneus bone, specifically the calcaneal tuberosity. The talus is part of the ankle joint, articulating with the calcaneus to form the heel. Being the most superior of the tarsal bones it is responsible for transmitting the weight of the body to the calcaneus.",
"id": "10025861",
"label": "b",
"name": "Talus bone",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The Achilles tendon inserts at the calcaneal tuberosity of the calcaneus bone of the foot.",
"id": "10025860",
"label": "a",
"name": "Calcaneal tuberosity",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The Achilles tendon inserts at the calcaneus bone, specifically the calcaneal tuberosity. The cuneiforms are the location of insertion for many muscles including but not limited to tibialis anterior and part of tibialis posterior.",
"id": "10025863",
"label": "d",
"name": "The cuneiforms",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5866",
"name": "Achilles tendonitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5866,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17570",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 22 year old male patient presents to the GP with ankle pain. This pain is at the back of his left ankle and has been present intermittently for the past six months. There is no history of trauma.\n\nThe GP diagnoses Achilles tendonitis.\n\nIn which of the following structures does the Achilles tendon insert?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,734 | false | 28 | null | 6,495,189 | null | false | [] | null | 17,571 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is not one of the functions of the biceps brachii, so would not be impaired due to a biceps tendon rupture. Instead, extension of the arm at the elbow is achieved by the action of the triceps brachii.",
"id": "10025867",
"label": "c",
"name": "Extension of the arm at the elbow",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The biceps brachii are responsible for supination of the forearm and flexion of the arm at the elbow and shoulder. Tendon rupture can occur with heavy overhead lifting and can result in what is known as 'pop eye' deformity. A biceps tendon rupture is therefore most likely to result in an impairment of supination of the forearm.",
"id": "10025865",
"label": "a",
"name": "Supination of the forearm",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Flexion at the wrist is not one of the functions of the biceps brachii. and so would not be impaired due to a biceps tendon rupture. Flexion at the wrist is achieved by multiple muscles in the anterior compartment of the forearm; mainly flexor carpi ulnaris and flexor carpi radialis.",
"id": "10025868",
"label": "d",
"name": "Flexion at the wrist",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Pronation is not one of the functions of the biceps brachii, and so would not be impaired due to a biceps tendon rupture. Instead, pronation is achieved through the action of pronator teres, pronator quadratus and brachioradialis.",
"id": "10025866",
"label": "b",
"name": "Pronation of the forearm",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Extension at the shoulder is not one of the functions of the Biceps brachii, and so would not be impaired due to a biceps tendon rupture. Extension at the shoulder is achieved by the action of latissimus dorsi, teres major, pectoralis major, deltoid and the long head of triceps brachii.",
"id": "10025869",
"label": "e",
"name": "Extension at the shoulder",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5867",
"name": "Biceps Tendon Tear",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5867,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17571",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 60 year old male presents to A&E with excruciating left arm pain. It came on suddenly that afternoon while he was lifting a heavy box above his head. On examination there is significant pain in the distal aspect of the left biceps, accompanied by swelling. He is diagnosed with a biceps tendon rupture.\n\nWhich of the following movements is most likely to be impaired?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,735 | false | 29 | null | 6,495,189 | null | false | [] | null | 17,572 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The greater tuberosity is the site of insertion of supraspinatus, infraspinatus and teres minor of the rotator cuff muscles. Pathology at this insertion site would not cause pain reproducible with resisted extension of the forearm.",
"id": "10025872",
"label": "c",
"name": "Greater tuberosity of the humerus",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the site of insertion of the flexors of the forearm. Pain would therefore be reproduced when resisting flexion of the forearm. This would give rise to the chronic overuse syndrome 'golfer's elbow', also known as medial epicondylitis.",
"id": "10025871",
"label": "b",
"name": "Medial epicondyl of the humerus",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This presentation is characteristic of 'tennis elbow', also known as lateral epicondylitis. This is a chronic overuse syndrome, with pain at the site of the forearm extensor muscle insertion; the lateral epicondyle of the humerus.",
"id": "10025870",
"label": "a",
"name": "Lateral epicondyl of the humerus",
"picture": null,
"votes": 57
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The lesser tuberosity is the site of insertion of the subscapularis muscle of the rotator cuffs. Pathology at this insertion site would not cause pain reproducible on resisted extension of the forearm.",
"id": "10025873",
"label": "d",
"name": "Lesser tuberosity of the humerus",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The olecranon is the site of attachment of triceps brachii. Pathology at this insertion site would not cause pain reproducible on resisted extension of the forearm.",
"id": "10025874",
"label": "e",
"name": "Olecranon of the ulna bone",
"picture": null,
"votes": 9
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5688",
"name": "Lateral epicondylitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5688,
"conditions": [],
"difficulty": 1,
"dislikes": 1,
"explanation": null,
"highlights": [],
"id": "17572",
"isLikedByMe": 0,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 40 year old male presents to the GP with persistent right elbow pain that has been present intermittently for around two months. There is no history of trauma. The patient is usually fit and well, and is a keen sportsman. On examination, there is severe pain in the lateral aspect of the elbow that is reproduced on resisted elbow extension.\n\nWhich of the following tendon insertion sites is implicated in the patient's presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 77,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,736 | false | 30 | null | 6,495,189 | null | false | [] | null | 17,573 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Psoriatic arthritis is an inflammatory arthritis associated with nail changes, dactylitis and psoriatic skin changes. None of these are present in this case.",
"id": "10025878",
"label": "d",
"name": "Psoriatic arthritis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Risk factors for the development of osteoarthritis include age (60 and above) and female sex. It is associated with pain in the affected joint during and after use. Although there is morning stiffness, as this lasts for less than 30 minutes it is not an indicator of inflammatory arthritis.",
"id": "10025875",
"label": "a",
"name": "Osteoarthritis",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Rheumatoid arthritis is an inflammatory arthritis. Unlike osteoarthritis, it tends to present with multiple joint involvement, is often symmetrical and is sometimes accompanied by systemic symptoms. It is also characterised by morning stiffness lasting for more than 30 minutes. Unlike in osteoarthritis, pain often improves with movement of the joints.",
"id": "10025876",
"label": "b",
"name": "Rheumatoid arthritis",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Septic arthritis presents acutely with a swollen, painful and red joint, as well as signs of systemic infection. This patient is otherwise well, making osteoarthritis a more likely diagnosis.",
"id": "10025879",
"label": "e",
"name": "Septic arthritis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Gout is associated with acute attacks of pain, swelling and erythema of a joint; classically in the big toe or ankle. The chronicity of this patient's symptoms and lack of erythema make gout less likely than osteoarthritis in this case.",
"id": "10025877",
"label": "c",
"name": "Gout",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3976",
"name": "Osteoarthritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "146",
"name": "Rheumatology",
"typeId": 7
},
"topicId": 146,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3976,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17573",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 65 year old female patient presents to the GP with chronic left knee pain. This has been troubling her for around three months, and is worse after walking long distances. She also reports stiffness first thing in the morning, although this eases after around five minutes. Other than her pain she feels well. She takes medication for hypertension and type 2 diabetes.\n\nOn examination there is mild swelling of the left knee, but no erythema. There is tenderness and crepitus on passive flexion and extension of the left knee. No popliteal lumps.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,737 | false | 31 | null | 6,495,189 | null | false | [] | null | 17,574 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The signs of a radial nerve injury vary depending on where the damage occurs. Damage at the axilla or proximal humerus is associated with unopposed flexion of the wrist, and sensory loss over the lateral and posterior arm.",
"id": "10025882",
"label": "c",
"name": "Radial nerve",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Injury to the musculocutaneous nerve presents with weakness in shoulder and elbow flexion as well as loss of sensation over the lateral forearm.",
"id": "10025884",
"label": "e",
"name": "Musculocutaneous nerve",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The axillary nerve is commonly injured following shoulder dislocation. It presents as weakness in shoulder abduction and sensory loss over the inferior deltoid.",
"id": "10025883",
"label": "d",
"name": "Axillary nerve",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Ulnar nerve compression occurs in cubital tunnel syndrome. Symptoms are similar to that of carpal tunnel syndrome; including pain, paresthesia and numbness of the medial one and a half fingers.",
"id": "10025881",
"label": "b",
"name": "Ulnar nerve",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient is presenting with carpal tunnel syndrome, which is the compression of the median nerve as it passes through the carpal tunnel to the hand. Classic symptoms include pain, paresthesia, numbness in the distribution of the median nerve and wasting of the thenar eminence.",
"id": "10025880",
"label": "a",
"name": "Median nerve",
"picture": null,
"votes": 73
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3858",
"name": "Carpal tunnel syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3858,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17574",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old pregnant woman presents to her GP with tingling and pain in her left hand. This is limited to her thumb, index and middle finger. It is much worse at night but can also be troublesome during the day.\n\nOn examination there is reduced sensation of the thumb, index and middle finger, as well as slight wasting of the thenar eminence.\n\nWhich of the following nerves is most likely implicated in this patient's presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,738 | false | 32 | null | 6,495,189 | null | false | [] | null | 17,575 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, injuries to the lateral collateral ligament are typically seen following a blow to the lateral side of the knee in a planted foot. On examination, lateral rotation of the leg would elicit pain. MRI would show a tear to a ligament which attaches at the lateral epicondyle of the femur and lateral surface of the fibular head.",
"id": "10025889",
"label": "e",
"name": "Lateral collateral ligament tear",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient demonstrates a typical ACL injury involving a twisting motion, a popping sensation and rapid swelling. Other indicators include a positive anterior draw test that is consistent with ACL weakness. The MRI also describes an ACL tear: it attaches to the anterior intercondylar region of the tibia and the intercondylar fossa of the femur.",
"id": "10025885",
"label": "a",
"name": "Anterior cruciate ligament (ACL) tear",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The PCL is often injured following a direct blow to a flexed knee. This would show on examination as a positive posterior draw test. The PCL inserts at the posterior intercondylar region of the tibia and the anteromedial femoral condyle. These factors make an ACL tear more likely than a PCL tear in this case.",
"id": "10025886",
"label": "b",
"name": "Posterior cruciate ligament (PCL) tear",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Injuries to the medial collateral ligament are typically seen following a blow to the medial side of the knee in a planted foot. On examination, medial rotation of the leg would elicit pain. MRI would show a tear to a ligament which attaches to the medial epicondyle of the femur and medial condyle of the tibia. It would also likely show a meniscal tear as these structures are closely related. An ACL tear is therefore a more likely underlying diagnosis.",
"id": "10025888",
"label": "d",
"name": "Medial collateral ligament tear",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The patellar ligament is a continuation of the quadriceps femoris tendon and attaches to the tibial tuberosity. Injury to this ligament would present with a popping sensation and swelling, but examination would elicit an inability to straighten the knee. An ACL tear is therefore a more likely underlying diagnosis.",
"id": "10025887",
"label": "c",
"name": "Patellar ligament tear",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3873",
"name": "Cruciate ligament injuries",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3873,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17575",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 25 year old woman presents to A&E after sustaining a right knee injury whilst playing football. Her boot became stuck in the ground, causing her knee to twist. She reports a popping sensation, accompanied by sudden severe pain. On examination, there is significant swelling and tenderness in the right knee. The anterior draw test is positive.\n\nAn MRI shows a tear to the structure that attaches to the anterior intercondylar region of the tibia and the intercondylar fossa of the femur.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,739 | false | 33 | null | 6,495,189 | null | false | [] | null | 17,576 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Gabapentinoids such as pregabalin work by inhibiting pre-synaptic calcium channels, reducing the calcium influx into neurons. This prevents the release of excitatory neurotransmitters such as glutamate.",
"id": "10025894",
"label": "e",
"name": "Pregabalin",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Phenytoin is a non-specific sodium channel blocker and acts by increasing the refractory period of these channels, blocking the positive feedback loop that encourages action potentials. This in turn reduces the over-activity of excitatory neurons that generate seizures. As it is a non-selective sodium channel blocker it should be used with caution in heart block or sinus bradycardia.",
"id": "10025890",
"label": "a",
"name": "Phenytoin",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Levetiracetam targets the synaptic vesicle protein 2A which is expressed throughout the brain. Through this action it modulates the release of neurotransmitters, preventing the activation of excitatory neurons.",
"id": "10025892",
"label": "c",
"name": "Levetiracetam",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sodium valproate works by increasing the production of the inhibitory neurotransmitter GABA. This reduces the neuronal excitability causing seizures.",
"id": "10025891",
"label": "b",
"name": "Sodium valproate",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Benzodiazepines such as lorazepam increase the activity of the inhibitory neurotransmitter GABA by binding to postsynaptic benzodiazepine receptors.",
"id": "10025893",
"label": "d",
"name": "Lorazepam",
"picture": null,
"votes": 9
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5868",
"name": "Phenytoin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "172",
"name": "Pharmacology of the Nervous System",
"typeId": 7
},
"topicId": 172,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17576",
"isLikedByMe": 0,
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"likes": 1,
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"qaAnswer": null,
"question": "A 17 year old patient attends a neurology clinic following a recent suspected epileptic fit. He is commenced on anti-epileptic medication.\n\nWhich of the following drugs works by increasing the refractory period of sodium channels?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,740 | false | 34 | null | 6,495,189 | null | false | [] | null | 17,577 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atenolol is a beta-blocker which belongs to the V-W class II. An example of an antiarrhythmic drug from class IV would be verapamil. These drugs inhibit calcium channels, affecting phases 0 and 4 of the cardiac action potential.",
"id": "10025899",
"label": "e",
"name": "Class IV",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atenolol is a beta-blocker which belongs to the V-W class II. An example of an antiarrhythmic drug from class Ib would be lidocaine. This class of drugs acts by blocking fast sodium channels.",
"id": "10025897",
"label": "c",
"name": "Class Ib",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atenolol is a beta-blocker which belongs to the V-W class II. An example of an antiarrhythmic drug from class III would be amiodarone. Class III drugs act by blocking potassium channels, increasing the action potential recovery period of key structures within the heart.",
"id": "10025898",
"label": "d",
"name": "Class III",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Atenolol is a beta-blocker which belongs to the V-W class II. Beta-blockers are beta-1-adrenergic antagonists, which work to decrease the heart rate.",
"id": "10025895",
"label": "a",
"name": "Class II",
"picture": null,
"votes": 61
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atenolol is a beta-blocker which belongs to the V-W class II. An example of an antiarrhythmic drug from class Ia would be procainamide. This class of drugs acts by blocking fast sodium channels.",
"id": "10025896",
"label": "b",
"name": "Class Ia",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4566",
"name": "Class II anti-arrythmics: Beta-blockers",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4566,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 66 year old female presents to A&E after a week long history of palpitations, breathlessness and fatigue. She is found to have an irregularly irregular pulse. An ECG confirms atrial fibrillation at a rate of 120 beats per minute. She is prescribed atenolol to control her heart rate.\n\nWhich of the following Vaughan-Williamson (V-W) classifications does atenolol belong to?",
"sbaAnswer": [
"a"
],
"totalVotes": 74,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,741 | false | 35 | null | 6,495,189 | null | false | [] | null | 17,578 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Klebsiella pneumonia is most commonly seen in patients with alcohol dependence. A classic sign is red-currant jelly sputum. As the patient in this case only has around 3 units of alcohol per week, Streptococcus pneumoniae is a more likely causative organism.",
"id": "10025901",
"label": "b",
"name": "Klebsiella pneumoniae",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Haemophilus influenzae is the second most common cause of pneumonia, and is often associated with bronchiectasis exacerbations. It is not as common as Streptococcus pneumoniae, making this option incorrect.",
"id": "10025902",
"label": "c",
"name": "Haemophilus influenzae",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Pneumocystis jirovecii typically only causes pneumonia in patients who are immunocompromised or HIV positive (particularly if CD4 count is below 200cells/uL). As this patient has no past medical history, Pneumocystis jirovecii is an unlikely causative organism.",
"id": "10025904",
"label": "e",
"name": "Pneumocystis jirovecii",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Legionella pneumonia is associated with Legionnaire's disease. It is classically seen in a patient recently exposed to poor hotel air conditioning. Blood tests may show hyponatraemia and deranged liver function tests. It is not as common as Streptococcus pneumoniae, making this option incorrect.",
"id": "10025903",
"label": "d",
"name": "Legionella pneumophila",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The patient has classic signs and symptoms of a lower respiratory tract infection, or pneumonia. Their symptoms (shortness of breath and cough), examination findings and imaging results are all consistent with this diagnosis. The most common causative microorganism is streptococcus pneumoniae.",
"id": "10025900",
"label": "a",
"name": "Streptococcus pneumoniae",
"picture": null,
"votes": 62
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3709",
"name": "Pneumonia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3709,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17578",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 65 year old male presents to A&E feeling generally unwell. For the past 2 days, he has had a cough productive of purulent sputum and becomes breathless walking only short distances. He has no regular medications and no past medical history. He consumes one glass of wine on a Saturday and has never smoked cigarettes.\n\nOn examination, there is dullness to percussion over the left lower lobe, as well as increased vocal resonance. A chest x-ray shows consolidation in the left lower lobe.\n\nWhich of the following is the most likely causative microorganism?",
"sbaAnswer": [
"a"
],
"totalVotes": 77,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,742 | false | 36 | null | 6,495,189 | null | false | [] | null | 17,579 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The following aspects of the history make this the most likely answer:\n* Age of the patient- adenocarcinoma is the most common lung cancer subtype in patients aged under 45\n* Sex of the patient- adenocarcinoma is more common in women\n* Smoking status of the patient- adenocarcinoma is the most common lung cancer subtype in non-smokers\n* Pleural effusion on chest x-ray: adenocarcinomas commonly cause pleural effusion",
"id": "10025905",
"label": "a",
"name": "Adenocarcinoma",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Small cell carcinoma is commonly seen alongside paraneoplastic syndromes such as the syndrome of inappropriate antidiuretic hormone (SIADH), Cushing's syndrome or Lambert Eaton myasthenic syndrome. With no indication of paraneoplastic syndromes, adenocarcinoma is a more likely underlying diagnosis.",
"id": "10025907",
"label": "c",
"name": "Small cell carcinoma",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Large cell carcinoma is a poorly differentiated subtype of lung cancer which is often a diagnosis of elimination. This is more common in men and has a strong relationship with smoking. It is associated with beta-hCG secretion and can cause gynaecomastia. It is less common than adenocarcinoma.",
"id": "10025909",
"label": "e",
"name": "Large cell carcinoma",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Squamous cell carcinoma is strongly associated with cigarette smoking and cavitations on imaging. This subtype is also associated with paraneoplastic syndromes including ectopic parathyroid hormone secretion (hypercalcaemia) and hypertrophic pulmonary osteoarthropathy (which involves painful, swollen joints).",
"id": "10025908",
"label": "d",
"name": "Squamous cell carcinoma",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst mesothelioma is commonly associated with pleural effusions, it is strongly associated with occupational exposure to asbestos which this patient does not have. There is a median latency period of 40 years, meaning it would be extremely rare to see this condition in a 43 year old.",
"id": "10025906",
"label": "b",
"name": "Mesothelioma",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3702",
"name": "Lung Cancer",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3702,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17579",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
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"question": "A 43 year old female patient presents to A&E with acute breathlessness and haemoptysis. She has had a cough for around 3 months and has required treatment for five chest infections over the last 6 months. She reports 2 stone of unintentional weight loss across this period.\n\nHer past medical history includes osteoarthritis of the right hip, for which she takes occasional paracetamol. She has never smoked and drinks alcohol rarely. She denies any exposure to asbestos.\n\nA chest x-ray shows a right-sided mass associated with mediastinal lymphadenopathy and pleural effusion in the right lower lung field.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,743 | false | 37 | null | 6,495,189 | null | false | [] | null | 17,580 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Classic ECG features of AF include tachycardia, an irregularly irregular rhythm and the absence of p-waves. An irregular peripheral pulse may also be identified. Symptoms include palpitations as well as chest pain, shortness of breath and syncope in some cases.",
"id": "10025910",
"label": "a",
"name": "Atrial fibrillation (AF)",
"picture": null,
"votes": 69
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. On an ECG, ventricular tachycardia is associated with regular but broad QRS complexes as well as a fast rate (>100 beats per minute). It can occur with a pulse or it may be pulseless.",
"id": "10025912",
"label": "c",
"name": "Ventricular tachycardia",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Ventricular fibrillation is an irregular broad complex tachycardia. It is a medical emergency, and patients will not have a pulse.",
"id": "10025913",
"label": "d",
"name": "Ventricular fibrillation",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Typical ECG findings of atrial flutter include flutter waves, or a characteristic 'saw tooth' like pattern, as well as tachycardia.",
"id": "10025911",
"label": "b",
"name": "Atrial flutter",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. An ECG showing a narrow QRS complex, irregularly irregular rhythm and absent p waves is consistent with atrial fibrillation.",
"id": "10025914",
"label": "e",
"name": "Normal variation",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3714",
"name": "Atrial fibrillation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3714,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17580",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 55 year old woman presents to her GP with a 5 day history of palpitations. An ECG shows tachycardia of 120 beats per minute. The rhythm is irregularly irregular. There are no identifiable P waves, and the QRS complex is narrow.\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,744 | false | 38 | null | 6,495,189 | null | false | [] | null | 17,581 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Salbutamol is a short-acting β2-adrenoreceptor agonist used in acute asthma management. Its duration of action is up to around four hours. By contrast, long-acting β2-adrenoreceptor agonists such as salmeterol are effective for up to 12 hours.",
"id": "10025916",
"label": "b",
"name": "It is effective for up to 12 hours by inhalation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Salbutamol is a short-acting β2-adrenoreceptor agonist used in acute asthma management. It binds selectively and reversibly to receptors of the respiratory tract. This inhibits the contraction of bronchial smooth muscle, resulting in bronchodilation.",
"id": "10025915",
"label": "a",
"name": "It acts by relaxing bronchial smooth muscle",
"picture": null,
"votes": 70
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Salbutamol is a short-acting β2-adrenoreceptor agonist used in acute asthma management. It has little to no action on the β1 adrenoreceptors of the heart.",
"id": "10025917",
"label": "c",
"name": "They have a high affinity for the β1 adrenoreceptors of the heart",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Salbutamol is a short-acting β2-adrenoreceptor agonist used in acute asthma management. It is not an antagonist. Antagonism of these receptors would prevent bronchodilation, exacerbating the bronchoconstriction seen in asthma.",
"id": "10025918",
"label": "d",
