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Question 1
Correct
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Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT:
Your Answer: There is a much greater predilection to disseminate to extranodal sites than in Hodgkin lymphoma.
Explanation:Non-Hodgkin’s lymphoma (NHL) refers to a group of lymphoproliferative malignancies (about 85% of B-cell and 15% of T or NK (natural killer) cell origin) with different behavioural patterns and treatment responses. This group of malignancies encompasses all types of lymphoma without Reed-Sternberg cells being present. The Reed-Sternberg cell is classically seen in Hodgkin’s lymphoma.NHL is five times as common as Hodgkin’s lymphoma. The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.The following are recognised risk factors for NHL:Chromosomal translocations and molecular rearrangementsEpstein-Barr virus infectionHuman T-cell leukaemia virus type-1 (HTLV-1)Hepatitis CCongenital and acquired immunodeficiency statesAutoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditisThe most common clinical features at presentation are:Lymphadenopathy (typically asymmetrical and painless)Weight lossFatigueNight sweatsHepatosplenomegalyFor clinical purposes, NHL is divided into three groups: indolent, high-grade, and lymphoblastic.Indolent (low-grade) NHL:The cells are relatively matureDisease follows an indolent course without treatmentOften acceptable to follow a ‘watch and wait’ strategyLocal radiotherapy often effectiveRelatively good prognosis with median survival of 10 yearsHigh-grade NHL:Cells are immatureDisease progresses rapidly without treatmentSignificant number of patients can be cured with intensive combination chemotherapy regimensApproximately 40% cure rateLymphoblastic NHL:Cells are very immature and have a propensity to involve the CNSTreatment and progression are similar to that of acute lymphoblastic leukaemia (ALL)
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This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Incorrect
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Which of the following factors does NOT decrease glucagon secretion:
Your Answer: Somatostatin
Correct Answer: Catecholamines
Explanation:Factors that increase glucagon secretion:↓ Blood glucose↑ Amino acidsCholecystokininCatecholaminesAcetylcholineFactors that decrease glucagon secretion:↑ Blood glucoseInsulinSomatostatinFatty acids, ketoacids
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 3
Correct
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Hepatitis A is transmitted by which of the following routes:
Your Answer: Faecal-oral route
Explanation:Hepatitis A transmission is by the faecal-oral route; the virus is excreted in bile and shed in the faeces of infected people.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 4
Incorrect
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You review a patient with urinary sepsis and decide to start her on gentamicin.Which statement about gentamicin is true?
Your Answer: It acts by binding to the 50S subunit
Correct Answer: Ototoxicity is a dose-related effect
Explanation:Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.Gentamicin is given by injection because it is NOT absorbed orally. It is excreted in the kidneys by glomerular filtrationGentamicin is not to be used for the treatment of Neisseria meningitidis, Neisseria gonorrhoea, or Legionella pneumophila.There is a risk of patient going into shock from lipid A endotoxin release.Two of its most notable side effects are hearing loss reversible nephrotoxicity and which are both dose-related and levels should be monitored in patients.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 5
Incorrect
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Regarding aspirin at analgesic doses, which of the following statements is CORRECT:
Your Answer: The increased production of prostaglandins can irritate gastric mucosa.
Correct Answer: It is contraindicated in patients with severe heart failure.
Explanation:Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 6
Correct
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Which of the following is NOT a common effect of etomidate:
Your Answer: Significant hypotension
Explanation:Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 7
Incorrect
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Regarding threadworms, which of the following statements is CORRECT:
Your Answer: Symptoms are usually of abdominal discomfort and a change in bowel habit.
Correct Answer: First line treatment of threadworms is with mebendazole.
Explanation:First line treatment of threadworms is with mebendazole, with treatment of the whole family, and a repeat treatment after 2 weeks. Threadworms live in the large bowel, but direct multiplication of worms does not occur here. Threadworms most commonly infect children, and may be symptomatic or cause pruritus ani.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 8
Correct
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A 32 year old woman presents with episodes of flushing, headaches and palpitations. On examination her blood pressure is significantly elevated. Which of the following is the most likely diagnosis:
Your Answer: Pheochromocytoma
Explanation:Phaeochromocytomas are catecholamine-secreting tumours which occur in about 0.1% of patients with hypertension. In about 90% of cases they arise from the adrenal medulla. The remaining 10%, which arise from extra-adrenal chromaffin tissue, are termed paragangliomas. Common presenting symptoms include one or more of headache, sweating, pallor and palpitations. Less commonly, patients describe anxiety, panic attacks and pyrexia. Hypertension, whether sustained or episodic, is present in at least 90% of patients. Left untreated phaeochromocytoma can occasionally lead to hypertensive crisis, encephalopathy, hyperglycaemia, pulmonary oedema, cardiac arrhythmias, or even death.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 9
Incorrect
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Which family of receptors does the glucagon receptor belong?
Your Answer: Enzyme-linked receptors
Correct Answer: G-protein coupled receptors
Explanation:Glucagon binds to class B G-protein coupled receptors and activates adenylate cyclase, increasing cAMP intracellularly. This activates protein kinase A. Protein kinase A phosphorylates and activates important enzymes in target cells.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 10
Incorrect
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A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer: Posterior inferior cerebellar artery
Correct Answer: Anterior spinal artery
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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SESSION STATS - PERFORMANCE PER SPECIALTY
