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Question 1
Incorrect
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Which of the following best describes the positive predictive value of a diagnostic test:
Your Answer: The proportion of patients with the disease who are correctly identified by the test as having the disease
Correct Answer: The proportion of individuals with a positive test result who have the disease
Explanation:Positive predictive value (PPV) is the proportion of individuals with a positive test result who actually have the disease.PPV = a/(a+b)
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 2
Incorrect
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Which of the following is NOT a common myeloma laboratory finding:
Your Answer: Hypercalcaemia
Correct Answer: Elevated serum Bence-Jones protein
Explanation:Myeloma laboratory findings include:- The presence of a paraprotein in serum or urine (the paraprotein is IgG in 60 percent of cases, IgA in 20 percent, and light chain only in almost all the rest),- Increased serum immunoglobulin-free light chain proteins generated by plasma cells but not coupled with heavy chains – Reduced IgG, IgA, and IgM levels in the blood (immune paresis)- Anaemia, whether normochromic, normocytic, or macrocytic. – On a blood film, a Rouleaux formation has been marked. – In advanced illness, neutropenia and thrombocytopenia are common. – ESR is high. – Plasma cells in the bone marrow are overabundant, typically in aberrant forms. – Hypercalcemia- Creatinine levels are high. – Serum albumin levels are low in advanced illness. 60 percent of patients have osteolytic lesions, osteoporosis, or pathological fractures.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 3
Incorrect
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Inferior rectus and inferior oblique
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 4
Incorrect
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Loop diuretics primarily act on which Na+ transporter?
Your Answer:
Correct Answer: Na + /K + /2Cl - symporter
Explanation:The most potent diuretics are loop diuretics e.g. furosemide. They work by inhibiting the Na+/K+/2Cl-symporter in the thick ascending limb of the loop of Henle, which inhibits sodium, potassium, and chloride reabsorption. As a result, there is diuresis with loss of these electrolytes. There is a reduction in transcellular voltage difference, paracellular calcium and magnesium reabsorption.The medullary interstitium becomes more concentrated by salt reabsorption in the ascending limb. Loop diuretics block this process and reduce the ability of the kidney to concentrate urine. In the collecting duct, there is increased sodium delivery to the principal cells, which increases potassium secretion in return for sodium reabsorption.
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This question is part of the following fields:
- Physiology
- Renal
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Question 5
Incorrect
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Which of the following is most likely to cause a bitemporal hemianopia:
Your Answer:
Correct Answer: Pituitary adenoma
Explanation:A bitemporal hemianopia is most likely due to compression at the optic chiasm. This may be caused by pituitary tumour, craniopharyngioma, meningioma, optic glioma or aneurysm of the internal carotid artery. A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 6
Incorrect
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Where does angiotensin II directly act on the renal nephron:
Your Answer:
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 7
Incorrect
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Question 8
Incorrect
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All of the following are physiological effects of thyroid hormones except:
Your Answer:
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 9
Incorrect
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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:
Correct 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 10
Incorrect
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A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?
Your Answer:
Correct Answer: Atenolol
Explanation:Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels. This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific. They have a lower effect on airway resistance, although they are not without this adverse effect.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 11
Incorrect
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Regarding apoptosis, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.
Explanation:Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 12
Incorrect
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A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Superficial 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 13
Incorrect
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A 52-year old male comes to the out-patient department for a groin mass that protrudes when standing. The patient notes that it is reducible when lying down. On physical examination, there is presence of a cough impulse. The initial assessment is hernia. Further investigation reveals that the mass lies lateral to the epigastric vessels.Among the types of hernia, which is the most likely diagnosis of the case above?
Your Answer:
Correct Answer: Indirect inguinal hernia
Explanation:Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.Groin hernias are categorized into 2 main categories: inguinal and femoral.Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 14
Incorrect
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A 60-year-old patient with a history of hypertension and chronic kidney disease (CKD) walks into the clinic to discuss her most recent blood results indicating an accelerated progression of CKD.Which of the following is the correct definition for accelerated progression of CKD?
