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Question 1
Incorrect
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A 46-year-old nurse presents with a short history of epistaxis and bleeding gums. Her complete blood count, coagulation profile, and blood film are requested. The results are as follows:
Hb: 8.6 g/dL
WCC: 2.3 x 10^9/L
Plts: 18 x 10^9/L
Coagulation profile: deranged
Blood film: bilobed large mononuclear cells
What is the most likely diagnosis?Your Answer: Lymphoma
Correct Answer: Acute myeloid leukaemia
Explanation:This is a picture of bone marrow failure secondary to acute myeloid leukaemia (AML). AML is the acute expansion of the myeloid stem line, which may occur as a primary disease or follow the secondary transformation of a myeloproliferative disorder. It is more common over the age of 45 and is characterized by signs and symptoms largely related to bone marrow failure such as anaemia (pallor, lethargy), frequent infections due to neutropenia (although the total leucocyte count may be very high), thrombocytopaenia (bleeding), ostealgia, and splenomegaly.
The disease has poor prognosis if:
1. Age of the patient >60 years
2. >20% blasts seen after the first course of chemotherapy
3. Chromosomal aberration with deletion of part of chromosome 5 or 7.Acute promyelocytic leukaemia (APL) is an aggressive form of AML.
Other listed options are ruled out because:
1. Von Willebrand disease: may present with epistaxis and bleeding gums in severe cases but rarely with abnormalities on blood results.2. Acute lymphoblastic leukaemia: mostly seen in children.
3. Lymphoma: usually presents with rubbery enlargement of lymph nodes.
4. Warfarin overdose: no bilobed large mononuclear cells seen on blood film.
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This question is part of the following fields:
- Haematology & Oncology
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Question 2
Correct
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A 23-year-old female is admitted with acute severe asthma. Treatment is initiated with 100% oxygen, nebulised salbutamol and ipratropium bromide nebulisers and IV hydrocortisone. There is no improvement despite initial treatment.
What is the next step in management?Your Answer: IV magnesium sulphate
Explanation:A single dose of intravenous magnesium sulphate is safe and may improve lung function and reduce intubation rates in patients with acute severe asthma. Intravenous magnesium sulphate may also reduce hospital admissions in adults with acute asthma who have had little or no response to standard treatment.
Consider giving a single dose of intravenous magnesium sulphate to patients with acute severe asthma (PEF <50% best or predicted) who have not had a good initial response to inhaled bronchodilator therapy. Magnesium sulphate (1.2-2 g IV infusion over 20 minutes) should only be used following consultation with senior medical staff.
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This question is part of the following fields:
- Respiratory System
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Question 3
Incorrect
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In idiopathic hypercalciuria, what management should be initiated if there is renal stone disease or bone demineralization?
Your Answer: Increased fluid intake
Correct Answer: Dietary modification and thiazide diuretics
Explanation:Idiopathic hypercalciuria presents with excess calcium in the urine without an apparent cause. Dietary modification is the first step in addressing this condition, however, because hypercalciuria increases the risk of developing renal stones and bone demineralisation, thiazide diuretics should be prescribed to increase calcium reabsorption when these symptoms are also present.
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This question is part of the following fields:
- Renal System
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Question 4
Incorrect
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Which one of the following is the most common cause of hypothyroidism in the UK?
Your Answer: Lithium therapy
Correct Answer: Hashimoto's thyroiditis
Explanation:Hashimoto thyroiditis is the most common cause of hypothyroidism in developed countries. In contrast, worldwide, the most common cause of hypothyroidism is an inadequate dietary intake of iodine. This disease is also known as chronic autoimmune thyroiditis and chronic lymphocytic thyroiditis.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 5
Correct
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A 25-year-old previously well male presented with chest discomfort and difficulty in breathing while running to the bus. Symptoms disappeared after resting. But the symptoms reappeared whilst he was climbing the stairs. On examination he was not dyspnoeic at rest. BP was 110/70 mmHg and pulse rate was 72 bpm. His heart sounds were normal. There was an additional clicking noise in the fourth left intercostal space which is heard with each heartbeat. Which of the following is the most probable cause for his presentation?
