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Question 1
Incorrect
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Which of the following is NOT mainly characterised by intravascular haemolysis:
Your Answer: Thrombotic thrombocytopenic purpura
Correct Answer: Beta-Thalassaemia
Explanation:Causes of intravascular haemolysis:Haemolytic transfusion reactionsG6PD deficiencyRed cell fragmentation syndromesSome severe autoimmune haemolytic anaemiasSome drug-and infection-induced haemolytic anaemiasParoxysmal nocturnal haemoglobinuria
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This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Correct
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The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the postsynaptic cell responds to the neurotransmitter.Which of the following enzymes catalyses the breakdown of noradrenaline?
Your Answer: Catechol-O-methyltransferase (COMT)
Explanation:The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the post-synaptic cell responds to the neurotransmitter. This can be accomplished in a variety of ways:Re-uptakeBreakdownDiffusionSerotonin is an example of a neurotransmitter that is uptake. Serotonin is absorbed back into the presynaptic neuron via the serotonin transporter (SERT), which is found in the presynaptic membrane. Re-uptake neurotransmitters are either recycled by repackaging into vesicles or broken down by enzymes.Specific enzymes found in the synaptic cleft can also break down neurotransmitters. The following enzymes are examples of these enzymes:Acetylcholinesterase (AChE) catalyses the acetylcholine breakdown (ACh)The enzyme catechol-O-methyltransferase (COMT) catalyses the breakdown of catecholamines like adrenaline , dopamine and noradrenaline. The breakdown of catecholamines, as well as other monoamines like serotonin, tyramine, and tryptamine, is catalysed by monoamine oxidases (MOA).Diffusion of neurotransmitters into nearby locations can also be used to eliminate them.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 3
Incorrect
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A 59-year-old man presents to the emergency room with chest pain. The cardiology team recently discharged him. He underwent a procedure and was given several medications, including abciximab, during his stay. Which of the following statements about abciximab is correct?
Your Answer: It is a glycoprotein IIb/IIIa receptor agonist
Correct Answer: The platelet count should be checked 2-4 hours after starting treatment
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.It’s approved for use as a supplement to heparin and aspirin in high-risk patients undergoing percutaneous transluminal coronary intervention to prevent ischaemic complications. Only one dose of abciximab should be given (to avoid additional risk of thrombocytopenia).
Before using, it is recommended that baseline prothrombin time, activated clotting time, activated partial thromboplastin time, platelet count, haemoglobin, and haematocrit be measured. 12 and 24 hours after starting treatment, haemoglobin and haematocrit should be measured again, as should platelet count 2-4 hours and 24 hours after starting treatment.
When used for high-risk patients undergoing angioplasty, the EPIC trial found that abciximab reduced the risk of death, myocardial infarction, repeat angioplasty, bypass surgery, and balloon pump insertion.The use of abciximab is contraindicated in the following situations:
Internal bleeding is present.
Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
Stroke in the previous two yearsIntracranial tumour
Aneurysm or arteriovenous malformation
Haemorrhagic diathesis
Vasculitis
Retinopathy caused by hypertension
The following are some of the most common abciximab side effects:
Manifestations of bleeding
Bradycardia
Back ache
Pain in the chest
Vomiting and nausea
Pain at the puncture site
Thrombocytopenia
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 4
Incorrect
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An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:
Your Answer: Weakness of abduction of the arm
Correct Answer: Weakness of medial rotation of the arm
Explanation:Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus. The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Incorrect
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Which segment of the colon is most likely to be affected in diverticulitis?
Your Answer: Descending colon
Correct Answer: Sigmoid colon
Explanation:Diverticulitis refers to inflammation and infection associated with a diverticulum and is estimated to occur in 10% to 25% of people with diverticulosis. Peridiverticular and pericolic infection results from a perforation (either macroscopic or microscopic) of a diverticulum, which leads to contamination, inflammation, and infection. The spectrum of disease ranges from mild, uncomplicated diverticulitis that can be treated in the outpatient setting, to free perforation and diffuse peritonitis that requires emergency laparotomy. Most patients present with left sided abdominal pain, with or without fever, and leucocytosis. The most common location for diverticulitis is the sigmoid colon.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 6
Correct
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An X-ray of a 24-year-old female hockey player who arrives at the hospital with a left foot injury reveals an avulsion fracture of the fifth metatarsal tuberosity. Which of the following muscles is most likely responsible for the movement of the fractured fragment?