"name": "It belongs to the β2-adrenoreceptor antagonist class of drugs",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Salbutamol is a short-acting β2-adrenoreceptor agonist used in acute asthma management. It is used as reliever therapy when required. If it is required more than three times a week then the patient is said to have uncontrolled asthma and should be offered a regular 'preventer' inhaler.",
"id": "10025919",
"label": "e",
"name": "They should be used once a day for well controlled asthma",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4225",
"name": "Salbutamol",
"status": null,
"topic": {
"__typename": "Topic",
"id": "189",
"name": "Respiratory Pharmacology",
"typeId": 7
},
"topicId": 189,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4225,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17581",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
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"question": "A 14-year-old teenage boy presents to their GP with shortness of breath and a cough that is worse at night. His only medical history is allergic rhinitis and eczema.\n\nSpirometry shows an obstructive pattern of lung disease and positive reversibility testing. He is prescribed a salbutamol inhaler.\n\nWhich of the following is true of a salbutamol inhaler?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,745 | false | 39 | null | 6,495,189 | null | false | [] | null | 17,582 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Excretion of sodium from the kidney would in turn increase water excretion, which follows sodium via osmosis. This would therefore reduce the circulating blood volume and consequently reduce the stroke volume of the heart. This would reduce mean arterial blood pressure.",
"id": "10025922",
"label": "c",
"name": "Increasing renal excretion of sodium",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Activation of the sympathetic nervous system increases heart rate and increases peripheral vascular resistance. Mean arterial pressure is determined by the cardiac output multiplied by total peripheral resistance. Cardiac output is determined by the heart rate and stroke volume. Therefore by increasing heart rate, the cardiac output and consequently the mean arterial pressure also increase. The increase in peripheral vascular resistance further contributes to an increase in mean arterial pressure.",
"id": "10025920",
"label": "a",
"name": "Sympathetic nervous system activation",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. An increase in body temperature would cause vasodilation, thus reducing peripheral vascular resistance. This in turn reduces mean arterial blood pressure.",
"id": "10025923",
"label": "d",
"name": "Increase in body temperature",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Histamine causes vasodilation, thus reducing peripheral vascular resistance. This in turn reduces mean arterial blood pressure.",
"id": "10025924",
"label": "e",
"name": "Histamine release",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The parasympathetic system decreases heart rate. This reduces cardiac output, consequently reducing mean arterial pressure. Activation of the parasympathetic nervous thus causes a decrease in blood pressure.",
"id": "10025921",
"label": "b",
"name": "Parasympathetic nervous system activation",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3701",
"name": "Hypertension",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3701,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17582",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 58 year old male attends his GP surgery after noticing his blood pressure was high on his husband's home blood pressure monitor. He would like to know more about hypertension and its causes.\n\nWhich of the following is associated with an increase in blood pressure?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,746 | false | 40 | null | 6,495,189 | null | false | [] | null | 17,583 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst lung cancer is an important differential to consider, the absence of weight loss and haemoptysis is reassuring. Furthermore, lung cancer would be expected to show a mass or effusion on chest x-ray. The absence of these features makes COPD a more likely underlying diagnosis.",
"id": "10025926",
"label": "b",
"name": "Lung cancer",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst lung cancer is an important differential to consider, the absence of weight loss and haemoptysis is reassuring. Furthermore, lung cancer would be expected to show a mass or effusion on chest x-ray. The absence of these features makes COPD a more likely underlying diagnosis.",
"id": "10025928",
"label": "d",
"name": "Asthma",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst a lower respiratory tract infection or pneumonia can present with a productive cough and shortness of breath, the chronic duration of these symptoms and the absence of a temperature make COPD a more likely underlying diagnosis. This is also supported by the chest x-ray and spirometry findings.",
"id": "10025929",
"label": "e",
"name": "Pneumonia",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Interstitial lung disease shows a restrictive pattern on spirometry. FEV1 and FVC are equally reduced, resulting in a preserved FEV1/FVC. Given the reduced FEV1/FVC ratio seen in this case, an obstructive lung disease such as COPD is a more likely underlying explanation.",
"id": "10025927",
"label": "c",
"name": "Interstitial lung disease",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. COPD typically presents as chronic breathlessness and cough in an elderly patient with a significant smoking history. The examination finding of bilateral expiratory wheeze is also typical of COPD, while the hyper-resonant percussion note is due to 'barrel chest' or lung hyperinflation which is also seen on x-ray.\n \n\n COPD also shows an obstructive pattern of disease on spirometry which is an FEV1/FVC ratio of less than 0.7, as seen in this case.",
"id": "10025925",
"label": "a",
"name": "Chronic obstructive pulmonary disease (COPD)",
"picture": null,
"votes": 75
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3717",
"name": "Chronic obstructive pulmonary disease (COPD)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "132",
"name": "Respiratory",
"typeId": 7
},
"topicId": 132,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3717,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "Chronic obstructive pulmonary disease (COPD)",
"highlights": [],
"id": "17583",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 70-year-old woman presents with a chronic productive cough, breathlessness, and recurrent chest infections over the past year. She denies haemoptysis or weight loss but experiences shortness of breath when walking upstairs, though she can walk comfortably on flat surfaces. She does not drink alcohol but has smoked one packet of cigarettes a day for the last 55 years.\n\nOn examination, there is a bilateral expiratory wheeze, hyper-resonance on percussion throughout the lung fields, and a mildly elevated respiratory rate of 22 breaths per minute, with otherwise normal observations.\n\nA chest x-ray shows hyperinflation of the chest with no masses, effusions or lymphadenopathy. Spirometry shows a reduced FEV1/FVC ratio of 0.6.\n\n\nWhich of the following is the most likely underlying diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,747 | false | 41 | null | 6,495,189 | null | false | [] | null | 17,584 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Female sex is associated with a relatively lower risk of coronary artery disease compared to males.",
"id": "10025932",
"label": "c",
"name": "Sex",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Osteoarthritis is not directly related to an individual's risk of coronary artery disease.",
"id": "10025933",
"label": "d",
"name": "Osteoarthritis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although ethnicity is related to an individual's risk of developing coronary artery disease, those of Caucasian origin are at a relatively lower risk. Being of South Asian descent is a known risk factor.",
"id": "10025934",
"label": "e",
"name": "Ethnicity",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This vignette is typical of a non-ST elevation myocardial infarction. Hypertension leads to atherosclerosis which can either lead to thrombus or ischaemia through reduced blood flow through the coronary arteries.",
"id": "10025930",
"label": "a",
"name": "Hypertension",
"picture": null,
"votes": 73
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Although drinking alcohol significantly above recommended limits can increase the risk of coronary artery disease, drinking 1-2 glasses of wine a week is not a risk factor.",
"id": "10025931",
"label": "b",
"name": "Alcohol intake",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3713",
"name": "Myocardial infarction and Acute Coronary Syndrome (ACS)",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3713,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17584",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 55 year old Caucasian female presents to A&E with sudden onset crushing chest pain that radiates down her left arm. She has never smoked, drinks 1-2 glasses of wine at weekends and has a past medical history of osteoarthritis and hypertension. She has a BMI of 24.9kg/m2.\n\n\nAn ECG shows inferior ST-elevation, while a high-sensitivity troponin I assay yields a level of 35ng/litre (<11.6ng/litre).\n\n\nWhich of the following is a risk factor for the patient's presentation?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,748 | false | 42 | null | 6,495,189 | null | false | [] | null | 17,585 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; this ABG shows a metabolic alkalosis. This is indicated by the high pH value and the fact that the bicarbonate is high.",
"id": "10025939",
"label": "e",
"name": "pH- 7.51, PaO2-12.0kPa, PaCO2- 6.1kPa, HCO3-35mmol/L",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; this ABG shows respiratory **alkalosis** rather than acidosis. This is indicated by the alkaline (raised) pH and the low carbon dioxide.",
"id": "10025936",
"label": "b",
"name": "pH- 7.48, PaO2-12.0kPa, PaCO2- 3.8kPa, HCO3-22mmol/L",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect; this ABG is normal.",
"id": "10025937",
"label": "c",
"name": "pH- 7.36, PaO2-14.0kPa, PaCO2- 6.2kPa, HCO3-25mmol/L",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst this ABG does show acidosis, this appears to have a metabolic rather than respiratory cause. This is indicated by a low/normal CO2 and a low bicarbonate. The low bicarbonate level indicates that more bicarbonate is being used to react with hydrogen ions to make carbonic acid, which makes the blood more acidic. The carbon dioxide being low/normal suggests the respiratory system is beginning to compensate for this decrease in pH by expelling more (acidic) CO2.",
"id": "10025938",
"label": "d",
"name": "pH- 7.3, PaO2-12.0kPa, PaCO2- 4.5kPa, HCO3-14mmol/L",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct; these ABG results are in keeping with respiratory acidosis. Note there is a low pH, demonstrating acidosis, coupled with a high PaCO2, which indicates a respiratory cause. The slightly raised bicarbonate level also indicates some metabolic compensation. This in turn suggests a more chronic respiratory acidosis.",
"id": "10025935",
"label": "a",
"name": "pH- 7.3, PaO2-10.5kPa, PaCO2- 7.0kPa, HCO3-32mmol/L",
"picture": null,
"votes": 62
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4015",
"name": "Causes of respiratory acidosis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4015,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17585",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 45 year old man attends A&E with acute shortness of breath. He has been feeling generally unwell for the past 5 days, with a cough productive of green sputum. He is a long-term smoker with a known diagnosis of COPD. An arterial blood gas (ABG) is performed.\n\nWhich of the following ABG results are in keeping with respiratory acidosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,749 | false | 43 | null | 6,495,189 | null | false | [] | null | 17,586 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the mechanism of ticagrelor, an anti-platelet that can be used as part of secondary prevention for cardiovascular disease. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.",
"id": "10025944",
"label": "e",
"name": "P2Y12 receptor antagonist",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Atorvastatin is a type of statin, which can be given as primary prevention of cardiovascular disease when Qrisk score is raised (>10%). Statins reduce cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.",
"id": "10025940",
"label": "a",
"name": "Inhibition of HMG-CoA reductase",
"picture": null,
"votes": 78
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. ACE inhibitors such as ramipril are used as part of secondary prevention for cardiovascular disease. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.",
"id": "10025941",
"label": "b",
"name": "Inhibition of Angiotensin converting enzyme (ACE)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Aldosterone antagonists are used as part of secondary prevention for cardiovascular disease if the patient has clinical heart failure. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.",
"id": "10025943",
"label": "d",
"name": "Antagonism of aldosterone",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Beta-blockers are used as part of secondary prevention for cardiovascular disease. Atorvastatin is a statin that reduces cholesterol by inhibiting HMG-CoA reductase; an enzyme involved in the liver's production of cholesterol.",
"id": "10025942",
"label": "c",
"name": "Blockade of beta adrenergic receptors",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4116",
"name": "Statins",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4116,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17586",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 52 year old male attends his GP surgery for an annual medical review, as required for his profession as a lorry driver. He is found to have a Qrisk score of 15%. The GP recommends he commence atorvastatin to reduce his risk of having a major cardiovascular event.\n\nWhich of the following describes the mechanism of action of atorvastatin?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,750 | false | 44 | null | 6,495,189 | null | false | [] | null | 17,587 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. CRP is an inflammatory marker which is raised in inflammatory disorders or infections. It is not specific to ischaemic cardiac myocyte damage.",
"id": "10025947",
"label": "c",
"name": "CRP",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Actin is a contractile protein present in skeletal muscle that the myosin head attaches to in muscle contraction. It is not released in cardiac myocyte injury.",
"id": "10025948",
"label": "d",
"name": "Actin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Troponin is a cardiac enzyme that is released following damage to cardiac myocytes. It is elevated in myocardial infarction, however, it can also be raised due to other conditions such as pericarditis or aortic dissection.",
"id": "10025945",
"label": "a",
"name": "Troponin",
"picture": null,
"votes": 72
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Raised serum cholesterol levels are a risk factor for the development of coronary artery disease. However, it is not raised secondary to cardiac myocyte damage, making this option incorrect.",
"id": "10025949",
"label": "e",
"name": "Cholesterol",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Creatine kinase is released in response to general muscle damage; the specific type released when cardiac muscle is damaged is creatine kinase myocardial band (CK-MB). This is useful in determining whether reinfarction has occurred as it has a shorter half-life than troponin. As this option is creatine kinase, not CK-MB, it is not the single best answer.",
"id": "10025946",
"label": "b",
"name": "Creatine kinase",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4070",
"name": "Troponin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4070,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17587",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 67 year old female patient presents to A&E with central crushing chest pain that radiates down her left arm. She also reports nausea and dizziness but has not yet vomited. Her observations are all within the normal range.\n\nWhich of the following blood markers is released following damage to cardiac myocytes?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,751 | false | 45 | null | 6,495,189 | null | false | [] | null | 17,588 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. High levels of aldosterone cause increased sodium resorption from the distal tubule of the nephron. This causes hypernatraemia rather than hyponatraemia.",
"id": "10025952",
"label": "c",
"name": "Hyponatraemia",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Conn's syndrome causes hypokalaemia due to high levels of aldosterone. Aldosterone is released from the zona glomerulosa of the adrenal gland and acts on the nephron to increase potassium secretion from the distal tubule. Thus, hypokalaemia is a feature of Conn's syndrome.",
"id": "10025950",
"label": "a",
"name": "Hypokalaemia",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Renin will be low in primary hyperaldosteronism, as its release is suppressed by the high blood pressure seen in Conn's syndrome.",
"id": "10025953",
"label": "d",
"name": "Raised serum renin",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Aldosterone is high in Conn's syndrome, which causes an increase in sodium reabsorption from the kidney. Water follows sodium in the kidney, therefore the volume of the blood is higher. This increases stroke volume and thus cardiac output. If cardiac output is increased then mean arterial pressure will be increased (mean arterial pressure = cardiac output x peripheral resistance). Thus, hypertension is a feature of Conn's syndrome, not hypotension.",
"id": "10025951",
"label": "b",
"name": "Low blood pressure",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. High levels of aldosterone will cause an increase in the secretion of hydrogen ions from the collecting ducts. This will increase the pH, causing metabolic alkalosis.",
"id": "10025954",
"label": "e",
"name": "Metabolic acidosis",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5869",
"name": "Hyperaldosteronism and Conn's syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "170",
"name": "Clinical Chemistry",
"typeId": 7
},
"topicId": 170,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5869,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17588",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old female presents to endocrinology clinic to discuss a new diagnosis of primary hyperaldosteronism (Conn's syndrome).\n\nWhich of the following investigations is most likely to confirm the diagnosis?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,752 | false | 46 | null | 6,495,189 | null | false | [] | null | 17,589 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. By contrast, spongiocytes are located within the zona fasciculata of the adrenal cortex. This is responsible for the release of cortisol, and so whilst it may cause hypertension, it would not account for the other aspects of the clinical presentation and is not the location of a phaeochromocytoma.",
"id": "10025957",
"label": "c",
"name": "Spongiocytes",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. By contrast, chief cells are located in the parathyroid gland and are responsible for the secretion of parathyroid hormone. This is not the location of a phaeochromocytoma.",
"id": "10025959",
"label": "e",
"name": "Chief cells",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Hypertension, tachycardia, anxiety and sweating are all suggestive of high levels of adrenaline and noradrenaline. These hormones are secreted by the chromaffin cells of the adrenal medulla. Tumours of the chromaffin cells are known as phaeochromocytomas and are an important differential in cases of resistant hypertension.",
"id": "10025955",
"label": "a",
"name": "Chromaffin Cells",
"picture": null,
"votes": 56
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. Whilst a tumour of the zoma glomerulosa would explain this patient's resistant hypertension (due to hyperaldosteronism), it would not explain the palpitations, sweating and tachycardia and is not the location of a phaeochromocytoma.",
"id": "10025956",
"label": "b",
"name": "Zona glomerulosa cells",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells in the adrenal medulla. By contrast, the zona reticularis is responsible for the secretion of androgen precursors. A tumour of these cells would not give rise to the clinical presentation above and is not the location of a phaeochromocytoma.",
"id": "10025958",
"label": "d",
"name": "Zona reticularis cells",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5870",
"name": "Adrenal medullary catecholamines",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5870,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17589",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 50 year old man presents to his GP with anxiety and palpitations. He has struggled for many years to control his hypertension, despite optimal medical management. He is otherwise fit and well with no other medical conditions.\n\nOn examination, his blood pressure reads at 180/94. He appears sweaty, with a heart rate of 120 beats per minute. The GP decides to refer him to secondary care, where he is diagnosed with a phaeochromocytoma.\n\nWhich of the following cell types make up a phaeochromocytoma?",
"sbaAnswer": [
"a"
],
"totalVotes": 77,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,753 | false | 47 | null | 6,495,189 | null | false | [] | null | 17,590 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Cortisol is released by the zona fasciculata of the adrenal cortex. The zona reticularis is responsible for the production of androgen precursors.",
"id": "10025963",
"label": "d",
"name": "Zona reticularis of the adrenal cortex",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Cortisol is released by the zona fasciculata of the adrenal cortex. The zona glomerulosa is responsible for the production of mineralocorticoids.",
"id": "10025962",
"label": "c",
"name": "Zona glomerulosa of the adrenal cortex",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, the anterior pituitary gland is responsible for the production of ACTH amongst other things. ACTH stimulates the zona fasciculata to produce cortisol. Cortisol is released by the zona fasciculata of the adrenal cortex.",
"id": "10025964",
"label": "e",
"name": "Anterior pituitary gland",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Cortisol is released by the zona fasciculata of the adrenal cortex. The adrenal medulla is responsible for the production of adrenaline and noradrenaline.",
"id": "10025961",
"label": "b",
"name": "Adrenal medulla",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Cortisol is released by the zona fasciculata of the adrenal cortex. Cushing's syndrome is caused by high levels of exogenous glucocorticoids, as opposed to Cushing’s disease (caused by an ACTH-secreting pituitary tumour). It is characterised by a range of symptoms including a round 'moon' face, central obesity and abdominal striae. It can also cause psychiatric features such as depression.",
"id": "10025960",
"label": "a",
"name": "Zona fasciculata of the adrenal cortex",
"picture": null,
"votes": 60
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4532",
"name": "Cortisol",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4532,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17590",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old female patient consults the GP about her reducing regime of steroids. Whilst on a high dose she struggled with low mood, abdominal striae and weight gain. Fortunately, these symptoms have improved significantly since the dose was lowered.\n\nShe is keen to learn more about where in the body cortisol is produced.\n\nWhich of the following glands is responsible for endogenous cortisol production?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,754 | false | 48 | null | 6,495,189 | null | false | [] | null | 17,591 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Coeliac disease is associated with hyposplenism, giving patients a higher susceptibility to infections.",
"id": "10025967",
"label": "c",
"name": "Splenomegaly",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Iron is largely absorbed in the duodenum, which is extensively damaged in this patient. She is therefore at particular risk of iron deficiency anaemia, and should be monitored regularly.",
"id": "10025965",
"label": "a",
"name": "Iron deficiency anaemia",
"picture": null,
"votes": 66
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Patients with coeliac disease who do not adhere to a gluten-free diet are associated with an increased risk of enteropathy-associated T-cell lymphoma, which is a rare non-Hodgkin lymphoma.",
"id": "10025966",
"label": "b",
"name": "Hodgkin lymphoma",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Cushing's syndrome is caused by exogenous glucocorticoid excess. The management of coeliac disease is a gluten-free diet or surgery in extreme cases. Whilst glucocorticoids are used in select, severe cases, there is no indication for their use in this case. This option is therefore incorrect.",
"id": "10025968",
"label": "d",
"name": "Cushing's syndrome",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Electrolytes can be absorbed in the duodenum and upper jejunum, so cases of severe damage could lead to electrolyte abnormalities. However, hypokalaemia due to reduced absorption is more likely than hyperkalaemia. This option is therefore incorrect.",
"id": "10025969",
"label": "e",
"name": "Hyperkalaemia",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4236",
"name": "Coeliac disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4236,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17591",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 55 year old female patient with a long history of coeliac disease presents to her GP to discuss the findings of her recent endoscopy. It showed extensive damage to the lining of the duodenum and proximal jejunum.\n\nWhich of the following complications is this patient at risk of, given her endoscopy findings?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,755 | false | 49 | null | 6,495,189 | null | false | [] | null | 17,592 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Salmonella tends to cause watery diarrhoea which resolves within a week. It is not implicated in the development of HUS and is therefore incorrect.",
"id": "10025974",
"label": "e",
"name": "Salmonella",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Staphylococcus aureus tends to cause gastroenteritis. Symptoms start within hours of ingestion and last only 12-24 hours. This bacterium is not implicated in the development of HUS.",
"id": "10025973",
"label": "d",
"name": "Campylobacter Jejuni",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Bacillus cereus causes a watery diarrhoea which resolves within 24 hours. It is classically caused by eating fried rice that has been left at room temperature.",
"id": "10025972",
"label": "c",
"name": "Bacillus Cereus",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This patient is presenting with haemolytic uraemic syndrome (HUS), which can be identified by his anaemia, thrombocytopenia and an acute kidney injury following a bout of gastroenteritis. HUS is commonly caused by the shiga toxin. This is classically produced by the E.coli 0157 bacterium.",
"id": "10025970",
"label": "a",
"name": "E.coli 0157",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Staphylococcus aureus tends to cause gastroenteritis. Symptoms start within hours of ingestion and last only 12-24 hours. This bacterium is not implicated in the development of HUS.",
"id": "10025971",
"label": "b",
"name": "Staphylococcus Aureus",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5871",
"name": "Gastroenteritis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "194",
"name": "Infectious Diseases",
"typeId": 7
},
"topicId": 194,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5871,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": "E.coli 0157",
"highlights": [],
"id": "17592",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 36-year-old male presents with bloody diarrhoea (up to 20 times daily), vomiting, and recent haematuria, starting after eating undercooked steak. He has not traveled abroad in the past year. \n\nHis past medical history includes type 1 diabetes, and he takes insulin. He denies a personal or family history of inflammatory bowel disease or colorectal cancer.\n\n\n\nBlood results are as follows:\n\n\n\n||||\n|--------------|:-------:|---------------|\n|Haemoglobin|88 g/L|(M) 130 - 170, (F) 115 - 155|\n|Mean Cell Volume (MCV)|84 fL|80 - 96|\n|White Cell Count|10.2x10<sup>9</sup>/L|3.0 - 10.0|\n|Platelets|72x10<sup>9</sup>/L|150 - 400|\n|Sodium|135 mmol/L|135 - 145|\n|Potassium|4.0 mmol/L|3.5 - 5.3|\n|Urea|12.1 mmol/L|2.5 - 7.8|\n|Creatinine|146 µmol/L|60 - 120|\n\n\n\nWhich of the following organisms is the most likely cause of this patient's gastroenteritis?",