Your Answer: Spontaneous pneumothorax
Explanation:The given history is more compatible with spontaneous pneumothorax. Left-sided pneumothoraxes may be associated with a clicking noise, which is heard with each heart-beat and can sometimes be heard by the patient.
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This question is part of the following fields:
- Cardiovascular System
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Question 6
Correct
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A 47-year-old man is seen in clinic with a 3 month history of chronic epigastric discomfort. The pain comes and goes and radiates to his back and his right shoulder tip at times. It is worse after meals but there is no relieving factor. He feels nauseous most of the time and has foul-smelling stools. He has lost 2 stones in weight. He also complains of intermittent light-headedness. He drinks a bottle of wine on most nights and smokes 20 cigarettes /day.
On examination, he is thin and looks neglected. His abdomen is soft, but tender on deep palpation in the epigastric area. He has a 2 cm non-tender liver edge. He also has decreased sensation to light touch on both feet.
Bloods:
sodium 131 mmol/l
potassium 4.2 mmol/l
creatine 64 μmol/l
amylase 35 U/l
alanine aminotransferase (ALT) 104 U/l
alkaline phosphatase (ALP) 121 U/l
bilirubin 24 μmol/l
calcium 2.01 mmol/l
whole cell count (WCC) 12.1 × 109/l
haemoglobin (Hb) 10.2 g/dl
platelets 462 × 109/l
abdominal X-ray (AXR) normal
oesophago-gastro duodenoscopy (OGD) mild gastritis
Campylobacter-like organism (CLO) test negative
ultrasound abdomen mildly enlarged liver with fatty change
spleen and kidneys normal
pancreas partially obscured by overlying bowel gas
72-h stool fat 22 g in 72 h
He is referred for a secretin test:
volume collected 110 ml
bicarbonate 52 mEq/l
What is the most likely diagnosis?Your Answer: Chronic pancreatitis
Explanation:The question describes an alcohol abusing man with chronic epigastric discomfort, radiating into his back, worse with meals, and foul-smelling stools, weight loss, as well as chronic nausea. This is likely, thus chronic pancreatitis due to alcohol abuse. Hepatomegaly and peripheral neuropathy secondary to anaemia support the diagnosis of long term alcohol abuse. Bacterial overgrowth may present with diarrhoea and is a less likely diagnosis than pancreatitis. Celiac disease is a less likely diagnosis than pancreatitis, and you would also expect mention of diarrhoea. VIPoma would also likely present with diarrhoea. Cecal carcinoma would more than likely present with blood in the stool.
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This question is part of the following fields:
- Gastrointestinal System
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Question 7
Incorrect
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A 66-year-old baker presents to the oncology clinic with six-month history of weight loss and anorexia. Tumour marker profile shows an elevated level of bombesin.
Out of the following, which is the most likely cancer to account for this result?Your Answer: Prostate carcinoma
Correct Answer: Small cell lung carcinoma
Explanation:Bombesin is a tumour marker elevated in small cell lung carcinomas, as well as in gastric carcinomas and retinoblastomas.
Tumour markers can be divided into:
1. Monoclonal antibodies
CA 125: Ovarian cancer, primary peritoneal cancer
CA 19-9: Pancreatic cancer
CA 15-3: Breast cancer2. Tumour specific antigens
Prostate specific antigen (PSA): Prostatic carcinoma
Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA): Colorectal cancer
S-100: Melanoma, schwannomas
Bombesin: Small cell lung carcinoma, gastric cancer3. Enzymes
Alkaline phosphatase (ALP)
Neuron specific enolase (NSE)4. Hormones
Calcitonin
Antidiuretic hormone (ADH)
Human chorionic gonadotropin (hCG) -
This question is part of the following fields:
- Haematology & Oncology
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Question 8
Incorrect
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A 50-year-old woman is referred to the outpatient clinic with a 6-month history of diarrhoea. She has had intermittent loose normal-coloured stools 2-3 times a day. She also has up to 10 hot flushes a day but thinks she is entering menopause; her GP has recently started her on hormone replacement therapy.
