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Question 1
Correct
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Arterial baroreceptors are located primarily in which of the following:
Your Answer: Carotid sinus and aortic arch
Explanation:Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 2
Correct
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Which of the following is NOT a typical clinical feature of diabetic ketoacidosis:
Your Answer: Cheyne–Stokes respiration
Explanation:Clinical features of DKA: Symptoms: Polyuria, polydipsia, thirst, lethargy, weight loss, nausea, vomiting, anorexia, abdominal pain, dehydration, headache, altered mental stateSigns: Dry mucous membranes, ketotic breath, tachycardia, hypotension, Kussmaul breathing, focal signs of precipitant e.g. infection
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 3
Incorrect
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A 35-year-old man presents with haemoptysis, night sweats, and weight loss. Further examinations were done and a diagnosis of tuberculosis is suspected. Which of the following statements is considered correct regarding Mycobacterium tuberculosis?
Your Answer: The Ghon focus typically appears at the base of the lower lobe of the lung
Correct Answer: It is impervious to decolourisation with acid
Explanation:Mycobacterium tuberculosis are part of the Mycobacteriaceae family. They are described to have the characteristics of a Gram-positive cell wall but they are not easily stained with Gram stain. This is because their cell wall contains a high lipid content, and this lipid allows the Mycobacteria to bind to alkaline stains with the application and help of heat. Once stained, they are able to resist decolorization even with the use of acid alcohol as the decolourizer, making them very difficult to decolorize, that is why they are known to be acid-fast.The Ghon complex is a non-pathognomonic radiographic finding on a chest x-ray that is significant for pulmonary infection of tuberculosis. The location of the Ghon’s focus is usually subpleural and predominantly in the upper part of the lower lobe and lower part of the middle or upper lobe. Skeletal tuberculosis of the spine is referred to as Pott disease.The risk of reactivation TB is about 3.3% during the first year after a positive PPD skin test and a total of 5% to 15% thereafter in the person’s lifetime. Progression from infection to active disease varies with age and the intensity and duration of exposure. Reactivation TB occurs when there is an alteration or suppression of the cellular immune system in the infected host that favoursreplication of the bacilli and progression to disease.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 4
Correct
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A 24-year-old waiter cuts his hand on a dropped plate that smashed and damages the nerve that innervates opponens digiti minimi.The opponens digiti minimi muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer: The deep branch of the ulnar nerve
Explanation:Opponens digiti minimi is a triangular-shaped muscle in the hand that forms part of the hypothenar eminence. It originates from the hook of the hamate bone and the flexor retinaculum and inserts into the medial border of the 5thmetacarpal.Opponens digiti minimi is innervated by the deep branch of the ulnar nerve and receives its blood supply from the ulnar artery.Opponens digiti minimi draws the fifth metacarpal bone anteriorly and rotates it, bringing the fifth digiti into opposition with the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Correct
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One of your patients is undergoing resuscitation and is in septic shock. The intensive care outreach team arrives to assess them and determines that a dobutamine infusion should be started.Which of the following receptors does dobutamine primarily affect?
Your Answer: Beta-1 receptors
Explanation:Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.A summary of the mechanism and effects of different inotropic agents is shown below:InotropeMechanismEffectsAdrenaline (epinephrine)Beta-1 and -2 agonist at increasing doses;Alpha-agonist at high dosesIncreased cardiac output;Vasoconstriction at higher dosesNoradrenaline (norepinephrine)Mainly alpha-agonist;Beta-1 and -2 agonist at increasing dosesVasoconstriction;Some increased cardiac outputDopamineDopamine agonist at low doses;Beta-1 and -2 agonist at increasing doses;Alpha-agonist at high dosesIncreased cardiac output;Vasoconstriction at higher dosesDobutamineMainly beta-1 agonistIncreased cardiac output
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Correct
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A clinical audit cycle comprises of 5 steps. Each of these processes are listed below:Which is the correct order that these should occur?1. Observation of practice and collection of data2. Identification of the problem3. Implementation of change4. Definition of criteria and setting of standards5. Analysis of data and comparison of performance with the criteria and standards
Your Answer: 2,4,1,5,3
Explanation:An audit assesses if a certain aspect of health care is attaining a recognized standard. This lets care providers and patients know where their service is doing well, and where there could be improvements. The aim is to achieve quality improvement and improve outcomes for patients.Audits are a quality improvement measure and one of the 7 pillars of clinical governance. It allows organizations to continually work toward improving quality of care by showing them where they are falling short, allows them to implement improvements, and reaudit or close the audit cycle to see if beneficial change has taken place.Clinical audits are a cycle with several steps:1. Identification of the problem2. Definition of criteria and setting of standards3. Observation of practice and collection of data4. Analysis of data and comparison of performance with the criteria and standards5. Implementation of change
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This question is part of the following fields:
- Evidence Based Medicine
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Question 7
Incorrect
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Which of the following ligaments supports the head of the talus?