"sbaAnswer": [
"a"
],
"totalVotes": 78,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,756 | false | 50 | null | 6,495,189 | null | false | [] | null | 17,593 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. UC is associated with primary sclerosing cholangitis, which is an autoimmune condition causing inflammation of the bile ducts. Although gallstones can feature in UC, they are more commonly a feature of Crohn's disease.",
"id": "10025979",
"label": "e",
"name": "Gallstones",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. UC is associated with pseudopolyps on endoscopy. Cobblestone appearance on endoscopy is a feature of Crohn's disease.",
"id": "10025978",
"label": "d",
"name": "Cobblestone appearance on endoscopy",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. UC is associated with continuous disease. Skip lesions are a feature of Crohn's disease.",
"id": "10025977",
"label": "c",
"name": "Skip lesions",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Ulcerative colitis is associated with crypt abscesses on histology, secondary to migration of neutrophils through the walls of glands.",
"id": "10025975",
"label": "a",
"name": "Crypt abscesses",
"picture": null,
"votes": 55
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. UC is associated with inflammation that starts at the rectum and does not spread beyond the ileocaecal valve. Lesions that may occur anywhere along the GI tract are a feature of Crohn's disease.",
"id": "10025976",
"label": "b",
"name": "Lesions anywhere along the GI tract",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3732",
"name": "Ulcerative Colitis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3732,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17593",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 22 year old female presents to the GP to discuss the results of her recent colonoscopy. She has been having abdominal pains and diarrhoea with some blood. Her colonoscopy revealed a diagnosis of ulcerative colitis (UC).\n\nWhich of the following is a feature of this condition?",
"sbaAnswer": [
"a"
],
"totalVotes": 77,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,837 | false | 1 | null | 6,495,194 | null | false | [] | null | 17,594 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Statins inhibit HMG-CoA reductase. Lipoprotein lipase (LPL) is responsible for the absorption of exogenous lipids by breaking down chylomicrons to release free fatty acids which are then taken up by cells.",
"id": "10025982",
"label": "c",
"name": "Inhibits lipoprotein lipase",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Statins inhibit HMG-CoA reductase. Acetyl-CoA carboxylase is responsible for the conversion of acetyl-CoA to malonyl-CoA in the fatty acid synthesis pathway.",
"id": "10025983",
"label": "d",
"name": "Inhibits acetyl-CoA carboxylase",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Statins inhibit HMG-CoA reductase, which catalyses the rate-limiting step in cholesterol synthesis. This prevents plaque buildup (atherosclerosis), thus reducing the risk of future MIs.",
"id": "10025980",
"label": "a",
"name": "Inhibits HMG-CoA reductase",
"picture": null,
"votes": 62
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Statins inhibit HMG-CoA reductase. Carnitine acetyltransferase facilitates the transfer of long-chain fatty acids to the mitochondria for β-oxidation.",
"id": "10025984",
"label": "e",
"name": "Inhibits carnitine acetyltransferase",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Statins inhibit HMG-CoA reductase. Increasing synthesis of HMG-CoA reductase would increase cholesterol synthesis, and thus increase the risk of a future MI.",
"id": "10025981",
"label": "b",
"name": "Increases synthesis of HMG-CoA reductase",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4116",
"name": "Statins",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4116,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17594",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"qaAnswer": null,
"question": "A 62 year old man presents to the Emergency Department describing a crushing, left sided chest pain that radiates down the left arm and is associated with nausea. No ST-segment elevation is seen on electrocardiogram, but repeat troponin levels are raised. He is diagnosed with a myocardial infarction (MI).\n\nAs part of the secondary prevention regime, he is prescribed atorvastatin 80mg.\n\nWhich of the following describes the mechanism of action of atorvastatin?",
"sbaAnswer": [
"a"
],
"totalVotes": 79,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,838 | false | 2 | null | 6,495,194 | null | false | [] | null | 17,595 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The primary pacemaker of the heart is the sinoatrial node. Atrial myocytes can display abnormal pacemaker activity, however, and this is believed to play an important role in the development of atrial fibrillation.",
"id": "10025989",
"label": "e",
"name": "Atrial myocytes",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Purkinje fibres are responsible for the conduction of impulses from the right and left bundle branches to the ventricular myocytes. Similarly to the atrioventricular node, they have latent pacemaker cells that are normally overridden in the healthy heart due to the sinoatrial node having the fastest rate.",
"id": "10025987",
"label": "c",
"name": "Purkinje fibres",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The bundle of His is responsible for conducting the electrical impulse down the interventricular septum from the atrioventricular node. It is not the primary pacemaker of the heart.",
"id": "10025988",
"label": "d",
"name": "Bundle of His",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The SAN is situated in the upper part of the wall of the right atrium. Cardiac pacemaker cells are mostly found in the SAN. The pacemaker cells continuously generate electrical impulses, thereby setting the normal rhythm and rate in a healthy heart; hence the SAN is known as the primary pacemaker.",
"id": "10025985",
"label": "a",
"name": "Sinoatrial node (SAN)",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The AVN is responsible for conducting electrical impulses from the atria to the ventricles via the bundle branches. The AVN has latent pacemaker cells, however, the rate of the sinoatrial node is faster, so these are normally overridden.",
"id": "10025986",
"label": "b",
"name": "Atrioventricular node (AVN)",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3962",
"name": "Cardiac Action Potential Generation and Conduction",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3962,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17595",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 22 year old male is diagnosed with atrial fibrillation (AF) after presenting to his General Practitioner with palpitations. AF is caused by a problem in the pacemaker cells of the heart.\n\nWhich of the following regions of the heart is the primary pacemaker?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,839 | false | 3 | null | 6,495,194 | null | false | [] | null | 17,596 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Baroreceptors are mechanoreceptors located in the aortic arch and carotid sinus which constantly monitor mean arterial blood pressure and pulse pressure. A decrease in arterial pressure results in increased baroreceptor activity, increasing sympathetic activity and thus raising blood pressure.",
"id": "10025990",
"label": "a",
"name": "Carotid sinus and aortic arch",
"picture": null,
"votes": 77
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch.",
"id": "10025993",
"label": "d",
"name": "Abdominal aorta",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch.",
"id": "10025994",
"label": "e",
"name": "Carotid sinus and vertebral arteries",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch. There are baroreceptors located in the atria and pulmonary arteries, however, these are not the arterial baroreceptors.",
"id": "10025992",
"label": "c",
"name": "Atria and pulmonary arteries",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The baroreceptors responsible for the baroreceptor reflex are located in the carotid sinus and aortic arch.",
"id": "10025991",
"label": "b",
"name": "Renal arteries",
"picture": null,
"votes": 0
}
],
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"__typename": "Concept",
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"__typename": "Chapter",
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4219",
"name": "Baroreceptor reflex",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17596",
"isLikedByMe": null,
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"likes": 0,
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"question": "A 75 year old woman attends her GP surgery with concerns that she sometimes becomes dizzy upon standing. Her blood pressure is measured and found to be 130/95 on sitting but only 105/77 after 3 minutes of standing.\n\nThe GP explains that the baroreceptor reflex is one mechanism responsible for limiting the decrease in blood pressure.\n\nIn which of the following structures are **arterial** baroreceptors located?",
"sbaAnswer": [
"a"
],
"totalVotes": 80,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,840 | false | 4 | null | 6,495,194 | null | false | [] | null | 17,597 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.\n\nTherefore, the proximal duodenum is a foregut structure.",
"id": "10025995",
"label": "a",
"name": "Proximal duodenum",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.\n\nTherefore, the descending colon is not a foregut structure. It is part of the hindgut.",
"id": "10025998",
"label": "d",
"name": "Descending colon",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.\n\nTherefore, the distal duodenum is not a foregut structure. It is part of the midgut",
"id": "10025996",
"label": "b",
"name": "Distal duodenum",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.\n\nTherefore, the caecum is not a foregut structure. It is a midgut structure",
"id": "10025999",
"label": "e",
"name": "Caecum",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The foregut gives rise to the oesophagus, stomach, liver, gallbladder, bile ducts, pancreas and proximal duodenum, ending after the entry of the common bile duct into the duodenum.\n\nTherefore, the jejunum is not a foregut structure. It is part of the midgut.",
"id": "10025997",
"label": "c",
"name": "Jejunum",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3942",
"name": "Development of the foregut",
"status": null,
"topic": {
"__typename": "Topic",
"id": "171",
"name": "Embryology",
"typeId": 7
},
"topicId": 171,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3942,
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"question": "A 63 year old man presents to the Emergency Department with epigastric pain. The foundation doctor recalls that epigastric pain originates from foregut structures.\n\nWhich of the following is a foregut structure?",
"sbaAnswer": [
"a"
],
"totalVotes": 68,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,841 | false | 5 | null | 6,495,194 | null | false | [] | null | 17,598 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The common hepatic artery gives rise to the gastroduodenal artery however is not itself closely related to the duodenum.",
"id": "10026004",
"label": "e",
"name": "Common hepatic artery",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The superior mesenteric artery arises below the level of the coeliac trunk at L1. The inferior duodenum can be found posterior to the superior mesenteric artery, however it is not the most closely related to the duodenum and thus not the most likely source of the bleed.",
"id": "10026001",
"label": "b",
"name": "Superior mesenteric artery",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The superior pancreaticoduodenal artery is a branch of the gastroduodenal artery. It does provide some blood supply to the duodenum, however, is not the most closely related vessel and thus is not the most likely source of the bleed.",
"id": "10026003",
"label": "d",
"name": "Superior pancreaticoduodenal artery",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The gastroduodenal artery runs directly behind the posterior duodenal wall. Deep peptic ulcers in the duodenum may erode the artery and cause significant bleeding.",
"id": "10026000",
"label": "a",
"name": "Gastroduodenal artery",
"picture": null,
"votes": 37
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The left gastric artery is not directly related to the duodenum. It runs along the lesser curvature of the stomach and supplies the upper right portions of the fundus and body of the stomach, as well as the lower oesophagus.",
"id": "10026002",
"label": "c",
"name": "Left gastric artery",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4390",
"name": "Upper GI bleed",
"status": null,
"topic": {
"__typename": "Topic",
"id": "136",
"name": "Gastroenterology",
"typeId": 7
},
"topicId": 136,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4390,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
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"question": "A 57 year old man presents to the Emergency Department with severe epigastric pain. He has vomited bright red blood and blood tests show a raised urea, as well as a reduced haemoglobin.\n\nUpon questioning, he admits to drinking an average of 50 units of alcohol per week. He takes amlodipine for hypertension and regular naproxen for chronic lower back pain.\n\nAn oesophago-gastro-duodenoscopy (OGD) shows a bleeding ulcer in the proximal duodenum.\n\nWhich of the following arteries is the most likely source of the bleeding?",
"sbaAnswer": [
"a"
],
"totalVotes": 59,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,842 | false | 6 | null | 6,495,194 | null | false | [] | null | 17,599 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Na+/K+ ATPase is responsible for maintaining electrochemical gradients that allow monosaccharide absorption but does not directly transport monosaccharides.",
"id": "10026009",
"label": "e",
"name": "Na+/K+ ATPase",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, GLUT-5 is responsible for the absorption of fructose from the lumen of the digestive tract into epithelial cells.",
"id": "10026006",
"label": "b",
"name": "GLUT-5",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. GLUT-2 is the protein responsible for transporting monosaccharides from the epithelial cells of the digestive tract into the interstitial space.",
"id": "10026005",
"label": "a",
"name": "GLUT-2",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Aquaporin-1 (AQP-1) is a water channel found in the kidney.",
"id": "10026008",
"label": "d",
"name": "AQP1",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect, SGLT-1 is responsible for the absorption of glucose and galactose from the lumen of the digestive tract into epithelial cells",
"id": "10026007",
"label": "c",
"name": "SGLT-1",
"picture": null,
"votes": 25
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5872",
"name": "Carbohydrate absorption",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5872,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17599",
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"question": "A 30 year old male presents to his General Practitioner with a 10-week history of diarrhoea, 4kg weight loss and frequent episodes of loose, foul-smelling stools. The diarrhoea is worse after he has just eaten a meal containing lots of carbohydrates. He reports feeling weak and fatigued despite maintaining a regular diet. Stool samples have shown high levels of unabsorbed sugars.\n\nWhich of the following transport proteins is responsible for the absorption of monosaccharides from the enterocyte into the interstitial space?",
"sbaAnswer": [
"a"
],
"totalVotes": 64,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,843 | false | 7 | null | 6,495,194 | null | false | [] | null | 17,600 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The right hepatic vein is responsible for draining segments VI and VII of the liver, and occasionally segments V and VIII. It drains into the inferior vena cava near the upper border of the caudate lobe of the liver, and does not contribute to the portal venous system",
"id": "10026011",
"label": "b",
"name": "Right hepatic vein",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The hepatic artery supplies oxygenated blood to the liver. However, it is not part of the portal venous system, which carries deoxygenated blood from the small bowel.",
"id": "10026012",
"label": "c",
"name": "Hepatic artery",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The common iliac vein is formed by the external and internal iliac veins, which drain blood from the lower limbs and gluteal region. It does not contribute to the hepatic portal vein.",
"id": "10026014",
"label": "e",
"name": "Common iliac vein",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The inferior vena cava carries blood from multiple hepatic veins and returns deoxygenated blood to the heart. It does not contribute to the hepatic portal vein.",
"id": "10026013",
"label": "d",
"name": "Inferior vena cava",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "the superior mesenteric vein and its tributaries are part of the portal system and drain the midgut structures.",
"id": "10026010",
"label": "a",
"name": "Superior mesenteric vein",
"picture": null,
"votes": 28
}
],
"comments": [],
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"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4500",
"name": "Hepatic circulation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4500,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17600",
"isLikedByMe": null,
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"likes": 0,
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"question": "A 38 year old woman with a previous liver infarction attends her GP surgery for monitoring of her liver function. The GP explains that the hepatic portal system is responsible for carrying nutrient-rich blood to the liver.\n\nWhich of the following blood vessels contributes to the hepatic portal venous system?",
"sbaAnswer": [
"a"
],
"totalVotes": 61,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,844 | false | 8 | null | 6,495,194 | null | false | [] | null | 17,601 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Guanylate cyclase (also known as guanyl cyclase and guanylyl cyclase) is responsible for the conversion of GTP to cGMP.",
"id": "10026016",
"label": "b",
"name": "Guanylate cyclase",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phospholipase C is responsible for the hydrolysis of inositol phospholipids into inositol triphosphate (IP3) and diacylglycerol (DAG).",
"id": "10026018",
"label": "d",
"name": "Phospholipase C",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. There are 6 classes of adenylate cyclase (also known as adenyl cyclase and adenylyl cyclase) enzymes, all of which are responsible for catalysing the conversion of ATP to cAMP + diphosphate.",
"id": "10026015",
"label": "a",
"name": "Adenylate cyclase",
"picture": null,
"votes": 50
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phosphodiesterase catalyses the reaction that converts cAMP to AMP",
"id": "10026017",
"label": "c",
"name": "Phosphodiesterase",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Acetylcholinesterase (AChE) is responsible for the hydrolysis of acetylcholine into acetic acid and choline.",
"id": "10026019",
"label": "e",
"name": "Acetylcholinesterase",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4561",
"name": "G protein-coupled receptors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4561,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17601",
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"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 34 year old woman with chronic obesity is prescribed a new medication by the weight management clinic. This acts on a G-protein coupled receptor (GPCR).\n\nActivation of the GPCR leads to an increase in the intracellular concentration of cyclic AMP (cAMP). This is achieved by the conversion of ATP to cAMP by an enzyme.\n\nWhich enzyme is responsible for the conversion of ATP to cAMP?",
"sbaAnswer": [
"a"
],
"totalVotes": 61,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,845 | false | 9 | null | 6,495,194 | null | false | [] | null | 17,602 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Competitive antagonists bind to the same receptor site as the agonist (opioid molecules in this case) but do not activate it, thus blocking the agonist's action.",
"id": "10026020",
"label": "a",
"name": "Competitive antagonist",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. An agonist would bind to the receptor and activate it. Naloxone does not activate the receptor and thus is not an agonist.",
"id": "10026022",
"label": "c",
"name": "Agonist",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A non-competitive antagonist prevents the activation of a receptor by binding to an allosteric (non-agonist) site on the receptor. Because naloxone binds to the same receptor site as the opioid molecules, it is not a non-competitive antagonist.",
"id": "10026021",
"label": "b",
"name": "Non-competitive antagonist",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A negative allosteric modulator would lower the affinity/efficacy of the agonist. Naloxone binds to the same receptor site as opioid molecules and does not activate the receptor, making it a competitive antagonist and not a negative allosteric modulator.",
"id": "10026024",
"label": "e",
"name": "Negative allosteric modulator",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A positive allosteric modulator would increase the affinity and/or efficacy of the agonist. Naloxone prevents the agonist from binding to the receptor, so it is not a positive allosteric modulator. It is a competitive antagonist.",
"id": "10026023",
"label": "d",
"name": "Positive allosteric modulator",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5873",
"name": "Types of antagonists",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5873,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17602",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A woman is brought into the emergency department by ambulance after being found unresponsive with a low respiratory rate. On examination, she has pinpoint pupils.\n\nOpioid overdose is suspected, and she is given naloxone. The clinician explains that naloxone acts on the same receptor site as opioid molecules but does not activate the receptor.\n\nWhich of the following terms best describes the mechanism of action of naloxone?",
"sbaAnswer": [
"a"
],
"totalVotes": 56,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,846 | false | 10 | null | 6,495,194 | null | false | [] | null | 17,603 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Skeletal muscle is voluntarily controlled. Smooth muscle and cardiac muscle are not.",
"id": "10026026",
"label": "b",
"name": "Involuntarily controlled",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Skeletal muscle does not make up the composition of internal organs. Instead, it is found in the muscles that attach to bone to move the body. Smooth muscle and cardiac muscle are found in internal organs.",
"id": "10026027",
"label": "c",
"name": "Found in internal organs",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Nitric oxide (NO) causes relaxation in smooth muscle cells, not striated muscle cells.",
"id": "10026029",
"label": "e",
"name": "Nitric oxide causes relaxation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Skeletal muscle and cardiac muscle are striated. This refers to the 'striped' appearance on microscopic examination, which comes from their repeating functional units or sarcomeres that allow skeletal muscle contraction.",
"id": "10026025",
"label": "a",
"name": "Striated",
"picture": null,
"votes": 54
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Smooth muscle cells are linked by gap junctions, to allow a rapid spread of depolarisation. Skeletal muscle cells are not linked by gap junctions.",
"id": "10026028",
"label": "d",
"name": "Cells are linked by gap junctions",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3783",
"name": "Types of muscle",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3783,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17603",
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"question": "A 47 year old male is undergoing investigations for a suspected neuromuscular dystrophy. As part of this, a muscle biopsy is taken and sent for histological examination.\n\nWhich of the following is a feature of skeletal muscle fibres?",
"sbaAnswer": [
"a"
],
"totalVotes": 59,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,847 | false | 11 | null | 6,495,194 | null | false | [] | null | 17,604 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Osteoclasts are bone-resorbing cells. By contrast, osteoblasts synthesise bone and deposit osteoid to form bone tissue.",
"id": "10026031",
"label": "b",
"name": "Osteoblasts are bone-resorbing cells",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Osteoprogenitor cells (also called osteogenic cells) are precursor bone cells. Osteoblasts synthesise bone and deposit osteoid to form bone tissue.",
"id": "10026034",
"label": "e",
"name": "Osteoblasts act as a precursor to bone cells",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Osteoblasts synthesise bone and deposit osteoid to form bone tissue.",
"id": "10026030",
"label": "a",
"name": "Osteoblasts are responsible for the synthesis and mineralisation of the matrix",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Osteocytes are mature bone cells. Osteoblasts synthesise bone and deposit osteoid to form bone tissue. Osteoblasts become osteocytes following calcification.",
"id": "10026032",
"label": "c",
"name": "Osteoblasts are mature bone cells",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Osteocytes are found in lacunae in the central canal of compact bone. Osteoblasts are found along the surface of bone.",
"id": "10026033",
"label": "d",
"name": "Osteoblasts are found in the central canal of compact bone",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4201",
"name": "Osteoblasts",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4201,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17604",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 55 year old woman is reviewed in the bone health clinic after falling and sustaining her third wrist fracture. The clinician explains that osteoblasts are important cells involved in bone formation.\n\nWhich of the following correctly describes osteoblasts?",
"sbaAnswer": [
"a"
],
"totalVotes": 57,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,848 | false | 12 | null | 6,495,194 | null | false | [] | null | 17,605 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type II collagen is found in cartilage. Type I collagen is found in bone.",
"id": "10026036",
"label": "b",
"name": "Type II",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type V collagen is found in cell surfaces, hair and the placenta. Type I collagen is found in bone.",
"id": "10026039",
"label": "e",
"name": "Type V",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type IV collagen forms the basal lamina of the basement membrane. Type I collagen is found in bone.",
"id": "10026038",
"label": "d",
"name": "Type IV",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type III collagen is secreted by reticular cells. It makes up reticulin fibres, a type of connective tissue that makes up the liver, bone marrow and lymphatic system. By contrast, type I collagen is found in bone.",
"id": "10026037",
"label": "c",
"name": "Type III",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Type I collagen is found in bone and can also be found in skin, tendons, vasculature and organs",
"id": "10026035",
"label": "a",
"name": "Type I",
"picture": null,
"votes": 26
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4573",
"name": "Bone composition",
"status": null,
"topic": {
"__typename": "Topic",
"id": "154",
"name": "Musculoskeletal physiology and disease",
"typeId": 7
},
"topicId": 154,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4573,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17605",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 35 year old woman attends A&E after falling on an outstretched hand. X-ray shows a dorsal radius fracture. The patient is keen to know more about the composition of bone.\n\nWhich of the following types of collagen is found in bone tissue?",
"sbaAnswer": [
"a"
],
"totalVotes": 54,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,849 | false | 13 | null | 6,495,194 | null | false | [] | null | 17,606 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A renal stone in the bladder is unlikely to cause obstruction, as to reach the bladder the stone must be small enough to pass through the strictures of the ureter.",
"id": "10026044",
"label": "e",
"name": "Bladder",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The pelviureteric junction (PUJ) is the narrowest part of the ureter, and therefore is the most likely place for a renal stone to obstruct.",
"id": "10026040",
"label": "a",
"name": "Pelviureteric junction (PUJ)",
"picture": null,
"votes": 32
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "A renal stone in the urethra is unlikely to cause obstruction, as to reach the urethra the stone must be small enough to pass through the strictures of the ureter.",