Your Answer: Fibularis brevis
Explanation:An avulsion fracture of the base of the fifth metatarsal happens when the ankle is twisted inwards. When the ankle is twisted inwards a muscle called the fibularis brevis contracts to stop the movement and protect the ligaments of the ankle. The base of the fifth metatarsal is where this muscle is attached. The group of lateral leg muscles that function to plantarflex the foot includes the fibularis brevis and the fibularis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 7
Incorrect
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Where does angiotensin II directly act on the renal nephron:
Your Answer: Distal convoluted tubule
Correct Answer: Proximal tubule
Explanation:Angiotensin II acts to directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters).
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This question is part of the following fields:
- Physiology
- Renal
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Question 8
Correct
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Which of the following is NOT a pharmacological effect of beta-blockers:
Your Answer: Reduced AV conduction time
Explanation:Effects of beta-blockers:Cardiovascular system: Reduce blood pressureReduce heart rate, contractility and cardiac outputIncrease AV conduction time, refractoriness and suppress automaticityEye:Reduce intraocular pressureRespiratory system:Cause bronchoconstriction
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 9
Correct
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Fusidic acid is primarily indicated for infections caused by which of the following microorganisms:
Your Answer: Staphylococcal infections
Explanation:Fusidic acid is a narrow spectrum antibiotic used for staphylococcal infections, primarily topically for minor staphylococcal skin (impetigo) or eye infection. It is sometimes used orally for penicillin-resistant staphylococcal infection, including osteomyelitis or endocarditis, in combination with other antibacterials.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 10
Incorrect
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A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.
Your Answer: Pulmonary capillary blood will have similar PO 2 and PCO 2
Correct Answer: Atelectasis is an example of a perfusion defect
Explanation:Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 11
Incorrect
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A 33 year old female patient presents to emergency room with some symptoms that she thinks might be due to a drug that she has recently started. She was started on hyoscine butyl bromide for symptomatic relief of irritable bowel syndrome. The least likely expected side effect of this drug in this patient is:
Your Answer: Dry mouth
Correct Answer: Diarrhoea
Explanation:One of the commonest antispasmodic medications that is used is hyoscine butylbromide. It is an antimuscarinic and typical side effects of this class of drugs include:- dilation of pupils with loss of accommodation (cycloplegia) -photophobia resulting in blurred vision (Blind as a bat) -dry mouth, eyes and skin (Dry as a bone), -elevated temperature (Hot as a hare)-skin flushing (Red as a beet)-confusion or agitation particularly in the elderly (Mad as a hatter)-reduced bronchial secretions-transient bradycardia followed by tachycardia, palpitation and arrhythmias-urinary retention and/or constipation
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 12
Incorrect
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Doxycycline is indicated first line for treatment of which of the following infections:
Your Answer:
Correct Answer: Chlamydia
Explanation:Doxycycline may be used first line for chlamydia, pelvic inflammatory disease (with metronidazole and ceftriaxone), acute bacterial sinusitis, exacerbation of chronic bronchitis, moderate-severity community acquired pneumonia and high-severity community acquired pneumonia (with benzylpenicillin).
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 13
Incorrect
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Regarding antihistamines, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Elderly patients and children are more susceptible to side effects.
Explanation:Elderly patients and children are more susceptible to side effects. Antihistamines are competitive inhibitors at the H1-receptor. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent. Antihistamines are used as a second line adjunct to adrenaline in anaphylaxis.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 14
Incorrect
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Liquefactive necrosis is most commonly seen in which of the following conditions:
Your Answer:
Correct Answer: Ischaemic stroke
Explanation:Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 15
Incorrect
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A 60-year-old man with insulin-controlled diabetes mellitus asks you about how his ability to drive is affected. He owns a car as well as a motorcycle.Which of the following statements about driving with diabetes under insulin control is correct?