Your Answer:
Correct Answer: A sustained decrease in GFR of 15 ml/minute/1.73 m 2 per year
Explanation:Chronic kidney disease (CKD) is a disorder in which kidney function gradually deteriorates over time. It’s fairly prevalent, and it typically remains unnoticed for years, with only advanced stages of the disease being recognized. There is evidence that medication can slow or stop the progression of CKD, as well as lessen or prevent consequences and the risk of cardiovascular disease (CVD).CKD is defined as kidney damage (albuminuria) and/or impaired renal function (GFR 60 ml/minute per 1.73 m2) for three months or longer, regardless of clinical diagnosis.A prolonged decline in GFR of 25% or more with a change in GFR category within 12 months, or a sustained drop in GFR of 15 ml/minute/1.73 m² per year, is considered accelerated CKD progression.End-stage renal disease (ESRD) is defined as severe irreversible kidney impairment with a GFR of less than 15 ml/minute per 1.73 m² and a GFR of less than 15 ml/minute per 1.73 m².
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 15
Incorrect
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A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.Which of these statements describes the mechanism of action of corticosteroids in asthma?
Your Answer:
Correct Answer: Reduction of bronchial inflammation
Explanation:Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 16
Incorrect
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A 26-year-old woman is currently 9 weeks pregnant. Upon interview and history taking, she mentioned that she visited a friend whose child had just been diagnosed with slapped cheek disease.If the mother contracts an illness during pregnancy, which among the following is not known to cause fetal abnormalities?
Your Answer:
Correct Answer: Hepatitis A
Explanation:Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)toxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 17
Incorrect
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You review a 56-year-old man who has recently been prescribed antibiotics for a chest infection. He suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, he has been experiencing nausea, vomiting and abdominal pain.Which of the following antibiotics is he MOST LIKELY to have been prescribed for his chest infection? Select ONE answer only .
Your Answer:
Correct Answer: Levofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:Drugs increasing plasma concentration of theophyllineDrugs decreasing plasma concentration of theophyllineCalcium channel blockers, e.g. VerapamilCimetidineFluconazoleMacrolides, e.g. erythromycinQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitolPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 18
Incorrect
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After reviewing a child with respiratory distress who presented to the clinic, you make a diagnosis of bronchiolitis.What is the most common causative organism?
Your Answer:
Correct Answer: Respiratory syncitial virus
Explanation:Bronchiolitis is a common respiratory infection that occurs in infancy between the ages of 3-6 months and in the winter months. It is most commonly caused by the respiratory syncytial virus (70% of cases)Although it can also be caused by parainfluenza virus, adenovirus, coronavirus, rhinovirus, and influenza virus, these are not the most common causes
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 19
Incorrect
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A new chemotherapy drug is being tested. The intervention reduces the risk of death from 10 in 1000 to 5 in 1000. What is the number needed to treat to prevent one death:
Your Answer:
Correct Answer: 200
Explanation:Absolute risk reduction (ARR) of treatment = risk of death in control group – risk of death in treatment groupARR = (10/1000) – (5/1000) = 5/1000 = 0.005Number needed to treat (NNT) = 1/ARR = 1/0.005 = 200Therefore 200 people would need to be treated to prevent one extra death.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 20
Incorrect
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Which of the following clinical features is NOT typical of a facial nerve palsy:
Your Answer:
Correct Answer: Inability to raise the eyelid
Explanation:Facial nerve palsy can result in inability to close the eye due to paralysis of the orbicularis oculi muscle. Elevation of the eyelid in eye opening is a function of the levator palpebrae superioris muscle and the superior tarsal muscle, innervated by the oculomotor nerve and the sympathetic chain respectively.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 21
Incorrect
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A 50-year-old man managed by the renal team for stage 4 chronic kidney disease which appears to be deteriorating presents with a history of shortness of breath and ankle oedema. His most recent blood tests shows low calcium levels.Which of these increases the renal reabsorption of calcium?