"id": "10026043",
"label": "d",
"name": "Urethra",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Renal stones are most likely to be found obstructing the pelviureteric junction (PUJ) as this is the narrowest part of the ureter. The vesicoureteric Junction (VUJ), and the point at which the ureter crosses the pelvic brim, are also common sites of stone obstruction.",
"id": "10026041",
"label": "b",
"name": "Distal third of the ureter",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The vas deferens is a tubular structure in the male reproductive system that transports sperm cells from the epididymis. It is not directly connected to the ureters and would not contain a renal stone.",
"id": "10026042",
"label": "c",
"name": "Vas deferens",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4413",
"name": "Renal Stones",
"status": null,
"topic": {
"__typename": "Topic",
"id": "142",
"name": "Nephrology",
"typeId": 7
},
"topicId": 142,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4413,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17606",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 43 year old woman presents to the Emergency Department with sudden onset loin to groin pain. She describes this as a 10/10 severity and has just started vomiting. A CT scan of the renal tract reveals an obstructing stone.\n\nWhich of the following is the most likely place for a renal stone to cause obstruction?",
"sbaAnswer": [
"a"
],
"totalVotes": 53,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,850 | false | 14 | null | 6,495,194 | null | false | [] | null | 17,607 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, tibial nerve damage would present with impaired foot plantarflexion and inversion, and sensory loss to the sole of the foot. The tibial nerve is not commonly injured as it is deep and well-protected. However, it can be injured in popliteal trauma and posterior knee dislocation.",
"id": "10026048",
"label": "d",
"name": "Tibial nerve",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This is a classic example of foot drop, which is caused by common peroneal nerve injury. Because of the relatively superficial relation of the common peroneal nerve to the fibular head, the common peroneal nerve is susceptible to damage following compression by plaster casts.",
"id": "10026045",
"label": "a",
"name": "Common peroneal nerve",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, sciatic nerve damage would present with impaired knee flexion and hip adduction, as well as impaired foot plantarflexion, eversion and foot drop. The sciatic nerve splits into the tibial nerve and common peroneal nerve and is susceptible to injury with lumbar disc herniation, posterior hip dislocation and direct trauma.",
"id": "10026049",
"label": "e",
"name": "Sciatic nerve",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, femoral nerve damage would present with impaired hip flexion and sensory loss to the anterior and medial aspect of the thigh and lower leg. The femoral nerve is particularly susceptible to injury in hip and pelvic trauma.",
"id": "10026046",
"label": "b",
"name": "Femoral nerve",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is a classic example of foot drop, which is caused by common peroneal nerve injury. By contrast, obturator nerve damage will present with impaired hip adduction and sensory loss/paraesthesia over the inner aspect of the thigh. The obturator nerve is particularly susceptible to injury in anterior hip dislocation and pelvic surgery.",
"id": "10026047",
"label": "c",
"name": "Obturator nerve",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3773",
"name": "Common peroneal nerve injury",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3773,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17607",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 17 year old male fractures his left tibia while playing rugby. As part of his management, his tibia is immobilised in a plaster cast. After the cast is removed, he presents to his General Practitioner struggling to lift the front of his left foot from the floor. To compensate, he has been lifting each leg high in the air to allow him to walk.\n\nWhich of the following nerves has been damaged?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,851 | false | 15 | null | 6,495,194 | null | false | [] | null | 17,608 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The median nerve is classically susceptible to palsy in carpal tunnel syndrome. Median nerve injury would present with sensory loss to the palmar aspect of the lateral three and a half digits. Motor deficits vary depending on the location of the median nerve lesion, with lesions at the elbow leading to a loss of pronation of the forearm and weak wrist flexion, and lesions at the wrist leading to paralysis of the thenar muscles and opponens pollicis.",
"id": "10026051",
"label": "b",
"name": "Median nerve",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The axillary nerve is classically injured following a humeral neck fracture or dislocation. It presents with sensory loss to the 'regimental badge' area (the inferior region of the deltoid) and weakness of shoulder abduction.",
"id": "10026053",
"label": "d",
"name": "Axillary nerve",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Isolated musculocutaneous nerve injury is rare; it is often injured as part of a brachial plexus injury. However, it would present with sensory loss to the lateral part of the forearm and weakness of elbow flexion and supination.",
"id": "10026054",
"label": "e",
"name": "Musculocutaneous nerve",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The radial nerve is classically damaged in humeral midshaft fractures, and palsy results in wrist drop (inability to extend the wrist). The radial nerve gives sensory innervation to a small area on the dorsum of the hand between the 1st and 2nd metacarpals.",
"id": "10026050",
"label": "a",
"name": "Radial nerve",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The ulnar nerve is classically susceptible to damage following a fracture of the medial epicondyle. It would present with sensory loss to the medial one and a half digits, and weak wrist flexion. The classic sign is a 'claw hand'.",
"id": "10026052",
"label": "c",
"name": "Ulnar nerve",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3950",
"name": "Radial nerve injuries",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3950,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17608",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 26 year old man is brought to the emergency department after falling off a ladder. An x-ray shows a fracture of the midshaft of his right humerus.\n\nFollowing management of the fracture, it is noted that the man cannot extend his right wrist, and has sensory loss to the area between the dorsal aspect of the 1st and 2nd metacarpals on his right side. Examination of the left upper limb is normal.\n\nWhich of the following nerves has been damaged?",
"sbaAnswer": [
"a"
],
"totalVotes": 51,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,852 | false | 16 | null | 6,495,194 | null | false | [] | null | 17,609 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. The long thoracic nerve is susceptible to damage during chest drain insertion, thoracic surgery or the prolonged use of crutches.\n\nFurthermore, long thoracic nerve damage typically causes 'winging' of the scapula, and would not affect shoulder abduction or sensation in the regimental badge area.",
"id": "10026059",
"label": "e",
"name": "Long thoracic nerve",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. A midshaft fracture of the humerus would be more likely to cause radial nerve damage.\n\nFurthermore, radial nerve injury would result in wrist drop, and would not affect shoulder abduction or sensation in the regimental badge area.",
"id": "10026056",
"label": "b",
"name": "Radial nerve",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. The median nerve is most commonly affected in carpal tunnel syndrome.\n\nFurthermore, median nerve injury would result in paralysis and wasting of the muscles of the thenar eminence and opponens pollicis, as well as sensory loss to the lateral three and a half digits. It would not affect shoulder abduction or sensation in the regimental badge area.",
"id": "10026058",
"label": "d",
"name": "Median nerve",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The axillary nerve is often damaged in fractures of the surgical neck of the humerus. In this case, the patient cannot abduct their arm as the axillary nerve supplies the deltoid muscle. It also provides sensory innervation to the lower deltoid area ('regimental badge' area).",
"id": "10026055",
"label": "a",
"name": "Axillary nerve",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A fracture of the surgical neck of the humerus is most likely to cause axillary nerve injury. A fracture affecting the medial epicondyle of the humerus would be likely to cause an ulnar nerve injury.\n\nFurthermore, ulnar nerve injury would result in a claw hand deformity and loss of sensation to the medial one and a half, and would not affect shoulder abduction or sensation in the regimental badge area.",
"id": "10026057",
"label": "c",
"name": "Ulnar nerve",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3909",
"name": "brachial plexus injuries",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3909,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17609",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 24 year old woman presents to the Emergency Department following a fall from a horse. An x-ray of her right arm shows a fracture of the surgical neck of the humerus.\n\nOn examination, it is noted that she has lost the ability to abduct her right arm, and has lost sensation to her lower right deltoid muscle. The left side is normal on examination.\n\nWhich of the following nerves has been damaged?",
"sbaAnswer": [
"a"
],
"totalVotes": 50,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,853 | false | 17 | null | 6,495,194 | null | false | [] | null | 17,610 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Carpal tunnel syndrome does not typically affect the back of the hand. It primarily involves the palmar side of the hand, specifically the thumb, index, and middle fingers due to median nerve compression at the carpal tunnel.",
"id": "10026064",
"label": "e",
"name": "Back of the hand",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Carpal tunnel syndrome primarily affects the thumb, index, and middle fingers, as the median nerve, which is compressed in the carpal tunnel, supplies sensation to these areas.",
"id": "10026061",
"label": "b",
"name": "Palm and fingers",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While carpal tunnel syndrome can cause discomfort, weakness, and sensory disturbances in the hand, it primarily affects the thumb, index, and middle fingers, not the entire hand.",
"id": "10026063",
"label": "d",
"name": "Entire hand",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The pinky finger and ring finger are primarily innervated by the ulnar nerve, which is not usually affected by carpal tunnel syndrome.",
"id": "10026062",
"label": "c",
"name": "Pinky finger and ring finger",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct. Carpal tunnel syndrome typically results in sensory loss or numbness in the thumb, index, and middle fingers. These are the specific areas innervated by the median nerve, which is compressed as it passes through the carpal tunnel in the wrist. Pregnancy is a risk factor for carpal tunnel syndrome",
"id": "10026060",
"label": "a",
"name": "Thumb, index and middle fingers",
"picture": null,
"votes": 38
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3909",
"name": "brachial plexus injuries",
"status": null,
"topic": {
"__typename": "Topic",
"id": "145",
"name": "Orthopaedics",
"typeId": 7
},
"topicId": 145,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3909,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17610",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old pregnant woman presents to her General Practitioner with tingling and sensory loss in her hand. The GP diagnoses her with carpal tunnel syndrome.\n\nWhich part of the hand will the sensory loss affect?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,854 | false | 18 | null | 6,495,194 | null | false | [] | null | 17,611 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Warfarin doesn't enhance fibrinolysis but instead works by inhibiting the synthesis of vitamin K-dependent clotting factors (Factors II, VII, IX, and X), which are essential for blood coagulation.",
"id": "10026068",
"label": "d",
"name": "Enhancement of fibrinolysis",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors (Factors II, VII, IX, and X), which are essential for blood coagulation. Fibrinolysis is a process whereby clots are broken down. Inhibiting this process would therefore increase the tendency of the blood to clot, rather than work as an anticoagulant.",
"id": "10026069",
"label": "e",
"name": "Inhibition of fibrinolysis",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While warfarin does indirectly affect thrombin production through its impact on clotting factors, it doesn't directly inhibit thrombin production. It inhibits vitamin K-dependent clotting factors. By contrast, dabigatran inhibits the action of thrombin, thus preventing the conversion of fibrinogen to fibrin.",
"id": "10026067",
"label": "c",
"name": "Inhibition of thrombin production",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct. Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors (Factors II, VII, IX, and X), which are essential for blood coagulation. This is the primary mechanism of action of warfarin.",
"id": "10026065",
"label": "a",
"name": "Inhibition of vitamin-K-dependent clotting factors",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Warfarin primarily affects the coagulation cascade by inhibiting the production of vitamin K-dependent clotting factors, rather than by preventing platelet aggregation.",
"id": "10026066",
"label": "b",
"name": "Inhibition of platelet aggregation",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4115",
"name": "Warfarin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "203",
"name": "Pharmacology of Haemostasis and Thrombosis",
"typeId": 7
},
"topicId": 203,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4115,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17611",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 68 year old male is diagnosed with aortic stenosis and undergoes a mechanical aortic valve replacement. Following the surgery, he is prescribed warfarin.\n\nWhich of the following describes the primary mechanism of action of warfarin?",
"sbaAnswer": [
"a"
],
"totalVotes": 57,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,855 | false | 19 | null | 6,495,194 | null | false | [] | null | 17,612 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid.",
"id": "10026070",
"label": "a",
"name": "Inhibition of gastric acid secretion by blocking the H+/K+ ATPase pump",
"picture": null,
"votes": 43
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid. Although this does indirectly protect the oesophageal lining by reducing its exposure to corrosive acid, it is not the best description of its mechanism of action.",
"id": "10026072",
"label": "c",
"name": "Protection of the oesophageal lining",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid.",
"id": "10026071",
"label": "b",
"name": "Enhancement of acid production in the stomach",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid. It does not directly inhibit histamine release but can indirectly reduce the effects of histamine by blocking the final step in acid production.",
"id": "10026073",
"label": "d",
"name": "Inhibition of histamine release",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Omeprazole is a proton pump inhibitor (PPI) which works by irreversibly blocking the hydrogen-potassium ATPase (proton pump) in the gastric parietal cells, thus reducing the secretion of stomach acid. PPIs do not stimulate mucus production.",
"id": "10026074",
"label": "e",
"name": "Stimulation of mucus production in the stomach",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5874",
"name": "Proton pump inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "229",
"name": "Pharmacology of the gastro-intestinal system",
"typeId": 7
},
"topicId": 229,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5874,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17612",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
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"question": "A 32 year old male presents to his General Practitioner with symptoms of acid reflux. He reports drinking an average of 20 units of alcohol per week. The GP prescribes omeprazole to improve his acid reflux and refers him to the local drug and alcohol liaison service.\n\nWhich of the following best describes the mechanism of action of omeprazole?",
"sbaAnswer": [
"a"
],
"totalVotes": 51,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,856 | false | 20 | null | 6,495,194 | null | false | [] | null | 17,613 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type I muscle fibres primarily rely on aerobic (oxidative) energy production, not anaerobic energy production.",
"id": "10026078",
"label": "d",
"name": "Anaerobic energy production",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Type I muscle fibres have a high fatigue resistance and are capable of sustaining contractions for extended periods.",
"id": "10026075",
"label": "a",
"name": "High resistance to fatigue",
"picture": null,
"votes": 21
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type I muscle fibres tend to have a smaller cross-sectional area compared to type II (fast-twitch) muscle fibres, as they are adapted for endurance rather than force production.",
"id": "10026079",
"label": "e",
"name": "Large cross-sectional area",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Type I muscle fibres have a relatively high myoglobin content, providing oxygen delivery and thus supporting their aerobic metabolism.",
"id": "10026077",
"label": "c",
"name": "Low myoglobin content",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Fast contraction speed is not a characteristic of type I muscle fibres. Type I fibers are known for their slow contraction speed, but high fatigue resistance.",
"id": "10026076",
"label": "b",
"name": "Fast contraction speed",
"picture": null,
"votes": 14
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5875",
"name": "Muscle physiology",
"status": null,
"topic": {
"__typename": "Topic",
"id": "311",
"name": "Bone physiology",
"typeId": 7
},
"topicId": 311,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5875,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17613",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 27 year old woman consults her GP about persistent muscle pain and fatigue. She has recently begun training for a marathon and is adhering to a strict exercise schedule. She is keen to learn more about the way her muscles work.\n\nWhich of the following is a characteristic of type I muscle fibres?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,857 | false | 21 | null | 6,495,194 | null | false | [] | null | 17,614 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. ACE-inhibitors, as the name suggests, inhibit the enzyme angiotensin-converting enzyme (ACE), which plays a crucial role in converting angiotensin I into angiotensin II. Angiotensin II is a potent vasoconstrictor. By inhibiting its production, ACE inhibitors reduce vasoconstriction and ultimately lower blood pressure.",
"id": "10026080",
"label": "a",
"name": "Inhibition of angiotensin II production",
"picture": null,
"votes": 52
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While ACE inhibitors can indirectly affect aldosterone levels, their primary mechanism of action is related to angiotensin II inhibition, not aldosterone suppression. Reduced aldosterone levels are a secondary effect of ACE inhibitors.",
"id": "10026082",
"label": "c",
"name": "Inhibition of aldosterone secretion",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. ACE inhibitors do not inhibit nitric oxide production; in fact, they may increase nitric oxide levels. Nitric oxide is a vasodilator, which means it helps relax blood vessels, leading to lower blood pressure.",
"id": "10026084",
"label": "e",
"name": "Inhibition of nitric oxide production",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. ACE inhibitors do the opposite and actually reduce angiotensin II levels, leading to a decrease in the stimulation of angiotensin II receptors.",
"id": "10026081",
"label": "b",
"name": "Stimulation of angiotensin II receptor",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. ACE inhibitors do not stimulate the sympathetic nervous system. They typically have a mild inhibitory effect on the sympathetic nervous system, which helps lower blood pressure.",
"id": "10026083",
"label": "d",
"name": "Stimulation of the sympathetic nervous system",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4614",
"name": "ACE-inhibitors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "188",
"name": "Renal Pharmacology",
"typeId": 7
},
"topicId": 188,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4614,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17614",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 61 year old white male with type 2 diabetes visits his General Practitioner for an annual health check. His blood pressure is measured at 154/100. The reading from his previous appointment is 146/97. The GP diagnoses him with hypertension and prescribes ramipril, an angiotensin-converting enzyme inhibitor (ACE-inhibitor).\n\nBy which of the following mechanisms do ACE inhibitors lower blood pressure?",
"sbaAnswer": [
"a"
],
"totalVotes": 56,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,858 | false | 22 | null | 6,495,194 | null | false | [] | null | 17,615 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Aldosterone does not directly affect GFR. It exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.",
"id": "10026087",
"label": "c",
"name": "Increases glomerular filtration rate (GFR)",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. ADH primarily regulates water reabsorption in the collecting ducts. Aldosterone exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.",
"id": "10026089",
"label": "e",
"name": "Stimulates the secretion of antidiuretic hormone (ADH)",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Aldosterone is a mineralocorticoid that is released from the zona glomerulosa of the adrenal cortex. It exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.",
"id": "10026085",
"label": "a",
"name": "Increases the expression of epithelial sodium channels in the collecting ducts",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While the sodium-potassium pump is involved in sodium reabsorption, aldosterone primarily acts on the collecting ducts, not the proximal tubules. It exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.",
"id": "10026086",
"label": "b",
"name": "Directly stimulates the sodium-potassium pump (Na+/K+ pump) in the proximal tubules",
"picture": null,
"votes": 20
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This describes the mechanism of ACE inhibitors such as ramipril, which reduces angiotensin II levels. Aldosterone exerts its effects by increasing the expression of epithelial sodium channels (ENaCs) in the collecting ducts of the nephron. This brings about the reabsorption of sodium and excretion of potassium.",
"id": "10026088",
"label": "d",
"name": "Inhibits angiotensin-converting enzyme (ACE)",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3896",
"name": "Actions of aldosterone",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3896,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17615",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 56-year-old woman presents to her General Practitioner for a review of her chronic hypertension. She has been on ramipril and amlodipine for a number of years, but her blood pressure has been consistently elevated. The patient is keen to learn more about the hormones involved in the regulation of blood pressure.\n\nWhich of the following best describes the action of aldosterone?",
"sbaAnswer": [
"a"
],
"totalVotes": 57,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,859 | false | 23 | null | 6,495,194 | null | false | [] | null | 17,616 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The distal tubules are critically involved in acid-base balance, and while the proximal tubules play a role in reabsorbing bicarbonate, the primary regulation of H+ ion secretion occurs in the distal tubules.",
"id": "10026093",
"label": "d",
"name": "The distal tubules play a minimal role in acid-base balance, with the primary regulation occurring in the proximal tubules",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The primary function of the distal tubules is to secrete H+ ions and reabsorb bicarbonate ions, which is the reverse of what this option suggests.",
"id": "10026094",
"label": "e",
"name": "The distal tubules primarily reabsorb H+ ions and excrete bicarbonate ions to maintain acid-base balance",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The distal tubules are crucial for regulating acid-base balance. They secrete H+ ions into the urine and reabsorb bicarbonate ions to help maintain proper pH in the body.",
"id": "10026090",
"label": "a",
"name": "H+ ions are secreted into urine at the distal tubules whilst bicarbonate ions are reabsorbed",
"picture": null,
"votes": 22
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not correct. While the proximal tubules are involved in various processes, including bicarbonate reabsorption, the primary site for H+ ion secretion to regulate acid-base balance is the distal tubules.",
"id": "10026091",
"label": "b",
"name": "H+ ion secretion occurs primarily in the proximal tubules",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Impaired H+ ion secretion in the distal tubules would lead to metabolic acidosis, not metabolic alkalosis.",
"id": "10026092",
"label": "c",
"name": "Impaired H+ ion secretion in the distal tubules contributes to metabolic alkalosis",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5876",
"name": "Hydrogen ion secretion at the distal tubule",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5876,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17616",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 40 year old man presents to the Emergency Department with complaints of extreme fatigue, muscle weakness and confusion. He has a history of chronic kidney disease and type 2 diabetes. Blood tests reveal severe metabolic acidosis.\n\nWhich of the following describes the renal mechanism by which acid-balance status is usually maintained?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,860 | false | 24 | null | 6,495,194 | null | false | [] | null | 17,617 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Chloride levels are closely linked to sodium levels in the body, and the activation of RAAS tends to increase sodium reabsorption. Consequently, chloride levels also tend to increase in response to RAAS activation.",
"id": "10026097",
"label": "c",
"name": "Cl-",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. When the RAAS is stimulated, aldosterone is released. Aldosterone primarily acts on the distal tubules of the kidney, promoting the reabsorption of sodium and the excretion of potassium. This can result in reduced levels of potassium in the bloodstream, a condition known as hypokalaemia.",
"id": "10026095",
"label": "a",
"name": "K+",
"picture": null,
"votes": 40
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Activation of RAAS generally leads to increased sodium reabsorption in the distal tubules of the kidney. At the same time, it increases the excretion of potassium, thus leading to hypokalaemia in some cases.",
"id": "10026096",
"label": "b",
"name": "Na+",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. RAAS activation does not have a direct effect on phosphate levels in the blood. Phosphate regulation primarily occurs through mechanisms involving parathyroid hormone (PTH) and dietary intake, rather than the RAAS.",
"id": "10026098",
"label": "d",
"name": "PO4-",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While RAAS indirectly affects calcium levels by promoting the reabsorption of sodium and water, leading to volume expansion, it does not have a direct effect on calcium levels. Calcium regulation is primarily under the control of parathyroid hormone (PTH) and calcitonin.",
"id": "10026099",
"label": "e",
"name": "Ca++",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
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"id": "2693",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4531",
"name": "The effect of the renin-angiotensin system on electrolytes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4531,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17617",
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"question": "A 46 year old woman attends the Emergency Department with reports of severe dizziness that is worse on standing. Her blood pressure is measured at 86/45. The clinician explains that the renin-angiotensin-aldosterone system (RAAS) is activated in response to low blood pressure.\n\nWhich of the following electrolytes are reduced by RAAS activation?",