15 years ago she had a normal colonoscopy after presenting with abdominal pain and intermittent constipation. She has asthma controlled by inhalers, hypertension controlled by ACE inhibitors and hypothyroidism controlled by thyroxine. She smoked 10 cigarettes a day for the last 30 years and drinks alcohol about 14 units/week.
On examination, she looks hot and flushed. She is afebrile. Her pulse is regular 92 bpm and her BP is 164/82 mmHg. Her respirator rate is 20 breaths/min at rest and she sounds quite wheezy. A widespread polyphonic expiratory wheeze can be heard on chest auscultation.
Her abdomen is soft. Her liver is enlarged 4 cm below the right costal margin but not-tender.
Results of blood tests show:
Na 140 mmol/l
K 4.8 mmol/l
Glucose 9.8 mmol/l
Albumin 41 g/l
ALT 94 U/l
ALP 61 U/l
Bilirubin 18 mmol/l
Ca 2.47 mmol/l
WCC 10.1 × 109/l
Hb 12.2 g/dl
MCV 90.5 fl
Platelets 234 × 109 /l
PT 13 s
Chest X-ray is normal.
Ultrasound of the liver shows an enlarged liver containing three ill-defined mass lesions in the right lobe.
What is the most likely diagnosis?Your Answer: VIPoma
Correct Answer: Carcinoid syndrome
Explanation:Carcinoid tumours are of neuroendocrine origin and derived from primitive stem cells in the gut wall, especially the appendix. They can be seen in other organs, including the lungs, mediastinum, thymus, liver, bile ducts, pancreas, bronchus, ovaries, prostate, and kidneys. While carcinoid tumours tend to grow slowly, they have the potential to metastasise.
Signs and symptoms seen in larger tumours may include the following:
– Periodic abdominal pain: Most common presentation for a small intestinal carcinoid; often associated with malignant carcinoid syndrome.
– Cutaneous flushing: Early and frequent (94%) symptom; typically affects head and neck.
– Diarrhoea and malabsorption (84%): Watery, frothy, or bulky stools, gastrointestinal (GI) bleed or steatorrhea; may or may not be associated with abdominal pain, flushing, and cramps.
– Cardiac manifestations (60%): Valvular heart lesions, fibrosis of the endocardium; may lead to heart failure with tachycardia and hypertension.
– Wheezing or asthma-like syndrome (25%): Due to bronchial constriction; some tremors are relatively indolent and result in chronic symptoms such as cough and dyspnoea.
– Pellagra with scale-like skin lesions, diarrhoea and mental disturbances.
– Carcinoid crisis can be the most serious symptom of the carcinoid tumours and life-threatening. It can occur suddenly or after stress, including chemotherapy and anaesthesia. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 9
Incorrect
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A 45-year-old male presented with chronic diarrhoea and right lower abdominal pain. On examination he was febrile and there was tenderness over the right lower quadrant and an anal fissure. Which of the following is the most probable cause for his abdominal pain?
Your Answer:
Correct Answer: Inflammatory bowel disease (IBD)
Explanation:From the given answers, IBD and IBS are the causes for chronic diarrhoea. Pyelonephritis and ureteric colic are associated with urinary symptoms. Tenderness of pyelonephritis is at the loin region. Perianal disease is associated with fifty percent of patients with Crohn’s disease.
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This question is part of the following fields:
- Gastrointestinal System
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Question 10
Incorrect
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Which the following features is most suggestive of megaloblastic anaemia?
Your Answer:
Correct Answer: Hypersegmented neutrophils in peripheral blood film
Explanation:Hypersegmented neutrophils in the peripheral blood film is suggestive of megaloblastic changes in bone marrow.