Your Answer:
Correct Answer: He must monitor his blood glucose levels every 2 hours whilst driving
Explanation:The DVLA sends a detailed information sheet about their licence and driving to all drivers with diabetes mellitus. The primary danger of driving while diabetic is hypoglycaemia.The DVLA must be notified of the following diabetic patients:All of the drivers are on insulin. (Licenses are being reviewed more frequently.)Those who are at high risk of hypoglycaemia and have had more than one episode of severe hypoglycaemia in the previous year. (Severe hypoglycaemia is defined as requiring the assistance of another person to manage.)Those who are unaware of their hypoglycaemiaAnyone who has ever been in a car accident due to hypoglycaemiaAnyone with diabetic retinopathy who needs laser treatment (to both eyes or to a second eye if sight only in one eye)Patients with diabetes complications that impair their ability to drive.To drive, drivers with insulin-treated diabetes must meet the following requirements:They need to be aware of hypoglycaemia.They must not have had more than one episode of hypoglycaemia in the previous 12 months that necessitated the assistance of another person.They must check their blood glucose levels no later than 2 hours before the first journey.While driving, they must check their blood glucose levels every two hours.The visual acuity and visual field standards must be met.Any significant changes in their condition must be reported to the DVLA. Furthermore, on days when they are not driving, group 2 licence holders must test their blood glucose twice daily using a metre that can store three months’ worth of readings.In addition to this advice, the DVLA also offers the following advice to diabetic patients:When taking tablets that have the potential to cause hypoglycaemia (such as sulfonylureas and glinides), monitoring may be necessary if there has been more than one episode of severe hypoglycaemia.Drivers must show good control and be able to recognise hypoglycaemia.Verify that your vision meets the required standard.If a patient feels hypoglycaemic or has a blood glucose level of less than 4.0 mmol/L, they should not drive. Driving should not be resumed until blood glucose levels have returned to normal, which should take 45 minutes.If there are any warning signs, patients should carry rapidly absorbed sugar in their vehicle and stop, turn off the ignition, and eat it.If resuscitation is required, a card stating which medications they are taking should be carried.If hypoglycaemia causes an accident, a diabetic driver may be charged with driving under the influence of drugs.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 16
Incorrect
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Which of the following is NOT an effect of gastrin:
Your Answer:
Correct Answer: Stimulation of insulin release
Explanation:Gastrin acts to:Stimulate acid secretion from parietal cells (both directly and indirectly by stimulating release of histamine from ECL cells)Stimulate pepsinogen secretion from chief cellsIncrease gastric motilityStimulate growth of gastric mucosa
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 17
Incorrect
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Regarding the phases of gastric secretion, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: A high pH in the stomach inhibits gastrin secretion.
Explanation:A low pH in the stomach inhibits gastrin secretion, therefore when the stomach is empty or when acid has been secreted for some time after food has entered it, there is inhibition of acid secretion. However, when food first enters the stomach, the pH rises, and this leads to release of the inhibition and causes a maximum secretion of gastrin. Thus gastric acid secretion is self-regulating.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 18
Incorrect
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Which of the following is the most common cause of hyperthyroidism:
Your Answer:
Correct Answer: Graves disease
Explanation:Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disease in which autoantibodies against TSH receptors are produced. These antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Therefore, the signs and symptoms of Graves disease are the same as those of hyperthyroidism, reflecting the actions of increased circulating levels of thyroid hormones: increased heat production, weight loss, increased 02 consumption and cardiac output and exophthalmos (bulging eyes, not drooping eyelids). TSH levels will be decreased (not increased) as a result of the negative feedback effect of increased T3 levels on the anterior pituitary.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 19
Incorrect
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A 53-year-old male has presented to your clinic with the complaint of a rash on his right forearm. On examination, you discover small reddish-purple spots on the skin measuring less than 2-3 mm. They do not blanch on applying pressure. Which one of the following best fits the description given above?
Your Answer:
Correct Answer: Petechiae
Explanation:Petechiae are small red or purple spots on the skin measuring less than 3 mm, caused by minor haemorrhages which do not blanch on applying pressure.Purpura measures between 3mm and 1 cm in diameter, while ecchymoses are greater than 1 cm in diameter. Both are caused due to haemorrhage. Erythema is the generalised redness of the skin. A macule is a flat, discoloured area of the skin measuring less than 1 cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 20
Incorrect
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Which of the following increases the tendency for oedema to occur?