Your Answer:
Correct Answer: Parathyroid hormone
Explanation:Parathyroid hormone (PTH), a polypeptide containing 84 amino acids, is the principal hormone that controls free calcium in the body.Its main actions are:Increases osteoclastic activity Increases plasma calcium concentrationDecreases renal phosphate reabsorptionDecreases plasma phosphate concentrationIncreases renal tubular reabsorption of calciumIncreases calcium and phosphate absorption in the small intestineIncreases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 22
Incorrect
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A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been going on for 3 days.Among the following microorganisms, which is considered to be a cause of infectious bloody diarrhoea?
Your Answer:
Correct Answer: Entamoeba histolytica
Explanation:The following are organisms that are capable of producing acute, bloody diarrhoea:- Campylobacter jejuni- Escherichia coli O157:H7- Salmonella species- Shigella species- Yersinia species- Entamoeba histolyticaOther E. coli strains, Giardia, Vibrio, and other parasites are associated with watery, but not bloody, diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 23
Incorrect
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Which of the following statements about propofol is TRUE:
Your Answer:
Correct Answer: Propofol has some antiemetic action.
Explanation:Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 24
Incorrect
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Hartmann's solution contains how much sodium:
Your Answer:
Correct Answer: 131 mmol/L
Explanation:Hartmann’s solution (compound sodium lactate) contains: Na+131 mmol/L, K+5 mmol/L, HCO3-29 mmol/L (as lactate), Cl-111 mmol/L, Ca2+2 mmol/L. It can be used instead of isotonic sodium chloride solution during or after surgery, or in the initial management of the injured or wounded; it may reduce the risk of hyperchloraemic acidosis.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 25
Incorrect
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A 52-year-old woman visits her local pharmacy to get medication to help with mild dyspepsia symptoms. The pharmacist on duty suggests she uses an over-the-counter antacid. She purchases an antacid that contains magnesium carbonate, which relieves her symptoms, but she unfortunately also develops a side effect.Out of the following, which side effect is she MOST likely to develop after using the antacid?
Your Answer:
Correct Answer: Diarrhoea
Explanation:Magnesium carbonate is an over the counter antacid commonly used to relieve symptoms in ulcer dyspepsia and non-erosive gastro-oesophageal reflux.Antacids containing magnesium also tend to work as a laxative, while the antacids with aluminium may cause constipation. There is no significant increased risk of anaphylaxis, hepatotoxicity or renal impairment.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 26
Incorrect
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Regarding cytotoxic T cells, which of the following statements is CORRECT:
Your Answer:
Correct Answer: They kill target cells by inducing cell apoptosis.
Explanation:CD8+ T-cells (Cytotoxic T cells)Recognise antigen only in association with HLA Class I molecules (found on all nucleated cells; present endogenous antigens such as those found in cells infected by viruses or intracellular bacteria.)Comprise about 25% of peripheral T-cellsResponsible for cytotoxic killing of target cells
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 27
Incorrect
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Regarding bile, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Bile passes into the duodenum through the ampulla of Vater.
Explanation:Bile is synthesised in the liver. Bile functions to eliminate endogenous and exogenous substances from the liver, to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile is stored and concentrated in the gallbladder. Bile passes out of the gallbladder via the cystic duct. Bile passes into the duodenum through the ampulla of Vater regulated by the sphincter of Oddi.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 28
Incorrect
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A blood culture was performed from a sample taken from a patient. It was noted that a Gram-positive coccus organism was grown.Among the following microorganisms, which is considered an example of a Gram-positive coccus?
Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Bacillus cereus = Gram-positive bacillusNeisseria meningitidis = Gram-negative coccusSalmonella enterica & Escherichia coli = Gram-negative bacilliIn Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative. The Staphylococci that are associated with infections in humans are colonizers of various skin and mucosal surfaces. Because the carrier state is common among the human population, infections are frequently acquired when the colonizing strain gains entrance to a normally sterile site as a result of trauma or abrasion to the skin or mucosal surface.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 29
Incorrect
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The pelvic bone is formed by which of the following:
Your Answer:
Correct Answer: Ilium, ischium and pubis
Explanation:Each pelvic bone is formed by three elements: the ilium (superiorly), the pubis (anteroinferiorly) and the ischium (posteroinferiorly).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 30
Incorrect
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The mechanism of action of abciximab is by:
Your Answer:
Correct Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites
Explanation:Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