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This question is part of the following fields:
- Haematology & Oncology
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Question 11
Incorrect
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A 19-year-old male presents with a 1-year history of diarrhoea as well as abdominal discomfort. He has 10 episodes of loose stools per day and 3 episodes of loose stools per night. He reports weight loss in the past few months. On examination of the abdomen, tenderness was present in the right lower quadrant. Endoscopy revealed cobblestone mucosa in the ileum. Which of the following conditions is he most likely suffering from?
Your Answer:
Correct Answer: Crohn's Disease
Explanation:Cobblestone mucosa is characteristic of Crohn’s Disease. It is not a feature of any of the other options mentioned. Crohn’s disease is a condition of IBD (Inflammatory Bowel Disease).
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This question is part of the following fields:
- Gastrointestinal System
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Question 12
Incorrect
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A 28-year-old male was admitted with severe central abdominal pain managed as an acute pancreatitis due to his serum amylase being markedly elevated. He is a known epileptic patient and has been on anti-epileptics. What would be the antiepileptic drug responsible for this clinical presentation?
Your Answer:
Correct Answer: Sodium valproate/Carbamazepine
Explanation:Both Sodium valproate and Carbamazepine are correct. These drugs can cause drug induced pancreatitis however more cases have been reported with Sodium valproate.
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This question is part of the following fields:
- Gastrointestinal System
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Question 13
Incorrect
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A 23-year-old student presented with swelling and tenderness near the Lister tubercle of the radius. Passive extension of thumb and index finger further increases the pain. X-ray was normal. What will be the next step in the management of this case?
Your Answer:
Correct Answer: Immobilization with a cast
Explanation:This patient most likely has distal intersection syndrome, which occurs in the proximal forearm due to the tenosynovitis of extensor pollicis longus muscle tendons.
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This question is part of the following fields:
- Musculoskeletal System
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Question 14
Incorrect
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A 40-year-old female presented with fever, jaundice, and pain in the middle and upper abdomen. Her stools are clay-coloured. Which of the following should be done now?
Your Answer:
Correct Answer: Endoscopic retrograde cholangio pancreatography (ERCP)
Explanation:ERCP is necessary to look for any obstruction or compression of the extra-hepatic bile duct. The clay-coloured stools are a result of impaired bilirubin movement into the duodenum.
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This question is part of the following fields:
- Hepatobiliary System
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Question 15
Incorrect
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A 24-year-old man was hit on the lateral aspect of his head by a high velocity cricket ball and lost consciousness immediately. Paramedics found him to have a Glasgow coma score of 15 but take him to the A&E for further investigation. His Glasgow coma score on examination in the A&E is 13 (M5, V4, E4) and he has anterograde and retrograde amnesia to recent events. The doctors arrange an urgent CT scan. Which clinical sign would be most concerning if present?
Your Answer:
Correct Answer: Bradycardia
Explanation:Intracranial pressure (ICP) is a complex brain modality that determines cerebral perfusion pressure (CPP), which is the difference between arterial blood pressure (ABP), and ICP. Raised ICP reduces CPP and blood delivery to the brain. This jeopardizes cerebral function and organismal survival in many species. A massive rise in ICP is also known to produce an increase in ABP, bradycardia and respiratory irregularities termed Cushing response. This mechanism is generally considered to be an agonal and terminal event occurring in extreme condition of brainstem ischaemia leading to a sympatho-adrenal response.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 16
Incorrect
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Regarding the 3rd heart sound, which one of the following statements is correct?
Your Answer:
Correct Answer: It may be a normal finding in women up to the age of 50
Explanation:The 3rd heart sound corresponds to early diastolic filling in ventricular relaxation after the closure of the aortic valve. Associated conditions include cardiac failure, constrictive pericarditis and atrial myxomas. It is low pitched and accentuated by inspiration. The 3rd heart sound may arise from ventricular relaxation and it can be seen as a normal finding among children, young adults and women till 50 years of age.