Your Answer:
Correct Answer: Increased venous pressure
Explanation:When more fluid is filtered out of the capillaries than can be returned to the circulation by the lymphatics, oedema occurs. Changes that increase capillary hydrostatic pressure or decrease plasma oncotic pressure will increase filtration. Arteriolar constriction reduces hydrostatic capillary pressure and transiently increase absorption of fluid. Dehydration increases plasma protein concentration and therefore increases plasma oncotic pressure and absorption. Capillary hydrostatic pressure and filtration are increased when there is increased venous pressure.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 21
Incorrect
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A 66-year-old female presents to the Emergency Department with a nose bleed. She says that she has been having frequent episodes of nose bleeds over the past four months, along with increasing fatigue and some weight loss. On examination, she has a diffuse petechial rash and hypertrophy of the gingiva. Which one of the following conditions is this patient most likely to have?
Your Answer:
Correct Answer: Acute myeloid leukaemia (AML)
Explanation:The history of nosebleeds and fatigue, and gingival hyperplasia presents a typical picture of acute myeloid leukaemia. Leukemic infiltrates within the gingiva cause hypertrophy and distinguish this condition from other types of leukaemia. The fatigue is secondary to anaemia, while the nosebleeds are caused by thrombocytopenia secondary to leukemic infiltration of bone marrow. Patients may also report frequent infections secondary to neutropenia and hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 22
Incorrect
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Which of the following does NOT typically cause a neutrophil leucocytosis:
Your Answer:
Correct Answer: Glandular fever
Explanation:Causes of neutrophil leucocytosis:Bacterial infectionInflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)PregnancyAcute haemorrhage or haemolysisNeoplasms of all typesDrugs (e.g. corticosteroid therapy, lithium, tetracyclines)AspleniaMyeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)Rare inherited disorders
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 23
Incorrect
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Which of the following antibiotics may be used for malaria prophylaxis:
Your Answer:
Correct Answer: Doxycycline
Explanation:Doxycycline may be used for malaria prophylaxis and as an adjunct to quinine in the treatment of Plasmodium falciparum malaria.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 24
Incorrect
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A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.Which of the following statements regarding the opponens pollicis muscle is considered correct?
Your Answer:
Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint
Explanation:Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 25
Incorrect
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer:
Correct Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 26
Incorrect
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Many of the chemical digestion and absorption takes place in the small intestine. Most digestive enzymes in the small intestine are secreted by the pancreas and enter the small intestine through the pancreatic duct.Which of these digestive enzymes is responsible for breaking down carbohydrates into monosaccharides?
Your Answer:
Correct Answer: Glucoamylase
Explanation:Majority of carbohydrates are broken down into monosaccharides (glucose, fructose galactose) and are absorbed by the small intestine. Enzymes released from the brush border break down carbohydrate. Some carbohydrates, such as cellulose, are not digested at all, despite being made of multiple glucose units. This is because the cellulose is made out of beta-glucose that makes the inter-monosaccharide bindings different from the ones present in starch, which consists of alpha-glucose. Humans lack the enzyme for splitting the beta-glucose-bond.The principal brush border enzymes are dextranase and glucoamylase. Other brush border enzymes are maltase, sucrase, and lactase.Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Dextranase and glucoamylase, then further break down oligosaccharides.Trypsin aids in digestion of protein.Chymotrypsin is a proteolytic enzyme that digests proteinCarboxypeptidase hydrolyses the first peptide or amide bond at the carboxyl or C-terminal end of proteins and peptides
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 27
Incorrect
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An ambulance transports a 40-year-old man to the hospital. He ingested a significant amount of aspirin.In the early stages of an aspirin overdose, which form of acid-base problem should you anticipate?