"sbaAnswer": [
"a"
],
"totalVotes": 55,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,861 | false | 25 | null | 6,495,194 | null | false | [] | null | 17,618 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the assumed PaCO2 used in the alveolar gas equation but is not the alveolar PO2.",
"id": "10026104",
"label": "e",
"name": "40mmHg",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the partial pressure of water vapour (PH2O).",
"id": "10026101",
"label": "b",
"name": "47mmHg",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the atmospheric pressure, not the alveolar PO2",
"id": "10026103",
"label": "d",
"name": "760mmHg",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. It does not represent the alveolar PO2",
"id": "10026102",
"label": "c",
"name": "150mmHg",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Correct. This is the calculated apparent alveolar PO2 using the alveolar gas equation, taking into account the given FiO2, atmospheric pressure, and assuming a PaCO2 of 40 mmHg and a respiratory exchange ratio of 0.8.\n\nThe alveolar gas equation is PAO2 = (FiO2 * (PATM - PH2O)) - (PaCO2 / R), where R is 0.8. Inserting the above values into this equation gives a PAO2 of 100mmHg.",
"id": "10026100",
"label": "a",
"name": "100mmHg",
"picture": null,
"votes": 19
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
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"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4198",
"name": "Gaseous exchange and transport",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4198,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17618",
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"likes": 0,
"multiAnswer": null,
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"question": "A 16 year old female attends the lung function clinic for spirometry testing.\n\nHer tidal volume is 500ml, respiratory rate 12 breaths/minute. The fraction of inspired oxygen is 0.21.\n\nAtmospheric pressure (PATM) is 760mmHg. The partial pressure of water (PH2O) is 47mmHg and the partial pressure of carbon dioxide (PaCO2) is 40mmHg.\n\nCalculate the apparent alveolar partial pressure of oxygen (PO2) using the alveolar gas equation.",
"sbaAnswer": [
"a"
],
"totalVotes": 45,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,862 | false | 26 | null | 6,495,194 | null | false | [] | null | 17,619 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Pulmonary fibrosis is a lung disease characterized by the formation of scar tissue within the lung parenchyma. This scar tissue makes the lungs stiff and less compliant.",
"id": "10026105",
"label": "a",
"name": "Decreased lung compliance is associated with conditions like pulmonary fibrosis",
"picture": null,
"votes": 42
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Decreased lung compliance can lead to impaired gas exchange due to reduced lung expansion and difficulty in ventilating the alveoli effectively.",
"id": "10026107",
"label": "c",
"name": "Decreased lung compliance improves the efficiency of gas exchange in the alveoli",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Decreased lung compliance is primarily caused by factors that reduce lung elasticity, such as pulmonary fibrosis or scarring of lung tissue. Increased lung elasticity would typically lead to increased lung compliance, making it easier to expand the lungs during inhalation.",
"id": "10026109",
"label": "e",
"name": "Decreased lung compliance is primarily caused by increased lung elasticity",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Decreased lung compliance results in increased work of breathing for the patient as more effort is required to expand the lungs and overcome the reduced compliance.",
"id": "10026108",
"label": "d",
"name": "Decreased lung compliance results in reduced work of breathing for the patient",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Decreased lung compliance actually makes it harder for the lungs to expand during inhalation, which can lead to increased effort required for breathing.",
"id": "10026106",
"label": "b",
"name": "Decreased lung compliance leads to easier expansion of the lungs during inhalation",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5877",
"name": "Lung compliance",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17619",
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"question": "A 60-year-old patient with a history of smoking and a recent diagnosis of pulmonary fibrosis presents to the emergency department. The patient is experiencing increasing difficulty breathing and is coughing frequently. The clinician suspects a decrease in lung compliance and requests a chest X-ray for evaluation.\n\nWhich of the following statements about lung compliance is correct?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,863 | false | 27 | null | 6,495,194 | null | false | [] | null | 17,620 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The sodium-potassium pump actively transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.",
"id": "10026111",
"label": "b",
"name": "1 sodium ion out, 1 potassium ion in",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The sodium-potassium pump is a transmembrane ATPase pump. In each cycle, it actively moves 3 sodium ions out of the cell and 2 potassium ions into the cell. This is a fundamental process in maintaining cell function and regulating the electrochemical gradients across the cell membrane.",
"id": "10026110",
"label": "a",
"name": "3 sodium ions out, 2 potassium ions in",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The sodium-potassium pump transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.",
"id": "10026112",
"label": "c",
"name": "3 sodium ions out, 3 potassium ions in",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The sodium-potassium pump actively transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.",
"id": "10026113",
"label": "d",
"name": "2 sodium ions out, 1 potassium ion in",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The sodium-potassium pump actively transports 3 sodium ions out of the cell and 2 potassium ions into the cell in each cycle.",
"id": "10026114",
"label": "e",
"name": "1 sodium ion out, 2 potassium ions in",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5878",
"name": "The sodium potassium pump",
"status": null,
"topic": {
"__typename": "Topic",
"id": "181",
"name": "Structure and Function of Cells",
"typeId": 7
},
"topicId": 181,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5878,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17620",
"isLikedByMe": null,
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"likes": 0,
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"question": "A 55 year old female is admitted to the general medical ward with severe dehydration and electrolyte imbalances due to prolonged vomiting and diarrhoea.\n\nThe sodium-potassium pump is a critical ion transporter in maintaining cell function.\n\nWhich of the following describes the movement of sodium and potassium ions for each cycle of the sodium-potassium pump?",
"sbaAnswer": [
"a"
],
"totalVotes": 54,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,864 | false | 28 | null | 6,495,194 | null | false | [] | null | 17,621 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The procedure described, whereby the patient breathes in as much as they can and then exhales as much as they can, is typically used to measure Vital Capacity (VC). Vital Capacity represents the maximum amount of air a person can inhale and then exhale during a single, maximal effort, and it is a common measure of lung function in spirometry.",
"id": "10026115",
"label": "a",
"name": "Vital capacity (VC)",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. FRC is the volume of air remaining in the lungs after a normal exhalation and does not involve maximal inhalation and exhalation.",
"id": "10026116",
"label": "b",
"name": "Functional residual capacity (FRC)",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Total Lung Capacity is the maximum volume of air the lungs can hold at full inspiration.",
"id": "10026118",
"label": "d",
"name": "Total lung capacity (TLC)",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. FEV1 is a specific spirometric measurement that assesses the volume of air a person can forcibly exhale in one second after taking a deep breath.",
"id": "10026119",
"label": "e",
"name": "Forced expiratory volume in 1 second (FEV1)",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. IRV represents the additional volume of air that can be inhaled after a normal inspiration.",
"id": "10026117",
"label": "c",
"name": "Inspiratory reserve volume (IRV)",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4212",
"name": "Lung volumes",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4212,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17621",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 54 year old male patient attends the lung function clinic for spirometry testing. As part of the test, the patient breathes in as deeply as they can and then exhales as much as they can until their lungs feel empty.\n\nWhich of the following measures of lung function is being tested?",
"sbaAnswer": [
"a"
],
"totalVotes": 53,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,865 | false | 29 | null | 6,495,194 | null | false | [] | null | 17,622 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Damage to the afferent arteriole is more likely to affect glomerular blood flow and filtration pressure rather than causing haematuria.",
"id": "10026122",
"label": "c",
"name": "Afferent arteriole",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This vignette is consistent with post-streptococcal glomerulonephritis, as indicated by the recent sore throat and haematuria. Haematuria (blood in urine) is often associated with damage to the glomerular basement membrane, a critical filtration barrier within the glomerulus. When the basement membrane is compromised, red blood cells can leak into the urine.",
"id": "10026120",
"label": "a",
"name": "Glomerular basement membrane",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Damage to the efferent arteriole can impact glomerular haemodynamics but is less likely to directly result in haematuria.",
"id": "10026123",
"label": "d",
"name": "Efferent arteriole",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Damage to podocytes can also lead to haematuria, but it is not the primary structure associated with blood in the urine. Podocytes play a role in maintaining the integrity of the glomerular filtration barrier.",
"id": "10026121",
"label": "b",
"name": "Podocytes",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Damage to Bowman's capsule is more likely to affect the initial collection of filtrate but is less likely to be the primary cause of blood in the urine.",
"id": "10026124",
"label": "e",
"name": "Bowman's capsule",
"picture": null,
"votes": 6
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4658",
"name": "Glomerulus Structure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4658,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17622",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 13 year old boy presents to the General Practitioner with his father. The boy has noticed blood in his urine but denies any pain. His father describes him as 'coming down with a cold and sore throat' 3 days previously. He is usually fit and well with no past medical history and no regular medications.\n\nWhich of the following structures of the glomerulus is most likely damaged?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,866 | false | 30 | null | 6,495,194 | null | false | [] | null | 17,623 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While some DOACs, specifically the direct thrombin inhibitors, can inhibit Factor IX, the primary target of most DOACs is Factor Xa.",
"id": "10026128",
"label": "d",
"name": "Factor IX",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Factor VIII is involved in the intrinsic pathway of coagulation, while DOACs primarily target the common pathway by inhibiting Factor Xa or thrombin (Factor IIa).",
"id": "10026126",
"label": "b",
"name": "Factor VIII",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Factor XIII is involved in the final stabilization of fibrin clots and is not a direct target of DOACs.",
"id": "10026129",
"label": "e",
"name": "Factor XIII",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Factor VIIa is part of the extrinsic pathway and is not directly inhibited by DOACs.",
"id": "10026127",
"label": "c",
"name": "Factor VIIa",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Most DOACs, such as apixaban, rivaroxaban, and edoxaban, primarily inhibit Factor Xa. This is a key factor in the common pathway of the coagulation cascade. By inhibiting Factor Xa, these medications reduce the formation of thrombin, which is essential for blood clot formation.",
"id": "10026125",
"label": "a",
"name": "Factor Xa",
"picture": null,
"votes": 34
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4479",
"name": "Direct oral anticoagulants",
"status": null,
"topic": {
"__typename": "Topic",
"id": "203",
"name": "Pharmacology of Haemostasis and Thrombosis",
"typeId": 7
},
"topicId": 203,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4479,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17623",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 42 year old woman presents to the emergency department complaining of pain and swelling in her right calf. On questioning, she states that she recently returned from visiting family in Australia and takes the combined oral contraceptive pill. On examination, the right calf is 4cm larger than the left and is visibly red. The right calf is also extremely tender to touch.\n\nAn ultrasound scan confirms the presence of a deep vein thrombosis (DVT) and she is given a direct oral anticoagulant (DOAC).\n\nWhich of the following clotting factors is primarily inhibited by DOACs?",
"sbaAnswer": [
"a"
],
"totalVotes": 52,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,867 | false | 31 | null | 6,495,194 | null | false | [] | null | 17,624 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The right atrium connects to the right ventricle through the tricuspid valve. By contrast, the ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.",
"id": "10026131",
"label": "b",
"name": "The ductus arteriosus connects the right atrium to the right ventricle",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The left atrium connects to the left ventricle through the mitral (bicuspid) valve. By contrast, the ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.",
"id": "10026132",
"label": "c",
"name": "The ductus arteriosus connects the left atrium to the left ventricle",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The pulmonary veins carry oxygenated blood from the lungs to the left atrium. By contrast, the ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.",
"id": "10026134",
"label": "e",
"name": "The ductus arteriosus connects the pulmonary vein to the left atrium",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The connection between the aorta and the superior vena cava is not primarily associated with the ductus arteriosus. The ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta.",
"id": "10026133",
"label": "d",
"name": "The ductus arteriosus connects the aorta to the superior vena cava",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The ductus arteriosus is a foetal blood vessel that connects the pulmonary artery to the aorta. It allows a portion of the blood to bypass the lungs in the foetal circulation, as the lungs are not yet functional in the uterus.",
"id": "10026130",
"label": "a",
"name": "The ductus arteriosus connects the pulmonary artery to the aorta",
"picture": null,
"votes": 44
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3867",
"name": "Foetal Circulation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3867,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17624",
"isLikedByMe": null,
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"question": "A 2 week old baby boy is brought to the paediatric emergency department when his parents noticed that he was breathing more rapidly than usual. They note poor feeding since birth, and failure to gain weight.\n\nUpon examination, a continuous heart murmur is heard, it is loudest over the left upper chest area. A clinical diagnosis of a patent ductus arteriosus is made.\n\nWhich of the following statements correctly describes the path of the ductus arteriosus in the foetal circulation?",
"sbaAnswer": [
"a"
],
"totalVotes": 53,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,868 | false | 32 | null | 6,495,194 | null | false | [] | null | 17,625 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The tunica intima should be the innermost layer, followed by the tunica media and then the tunica externa.",
"id": "10026139",
"label": "e",
"name": "Tunica externa, tunica intima, tunica media",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. In a blood vessel, the layers are arranged in the following order from superficial to deep: tunica externa (outermost layer), tunica media and tunica intima (innermost layer).",
"id": "10026135",
"label": "a",
"name": "Tunica intima, tunica media, tunica externa",
"picture": null,
"votes": 46
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The tunica media should be between the tunica intima and tunica externa.",
"id": "10026137",
"label": "c",
"name": "Tunica media, tunica intima, tunica externa",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In a typical blood vessel, the tunica intima is the innermost layer, followed by the tunica media, and the tunica externa is the outermost layer.",
"id": "10026136",
"label": "b",
"name": "Tunica externa, tunica media, tunica intima",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The tunica media should be located between the tunica intima and tunica externa.",
"id": "10026138",
"label": "d",
"name": "Tunica intima, tunica externa, tunica media",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3809",
"name": "Structure and physiology of blood vessels",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3809,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "17625",
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"question": "A 28 year old man attends the haematology clinic. He has a history of haemochromatosis, for which he undergoes regular phlebotomy.\n\nWhich of the following represents the correct order of layers in a typical blood vessel, arranged from the most deep to most superficial?",
"sbaAnswer": [
"a"
],
"totalVotes": 54,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,869 | false | 33 | null | 6,495,194 | null | false | [] | null | 17,626 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Delta cells in the pancreas produce somatostatin, a hormone that regulates the release of both insulin and glucagon. They do not directly produce insulin.",
"id": "10026142",
"label": "c",
"name": "Delta cells",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Gamma cells do not exist as a recognized cell type in the pancreas.",
"id": "10026143",
"label": "d",
"name": "Gamma cells",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Parietal cells can be found in the stomach where they secrete stomach acid. They are not found in the pancreas, nor do they secrete insulin.",
"id": "10026144",
"label": "e",
"name": "Parietal cells",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Beta cells in the pancreas are responsible for producing insulin. In type 1 diabetes, there is a loss of functional beta cells, leading to a lack of insulin production and elevated blood glucose levels.",
"id": "10026140",
"label": "a",
"name": "Beta cells",
"picture": null,
"votes": 49
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Alpha cells in the pancreas are responsible for producing glucagon, not insulin. Glucagon and insulin have opposing roles in regulating blood glucose levels.",
"id": "10026141",
"label": "b",
"name": "Alpha cells",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4058",
"name": "Diabetes Mellitus",
"status": null,
"topic": {
"__typename": "Topic",
"id": "167",
"name": "Endocrine physiology",
"typeId": 7
},
"topicId": 167,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4058,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17626",
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"likes": 0,
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"question": "A 14 year old girl attends a paediatric clinic complaining of frequent urination and fatigue. She has often been waking in the night needing to urinate. It is noted that the girl has lost a significant amount of weight since the last time she was weighed 6 months ago.\n\n\nHer blood glucose reading is 16.6mmol/L (normal <6.1 mmol/L). She is diagnosed with type 1 diabetes mellitus.\n\n\nWhich of the following cells are normally responsible for insulin production in the pancreas?",
"sbaAnswer": [
"a"
],
"totalVotes": 52,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,870 | false | 34 | null | 6,495,194 | null | false | [] | null | 17,627 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The colon is not primarily responsible for bile acid reabsorption. Bile acids are primarily reabsorbed in the ileum of the small intestine.",
"id": "10026149",
"label": "e",
"name": "Colon",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The majority of bile acid reabsorption takes place in the ileum, the last segment of the small intestine. Bile acids are reabsorbed in the ileum and recycled back to the liver in a process called enterohepatic circulation.",
"id": "10026145",
"label": "a",
"name": "Ileum",
"picture": null,
"votes": 29
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The jejunum is not the primary site for bile acid reabsorption. The majority of bile acid reabsorption occurs in the ileum.",
"id": "10026148",
"label": "d",
"name": "Jejunum",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The stomach is not primarily involved in bile acid reabsorption. Bile acids are primarily reabsorbed in the lower part of the small intestine.",
"id": "10026146",
"label": "b",
"name": "Stomach",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While the duodenum is an important part of the small intestine for digestion, it is not the primary site for bile acid reabsorption. Bile acids are reabsorbed further down in the small intestine.",
"id": "10026147",
"label": "c",
"name": "Duodenum",
"picture": null,
"votes": 8
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4528",
"name": "Bile structure, function and metabolism",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4528,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17627",
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"likes": 0,
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"question": "A 36 year old woman attends her GP surgery with chronic diarrhoea. She has a known history of bile-acid malabsorption associated with Crohn's disease.\n\nWhich of the following sites is usually responsible for the majority of bile acid reabsorption?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,871 | false | 35 | null | 6,495,194 | null | false | [] | null | 17,628 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While the duodenum is involved in digestion, the majority of fluid absorption takes place in the lower parts of the small intestine, specifically the jejunum.",
"id": "10026152",
"label": "c",
"name": "Duodenum",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. While the colon does absorb some fluids, the majority of fluid absorption takes place in the small intestine, primarily the jejunum.",
"id": "10026154",
"label": "e",
"name": "Colon",
"picture": null,
"votes": 19
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The jejunum plays a role in nutrient absorption, but the majority of fluid absorption occurs in the jejunum",
"id": "10026153",
"label": "d",
"name": "Ileum",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The stomach is primarily responsible for the digestion of food, but it is not a significant site for fluid absorption. Fluid absorption primarily occurs in the jejunum.",
"id": "10026151",
"label": "b",
"name": "Stomach",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct answer. The jejunum is the primary site for the absorption of the majority of fluid in the GI tract.",
"id": "10026150",
"label": "a",
"name": "Jejunum",
"picture": null,
"votes": 11
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4568",
"name": "Fluid and electrolyte absorption in the GI tract",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4568,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"highlights": [],
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"question": "A 45 year old woman presents to the General Practitioner with chronic diarrhoea. The patient has been experiencing loose stools for almost 2 weeks and is concerned about becoming dehydrated.\n\nWhere is the majority of fluid normally absorbed in the gastrointestinal tract?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,872 | false | 36 | null | 6,495,194 | null | false | [] | null | 17,629 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Steroid receptors are not primarily located in the Golgi apparatus. The Golgi apparatus is involved in processing and modifying proteins and lipids.",
"id": "10026159",
"label": "e",
"name": "Golgi apparatus",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Steroid receptors can be found in the cytoplasm, but their primary site of action is in the nucleus, where they modulate gene transcription.",
"id": "10026156",
"label": "b",
"name": "Cytoplasm",
"picture": null,
"votes": 14
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Steroid receptors are primarily located in the nucleus of the cell. When bound to their ligands (steroid hormones), they act as transcription factors, influencing gene expression by regulating DNA transcription.",
"id": "10026155",
"label": "a",
"name": "Nucleus",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Steroid receptors are not typically located on the cell membrane. Cell membrane receptors are responsible for signalling in response to non-steroid hormones.",
"id": "10026157",
"label": "c",
"name": "Cell membrane",
"picture": null,
"votes": 16
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Steroid receptors are not primarily located in the endoplasmic reticulum. The endoplasmic reticulum has other roles in cellular processes such as protein synthesis.",
"id": "10026158",
"label": "d",
"name": "Endoplasmic reticulum",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5879",
"name": "Steroid receptors",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5879,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17629",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A 45 year old woman approaches her General Practitioner with concerns about hot flashes, mood swings, and irregular menstrual cycles. She has noticed these symptoms gradually worsening over the past several months. Investigations reveal reduced oestrogen levels.\n\nThe patient is keen to know more about how oestrogen usually binds to steroid receptors to exert its effect.\n\nIn which of the following structures are steroid receptors primarily located within cells?",
"sbaAnswer": [
"a"
],
"totalVotes": 49,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,873 | false | 37 | null | 6,495,194 | null | false | [] | null | 17,630 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the level at which the aorta bifurcates The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.",
"id": "10026163",
"label": "d",
"name": "L4",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.",
"id": "10026161",
"label": "b",
"name": "L2",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the origin of the inferior mesenteric artery (IMA). The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.",
"id": "10026164",
"label": "e",
"name": "L3",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the origin of the coeliac trunk. The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.",
"id": "10026162",
"label": "c",
"name": "T12",
"picture": null,
"votes": 9
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The SMA typically originates at the vertebral level of L1, which is just below the origin of the coeliac trunk.",
"id": "10026160",
"label": "a",
"name": "L1",
"picture": null,
"votes": 27
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4418",
"name": "Acute mesenteric ischaemia",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4418,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17630",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"question": "A 60 year old male patient is admitted to the hospital with severe abdominal pain, nausea, and vomiting. He has a history of atherosclerosis and was recently diagnosed with a blocked superior mesenteric artery (SMA).\n\nTo plan for potential revascularization, the team conducts diagnostic tests to precisely determine the vertebral level at which the SMA originates within the abdominal aorta.\n\nAt which of the following vertebral levels does the SMA typically originate?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,874 | false | 38 | null | 6,495,194 | null | false | [] | null | 17,631 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The femoral nerve is the most lateral structure, followed by the femoral artery and then the femoral vein.",