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This question is part of the following fields:
- Cardiovascular System
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Question 17
Incorrect
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Which one of the following features is least associated with Waldenström's macroglobulinemia?
Your Answer:
Correct Answer: Bone pain
Explanation:Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include weight loss and lethargy; monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.
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This question is part of the following fields:
- Haematology & Oncology
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Question 18
Incorrect
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A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and flatulence. Clinical examination is unremarkable. Faecal occult bloods are negative and haematological and biochemical investigations are unremarkable.
Which of the following is the next most appropriate management step?Your Answer:
Correct Answer: Trial of dairy-free diet
Explanation:The best next step is to try a dairy-free diet, many patients may develop this in their lifetime. IBS is a diagnosis of exclusion, and one would need to rule lactose intolerance out as a potential aetiology first. She is only 28, and without overt bleeding or signs/sxs/labs suggestive of obstruction or inflammation; colonoscopy, flex sig and a barium enema are not indicated.
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This question is part of the following fields:
- Gastrointestinal System
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Question 19
Incorrect
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A 57-year-old, alcoholic male was admitted to the medical ward for an ascitic tap. The ascitic fluid was found to be yellow in colour. Which of the following had most likely lead to this observation?
Your Answer:
Correct Answer: Decompensated cirrhosis
Explanation:Uncomplicated cirrhotic ascites is usually translucent. If the patient is deeply jaundiced, the fluid might appear yellow/brown.
Turbidity or cloudiness of the ascites fluid suggests that infection is present and further diagnostic testing should be performed.
Pink or bloody fluid is most often caused by mild trauma, with subcutaneous blood contaminating the sample.
Bloody ascites is also associated with hepatocellular carcinoma or any malignancy-associated ascites.
Milky-appearing fluid usually has an elevated triglyceride concentration. Such fluid, commonly referred to as chylous ascites, can be related to thoracic duct injury or obstruction or lymphoma, but it is often related primarily to cirrhosis. -
This question is part of the following fields:
- Hepatobiliary System
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Question 20
Incorrect
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Where is the site of action of spironolactone?
Your Answer:
Correct Answer: Distal convoluted tubule
Explanation:Spironolactone is an aldosterone antagonist which acts in the distal convoluted tubule. It is a potassium-sparing diuretic that prevents the body from absorbing too much salt and keeps the potassium levels from getting too low. Spironolactone is used to treat heart failure, high blood pressure (hypertension), or hypokalaemia (low potassium levels in the blood).
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This question is part of the following fields:
- Pharmacology
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Question 21
Incorrect
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A patient presents with occasionally severe retrosternal chest pain and dysphagia for both solids and liquids. What would be the best management option if the barium swallow showed a dilated oesophagus which tapers to a fine distal end?
Your Answer:
Correct Answer: Dilatation of the LES
Explanation:Dysphagia for both solids and liquids indicates either obstruction or impaired oesophageal peristalsis which is usually due to neuromuscular causes such as achalasia. Achalasia is the failure of smooth muscle fibres to relax, which can cause the lower oesophageal sphincter to remain closed. The lower part of the oesophagus is more narrow than normal and presents as a birds beak appearance on barium swallow. If dysphagia was present only on solid food consumption, a benign or malignant tumour must be suspected.
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This question is part of the following fields:
- Gastrointestinal System
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Question 22
Incorrect
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A 35-year-old female complains of headache at the back of her head that has been occurring for several days and pain on neck flexion. She works as a housemaid. Which of the following is the most likely cause of her presentation?
Your Answer:
Correct Answer: Cervical spondylosis
Explanation:Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). Cervical spondylosis is very common and worsens with age.
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This question is part of the following fields:
- Musculoskeletal System
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Question 23
Incorrect
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A 16-year-old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2 cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?
Your Answer:
Correct Answer: Slipped femoral epiphysis
Explanation:The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.