Your Answer:
Correct Answer: Respiratory alkalosis
Explanation:When you take too much aspirin, you have a mix of respiratory alkalosis and metabolic acidosis. Respiratory centre stimulation produces hyperventilation and respiratory alkalosis in the early phases. The direct acid actions of aspirin tend to create a higher anion gap metabolic acidosis in the latter phases.Below summarizes some of the most common reasons of acid-base abnormalities:Respiratory alkalosis: – Hyperventilation (e.g. anxiety, pain, fever)- Pulmonary embolism- Pneumothorax- CNS disorders (e.g. CVA, SAH, encephalitis)- High altitude- Pregnancy- Early stages of aspirin overdoseRespiratory acidosis:- COPD- Life-threatening asthma- Pulmonary oedema- Respiratory depression (e.g. opiates, benzodiazepines)- Neuromuscular disease (e.g. Guillain-Barré syndrome, muscular dystrophy- Incorrect ventilator settings (hypoventilation)- ObesityMetabolic alkalosis:- Vomiting- Cardiac arrest- Multi-organ failure- Cystic fibrosis- Potassium depletion (e.g. diuretic usage)- Cushing’s syndrome- Conn’s syndromeMetabolic acidosis (with raised anion gap):- Lactic acidosis (e.g. hypoxaemia, shock, sepsis, infarction)- Ketoacidosis (e.g. diabetes, starvation, alcohol excess)- Renal failure- Poisoning (e.g. late stages of aspirin overdose, methanol, ethylene glycol)Metabolic acidosis (with normal anion gap):- Renal tubular acidosis- Diarrhoea- Ammonium chloride ingestion- Adrenal insufficiency
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 28
Incorrect
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Which of the following is where the rectovesical fascia is located:
Your Answer:
Correct Answer: Between the fundus of the bladder and the ampulla of the rectum
Explanation:In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 29
Incorrect
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One of these statements about cohort studies is true:
Your Answer:
Correct Answer: They are longitudinal in nature
Explanation:A cohort study is a longitudinal, observational study. It follows a group of patients (the cohort) forward in time and monitors the effects of the aetiological factor under study upon them.Cohort studies are usually of longer duration and are more expensive than case-control studies. They, however, provide more useful and reliable information.Cohort studies follow a cohort of patients who don’t have a disease and evaluate the absolute and relative risk of contracting the disease after exposure to the aetiological agent.Cross-sectional studies are the best way to determine the prevalence of a disease. while Cohort studies are better at determining the incidence of a disease.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 30
Incorrect
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The stomach G-cells are responsible for which of the following?
Your Answer:
Correct Answer: Secretion of gastrin
Explanation:G-cells are a type of cell found in the stomach’s pyloric antrum, duodenum, and pancreas. The secretion of the peptide hormone gastrin is their major function.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 31
Incorrect
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Which of the following best describes the process of opsonisation:
Your Answer:
Correct Answer: The coating of foreign particles with molecules which allow easier recognition of that cell by phagocytes
Explanation:An opsonin is any molecule that enhances phagocytosis by marking an antigen for an immune response, for example, immunoglobulin or complement. Opsonisation is the molecular mechanism whereby molecules, microbes, or apoptotic cells are chemically modified to have a stronger attraction to the cell surface receptors on phagocytes and natural killer cells. With the antigen coated in opsonins, binding to immune cells is greatly enhanced. Opsonisation also mediates phagocytosis via signal cascades from cell surface receptors.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 32
Incorrect
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Which of the following best describes the popliteal artery's course?
Your Answer:
Correct Answer: After exiting the popliteal fossa terminates at the lower border of the popliteus muscle
Explanation:The popliteal artery divides into the anterior and posterior tibial arteries at the lower border of the popliteus after exiting the popliteal fossa between the gastrocnemius and popliteus muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 33
Incorrect
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Since the fluid that enters the loop of Henle is isotonic, what is its estimated osmolality?
Your Answer:
Correct Answer: 300 mOsm
Explanation:The loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It is consists of three major segments, the thin descending limb, the thin ascending limb, and the thick ascending limb. The segments are differentiated based on structure, anatomic location, and function. The main action of the loop of Henle is to recover water and sodium chloride from urine. The liquid entering the loop of Henle is a solution of salt, urea, and other substances traversed along by the proximal convoluted tubule, from which most of the dissolved components are needed by the body, particularly glucose, amino acids, and sodium bicarbonate that have been reabsorbed into the blood. This fluid is isotonic. Isotonic fluids generally have an osmolality ranging from 270 to 310 mOsm/L. With the fluid that enters the loop of Henle, it is estimated to be 300 mOsm/L. However, after passing the loop, fluid entering the distal tubule is hypotonic to plasma since it has been diluted during its passage.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 34
Incorrect
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Urine flow rate = 2 ml/minUrine concentration of creatinine = 18 mg/ml Plasma concentration of creatinine = 0.25 mg/ml What is the estimated glomerular filtration rate (eGFR)?