"id": "10026165",
"label": "a",
"name": "Femoral nerve, femoral artery, femoral vein",
"picture": null,
"votes": 27
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it is the order from medial to lateral. The femoral nerve is the most lateral structure, followed by the femoral artery and then the femoral vein.",
"id": "10026167",
"label": "c",
"name": "Femoral artery, femoral vein, femoral nerve",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect because it reverses the positions of the femoral nerve and femoral vein. The femoral nerve is the most lateral structure, followed by the femoral artery and then the femoral vein.",
"id": "10026169",
"label": "e",
"name": "Femoral artery, femoral nerve, femoral vein",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect because it reverses the positions of the femoral artery and femoral vein. The femoral artery is typically more lateral than the femoral vein in the femoral canal.",
"id": "10026168",
"label": "d",
"name": "Femoral vein, femoral artery, femoral nerve",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect because it reverses the positions of the femoral vein and femoral artery. In the femoral canal, the femoral artery is typically more lateral than the femoral vein.",
"id": "10026166",
"label": "b",
"name": "Femoral nerve, femoral vein, femoral artery",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5880",
"name": "Femoral hernias",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5880,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17631",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
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"qaAnswer": null,
"question": "A 55 year old woman presents to the General Practitioner with a painful lump in the right side of her groin. On examination, there is an irreducible lump located inferolateral to the pubic tubercle.\n\nThe GP diagnoses a femoral hernia. This is where the bowel herniates into the femoral canal.\n\nName the structures of the femoral canal from lateral to medial.",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,875 | false | 39 | null | 6,495,194 | null | false | [] | null | 17,632 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. In type 1 diabetes, the immune system targets and damages the insulin-producing beta cells in the pancreas. As a result, the organ-specific target is the pancreas, leading to insulin deficiency and hyperglycaemia.",
"id": "10026170",
"label": "a",
"name": "Type 1 diabetes",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Perennial rhinitis is a form of allergic rhinitis and is not an autoimmune disease.",
"id": "10026173",
"label": "d",
"name": "Perennial rhinitis",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. RA is an inflammatory condition primarily affecting the joints. However, it can also impact other organ systems such as the lungs, so is not an organ-specific autoimmune disease.",
"id": "10026172",
"label": "c",
"name": "Rheumatoid arthritis (RA)",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. SLE is a systemic autoimmune disease affecting multiple organs and systems in the body. Thus, it is not organ-specific.",
"id": "10026171",
"label": "b",
"name": "Systemic lupus erythematosus (SLE)",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Chronic granulomatous disease is a primary immunodeficiency that inhibits the body's ability to combat infections. It is not an organ-specific autoimmune disease.",
"id": "10026174",
"label": "e",
"name": "Chronic granulomatous disease",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4650",
"name": "Autoimmune disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "158",
"name": "Immunology",
"typeId": 7
},
"topicId": 158,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4650,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17632",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 36 year old woman attends a rheumatology clinic to discuss a recent autoimmune diagnosis.\n\nWhich of the following is an organ-specific autoimmune disease?",
"sbaAnswer": [
"a"
],
"totalVotes": 50,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,876 | false | 40 | null | 6,495,194 | null | false | [] | null | 17,633 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A deficiency in haemoglobin would lead to anaemia, a condition characterized by a reduced ability of the blood to carry oxygen. However, respiratory distress in a premature infant is primarily related to lung pathology, not haemoglobin deficiency.",
"id": "10026176",
"label": "b",
"name": "Haemoglobin",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Vitamin D deficiency in a child would cause rickets. This presents with aching bones and joints and bow leg or knock knee deformity. It is not related to the pathophysiology of neonatal respiratory distress syndrome.",
"id": "10026178",
"label": "d",
"name": "Vitamin D",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. A deficiency in immunoglobulins could lead to an impaired immune system and an increased susceptibility to infections. However, immunoglobulin deficiency is not the primary cause of respiratory distress in a premature baby.",
"id": "10026177",
"label": "c",
"name": "Immunoglobulin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. In premature infants, particularly those born before 28 to 32 weeks of gestation, surfactant production may not be fully developed. Surfactant deficiency leads to neonatal respiratory distress syndrome, where the baby experiences difficulty breathing due to alveolar collapse.\n\nThis condition is common in premature infants and requires supplemental oxygen and supportive care.",
"id": "10026175",
"label": "a",
"name": "Surfactant",
"picture": null,
"votes": 44
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Vitamin C deficiency causes scurvy, which presents with easy bruising, bleeding and receding gums and poor wound healing. It is not related to the pathophysiology of neonatal respiratory distress syndrome.",
"id": "10026179",
"label": "e",
"name": "Vitamin C",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5881",
"name": "Neonatal respiratory distress syndrome",
"status": null,
"topic": {
"__typename": "Topic",
"id": "153",
"name": "Paediatrics",
"typeId": 7
},
"topicId": 153,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5881,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17633",
"isLikedByMe": null,
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"likes": 0,
"multiAnswer": null,
"pictures": [],
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"psaSectionId": null,
"qaAnswer": null,
"question": "A male baby is born at 28 weeks gestation via caesarean section. The child shows signs of respiratory distress and is given supplemental oxygen. He is diagnosed with neonatal respiratory distress syndrome.\n\nWhich of the following deficiencies leads to neonatal respiratory distress syndrome?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,877 | false | 41 | null | 6,495,194 | null | false | [] | null | 17,634 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The serratus anterior does attach to the ribs, but its function is to rotate the scapula to allow the arm to be raised over 90 degrees.",
"id": "10026183",
"label": "d",
"name": "Serratus anterior",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In inspiration, the diaphragm contracts and flattens, this increases the vertical diameter of the thoracic cavity. The diaphragm does not move the ribs.",
"id": "10026182",
"label": "c",
"name": "Diaphragm",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The external intercostal muscles connect the ribs in such a way that the contraction of the muscles lifts the ribs and rib cage, expanding the anteroposterior dimensions of the ribcage.",
"id": "10026180",
"label": "a",
"name": "External intercostal muscles",
"picture": null,
"votes": 28
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The internal intercostal muscles depress the ribs in forced expiration, they do not have a role in inspiration.",
"id": "10026181",
"label": "b",
"name": "Internal intercostal muscles",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The sternocleidomastoid rotates the head to the opposite side and flexes the neck.",
"id": "10026184",
"label": "e",
"name": "Sternocleidomastoid",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3778",
"name": "The role of chest muscles in breathing",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3778,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17634",
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"likes": 0,
"multiAnswer": null,
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"qaAnswer": null,
"question": "A 37 year old man attends the emergency department with an acute asthma exacerbation. They have an increased respiratory rate and are seen to be using accessory muscles to help them breathe.\n\nWhich of the following muscles raises the ribcage and sternum during inspiration?",
"sbaAnswer": [
"a"
],
"totalVotes": 51,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,878 | false | 42 | null | 6,495,194 | null | false | [] | null | 17,635 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Erythropoietin (EPO) is a glycoprotein hormone, naturally produced by the peritubular cells of the kidney. It stimulates red blood cell production. In chronic kidney disease, EPO deficiency contributes to anaemia.",
"id": "10026185",
"label": "a",
"name": "Erythropoietin",
"picture": null,
"votes": 51
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Thrombopoietin is released to stimulate and support platelet production.",
"id": "10026188",
"label": "d",
"name": "Thrombopoietin",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. PTH is released by the parathyroid glands and acts to increase blood calcium levels. PTH can stimulate haematopoietic cells through mechanisms that are not entirely understood. However, it is not the primary cause of anaemia in chronic kidney disease.",
"id": "10026189",
"label": "e",
"name": "Parathyroid hormone (PTH)",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Aldosterone is a steroid hormone released by the adrenal glands as part of the renin-angiotensin system. Its main role is to reabsorb sodium and water in the kidneys to regulate blood pressure.",
"id": "10026187",
"label": "c",
"name": "Aldosterone",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Insulin is released by the beta cells of the pancreas. Its function is to reduce blood glucose.",
"id": "10026186",
"label": "b",
"name": "Insulin",
"picture": null,
"votes": 0
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4056",
"name": "Haematopoiesis",
"status": null,
"topic": {
"__typename": "Topic",
"id": "193",
"name": "Haematological Science",
"typeId": 7
},
"topicId": 193,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4056,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17635",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 47 year old woman patient with chronic kidney disease presents to the renal clinic. She has been feeling extremely tired recently and becomes short of breath upon minimal exertion. She denies any changes to her diet and any blood loss. Blood tests show a low haemoglobin.\n\nWhich of the following hormones is normally produced by the kidney to stimulate the production of red blood cells?",
"sbaAnswer": [
"a"
],
"totalVotes": 52,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,879 | false | 43 | null | 6,495,194 | null | false | [] | null | 17,636 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The man's sympathetic nervous system has been activated due to the trauma. The sympathetic nervous system activates sweat glands via acetylcholine signalling.",
"id": "10026190",
"label": "a",
"name": "Increased sympathetic activity",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. There will be increased aldosterone secretion in response to the low blood pressure, however, the action of aldosterone is to retain water and sodium, not to cause sweating.",
"id": "10026191",
"label": "b",
"name": "Increased aldosterone secretion",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In an acute setting, raised cortisol is responsible for mobilizing glucose for energy, inhibiting pain and promoting a fight-or-flight response. It would not cause sweating.",
"id": "10026193",
"label": "d",
"name": "Increased cortisol secretion",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Increased antidiuretic hormone secretion would result in a lower volume of more concentrated urine being produced, not sweating.",
"id": "10026192",
"label": "c",
"name": "Increased antidiuretic hormone secretion",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst reduced blood glucose can cause symptoms such as sweating, this man's glucose would not be reduced as hormones such as cortisol would increase blood glucose.",
"id": "10026194",
"label": "e",
"name": "Reduced blood glucose",
"picture": null,
"votes": 2
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5882",
"name": "Sympathetic nervous system",
"status": null,
"topic": {
"__typename": "Topic",
"id": "152",
"name": "Neuroscience",
"typeId": 7
},
"topicId": 152,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5882,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17636",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 32 year old male is brought to the Emergency Department following a road traffic collision. On arrival, he is conscious, alert and orientated.\n\nHis abdomen is bruised and distended. He is pale and sweaty. He has an elevated heart rate at 134bpm, a blood pressure of 84/67mmHg and a respiratory rate of 24 breaths per minute.\n\nWhich of the following best describes the main reason the patient appears pale and sweaty?",
"sbaAnswer": [
"a"
],
"totalVotes": 50,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,880 | false | 44 | null | 6,495,194 | null | false | [] | null | 17,637 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phrenic nerve damage would most likely present with breathing difficulties. The phrenic nerve is more susceptible to damage in cardiac and thoracic surgery, rather than in thyroid surgery.",
"id": "10026196",
"label": "b",
"name": "Phrenic nerve",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Long thoracic nerve damage presents with a 'winged scapula' deformity. The long thoracic nerve is susceptible to damage following chest drain insertion or prolonged crutch use. It is not commonly damaged in thyroid surgery and is not associated with voice changes.",
"id": "10026198",
"label": "d",
"name": "Long thoracic nerve",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Hypoglossal nerve damage would present with tongue deviation/wasting. The hypoglossal nerve is susceptible to damage in a carotid endarterectomy, rather than in thyroid surgery.",
"id": "10026197",
"label": "c",
"name": "Hypoglossal nerve",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The recurrent laryngeal nerve is a branch of the vagus nerve and supplies the vocal cords. It is prone to damage in thyroid surgery, as well as thoracic surgery. Voice changes are a common sign of recurrent laryngeal nerve damage.",
"id": "10026195",
"label": "a",
"name": "Recurrent laryngeal nerve",
"picture": null,
"votes": 47
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Thoracodorsal nerve damage is likely to present with pain and weakness in the upper limb. The thoracodorsal nerve is vulnerable to injury in breast procedures. It is not commonly damaged in thyroid surgery and is not associated with voice changes.",
"id": "10026199",
"label": "e",
"name": "Thoracodorsal nerve",
"picture": null,
"votes": 1
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5883",
"name": "Complications of thyroid surgery",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 5883,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17637",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 60 year old woman undergoes a total thyroidectomy due to medullary thyroid cancer. Following the procedure, it is noted that her voice has become hoarse and breathy. The surgeon suspects intra-operative damage of a nerve.\n\nWhich of the following nerves has most likely been damaged?",
"sbaAnswer": [
"a"
],
"totalVotes": 51,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,881 | false | 45 | null | 6,495,194 | null | false | [] | null | 17,638 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The CBD forms after the cystic duct joins the common hepatic duct, not the right hepatic duct.",
"id": "10026204",
"label": "e",
"name": "Cystic duct and right hepatic duct",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The CBD is formed by the union of the cystic duct and common hepatic duct. It then joins with the pancreatic duct to form the hepatopancreatic ampulla of vater.",
"id": "10026200",
"label": "a",
"name": "Cystic duct and common hepatic duct",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The common hepatic duct is formed by the union of the left and right hepatic ducts.",
"id": "10026203",
"label": "d",
"name": "Left and right hepatic ducts",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The CBD forms after the cystic duct joins the common hepatic duct, not the left hepatic duct.",
"id": "10026202",
"label": "c",
"name": "Cystic duct and left hepatic duct",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The common hepatic duct joins with the cystic duct, not the pancreatic duct.",
"id": "10026201",
"label": "b",
"name": "Common hepatic duct and pancreatic duct",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3810",
"name": "Gallstone Disease",
"status": null,
"topic": {
"__typename": "Topic",
"id": "135",
"name": "General surgery",
"typeId": 7
},
"topicId": 135,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3810,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17638",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
"pictures": [],
"prescribeAnswer": null,
"presentations": [],
"psaSectionId": null,
"qaAnswer": null,
"question": "A 47 year old man with a BMI of 36 presents to the Emergency Department with severe right upper quadrant pain, yellowing of the skin, pale stools and dark urine.\n\nAn ultrasound scan reveals a gallstone in the common bile duct (CBD).\n\nWhich of the following biliary ducts join to form the CBD?",
"sbaAnswer": [
"a"
],
"totalVotes": 46,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,882 | false | 46 | null | 6,495,194 | null | false | [] | null | 17,639 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Saliva is formed from parasympathetic stimulation from the chorda lingual nerve. Atropine blocks the muscarinic receptors in the salivary glands resulting in reduced saliva production. It does not affect blood flow.",
"id": "10026205",
"label": "a",
"name": "Reduces secretions, no effect on blood flow",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atropine blocks the muscarinic receptors in the salivary glands resulting in reduced saliva production. It does not affect blood flow.",
"id": "10026209",
"label": "e",
"name": "No effect on secretions, reduces blood flow",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atropine blocks the muscarinic receptors in the salivary glands resulting in reduced saliva production. It does not affect blood flow.",
"id": "10026208",
"label": "d",
"name": "Increases secretions and reduces blood flow",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atropine blocks the muscarinic receptors in the salivary glands resulting in reduced saliva production. It does not affect blood flow.",
"id": "10026206",
"label": "b",
"name": "No effect on secretions or blood flow",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Atropine blocks the muscarinic receptors in the salivary glands resulting in reduced saliva production. It does not affect blood flow.",
"id": "10026207",
"label": "c",
"name": "Reduces secretions and reduces blood flow",
"picture": null,
"votes": 17
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3805",
"name": "Saliva",
"status": null,
"topic": {
"__typename": "Topic",
"id": "149",
"name": "Gastro-intestinal physiology",
"typeId": 7
},
"topicId": 149,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3805,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17639",
"isLikedByMe": null,
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"question": "A 78 year old woman is brought to the emergency department with bradycardia. She is given a dose of atropine.\n\nWhich of the following best describes the effect of atropine on salivary secretion and blood flow?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,883 | false | 47 | null | 6,495,194 | null | false | [] | null | 17,640 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Vd can be calculated with the following formula:\n\nVd = Dose / Concentration\n\nIn this case, the dose is 400mg and the concentration is 15mg/L.\n\n400/15 = 26.67L",
"id": "10026213",
"label": "d",
"name": "40L",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Vd can be calculated with the following formula:\n\nVd = Dose / Concentration\n\nIn this case, the dose is 400mg and the concentration is 15mg/L.\n\n400/15 = 26.67L",
"id": "10026211",
"label": "b",
"name": "35L",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Vd can be calculated with the following formula:\n\nVd = Dose / Concentration\n\nIn this case, the dose is 400mg and the concentration is 15mg/L.\n\n400/15 = 26.67L",
"id": "10026210",
"label": "a",
"name": "27L",
"picture": null,
"votes": 34
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Vd can be calculated with the following formula:\n\nVd = Dose / Concentration\n\nIn this case, the dose is 400mg and the concentration is 15mg/L.\n\n400/15 = 26.67L",
"id": "10026212",
"label": "c",
"name": "30L",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Vd can be calculated with the following formula:\n\nVd = Dose / Concentration\n\nIn this case, the dose is 400mg and the concentration is 15mg/L.\n\n400/15 = 26.67L",
"id": "10026214",
"label": "e",
"name": "20L",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3811",
"name": "Apparent volume of distribution",
"status": null,
"topic": {
"__typename": "Topic",
"id": "166",
"name": "General pharmacological concepts",
"typeId": 7
},
"topicId": 166,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"difficulty": 1,
"dislikes": 0,
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"highlights": [],
"id": "17640",
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"question": "A 62 year old with a body weight of 82kg is given 400mg of a drug intravenously. After reaching equilibrium, the plasma concentration is 15mg/L.\n\n\nWhat is the apparent volume of distribution (Vd), rounded to the nearest whole number?",
"sbaAnswer": [
"a"
],
"totalVotes": 47,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,884 | false | 48 | null | 6,495,194 | null | false | [] | null | 17,641 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect.\n\nIn a 20% shunt, 20% of the arterial blood will be mixed with venous blood.\n\nTherefore, to calculate arterial O2 content with a 20% shunt, the calculation is:\n\n((20/100) x 150) + ((80/100) x 200) = 190ml.l^-1\nThis is because 20% of the blood has the O2 content of mixed venous blood (150ml.l^-1) and 80% has the O2 content of arterial blood (200ml.l^-1)\n\nTo calculate arterial CO2 content with a 20% shunt, the calculation is:\n\n((20/100) x 520) + ((80/100) x 480) = 488ml.l^-1\nThis is because 20% of the blood has the CO2 content of mixed venous blood (520ml.l^-1) and 80% has the CO2 content of arterial blood (480ml.l^-1)",
"id": "10026217",
"label": "c",
"name": "O2 content = 140ml.l^-1\nCO2 content = 300ml.l^-1",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect.\n\nIn a 20% shunt, 20% of the arterial blood will be mixed with venous blood.\n\nTherefore, to calculate arterial O2 content with a 20% shunt, the calculation is:\n\n((20/100) x 150) + ((80/100) x 200) = 190ml.l^-1\nThis is because 20% of the blood has the O2 content of mixed venous blood (150ml.l^-1) and 80% has the O2 content of arterial blood (200ml.l^-1)\n\nTo calculate arterial CO2 content with a 20% shunt, the calculation is:\n\n((20/100) x 520) + ((80/100) x 480) = 488ml.l^-1\nThis is because 20% of the blood has the CO2 content of mixed venous blood (520ml.l^-1) and 80% has the CO2 content of arterial blood (480ml.l^-1)",
"id": "10026219",
"label": "e",
"name": "O2 content = 270ml.l^-1\nCO2 content = 440ml.l^-1",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect.\n\nIn a 20% shunt, 20% of the arterial blood will be mixed with venous blood.\n\nTherefore, to calculate arterial O2 content with a 20% shunt, the calculation is:\n\n((20/100) x 150) + ((80/100) x 200) = 190ml.l^-1\nThis is because 20% of the blood has the O2 content of mixed venous blood (150ml.l^-1) and 80% has the O2 content of arterial blood (200ml.l^-1)\n\nTo calculate arterial CO2 content with a 20% shunt, the calculation is:\n\n((20/100) x 520) + ((80/100) x 480) = 488ml.l^-1\nThis is because 20% of the blood has the CO2 content of mixed venous blood (520ml.l^-1) and 80% has the CO2 content of arterial blood (480ml.l^-1)",
"id": "10026218",
"label": "d",
"name": "O2 content = 250ml.l^-1\nCO2 content = 500ml.l^-1",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect.\n\nIn a 20% shunt, 20% of the arterial blood will be mixed with venous blood.\n\nTherefore, to calculate arterial O2 content with a 20% shunt, the calculation is:\n\n((20/100) x 150) + ((80/100) x 200) = 190ml.l^-1\nThis is because 20% of the blood has the O2 content of mixed venous blood (150ml.l^-1) and 80% has the O2 content of arterial blood (200ml.l^-1)\n\nTo calculate arterial CO2 content with a 20% shunt, the calculation is:\n\n((20/100) x 520) + ((80/100) x 480) = 488ml.l^-1\nThis is because 20% of the blood has the CO2 content of mixed venous blood (520ml.l^-1) and 80% has the CO2 content of arterial blood (480ml.l^-1)",
"id": "10026216",
"label": "b",
"name": "O2 content = 200ml.l^-1\nCO2 content = 496ml.l^-1",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct.\n\nIn a 20% shunt, 20% of the arterial blood will be mixed with venous blood.\n\nTherefore, to calculate arterial O2 content with a 20% shunt, the calculation is:\n\n((20/100) x 150) + ((80/100) x 200) = 190ml.l^-1\nThis is because 20% of the blood has the O2 content of mixed venous blood (150ml.l^-1) and 80% has the O2 content of arterial blood (200ml.l^-1)\n\nTo calculate arterial CO2 content with a 20% shunt, the calculation is:\n\n((20/100) x 520) + ((80/100) x 480) = 488ml.l^-1\nThis is because 20% of the blood has the CO2 content of mixed venous blood (520ml.l^-1) and 80% has the CO2 content of arterial blood (480ml.l^-1)",
"id": "10026215",
"label": "a",
"name": "O2 content = 190ml.l^-1\nCO2 content = 488ml.l^-1",
"picture": null,
"votes": 16
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
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"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4567",
"name": "V/Q ratio",
"status": null,
"topic": {
"__typename": "Topic",
"id": "150",
"name": "Respiratory physiology",
"typeId": 7
},
"topicId": 150,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4567,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17641",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"qaAnswer": null,
"question": "A patient presents to the Emergency Department with shortness of breath and a cough productive of thick, yellow-green mucus. A chest x-ray reveals consolidation consistent with the diagnosis of pneumonia.\n\nClinicians are concerned about the possibility of a left to right pulmonary shunt, whereby some of the blood passing through the lungs is not fully oxygenated.\n\nCalculate the expected arterial O2 and CO2 content resulting from a 20% shunt, using the values below:\n\nArterial O2 content = 200ml.l^-1\n\nArterial CO2 content = 480ml.l^-1\n\nMixed venous O2 content = 150ml.l^-1\n\nMixed venous CO2 content = 520ml.l^-1",
"sbaAnswer": [
"a"
],
"totalVotes": 43,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,885 | false | 49 | null | 6,495,194 | null | false | [] | null | 17,642 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. The Na+/K+ ATPase actively pumps 3 Na+ ions out of the cell and 2 K+ ions into the cell. The other channels listed are involved in other aspects of ion transport in the nephron but do not transport sodium into the interstitium from the thick ascending limb.",
"id": "10026220",
"label": "a",
"name": "Na+/K+ ATPase",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. These are ATP-dependent potassium channels that move potassium out of cells. They are involved in potassium recycling in the thick ascending limb and potassium secretion in the collecting duct. They do not transport sodium from the cell into the interstitium.",
"id": "10026224",
"label": "e",
"name": "Renal outer medullary potassium (ROMK) channels",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Chloride channels are important for stabilisation of cell membrane potential but do not transport sodium.",
"id": "10026223",
"label": "d",
"name": "Chloride (Cl-) channels",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. These channels facilitate the movement of water across cell membranes. They do not transport sodium.",
"id": "10026221",
"label": "b",
"name": "Aquaporin-1 (AQP-1) channels",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. These channels are located on the apical membrane of epithelial cells and facilitate the reabsorption of sodium ions across the apical membrane of epithelial cells in the distal nephron.",
"id": "10026222",
"label": "c",
"name": "Epithelial Na+ (eNaC) channels",
"picture": null,