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This question is part of the following fields:
- Musculoskeletal System
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Question 24
Incorrect
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 25
Incorrect
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A 12-year-old boy has a history of fever for one week (39C), with no other symptoms leading up to the fever. He recently had a surgical extraction of one of his incisors two weeks before consultation. On examination of CVS, a mid-systolic click followed by a late systolic murmur is heard. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Infection
Explanation:Tooth extraction or any surgical procedure may introduce bacteria into the blood stream. The most commonly involved organisms include Staphylococcus aureus and Streptococcus viridans. Once in the blood, these organisms have a very high tendency of attaching to the walls of the heart and causing inflammation known as endocarditis.
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This question is part of the following fields:
- Cardiovascular System
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Question 26
Incorrect
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A 32-year-old man, originally from Pakistan, was admitted with ascites and weight loss. The protein level on ascitic tap was 9 g/l.
Which of the following is the most likely cause of this presentation?Your Answer:
Correct Answer: Hepatic cirrhosis
Explanation:This is a low protein level, indicating the fluid is transudative. The only answer choice that is a transudative fluid is in hepatic cirrhosis. Exudative fluid would be seen in tuberculous peritonitis, peritoneal lymphoma, with liver mets, and with intra-abdominal malignancy.
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This question is part of the following fields:
- Hepatobiliary System
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Question 27
Incorrect
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A 74-year-old retired judge who is known to have Alzheimer's disease is examined in clinic. His latest Mini Mental State Examination (MMSE) score is 18 out of 30. Which of the following is the most appropriate treatment option?
Your Answer:
Correct Answer: Supportive care + donepezil
Explanation:NICE now recommends the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease. Memantine is reserved for patients with moderate to severe Alzheimer’s.
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This question is part of the following fields:
- Nervous System
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Question 28
Incorrect
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A 18-year-old male was screened for hypertrophic cardiomyopathy (HOCM) as his brother had the same condition. What is the echocardiographic finding that is related to the highest risk of sudden cardiac death?
Your Answer:
Correct Answer: Significant thickening of the interventricular septum
Explanation:There are five prognostic factors which indicate poor prognosis in HOCM:
-family history of HOCM-related sudden cardiac death
-unexplained recent syncope
-large left ventricular wall thickness (MLVWT > 30 mm)
-multiple bursts of nsVT on ambulatory electrocardiography
-hypotensive or attenuated blood pressure response to exercise -
This question is part of the following fields:
- Cardiovascular System
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Question 29
Incorrect
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A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer:
Correct Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
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This question is part of the following fields:
- Renal System
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Question 30
Incorrect
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A 32 year-old active male presents with a three month history of pain in his feet and lower legs. He was previously diagnosed with diabetes at age 14 and treated with insulin. He admits to drinking 30 units of alcohol per week and is a current cannabis smoker. On examination, pain and temperature sensation in his feet are diminished, but joint position and vibratory sensation appear normal. What is the most likely diagnosis?
Your Answer:
Correct Answer: Diabetic polyneuropathy
Explanation:The given history suggests a small fibre painful peripheral sensory neuropathy, the most common cause of which is diabetes. Joint position sense and vibratory sensation are carried through large fibres, and therefore are not currently affected. Sensory nerves are affected more often than motor, so reflexes usually remain in tact.
Vitamin B12 deficiency causes impairment of joint position and vibratory sensation.
Chronic inflammatory demyelinating polyneuropathy (CIPD) causes a large fibre peripheral neuropathy with areflexia.
In syringomyelia there is impaired pain and temperature noted in the upper limbs.
Finally, with alcoholic polyneuropathy, all fibre types are affected (sensory and motor loss). It is usually gradual with long term alcohol abuse and may be accompanied by a nutritional deficiency. In addition, pain is a more dominant feature.
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This question is part of the following fields:
- Nervous System
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SESSION STATS - PERFORMANCE PER SPECIALTY