Your Answer:
Correct Answer: 144 ml/min
Explanation:GFR can be estimated by:GFR = UCr x V / PCrWhere:UCr = urine concentration of creatininePCr = plasma concentration of creatinineV = rate of urine flowIn this case GFR = (18 x 2) / 0.25 = 144 ml/minNote: Creatinine is used to estimate GFR because it is an organic base naturally produced by muscle breakdown, it is freely filtered at the glomerulus, it is not reabsorbed from the nephron, it is not produced by the kidney, it is not toxic, and it doesn’t alter GFR.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 35
Incorrect
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Which of the following movements does the iliacus muscle produce?
Your Answer:
Correct Answer: Flexion of the thigh at the hip joint
Explanation:The iliacus flexes the thigh at the hip joint when the trunk is stabilised. It flexes the trunk against gravity when the body is supine.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 36
Incorrect
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A 30-year-old male with a known allergy to natural latex rubber presents with an allergic reaction to a food he has just eaten. Which ONE of these foods is most likely to cause an associated hypersensitivity in him?
Your Answer:
Correct Answer: Banana
Explanation:About one third of patients with allergy to natural latex rubber (NRL) have an associated allergy to some plant-derived foods. It is known as the latex-fruit syndrome and occurs commonly with consumption of fresh fruits. Banana and avocado are the most implicated fruits but it can also be seen with tomato, kiwi and chestnut.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 37
Incorrect
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Ipratropium bromide should be used with caution in patients with which of the following conditions:
Your Answer:
Correct Answer: Prostatic hyperplasia
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma)
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 38
Incorrect
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A 23 year old student presents to ED with a widespread maculopapular rash. She recently had a sore throat and was started on a course of antibiotics. The most likely antibiotic that she was prescribed is:
Your Answer:
Correct Answer: Amoxicillin
Explanation:Maculopapular rashes are commonly seen with ampicillin and amoxicillin. However they are not usually related to true penicillin allergy. Very often, they occur in patients with glandular fever and so, broad-spectrum penicillins should not be used blindly, for management and treatment of a sore throat. There is also an increased risk of rash in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 39
Incorrect
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A 26-year-old man is involved in a motorcycle accident that results in an open fracture of his tibia and fibula. The nerve that innervates peroneus tertius is damaged as a consequence of his injuries.Peroneus tertius receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Deep peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.Peroneus longus is innervated by the superficial peroneal nerve.Peroneus tertius is innervated by the deep peroneal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 40
Incorrect
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Salbutamol should be used with caution in patients with which of the following:
Your Answer:
Correct Answer: Susceptibility to QT-interval prolongation
Explanation:Beta-2 agonists should be used with caution in people with: Cardiovascular disease, including arrhythmias and hypertension (beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate)Diabetes(risk of hyperglycaemia and ketoacidosis, especially with intravenous use)Hyperthyroidism(beta-2 agonists may stimulate thyroid activity)Hypokalaemia(potentially serious hypokalaemia may result from beta-2 agonist therapy; this effect may be potentiated in severe asthma by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia)Susceptibility to QT-interval prolongationConvulsive disorders
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 41
Incorrect
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Regarding the lumbar plexus, which of the following is a direct muscular branch?
Your Answer:
Correct Answer: Nerve to quadratus lumborum
Explanation:The lumbar plexus gives rise to several branches which supply various muscles and regions of the posterior abdominal wall and lower limb. These branches include the Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral and obturator nerves.In addition, the lumbar plexus gives off muscular branches from its roots, a branch to the lumbosacral trunk and occasionally an accessory obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 42
Incorrect
-
Herpes simplex virus is transmitted most commonly through which of the following routes:
Your Answer:
Correct Answer: Direct contact spread
Explanation:Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 43
Incorrect
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Which of the following is the primary indication for loop diuretics?
Your Answer:
Correct Answer: Acute pulmonary oedema
Explanation:Loop diuretics have long been the cornerstone of pulmonary oedema treatment, with furosemide being the most commonly used of these drugs. Premedication with drugs that decrease preload (e.g., nitro-glycerine [NTG]) and afterload (e.g., angiotensin-converting enzyme [ACE] inhibitors) before the administration of loop diuretics can prevent adverse hemodynamic changes.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 44
Incorrect
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All of the following statement are correct regarding endothelium derived nitric oxide except:
Your Answer:
Correct Answer: Nitric oxide production is inhibited by local mediators such as bradykinin, histamine and serotonin.