Your Answer: Calcaneofibular ligament
Correct Answer: Spring ligament
Explanation:The spring-ligament complex is a significant medial arch stabilizer. The two important functions of this ligament include promoting the stability of the talonavicular joint by acting as a support for the talus head and by acting as a static support to maintain the medial longitudinal arch.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Correct
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You intend to suture a hand wound with plain 1 percent lidocaine.In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?
Your Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 9
Correct
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Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT for:
Your Answer: Hepatitis A
Explanation:Disease specific immunoglobulins are available for:hepatitis Brabiestetanusvaricella-zosterNormal immunoglobulin can be used to confer protection against hepatitis A.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 10
Incorrect
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Which of these cell types in the stomach releases pepsinogen?
Your Answer: G-cells
Correct Answer: Chief cells
Explanation:The gastric chief cells in the stomach wall releases pepsinogen. Pepsinogen is a proenzyme. It mixes with hydrochloric acid in the stomach and is converted to pepsin. Pepsin breaks down proteins into peptides aiding protein digestion.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 11
Incorrect
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Which of the following anatomic structures will gallstones most likely lodge into, and cause cholestasis?
Your Answer: Common bile duct
Correct Answer: Hartmann’s pouch
Explanation:Hartmann’s pouch is a diverticulum that can occur at the neck of the gallbladder. It is one of the rarest congenital anomalies of the gallbladder. Hartmann’s gallbladder pouch is a frequent but inconsistent feature of normal and pathologic human gallbladders. It is caused by adhesions between the cystic duct and the neck of the gallbladder. As a result, it is classified as a morphologic rather than an anatomic entity.There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 12
Correct
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Which JVP waveform correlates to atrial systole?
Your Answer: The a wave
Explanation:JVP Waveform in Cardiac Cycle Physiology: a wave Right atrial contraction causes atrial systole (end diastole). the c wave During right isovolumetric ventricular contraction, the tricuspid valve bulges into the right atrium, resulting in isovolumetric contraction (early systole). descent by x Rapid ventricular ejection (mid systole) is caused by a combination of right atrial relaxation, tricuspid valve downward movement during right ventricular contraction, and blood ejection from both ventricles. the v-wave Ventricular ejection and isovolumetric relaxation (late systole) occur as a result of venous return filling the right atrium. y lineage Ventricular filling occurs when the tricuspid valve opens, allowing blood to flow rapidly from the right atrium to the right ventricle.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 13
Correct
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Which of the following is NOT a function of bile:
Your Answer: Digestion of fats into monoglycerides and fatty acids.
Explanation:Bile functions to eliminate endogenous and exogenous substances from the liver (including bilirubin), to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile salts also act as bactericides, destroying many of the microbes that may be present in the food. Bile doesn’t contain digestive enzymes for digestion of lipids into monoglycerides and fatty acids; this is performed mainly by pancreatic lipase.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 14
Incorrect
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Regarding oral rehydration therapy, which of the following statements is INCORRECT:
Your Answer: Oral rehydration solutions should contain an alkalinising agent to counter acidosis.
Correct Answer: Oral rehydration solutions should be slightly hyperosmolar.