"votes": 11
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4242",
"name": "Salt Transport in the loop of Henle",
"status": null,
"topic": {
"__typename": "Topic",
"id": "168",
"name": "Renal Physiology",
"typeId": 7
},
"topicId": 168,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 4242,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
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"question": "A 45 year old male with a history of chronic kidney disease is admitted to the medical ward with deranged electrolyte levels. He is keen to learn more about the role of the kidney in regulating these electrolytes.\n\nIn the thick ascending limb of the loop of Henle, which of the following channels is responsible for the transport of sodium from the cell into the interstitium?",
"sbaAnswer": [
"a"
],
"totalVotes": 48,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,886 | false | 50 | null | 6,495,194 | null | false | [] | null | 17,643 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. NO does not inhibit the action of calmodulin. Its primary mechanism of action is through the activation of guanylate cyclase and the subsequent increase in cGMP.",
"id": "10026229",
"label": "e",
"name": "NO inhibits the action of the calcium-binding protein calmodulin, thereby reducing intracellular calcium levels",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. NO does not directly bind to calcium ions. Its primary mechanism of action is through the activation of guanylate cyclase and the subsequent increase in cGMP.",
"id": "10026226",
"label": "b",
"name": "NO directly binds to calcium ions, neutralizing them and preventing them from contributing to cellular processes",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Nitric oxide activates guanylate cyclase, which converts GTP to cGMP. Increased cGMP then activates protein kinase G (PKG), which acts to lower intracellular calcium through various mechanisms.",
"id": "10026225",
"label": "a",
"name": "NO activates guanylate cyclase, which converts GTP to cGMP",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. NO does not increase the activity of the Na+/K+ ATPase pump. Its primary mechanism of action is through the activation of guanylate cyclase and the subsequent increase in cGMP.",
"id": "10026228",
"label": "d",
"name": "NO increases the activity of the Na+/K+ ATPase pump, indirectly leading to a decrease in intracellular calcium",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. NO does not block calcium release from the endoplasmic reticulum. NO does not directly bind to calcium ions. Its primary mechanism of action is through the activation of guanylate cyclase and the subsequent increase in cGMP.",
"id": "10026227",
"label": "c",
"name": "NO blocks the release of calcium from the endoplasmic reticulum, thus reducing the amount of calcium available in the cell",
"picture": null,
"votes": 9
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3809",
"name": "Structure and physiology of blood vessels",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
"conceptId": 3809,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
"explanation": null,
"highlights": [],
"id": "17643",
"isLikedByMe": null,
"learningPoint": null,
"likes": 0,
"multiAnswer": null,
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"question": "A 60 year old patient with a history treatment-resistant of hypertension is reviewed in a cardiology clinic. The cardiologist explains the role of Nitric Oxide (NO) in regulating blood pressure and mentions that NO causes vasodilation by reducing intracellular calcium.\n\nBy which of the following mechanisms does NO reduce intracellular calcium?",
"sbaAnswer": [
"a"
],
"totalVotes": 51,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,927 | false | 1 | null | 6,495,197 | null | false | [] | null | 17,644 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is closer to the systolic blood pressure than the diastolic blood pressure. Since we spend more time in diastole than systole, this must be reflected in the mean arterial blood pressure calculation by weighting the diastolic blood pressure more heavily. We must therefore add a third of the pulse pressure to the diastolic pressure (rather than taking a third away from the systolic pressure) in order to give an accurate average of the arterial blood pressure.",
"id": "10026234",
"label": "e",
"name": "123 mmHg",
"picture": null,
"votes": 6
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The equation to calculate mean arterial blood pressure is (systolic blood pressure - diastolic blood pressure)/3 + diastolic blood pressure. In this case, we therefore do (137-95)/3 + 95 = 109.",
"id": "10026230",
"label": "a",
"name": "109 mmHg",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is just halfway between the systolic and diastolic blood pressure. Since we spend more time in diastole than systole, this must be reflected in the mean arterial blood pressure calculation by weighting the diastolic blood pressure more heavily. We must therefore add a third of the pulse pressure (not a half) to the diastolic pressure to give an accurate average of the arterial blood pressure.",
"id": "10026231",
"label": "b",
"name": "116 mmHg",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is just the systolic blood pressure. In order to average the mean arterial blood pressure, we must also include the diastolic blood pressure. This is done by first, subtracting systolic - diastolic blood pressure, secondly, dividing by 3, and thirdly adding the diastolic blood pressure - (137-95)/3 + 95 = 109.",
"id": "10026232",
"label": "c",
"name": "137 mmHg",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is just the diastolic blood pressure. In order to average the mean arterial blood pressure, we must also include the systolic blood pressure. This is done by first, subtracting systolic - diastolic blood pressure, secondly, dividing by 3, and thirdly adding the diastolic blood pressure - (137-95)/3 + 95 = 109.",
"id": "10026233",
"label": "d",
"name": "95 mmHg",
"picture": null,
"votes": 4
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4218",
"name": "Cardiac Volumes and Arterial Pressure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
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},
"conceptId": 4218,
"conditions": [],
"difficulty": 1,
"dislikes": 0,
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"question": "John, a 48-year-old gentleman, presents to the GP with a headache. As part of a routine check-up, a patient's blood pressure is recorded as 137/95 mmHg. Calculate the patient's mean arterial blood pressure.\n\n",
"sbaAnswer": [
"a"
],
"totalVotes": 68,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,928 | false | 2 | null | 6,495,197 | null | false | [] | null | 17,645 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer was incorrect as increasing sodium influx would speed up depolarisation and so increase the heart rate.",
"id": "10026237",
"label": "c",
"name": "Vagal activation increases sodium influx into the sinoatrial node cells",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The pacemaker potential is the section of slow depolarisation between two action potentials. It occurs when the movement of sodium and calcium ions into the nerve cells exceeds the outward movement of potassium ions, causing an overall increase in voltage inside the cells. When the vagus nerve is activated, it increases potassium efflux from the sinoatrial node cells, slowing the pacemaker potential incline. This means it takes longer for the voltage to reach the threshold potential, increasing the length of time between action potentials and so, decreasing the heart rate.",
"id": "10026235",
"label": "a",
"name": "Vagal activation increases potassium efflux from the sinoatrial node cells",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer was incorrect as even though decreasing sodium influx would slow down depolarisation of the pacemaker potential, the vagus nerve does not affect sodium channels.",
"id": "10026238",
"label": "d",
"name": "Vagal activation decreases sodium influx into the sinoatrial node cells",
"picture": null,
"votes": 38
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer was incorrect as increasing calcium influx would speed up depolarisation of the sinoatrial node cells and so increase heart rate.",
"id": "10026239",
"label": "e",
"name": "Vagal activation increases calcium influx into the sinoatrial node cells",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer was incorrect as decreasing potassium efflux would speed up depolarisation of the pacemaker potential and so increase the heart rate.",
"id": "10026236",
"label": "b",
"name": "Vagal activation decreases potassium efflux from the sinoatrial node cells",
"picture": null,
"votes": 7
}
],
"comments": [],
"concept": {
"__typename": "Concept",
"chapter": {
"__typename": "Chapter",
"explanation": null,
"files": null,
"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5884",
"name": "Autonomic Nervous System",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
"userChapter": null,
"userNote": null,
"videos": []
},
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"question": "What is the mechanism through which vagus nerve activation decreases the heart rate?",
"sbaAnswer": [
"a"
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173,465,929 | false | 3 | null | 6,495,197 | null | false | [] | null | 17,646 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "The pacemaker potential is the section of slow depolarisation between two action potentials. It occurs when the movement of sodium and calcium ions into the nerve cells exceeds the outward movement of potassium ions, causing an overall increase in voltage inside the cells. Adrenaline binds to beta-1 receptors causing increased calcium influx, hence speeding up the depolarisation of the pacemaker potential. This reduces the time taken for the cell to reach threshold potential. It occurs through L-type calcium channels.",
"id": "10026240",
"label": "a",
"name": "Adrenaline binds to beta-1 receptors causing increased calcium influx through L-type calcium channels into the sinoatrial node cells",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "The binding of adrenaline to Beta-1 receptors increases calcium influx, not efflux. Increasing the calcium efflux would slow down the depolarisation of the pacemaker potential, reducing the heart rate. Furthermore, the movement of calcium during the pacemaker potential is through L-type calcium channels, not T-type.",
"id": "10026242",
"label": "c",
"name": "Adrenaline binds to beta-1 receptors causing increased calcium efflux through T-type calcium channels into the sinoatrial node cells",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst adrenaline does indeed increase calcium influx, this is not done primarily via binding to beta-2 receptors. Beta-2 receptors are found mainly in vascular and bronchial smooth muscle. Whilst they are present in cardiac muscle, they are considerably less numerous and functionally important at that site than beta-1 receptors. Furthermore, the movement of calcium during the pacemaker potential is through L-type calcium channels, not T-type,",
"id": "10026243",
"label": "d",
"name": "Adrenaline binds to beta-2 receptors causing increased calcium influx through T-type calcium channels into the sinoatrial node cells",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst adrenaline does indeed increase calcium influx through L-type calcium channels, this is not done primarily via binding to beta-2 receptors. Beta-2 receptors are found mainly in vascular and bronchial smooth muscle. Whilst they are present in cardiac muscle, they are considerably less numerous and functionally important at that site than beta-1 receptors.",
"id": "10026241",
"label": "b",
"name": "Adrenaline binds to beta-2 receptors causing increased calcium influx through L-type calcium channels into the sinoatrial node cells",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst adrenaline does bind to beta-1 receptors, this does not affect potassium movement. Instead, adrenaline binding results in increased calcium influx into sinoatrial node cells, hence speeding up the depolarisation of the pacemaker potential, reducing the time taken for the cell to reach threshold potential. Furthermore, increasing potassium efflux would slow down the depolarisation of the pacemaker potential, reducing the heart rate.",
"id": "10026244",
"label": "e",
"name": "Adrenaline binds to beta-1 receptors causing increased potassium efflux out of the sinoatrial node cells",
"picture": null,
"votes": 1
}
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"id": "159",
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"question": "What is the mechanism through which raised levels of circulating adrenaline increase the heart rate?",
"sbaAnswer": [
"a"
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"totalVotes": 55,
"typeId": 1,
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173,465,930 | false | 4 | null | 6,495,197 | null | false | [] | null | 17,647 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as once the cell has depolarised, potassium moves outward (not inward) to begin repolarisation. At that point, L-type calcium channels open causing calcium influx, which balances the potassium efflux to bring about the plateau phase.",
"id": "10026247",
"label": "c",
"name": "Balanced calcium efflux and potassium influx",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as this unopposed potassium efflux describes the ion movement during repolarisation. This occurs briefly after depolarisation (during the partial rapid repolarisation phase) and after the plateau phase during terminal repolarisation. The plateau phase is caused by the balanced outward movement of potassium ions with the inward movement of calcium ions through L-type calcium channels.",
"id": "10026249",
"label": "e",
"name": "Potassium efflux",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as once the cell has depolarised, sodium channels are deactivated so sodium influx stops. The plateau phase is caused by the balanced outward movement of potassium ions with the inward movement of calcium ions through L-type calcium channels.",
"id": "10026246",
"label": "b",
"name": "Balanced sodium influx and potassium efflux",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Rapid depolarisation is first brought about by sodium influx. sodium channels are then inactivated and initial repolarisation begins to occur due to potassium efflux. At the same time, calcium influx occurs through L-type calcium channels. This potassium efflux and calcium influx are balanced, giving a plateau phase and prolonging the action potential. The L-type calcium channels are eventually inactivated, giving unopposed potassium efflux and hence repolarisation of the cell.",
"id": "10026245",
"label": "a",
"name": "Balanced calcium influx and potassium efflux",
"picture": null,
"votes": 26
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as this describes the ion movement during the rapid depolarisation phase. Once the cell has depolarised, sodium channels are deactivated so sodium influx stops. The plateau phase is caused by the balanced outward movement of potassium ions with the inward movement of calcium ions through L-type calcium channels.",
"id": "10026248",
"label": "d",
"name": "Sodium influx",
"picture": null,
"votes": 2
}
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"id": "3962",
"name": "Cardiac Action Potential Generation and Conduction",
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"name": "Cardiovascular physiology",
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"question": "Which of the following is the correct explanation for the plateau phase of the ventricular myocyte action potential?",
"sbaAnswer": [
"a"
],
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173,465,931 | false | 5 | null | 6,495,197 | null | false | [] | null | 17,648 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as isovolumetric contraction must occur before the aortic valve opens. If the aortic valve opened first, the pressure would still be higher in the aorta than the ventricle and so blood would pass back down from the aorta into the left ventricle. Instead, isovolumetric contraction occurs first to raise the left ventricular pressure above that of the aorta to open the aortic valve.",
"id": "10026253",
"label": "d",
"name": "Bicuspid valve closure, aortic valve opening, isovolumetric contraction, ventricular ejection",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is the correct order of events. Initially, the left ventricle begins to contract, raising its pressure above that of the left atrium so that the bicuspid valve closes. There is then the period of isovolumetric contraction whereby the ventricular pressure rises rapidly. Once this exceeds the pressure in the aorta, the aortic valve opens and ventricular ejection occurs.",
"id": "10026250",
"label": "a",
"name": "Bicuspid valve closure, isovolumetric contraction, aortic valve opening, ventricular ejection",
"picture": null,
"votes": 31
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as bicuspid valve closure must occur before isovolumetric contraction. Isovolumetric contraction is the period when both bicuspid and aortic valves are closed, such that the ventricle contracts, raising the pressure very rapidly. This allows the ventricular pressure to increase above that of the aorta so that the aortic valve can open. If isovolumetric contraction occurred before bicuspid valve closure, blood would be forced back up into the left atrium.",
"id": "10026252",
"label": "c",
"name": "Isovolumetric contraction, bicuspid valve closure, aortic valve opening, ventricular ejection",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Although the order of events is correct, the question refers specifically to the left ventricle and so it is the bicuspid valve that initially closes, not the tricuspid valve.",
"id": "10026251",
"label": "b",
"name": "Tricuspid valve closure, isovolumetric contraction, aortic valve opening, ventricular ejection",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect for two reasons. Firstly, the question refers specifically to the left ventricle and so it is the bicuspid valve that initially closes, not the tricuspid valve. Secondly, it is isovolumetric contraction, not relaxation, that occurs in systole to raise the ventricular pressure.",
"id": "10026254",
"label": "e",
"name": "Tricuspid valve closure, isovolumetric relaxation, aortic valve opening, ventricular ejection",
"picture": null,
"votes": 0
}
],
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"entitlement": null,
"id": "4231",
"name": "Blood flow through the heart",
"status": null,
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"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
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"question": "Which of the following is the correct sequence of events in left ventricular systole?",
"sbaAnswer": [
"a"
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} | MarksheetMark |
173,465,932 | false | 6 | null | 6,495,197 | null | false | [] | null | 17,649 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The T-tubule system describes the invaginations of cell membranes deep into the centre of cardiomyocytes, allowing rapid transmission of the action potential. This, therefore, helps with the initial depolarization of the cell but is not the site of calcium release. calcium is released from the sarcoplasmic reticulum.",
"id": "10026257",
"label": "c",
"name": "Calcium, released from the T-tubule system, binds to troponin-C, causing a conformation change and allowing actin and myosin to form cross-bridges, shortening the sarcomere",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst the sequence of events is otherwise correct, the process of myosin and actin filaments sliding past each other results in the shortening, not lengthening of the sarcomere. This is the basis of cardiomyocyte contraction.",
"id": "10026256",
"label": "b",
"name": "Calcium, released from the sarcoplasmic reticulum, binds to troponin-C, causing a conformation change and allowing actin and myosin to form cross-bridges, lengthening the sarcomere",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. calcium binds to troponin-C, not troponin-I. Troponin-I is the inhibitory form, preventing actin-myosin cross-bridge formation.",
"id": "10026259",
"label": "e",
"name": "Calcium, released from the sarcoplasmic reticulum, binds to troponin-I, causing a conformation change and allowing actin and myosin to form cross-bridges, lengthening the sarcomere",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This option is incorrect for two reasons. Firstly, the T-tubule system describes the invaginations of cell membranes deep into the centre of cardiomyocytes, allowing rapid transmission of the action potential. This, therefore, helps with the initial depolarization of the cell but is not the site of calcium release. calcium is released from the sarcoplasmic reticulum. Secondly, calcium binds to troponin-C, not troponin-I. Troponin-I is the inhibitory form, preventing actin-myosin cross-bridge formation.",
"id": "10026258",
"label": "d",
"name": "Calcium, released from the T-tubule system, binds to troponin-I, causing a conformation change and allowing actin and myosin to form cross-bridges, shortening the sarcomere",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Calcium is released from the sarcoplasmic reticulum during calcium-induced calcium release. This binds to troponin-C which causes a conformational change, moving troponin-C and exposing binding sites on the actin molecule. This allows myosin heads to bind. As the myosin and actin filaments slide past each other, the sarcomere is shortened.",
"id": "10026255",
"label": "a",
"name": "Calcium, released from the sarcoplasmic reticulum, binds to troponin-C, causing a conformation change and allowing actin and myosin to form cross-bridges, shortening the sarcomere",
"picture": null,
"votes": 25
}
],
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4534",
"name": "Myocytes",
"status": null,
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"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
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"question": "Which of the following statements is correct regarding excitation-contraction coupling in cardiomyocytes?",
"sbaAnswer": [
"a"
],
"totalVotes": 38,
"typeId": 1,
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} | MarksheetMark |
173,465,933 | false | 7 | null | 6,495,197 | null | false | [] | null | 17,650 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as skeletal muscle contraction squeezes the blood through the veins back to the heart, increasing venous return, and hence increasing the end diastolic volume. Due to Starling's law, this will also increase the stroke volume.",
"id": "10026262",
"label": "c",
"name": "Decreased end diastolic volume and decreased systolic volume",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Skeletal muscle contraction squeezes the blood through the veins back to the heart, increasing venous return, and hence increasing the end diastolic volume. Due to Starling's law, an increased end diastolic volume will stretch the myocardium, resulting in a greater force of contraction and hence larger stroke volume.",
"id": "10026260",
"label": "a",
"name": "Increased end diastolic volume and increased systolic volume",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst this will indeed result in an increased end diastolic volume, this answer is incorrect as the systolic volume should also increase. Due to Starling's law, an increased end diastolic volume will stretch the myocardium, resulting in a greater force of contraction and hence larger stroke volume.",
"id": "10026261",
"label": "b",
"name": "Increased end diastolic volume but no change in systolic volume",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is wrong for two reasons. Firstly, skeletal muscle contraction squeezes the blood through the veins back to the heart, increasing venous return, and hence increasing the end diastolic volume. Secondly, Startling's law states that an increased end diastolic volume will increase the systolic volume, and vice versa. Therefore, if the end diastolic volume were to decrease, it would also result in a decreased systolic volume. In this question, however, the correct answer was an increased end diastolic and systolic volume.",
"id": "10026264",
"label": "e",
"name": "Decreased end diastolic volume and increased systolic volume",
"picture": null,
"votes": 12
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This answer is incorrect. Whilst there is a limit to Starling's law whereby such a large increase in end diastolic volume will start to decrease ventricular contraction, this will not be reached by skeletal muscle contraction alone. Therefore, both the end diastolic and systolic volumes will be increased.",
"id": "10026263",
"label": "d",
"name": "Increased end diastolic volume and decreased systolic volume",
"picture": null,
"votes": 3
}
],
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},
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"demo": null,
"entitlement": null,
"id": "3892",
"name": "The Frank-Starling curve",
"status": null,
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"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
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"question": "What effect will repetitive skeletal muscle contraction have on the end diastolic volume and stroke volume of the heart?",
"sbaAnswer": [
"a"
],
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"typeId": 1,
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} | MarksheetMark |
173,465,934 | false | 8 | null | 6,495,197 | null | false | [] | null | 17,651 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of Class II antiarrhythmics, such as metoprolol. Flecainide targets sodium channels rather than beta-1-adrenergic receptors.",
"id": "10026268",
"label": "d",
"name": "Inhibits beta-1-adrenergic receptors",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of adenosine which opens potassium channels, resulting in hyperpolarisation and an increased refractory period. Flecainide targets sodium channels rather than potassium channels.",
"id": "10026269",
"label": "e",
"name": "Opens potassium channels",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of Class III antiarrhythmics, such as amiodarone. Flecainide targets sodium channels rather than potassium channels.",
"id": "10026267",
"label": "c",
"name": "Inhibit potassium channels",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Flecainide is a Class I anti-arrhythmic. These drugs inhibit the voltage-gated sodium channels, slowing the steep depolarisation section of the ventricular myocyte action potentials. This increases the refractory period so increases the time between action potentials.",
"id": "10026265",
"label": "a",
"name": "Inhibits voltage-gated sodium channels",
"picture": null,
"votes": 24
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is the mechanism of action of Class IV antiarrhythmics, such as verapamil. Flecainide targets sodium channels rather than calcium channels.",
"id": "10026266",
"label": "b",
"name": "Inhibit L-type calcium channels",
"picture": null,
"votes": 6
}
],
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"id": "5885",
"name": "Class I antiarrhythmics: Sodium-channel blockers",
"status": null,
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"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
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"question": "Annie, a 28-year-old female, is started on flecainide in the acute medical ward for the treatment of paroxysmal supraventricular tachycardia.\n\nWhat is the mechanism of action of flecainide?",
"sbaAnswer": [
"a"
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173,465,935 | false | 9 | null | 6,495,197 | null | false | [] | null | 17,652 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Adenosine is an anti-arrhythmic which works by opening potassium channels on cells in the sinoatrial node. This causes hyperpolarisation of the cell, meaning it is further from the threshold potential, therefore lengthening the refractory period and slowing conduction through the node.",
"id": "10026270",
"label": "a",
"name": "It opens potassium channels causing hyperpolarisation",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Adenosine is an anti-arrhythmic which works by opening potassium channels on cells in the sinoatrial node. This causes hyperpolarisation of the cell, meaning it is further from the threshold potential, therefore lengthening the refractory period and slowing conduction through the node.",
"id": "10026274",
"label": "e",
"name": "It does not affect potassium channels",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Adenosine is an anti-arrhythmic which works by opening potassium channels on cells in the sinoatrial node. This causes hyperpolarisation of the cell, meaning it is further from the threshold potential, therefore lengthening the refractory period and slowing conduction through the node.",
"id": "10026273",
"label": "d",
"name": "It closes potassium channels causing depolarisation",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst adenosine does cause hyperpolarisation of the sinoatrial node cells, this is done via opening, not closing, potassium channels. Since potassium moves from inside the cell to outside, opening more potassium channels would result in more outward movement and hence further lower the membrane potential of the cell.",