Explanation:Factors that elevate intracellular Ca2+ increase nitric oxide (NO) production by the endothelium included local mediators such as histamine and serotonin, bradykinin, and some neurotransmitters like substance P. NO production is also stimulated by increased flow (shear stress) and additionally activates prostacyclin synthesis. As a result of basal production of NO, there is continuous modulation of vascular resistance and as a result, there is increased production of nitric oxide acts which causes vasodilation. Platelet activation and thrombosis are inhibited by nitric oxide.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 45
Incorrect
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Which of the following cytokines is important for the maintenance of granulomatous inflammation:
Your Answer:
Correct Answer: TNF-alpha
Explanation:Granulomatous inflammation is a distinctive pattern of chronic inflammation that is encountered in a limited number of infectious and some non-infectious conditions. Briefly, a granuloma is a cellular attempt to contain an offending agent that is difficult to eradicate. In this attempt, there is often strong activation of T lymphocytes leading to macrophage activation, which can cause injury to normal tissues. IL-1 is important in initiating granuloma formation, IL-2 can cause them to enlarge and TNF-α maintains them.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 46
Incorrect
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Bordetella pertussis causes which of the following infectious diseases:
Your Answer:
Correct Answer: Whooping cough
Explanation:Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 47
Incorrect
-
Glucagon is the main catabolic hormone of the body and raises the concentration of glucose and fat in the bloodstream.Which pancreatic islet cells secretes glucagon?
Your Answer:
Correct Answer: Alpha
Explanation:Glucagon, secreted from the pancreatic islet alpha cells, is considered to be the main catabolic hormone of the body. It raises the concentration of glucose and fat in the bloodstreamThere are five different pancreatic islet cells:Alpha cells (20%) – produce glucagonBeta cells (70%) – produce insulin and amylinDelta cells (<10%) – produce somatostatinGamma cells (<5%) – produce pancreatic polypeptideEpsilon cells (<1%) – produce ghrelin
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 48
Incorrect
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Glomerular filtration rate can be calculated using any substance that:
Your Answer:
Correct Answer: is freely filtered and neither reabsorbed nor secreted by the nephron
Explanation:Clearance of a substance can provide an accurate estimate of the glomerular filtration rate (GFR) provided that the substance is:freely filterednot reabsorbed in the nephronnot secreted in the nephronnot synthesised or metabolised by the kidney
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This question is part of the following fields:
- Physiology
- Renal
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Question 49
Incorrect
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A 53 year old male is found to have megaloblastic anaemia secondary to folate deficiency. He has a known history of alcohol abuse. Which of the following is characteristic of this condition?
Your Answer:
Correct Answer: Increased mean corpuscular volume (MCV)
Explanation:Megaloblastic anaemia occurs when there is inhibition of DNA synthesis as red blood cells are produced. Impairment of DNA synthesis causes the cell cycle to be unable to progress from the growth stage to the mitosis stage. As a result, there is continuous cell growth without division, with an increase in mean corpuscular volume (MCV), which presents as macrocytosis. The most common cause of this defect in red cell DNA synthesis is hypovitaminosis, in particular, vitamin B12 deficiency or folate deficiency.Folate is an essential vitamin that can be found in most foods, and is highest in liver, green vegetables and yeast. 200 – 250 μg is found in the normal daily diet, and about 50% is absorbed. The daily adult requirement is about 100 μg and its absorption is principally from the duodenum and jejunum. Folate stores are normally only adequate for 4 months and so clinical features of folate deficiency usually become evident after this time.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 50
Incorrect
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Which of the following statements is correct with regards to insulin receptors?
Your Answer:
Correct Answer: Insulin has its intracellular effects via activation of tyrosine kinase.