Explanation:Oral rehydration therapy (ORT) is a fluid replacement strategy used to prevent or treat dehydration. It is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries. Oral rehydration solutions should be slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.ORT contains glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia. It also contains essential mineral salts.Current NICE guidance recommends that 50 ml/kg is given over 4 hours for the treatment of mild dehydration.Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 15
Correct
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A 32-year-old female is diagnosed case of bipolar disorder and is on medication. She presents to her psychiatric team with symptoms of severe depression. She is currently taking Lithium. Out of the following, which is TRUE regarding lithium?
Your Answer: It commonly causes a tremor
Explanation:Lithium is the drug of choice for bipolar disorders but is commonly associated with side effects and toxicity. Fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy with Lithium. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer. Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremors.Option The normal therapeutic range is 2.0-2.5 mmol/l: Lithium should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l. Levels should be checked one week after starting therapy and one week after every change in dosage. (Option Levels should be checked one month after starting therapy) Option It can induce hyperthyroidism: Lithium has a known effect on thyroid function. Lithium decreases the production of T4 and T3 and commonly causes hypothyroidism. More rarely, lithium causes hyperthyroidism due to thyroiditis.Option It can induce diabetes mellitus: Lithium can induce nephrogenic diabetes insipidus but not diabetes mellitus.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 16
Incorrect
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The renin-angiotensin-aldosterone system (RAAS) controls blood pressure and fluid balance.Which of the following sites produces the most angiotensinogen?Â
Your Answer: The kidneys
Correct Answer: The liver
Explanation:Angiotensinogen is an alpha-2-globulin generated predominantly by the liver and released into the blood. Renin, which cleaves the peptide link between the leucine and valine residues on angiotensinogen, converts it to angiotensin I.Angiotensinogen levels in the blood are raised by:Corticosteroid levels have risen.Thyroid hormone levels have risen.Oestrogen levels have risen.Angiotensin II levels have risen.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 17
Correct
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Which of the following classes of drugs may predispose to lithium toxicity:
Your Answer: Thiazide diuretics
Explanation:Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 18
Incorrect
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The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.Which of the following patients has had adequate tetanus protection?
Your Answer: 28-year-old man from Poland, cuts leg whilst working in garden, wound heavily contaminated with soil, uncertain of vaccination history – receives vaccination
Correct Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin
Explanation:25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 19
Incorrect
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Which of the following clinical features would you NOT expect to see in a tibial nerve palsy:
Your Answer: Loss of sensation over sole of the foot
Correct Answer: Weakened eversion of the foot
Explanation:Damage to the tibial nerve results in loss of plantarflexion of the ankle and weakness of inversion of the foot resulting in a shuffling gait, clawing of the toes and loss of sensation in its cutaneous distribution.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 20
Incorrect
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Gastrin release from antral G-cells is stimulated by all but which one of the following:
Your Answer: Vagal stimulation
Correct Answer: Secretin
Explanation:Gastrin secretion is stimulated by: The presence of small peptides and amino acids in chymeGastric distensionVagal stimulation directly via acetylcholine and indirectly via gastrin-releasing peptide (GRP)Raised gastric pH
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 21
Correct
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What is the main mechanism of action of flecainide:
Your Answer: Blocks Na+ channels
Explanation:Flecainide inhibits the transmembrane influx of extracellular Na+ ions via fast channels on cardiac tissues resulting in a decrease in rate of depolarisation of the action potential, prolonging the PR and QRS intervals. At high concentrations, it exerts inhibitory effects on slow Ca2+ channels, accompanied by moderate negative inotropic effect.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 22
Correct
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A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon observation and examination, it was noted that he is febrile and Kernig's sign is positive. A diagnosis of meningitis was suspected and a lumbar puncture was to be performed.Which of the following statements regarding meningitis is true?
Your Answer: The dura mater is the outermost layer
Explanation:Meningitis is defined as the inflammation of the meninges due to an infection caused by a bacteria or a virus. Symptoms usually include stiffness of the neck, headache, and fever. There are 3 meningeal layers that surround the spinal cord and they are the dura mater, arachnoid matter, and pia mater. The dura mater is the outermost and thickest layer out of all the 3 layers. The arachnoid atter is the middle layer, and is very thin.The third and deepest meningeal layer is the pia mater that is bound tightly to the surface of the spinal cord.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 23
Incorrect
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Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 12 months:
Your Answer: Meningococcal group C
Correct Answer: Polio
Explanation:At 12 months the following vaccines are given:Hib (4th dose) and Meningococcal group CPneumococcal (13 serotypes) (2nd dose)Measles, mumps and rubellaMeningococcal group B (3rd dose)
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 24
Correct
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Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.Which of the following statements about aspirin's mechanism of action is correct?