"id": "10026272",
"label": "c",
"name": "It closes potassium channels causing hyperpolarisation",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "Whilst adenosine does open potassium channels, this would result in hyperpolarisation, not depolarisation. Since potassium moves from inside the cell to outside, opening more potassium channels would result in more outward movement and hence further lower the membrane potential of the cell.",
"id": "10026271",
"label": "b",
"name": "It opens potassium channels causing depolarisation",
"picture": null,
"votes": 8
}
],
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"entitlement": null,
"id": "5886",
"name": "Acute narrow complex tachycardias",
"status": null,
"topic": {
"__typename": "Topic",
"id": "134",
"name": "Cardiology",
"typeId": 7
},
"topicId": 134,
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"question": "What effect does adenosine have on potassium channels in cells in the sinoatrial node?",
"sbaAnswer": [
"a"
],
"totalVotes": 40,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,936 | false | 10 | null | 6,495,197 | null | false | [] | null | 17,653 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the right option. This describes Poiseuille's law.",
"id": "10026277",
"label": "c",
"name": "The resistance in a blood vessel is directly proportional to both the viscosity of blood and the length of the vessel, but inversely proportional to the radius of the vessel",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the right option. This describes the Frank-Starling law.",
"id": "10026276",
"label": "b",
"name": "Increasing the left ventricular end-diastolic volume will stretch the myocytes, increasing their contractility, and hence giving a larger stroke volume",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the right option. This describes Ohm's law.",
"id": "10026279",
"label": "e",
"name": "The flow through a blood vessel can be calculated by the pressure gradient divided by the vascular resistance",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is not the right option. This describes the law of Laplace.",
"id": "10026278",
"label": "d",
"name": "The wall stress on a blood vessel is directly proportional to the blood pressure and vessel radius, but inversely proportional to the vessel wall thickness",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. This effect is an essential function of the aorta. By stretching during systole and recoiling during diastole, the aorta maintains the pressure giving continuous flow despite rhythmic contractions of the heart.",
"id": "10026275",
"label": "a",
"name": "The elastic wall of the aorta stretches during systole, allowing it to recoil during diastole to propel the blood forward and maintain blood pressure",
"picture": null,
"votes": 7
}
],
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"id": "3809",
"name": "Structure and physiology of blood vessels",
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"id": "159",
"name": "Cardiovascular physiology",
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"question": "Which of the following describes the Windkessel effect?",
"sbaAnswer": [
"a"
],
"totalVotes": 27,
"typeId": 1,
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} | MarksheetMark |
173,465,937 | false | 11 | null | 6,495,197 | null | false | [] | null | 17,654 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Ageing is associated with a loss of elastin from the walls of the blood vessels, making them stiffer and less elastic. Pulse pressure is the difference between the systolic and diastolic blood pressure. Lower vessel elasticity means the arteries cannot absorb the force from the heart contraction as well and hence the systolic pressure increases. This also means the arteries cannot recoil as well during diastole, giving a lower diastolic pressure. Overall, a loss of elastic therefore gives a larger pulse pressure.",
"id": "10026280",
"label": "a",
"name": "Increases pulse pressure due to a loss of elastin",
"picture": null,
"votes": 11
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Ageing is associated with a loss of elastin from the walls of the blood vessels, making them stiffer and less elastic. Pulse pressure is the difference between the systolic and diastolic blood pressure. Lower vessel elasticity means the arteries cannot absorb the force from the heart contraction as well and hence the systolic pressure increases. This also means the arteries cannot recoil as well during diastole, giving a lower diastolic pressure. Overall, a loss of elastic therefore gives a larger pulse pressure.",
"id": "10026283",
"label": "d",
"name": "Decreases pulse pressure due to a drop in nitric oxide levels",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst ageing is associated with a loss of elastin, this results in an increased pulse pressure. The loss of elastin results in the arteries becoming stiffer and less elastic. Pulse pressure is the difference between the systolic and diastolic blood pressure. Lower vessel elasticity means the arteries cannot absorb the force from the heart contraction as well and hence the systolic pressure increases. This also means the arteries cannot recoil as well during diastole, giving a lower diastolic pressure. Overall, a loss of elastic therefore gives a larger pulse pressure.",
"id": "10026281",
"label": "b",
"name": "Decreases pulse pressure due to a loss of elastin",
"picture": null,
"votes": 23
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Ageing is associated with a loss of elastin from the walls of the blood vessels, making them stiffer and less elastic. Pulse pressure is the difference between the systolic and diastolic blood pressure. Lower vessel elasticity means the arteries cannot absorb the force from the heart contraction as well and hence the systolic pressure increases. This also means the arteries cannot recoil as well during diastole, giving a lower diastolic pressure. Overall, a loss of elastic therefore gives a larger pulse pressure.",
"id": "10026284",
"label": "e",
"name": "There is no change to the pulse pressure",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst ageing is associated with an increased pulse pressure, this is due to a loss of elastin, not a a drop in nitric oxide levels. The loss of elastin results in the arteries becoming stiffer and less elastic. Pulse pressure is the difference between the systolic and diastolic blood pressure. Lower vessel elasticity means the arteries cannot absorb the force from the heart contraction as well and hence the systolic pressure increases. This also means the arteries cannot recoil as well during diastole, giving a lower diastolic pressure. Overall, a loss of elastic therefore gives a larger pulse pressure.",
"id": "10026282",
"label": "c",
"name": "Increases pulse pressure due to a drop in nitric oxide levels",
"picture": null,
"votes": 0
}
],
"comments": [],
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"name": "Structure and physiology of blood vessels",
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"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
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"question": "How does ageing affect pulse pressure?",
"sbaAnswer": [
"a"
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} | MarksheetMark |
173,465,938 | false | 12 | null | 6,495,197 | null | false | [] | null | 17,655 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. When you initially pump the cuff to a pressure above the systolic blood pressure, no sounds are heard as the artery is fully occluded. Korotkoff sounds are only heard when the cuff pressure is between the systolic and diastolic blood pressure as this is the period of turbulent flow.",
"id": "10026286",
"label": "b",
"name": "Korotkoff sounds are only heard when the cuff pressure is above the systolic pressure",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as this is when no sounds are heard. When you initially pump the cuff to a pressure above the systolic blood pressure, no sounds are heard as the artery is fully occluded. Once the cuff pressure is below the systolic but above the diastolic pressure, there is turbulent flow through the artery, giving the characteristic Korotkoff sounds (due to the impact of the blood onto the vessel wall causing vibrations). Once the cuff pressure is below the diastolic pressure, the artery returns to laminar flow so no sounds are heard.",
"id": "10026288",
"label": "d",
"name": "Korotkoff sounds are only heard when the cuff pressure is either above the systolic pressure or below the diastolic pressure",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. When you initially pump the cuff to a pressure above the systolic blood pressure, no sounds are heard as the artery is fully occluded. Once the cuff pressure is below the systolic but above the diastolic pressure, there is turbulent flow through the artery, giving the characteristic Korotkoff sounds (due to the impact of the blood onto the vessel wall causing vibrations). Once the cuff pressure is below the diastolic pressure, the artery returns to laminar flow and so no sounds are heard.",
"id": "10026285",
"label": "a",
"name": "Korotkoff sounds are only heard when the cuff pressure is between the systolic and diastolic pressure",
"picture": null,
"votes": 30
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Once the cuff pressure is below the diastolic pressure, there is normal laminar flow through the artery so no sounds are heard. Korotkoff sounds are only heard when the cuff pressure is between the systolic and diastolic blood pressure as this is the period of turbulent flow.",
"id": "10026287",
"label": "c",
"name": "Korotkoff sounds are only heard when the cuff pressure is below the diastolic pressure",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. When you initially pump the cuff to a pressure above the systolic blood pressure, no sounds are heard as the artery is fully occluded. Once the cuff pressure is below the systolic but above the diastolic pressure, there is turbulent flow through the artery, giving the characteristic Korotkoff sounds (due to the impact of the blood onto the vessel wall causing vibrations). Once the cuff pressure is below the diastolic pressure, the artery returns to laminar flow so no sounds are heard.",
"id": "10026289",
"label": "e",
"name": "Korotkoff sounds can be heard throughout the entire process",
"picture": null,
"votes": 0
}
],
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"question": "Which of the following correctly describes when Korotkoff sounds can be heard during a manual blood pressure reading?",
"sbaAnswer": [
"a"
],
"totalVotes": 34,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,939 | false | 13 | null | 6,495,197 | null | false | [] | null | 17,656 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Nitric oxide reduces the levels of Ca2+ in smooth muscle cells, causing relaxation and hence vasodilation.",
"id": "10026290",
"label": "a",
"name": "Nitric oxide",
"picture": null,
"votes": 36
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Cold temperature results in vasoconstriction to conserve body heat by reducing the volume of blood reaching the skin.",
"id": "10026294",
"label": "e",
"name": "Cold temperature",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Endothelins do the reverse of nitric oxide. They increase the level of Ca2+ in smooth muscle cells, causing them to contract, resulting in vasoconstriction",
"id": "10026291",
"label": "b",
"name": "Endothelin",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sympathetic nervous system activation is part of the 'fight or flight' response and causes vasoconstriction via the action of the noradrenaline neurotransmitter.",
"id": "10026293",
"label": "d",
"name": "Sympathetic nervous system activation",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Angiotensin II is a vasoconstriction released as part of the renin-angiotensin-aldosterone system to increase blood pressure.",
"id": "10026292",
"label": "c",
"name": "Angiotensin II",
"picture": null,
"votes": 2
}
],
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"name": "Structure and physiology of blood vessels",
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"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
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"question": "Which of the following results in vasodilation of blood vessels?",
"sbaAnswer": [
"a"
],
"totalVotes": 42,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,940 | false | 14 | null | 6,495,197 | null | false | [] | null | 17,657 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sympathetic activation results in the release of noradrenaline. This binds to alpha-1 receptors on endothelial cells to cause vasoconstriction. Noradrenaline also binds to beta-2 receptors which results in vasodilation, however, the binding to beta-2 receptors is weaker than to alpha-1 receptors. The overall effect is therefore vasoconstriction in response to sympathetic activation.",
"id": "10026296",
"label": "b",
"name": "Binding of noradrenaline from sympathetic fibres to alpha-1 receptors outweighs the binding to beta-2 receptors, resulting in vasodilation",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Sympathetic activation results in the release of noradrenaline. This binds to alpha-1 receptors on endothelial cells to cause vasoconstriction. Noradrenaline also binds to beta-2 receptors which results in vasodilation, however, the binding to beta-2 receptors is weaker than to alpha-1 receptors. The overall effect is therefore vasoconstriction in response to sympathetic activation.",
"id": "10026295",
"label": "a",
"name": "Binding of noradrenaline from sympathetic fibres to alpha-1 receptors outweighs the binding to beta-2 receptors, resulting in vasoconstriction",
"picture": null,
"votes": 15
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as it is the binding to alpha-1 receptors which causes vasoconstriction whereas binding to beta-2 receptors causes vasodilation. Hence, binding to alpha-1 must outweigh binding to beta-2 to give vasoconstriction overall.",
"id": "10026297",
"label": "c",
"name": "Binding of noradrenaline from sympathetic fibres to beta-2 receptors outweighs the binding to alpha-1 receptors, resulting in vasoconstriction",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Sympathetic activation results in the release of noradrenaline. This binds to alpha-1 receptors on endothelial cells to cause vasoconstriction. Noradrenaline also binds to beta-2 receptors which results in vasodilation, however, the binding to beta-2 receptors is weaker than to alpha-1 receptors. The overall effect is therefore vasoconstriction in response to sympathetic activation.",
"id": "10026298",
"label": "d",
"name": "Binding of noradrenaline from sympathetic fibres to beta-2 receptors outweighs the binding to alpha-1 receptors, resulting in vasodilation",
"picture": null,
"votes": 4
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect as noradrenaline is the neurotransmitter released from sympathetic fibres, not acetylcholine.",
"id": "10026299",
"label": "e",
"name": "Binding of acetylcholine from sympathetic fibres to alpha-1 receptors outweighs the binding to beta-2 receptors, resulting in vasoconstriction",
"picture": null,
"votes": 2
}
],
"comments": [],
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"__typename": "Concept",
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"id": "3809",
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"question": "Which of the following is the correct explanation for how sympathetic activation affects blood vessel tone?",
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"a"
],
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"typeId": 1,
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} | MarksheetMark |
173,465,941 | false | 15 | null | 6,495,197 | null | false | [] | null | 17,658 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the mechanism of action of phosphodiesterase inhibitors such as milrinone.",
"id": "10026301",
"label": "b",
"name": "Inhibition of phosphodiesterase",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Digoxin inhibits the Na+/K+ ATPase which prevents Na+ efflux from the cell, causing a rise in intracellular Na+. This lowers the Na+ gradient across the cell which makes the Na+/Ca2+ exchanger less effective, preventing Ca2+ efflux. This, therefore increases the Ca2+ levels in the cell, increasing contractility.",
"id": "10026300",
"label": "a",
"name": "Inhibition of the Na+/K+ ATPase",
"picture": null,
"votes": 25
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the mechanism of action of beta-blockers such as bisoprolol.",
"id": "10026303",
"label": "d",
"name": "Inhibition of beta-adrenergic receptors",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the mechanism of action of ivabradine.",
"id": "10026302",
"label": "c",
"name": "Inhibition of the funny currents",
"picture": null,
"votes": 7
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This is the mechanism of action of angiotensin II receptor blockers (ARBs) such as losartan.",
"id": "10026304",
"label": "e",
"name": "Inhibition of angiotensin II receptor",
"picture": null,
"votes": 2
}
],
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},
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"demo": null,
"entitlement": null,
"id": "4552",
"name": "Digoxin",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
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"question": "What is the mechanism of action of digoxin?",
"sbaAnswer": [
"a"
],
"totalVotes": 38,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,942 | false | 16 | null | 6,495,197 | null | false | [] | null | 17,659 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phosphodiesterase inhibitors work by preventing cAMP and cGMP degradation, increasing their intracellular levels. This in turn increases the release of Ca2+ from the sarcoplasmic reticulum, increasing the contractility of the muscle cell.",
"id": "10026309",
"label": "e",
"name": "Through inhibiting phosphodiesterases, they increase Ca2+ clearance from the cell",
"picture": null,
"votes": 1
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Since phosphodiesterases degrade cAMP and cGMP, by inhibiting them, these drugs increase cAMP and cGMP levels. This then increases Ca2+ release from the sarcoplasmic reticulum.",
"id": "10026306",
"label": "b",
"name": "Through inhibiting phosphodiesterases, they decrease the levels of cAMP and cGMP which increases Ca2+ release from the sarcoplasmic reticulum",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Phosphodiesterases (PDEs) breakdown the secondary messengers cAMP and cGMP. Phosphodiesterase inhibitors therefore work by preventing cAMP and cGMP degredation, increasing their intracellular levels. This in turn increases the release of Ca2+ from the sarcoplasmic reticulum, increasing the contractility of the muscle cell.",
"id": "10026305",
"label": "a",
"name": "Through inhibiting phosphodiesterases, they increase the levels of cAMP and cGMP which increases Ca2+ release from the sarcoplasmic reticulum",
"picture": null,
"votes": 18
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Phosphodiesterase inhibitors work by preventing cAMP and cGMP degradation, increasing their intracellular levels. This in turn increases the release of Ca2+ from the sarcoplasmic reticulum, increasing the contractility of the muscle cell.",
"id": "10026308",
"label": "d",
"name": "Through inhibiting phosphodiesterases, they decrease intracellular Na+ which reduces the Na+/Ca2+ exchanger activity, increasing intracellular Ca2+",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. This description is more similar to the mechanism of action of digoxin which blocks the Na+/K+ ATPase to increase intracellular Na+. Phosphodiesterase inhibitors work by preventing cAMP and cGMP degradation, increasing their intracellular levels. This in turn increases the release of Ca2+ from the sarcoplasmic reticulum, increasing the contractility of the muscle cell.",
"id": "10026307",
"label": "c",
"name": "Through inhibiting phosphodiesterases, they increase intracellular Na+ which reduces the Na+/Ca2+ exchanger activity, increasing intracellular Ca2+",
"picture": null,
"votes": 3
}
],
"comments": [],
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"id": "2693",
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},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "5887",
"name": "Phosphodiesterase (PDE) enzymes and heart failure",
"status": null,
"topic": {
"__typename": "Topic",
"id": "169",
"name": "Cardiovascular pharmacology",
"typeId": 7
},
"topicId": 169,
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"question": "Which of the following correctly describes the mechanism through which phosphodiesterase inhibitors act as inotropic drugs?",
"sbaAnswer": [
"a"
],
"totalVotes": 29,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,943 | false | 17 | null | 6,495,197 | null | false | [] | null | 17,660 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Adenosine in a vasodilator which increases blood flow to the heart. During times of increased metabolic activity, decreased blood flow, or decreased myocardial pO2, the heart requires a greater flow of blood and hence adenosine is released.",
"id": "10026310",
"label": "a",
"name": "Increased myocyte metabolic activity",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Adenosine is a vasodilator and hence will be released when there is a drop in blood flow to the heart, not an increase.",
"id": "10026311",
"label": "b",
"name": "Increased blood flow to the heart",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Since adenosine causes vasodilation, it is produced when a greater flow of blood is needed to the heart. A drop in oxygenation of the myocardial tissue would be an example of this, as opposed to an increased oxygen partial pressure as suggested in the question.",
"id": "10026312",
"label": "c",
"name": "Increased oxygen partial pressure in myocardial tissue",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Since adenosine causes vasodilation, it is produced when a greater flow of blood is needed to the heart. An increase in myocardial oxygen demand would therefore be an example of this, not a decrease.",
"id": "10026313",
"label": "d",
"name": "Decreased myocardial oxygen demand",
"picture": null,
"votes": 5
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Adenosine is a vasodilator and so will not be produced if the coronary arteries have already dilated.",
"id": "10026314",
"label": "e",
"name": "Coronary artery dilation",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"id": "2693",
"pictures": [],
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},
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"demo": null,
"entitlement": null,
"id": "3792",
"name": "Coronary blood flow",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
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},
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"question": "Which of the following conditions would result in an increased level of adenosine in myocardial tissue?",
"sbaAnswer": [
"a"
],
"totalVotes": 30,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,944 | false | 18 | null | 6,495,197 | null | false | [] | null | 17,661 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "This is correct. Countercurrent exchange is a mechanism to conserve heat. Heat from warm blood in arteries travelling towards to skin is transferred to veins travelling back towards the trunk. This maintains the trunk temperature while preventing heat loss from the skin.",
"id": "10026315",
"label": "a",
"name": "Transfer heat from arteries to adjacent veins",
"picture": null,
"votes": 10
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Countercurrent exchange helps with heat conservation, not oxygen transfer. Heat from warm blood in arteries travelling towards to skin is transferred to veins travelling back towards the trunk. This maintains the trunk temperature while preventing heat loss from the skin.",
"id": "10026317",
"label": "c",
"name": "Transfer oxygen from arteries to adjacent veins",
"picture": null,
"votes": 13
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Countercurrent exchange helps with heat conservation, not blood pressure regulation. Heat from warm blood in arteries travelling towards to skin is transferred to veins travelling back towards the trunk. This maintains the trunk temperature while preventing heat loss from the skin.",
"id": "10026319",
"label": "e",
"name": "Regulate blood pressure",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Countercurrent exchange helps with heat conservation, not oxygen transfer. Heat from warm blood in arteries travelling towards to skin is transferred to veins travelling back towards the trunk. This maintains the trunk temperature while preventing heat loss from the skin.",
"id": "10026318",
"label": "d",
"name": "Transfer oxygen from veins to adjacent arteries",
"picture": null,
"votes": 2
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. In countercurrent exchange, heat from warm blood in arteries travelling towards to skin is transferred to veins travelling back towards the trunk. This maintains the trunk temperature while preventing heat loss from the skin.",
"id": "10026316",
"label": "b",
"name": "Transfer heat from veins to adjacent arteries",
"picture": null,
"votes": 3
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"__typename": "Chapter",
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "4233",
"name": "Factors affecting blood flow to the skin circulation",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
"totalCards": null,
"typeId": null,
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"videos": []
},
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"question": "Which of the following is the primary function of countercurrent exchange in the cutaneous circulation?",
"sbaAnswer": [
"a"
],
"totalVotes": 31,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
173,465,945 | false | 19 | null | 6,495,197 | null | false | [] | null | 17,662 | {
"__typename": "QuestionSBA",
"choices": [
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The capillary hydrostatic pressure is the force coming from the heart contraction which drives fluid out of the capillary. Along the course of the capillary, this force drops significantly due to resistance in the vessel, meaning it is very small by the venous end of the capillary. Furthermore, if this force was significant, it would push fluid out of the capillary, whereas the question asked for the force driving the reabsorption of fluid back into the capillary.",
"id": "10026322",
"label": "c",
"name": "Capillary hydrostatic pressure",
"picture": null,
"votes": 3
},
{
"__typename": "QuestionChoice",
"answer": true,
"explanation": "Oncotic pressure is the osmotic force of large molecules, such as proteins, in a solution. The capillary oncotic pressure is therefore the force of large proteins within the capillary pulling fluid from the interstitium back into the capillary. At the arterial end of the capillary, the capillary hydrostatic force outweighs the capillary oncotic pressure, and hence fluid moves out into the interstitium. At the venous end of the capillary, however, the capillary hydrostatic force is much lower and hence the capillary oncotic pressure predominates, pulling fluid back from the interstitium into the capillary.",
"id": "10026320",
"label": "a",
"name": "Capillary oncotic pressure",
"picture": null,
"votes": 17
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. Whilst this force does indeed aid in pushing fluid back into the capillary, it is insignificant in comparison to the size of the capillary oncotic pressure.",
"id": "10026323",
"label": "d",
"name": "Tissue hydrostatic pressure",
"picture": null,
"votes": 8
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. It is the capillary oncotic pressure which primarily drives fluid reabsorption back into the capillary at the venous end.",
"id": "10026324",
"label": "e",
"name": "None of the above",
"picture": null,
"votes": 0
},
{
"__typename": "QuestionChoice",
"answer": false,
"explanation": "This is incorrect. The tissue oncotic pressure is essentially 0 in a healthy state as there shouldn't be any protein in the interstium. Furthermore, if this force was significant, it would pull fluid out of the capillary, whereas the question asked for the force driving the reabsorption of fluid back into the capillary.",
"id": "10026321",
"label": "b",
"name": "Tissue oncotic pressure",
"picture": null,
"votes": 5
}
],
"comments": [],
"concept": {
"__typename": "Concept",
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"highlights": [],
"id": "2693",
"pictures": [],
"typeId": 7
},
"chapterId": 2693,
"demo": null,
"entitlement": null,
"id": "3809",
"name": "Structure and physiology of blood vessels",
"status": null,
"topic": {
"__typename": "Topic",
"id": "159",
"name": "Cardiovascular physiology",
"typeId": 7
},
"topicId": 159,
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},
"conceptId": 3809,
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"question": "At the venous end of a capillary, the net movement of fluid is from the interstitium back into the capillary.\n\nWhich of the following is the predominant force driving this reabsorption?",
"sbaAnswer": [
"a"
],
"totalVotes": 33,
"typeId": 1,
"userPoint": null
} | MarksheetMark |
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