Explanation:Most cells have insulin receptors present on them which can be sequestered into the cell to inactivate them. These receptors consist of two extracellular alpha subunits which contain the insulin-binding site and two transmembrane beta subunits. Because insulin is a polypeptide hormone, it must act via cell surface receptors as it is unable to readily cross the cell membrane. On binding to the receptor, the beta subunit of insulin autophosphorylation, which activates tyrosine kinase. As a result, there is an intracellular cascade of phosphorylation, causing a translocation of the glucose transporter GLUT4 and GLUT-1 to the plasma membrane of the affected cell. This facilitates glucose entry.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 51
Incorrect
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A patient presents with a fever, headache and neck stiffness. A CSF sample of someone with meningococcal meningitis typically shows:
Your Answer:
Correct Answer: All of the above
Explanation:CSF analysis typically shows: cloudy turbid appearanceraised WCC – predominantly neutrophilshigh proteinlow glucose (typically < 40% of serum glucose)Gram-negative diplococci seen under microscopy
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 52
Incorrect
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Question 53
Incorrect
-
What is the main mechanism of action of dopamine as an inotropic sympathomimetic:
Your Answer:
Correct Answer: Beta1-receptor agonist
Explanation:Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 54
Incorrect
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The weight distribution in a group of patients included in a study was normal. The patients averaged 80 kg in weight. 5 kg was determined to be the standard deviation. Which of the following statements most accurately describes this group of patients:
Your Answer:
Correct Answer: 68% of the patients will weigh between 75 and 85 kg.
Explanation:We can estimate the range of values that would be anticipated to include particular proportions of observations if we know the mean and standard deviation of a collection of normally distributed data: 68.2 percent of the sample results fall within a one SD range above and below the mean (+/- 1 SD), implying that 68 percent of the patients will weigh between 75 and 85 kg. Because +/- 2 SD encompasses 95.4 percent of the data, around 95 percent of the patients will weigh between 70 and 90 kg. +/- 3 SD encompasses 99.7% of the values, implying that nearly all of the patients will weigh between 65 and 95 kg.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 55
Incorrect
-
Regarding nitrous oxide, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Nitrous oxide may be used for maintenance of anaesthesia where its use allows reduced dosage of other agents.
Explanation:For anaesthesia, nitrous oxide is commonly used in a concentration of around 50 – 66% in oxygen in association with other inhalation or intravenous agents. Nitrous oxide cannot be used as the sole anaesthetic agent due to lack of potency, but is useful as part of a combination of drugs since it allows reduction in dosage of other agents. Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12. Nitrous oxide increases cerebral blood flow and should be avoided in patients with, or at risk of, raised intracranial pressure. Nitrous oxide may be administered by any trained personnel experienced in its use.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 56
Incorrect
-
A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb. The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers. Which of these nerve(s) has most likely been affected?
Your Answer:
Correct Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:Loss of sensation to the lateral palm and the lateral three and a half fingers.Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals. Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialisWeakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 57
Incorrect
-
Which of the following occurs primarily to produce passive expiration:
Your Answer:
Correct Answer: Relaxation of diaphragm and external intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) and the elastic recoil of the lungs. In expiration, depression of the sternal ends of the ribs (‘pump handle’ movement), depression of the lateral shafts of the ribs (‘bucket handle’ movement) and elevation of the diaphragm result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in a decreased intrathoracic volume and increased intrathoracic pressure and thus air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 58
Incorrect
-
A 30-year-old man presents with diarrhoea, fever, vomiting, and abdominal cramps. A stool culture was ordered and showed growth of Salmonella spp.Among the following serotypes of Salmonella spp., which is considered to be the most common cause of salmonella gastroenteritis?
Your Answer:
Correct Answer: Serotype D
Explanation:A common cause of gastroenteritis, Salmonella enteritidis, and Salmonella typhi, which causes enteric fever, are both group D. Therefore, serotype D Salmonella species are most commonly associated with gastroenteritis.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 59
Incorrect
-
A 68-year-old man has a very fast heartbeat' and is out of breath. He has had a heart transplant in the past. His electrocardiogram reveals supraventricular tachycardia.Which of the following is the most appropriate adenosine dose for him to receive as a first dose?
Your Answer:
Correct Answer: Adenosine 3 mg IV
Explanation:A rapid IV bolus of adenosine is given, followed by a saline flush. The standard adult dose is 6 mg, followed by 12 mg if necessary, and then another 12 mg bolus every 1-2 minutes until an effect is seen.Patients who have had a heart transplant, on the other hand, are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 60
Incorrect
-
Which patient group are most commonly associated with infection with Klebsiella spp:
Your Answer:
Correct Answer: Hospitalised patients
Explanation:Klebsiella spp. are facultatively anaerobic Gram-negative rods, found in the normal intestinal and respiratory flora. These organisms are usually opportunistic pathogens that cause nosocomial infections, most commonly pneumonia and UTI.
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This question is part of the following fields:
- Microbiology
- Pathogens
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SESSION STATS - PERFORMANCE PER SPECIALTY