Your Answer: Inhibition of cyclo-oxygenase
Explanation:Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 25
Incorrect
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All of the following are physiological effects of thyroid hormones except:
Your Answer: Increased cardiac output
Correct Answer: Increased glycogenesis
Explanation:Thyroid hormones have multiple physiological effects on the body. These include:1. Heat production (thermogenesis)2. Increased basal metabolic rate3. Metabolic effects: (a) Increase in protein turnover (both synthesis and degradation are increased, although overall effect is catabolic)(b) Increase in lipolysis(c)Increase in glycogenolysis and gluconeogenesis4. Enhanced catecholamine effect – Increase in heart rate, stroke volume and thus cardiac output5. Important role in growth and development
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 26
Correct
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One of your patients is in resuscitation and is suffering from kidney failure. The intensive care outreach team arrives to assess them and determines that a dopamine infusion is necessary.Dopamine primarily acts on which of the following receptors at low doses?
Your Answer: Dopamine receptors
Explanation:Dopamine is a catecholamine that occurs naturally and is used to treat low cardiac output, septic shock, and renal failure. It is both adrenaline and noradrenaline’s immediate precursor.Dopamine acts on D1 and D2 dopamine receptors in the renal, mesenteric, and coronary beds at low doses (1-5 g/kg/min). Dopamine causes a significant decrease in renal vascular resistance and an increase in renal blood flow at these doses. Within this dose range, it is also involved in central modulation of behaviour and movement.Dopamine stimulates beta- and alpha-adrenergic receptors directly and indirectly at higher doses. Beta-stimulation predominates at a rate of 5-10 g/kg/min, resulting in a positive inotropic effect that increases cardiac output and coronary blood flow. Alpha-stimulation predominates at infusion rates greater than 15 g/kg/min, resulting in peripheral vasoconstriction and an increase in venous return and systolic blood pressure.Below is a summary of the mechanisms and effects of various inotropic agents:InotropeMechanismEffectsAdrenaline (epinephrine)Beta-1 and -2 agonist at increasing doses;Alpha-agonist at high dosesIncreased cardiac output;Vasoconstriction at higher dosesNoradrenaline (norepinephrine)Mainly alpha-agonist;Beta-1 and -2 agonist at increasing dosesVasoconstriction;Some increased cardiac outputDopamineDopamine agonist at low doses;Beta-1 and -2 agonist at increasing doses;Alpha-agonist at high dosesIncreased cardiac output;Vasoconstriction at higher dosesDobutamineMainly beta-1 agonistIncreased cardiac output
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 27
Correct
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In relation to ketamine, which of the following statements is TRUE:
Your Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.
Explanation:Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 28
Incorrect
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Which of the following is NOT a typical cerebellar sign:
Your Answer: Hypotonia
Correct Answer: Resting tremor
Explanation:An intention tremor is characteristic of cerebellar dysfunction. Resting tremor may be seen in Parkinsonism.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 29
Correct
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What is the main mechanism of action of cyclizine:
Your Answer: Histamine-H1 antagonist
Explanation:Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 30
Correct
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A diagnosis of acute osteomyelitis was made on a patient with a known history of sickle cell disease. He has no joint prosthesis on in-dwelling metal work and no known drug allergies.Which of the following is most likely the causative agent of the case presented above?
Your Answer: Salmonella spp .
Explanation:Patients with sickle cell disease are prone to infection of the bone and bone marrow in areas of infarction and necrosis. Although Staphylococcus aureus is the most common cause of osteomyelitis in the general population, studies have shown that in patients with sickle cell disease, the relative incidence of Salmonella osteomyelitis is twice that of staphylococcal infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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SESSION STATS - PERFORMANCE PER SPECIALTY
