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  • Question 1 - After returning from Thailand two days ago, a 61-year-old man presents to the...

    Correct

    • After returning from Thailand two days ago, a 61-year-old man presents to the department with severe diarrhoea and vomiting. He has a history of hypertension and takes an ACE inhibitor to treat it.Which of the following statements about angiotensin-converting enzyme inhibitors is correct?

      Your Answer: They have been shown to reduce mortality in heart failure

      Explanation:

      Angiotensin-converting enzyme (ACE) inhibitors prevent angiotensin I from being converted to angiotensin II. Angiotensin II has a variety of effects:Sympathetic activity has increased.Vasoconstriction in the arteriesSecretion of VasopressinSecretion of aldosteroneThe increase in systemic blood pressure is caused by arteriolar vasoconstriction. Vasopressin stimulates water reabsorption in the kidneys as well as the thirst sensation. In the distal convoluted tubules and collecting ducts, aldosterone causes the reabsorption of sodium and water from the urine in exchange for potassium secretion. As a result, ACE inhibitors lower systemic blood pressure while also causing hyperkalaemia.Angiotensin-converting enzyme inhibitors (ACE inhibitors) are used in a variety of clinical settings, including heart failure. According to a meta-analysis, ACE inhibitors reduce death, MI, and overall admission in patients with heart failure by 28%.ACE inhibitors are also used in the following clinical settings:HypertensionChronic kidney diseaseDiabetic nephropathy Following a myocardial infarctionIn the presence of renal artery stenosis, ACE inhibitors are contraindicated because they can cause or exacerbate renal failure.The most common side effect of ACE inhibitors is a dry cough caused by increased bradykinin production. There is, however, no known link to fibrosis of the lungs.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      43.9
      Seconds

  • Question 2 - Regarding haemoglobin, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding haemoglobin, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Haemoglobin synthesis occurs in mature erythrocytes.

      Explanation:

      Haemoglobin is composed of four polypeptide globin chains each with its own iron containing haem molecule. Haem synthesis occurs largely in the mitochondria by a series of biochemical reactions commencing with the condensation of glycine and succinyl coenzyme A under the action of the key rate-limiting enzyme delta-aminolevulinic acid (ALA) synthase. The globin chains are synthesised by ribosomes in the cytosol. Haemoglobin synthesis only occurs in immature red blood cells.There are three types of haemoglobin in normal adult blood: haemoglobin A, A2 and F:- Normal adult haemoglobin (HbA) makes up about 96 – 98 % of total adult haemoglobin, and consists of two alpha (α) and two beta (β) globin chains. – Haemoglobin A2 (HbA2), a normal variant of adult haemoglobin, makes up about 1.5 – 3.5 % of total adult haemoglobin and consists of two α and two delta (δ) globin chains.- Foetal haemoglobin is the main Hb in the later two-thirds of foetal life and in the newborn until approximately 12 weeks of age. Foetal haemoglobin has a higher affinity for oxygen than adult haemoglobin. Red cells are destroyed by macrophages in the liver and spleen after , 120 days. The haem group is split from the haemoglobin and converted to biliverdin and then bilirubin. The iron is conserved and recycled to plasma via transferrin or stored in macrophages as ferritin and haemosiderin. An increased rate of haemoglobin breakdown results in excess bilirubin and jaundice.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 3 - A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A...

    Incorrect

    • A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A diagnosis of a brain tumour has been established.Which of the following anatomical points in the visual pathway has the lesion occurred?

      Your Answer:

      Correct Answer: Lower optic radiation

      Explanation:

      Homonymous quadrantanopia is not a disease; it is a clinical finding that points towards a lesion of the optic radiations coursing through the temporal lobe.Homonymous superior quadrantanopia is caused by damage to the contralateral inferior parts of the posterior visual pathway: the inferior optic radiation (temporal Meyer loop), or the inferior part of the occipital visual cortex below the calcarine fissure.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 4 - A 12-year-old boy presents to you with a history of fever. A rash...

    Incorrect

    • A 12-year-old boy presents to you with a history of fever. A rash began as small red dots on the face, scalp, torso, upper arms and legs shortly afterwards and has now progressed to small blisters and pustules. You make a diagnosis of chickenpox.The following complications of chickenpox is the LEAST likely.

      Your Answer:

      Correct Answer: Bronchospasm

      Explanation:

      Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.Some recognized complications of chickenpox are:OrchitisHepatitisPneumoniaEncephalitisInfected spotsOtitis mediaMyocarditisGlomerulonephritisAppendicitisPancreatitis

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 5 - A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.Which...

    Incorrect

    • A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.Which of these statements about anaphylaxis is true?

      Your Answer:

      Correct Answer: The immunoglobulin-antigen complex binds to Fc receptors on the surface of mast cells.

      Explanation:

      Anaphylaxis is an example of a type I hypersensitivity reaction. It is IgE mediated. It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.Massive calcium influx into the cells leads to mast cell degranulation. The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 6 - How does dipyridamole mediate its antiplatelet effect: ...

    Incorrect

    • How does dipyridamole mediate its antiplatelet effect:

      Your Answer:

      Correct Answer: It is a phosphodiesterase inhibitor.

      Explanation:

      Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 7 - Which of the following would you NOT expect from a deep fibular nerve...

    Incorrect

    • Which of the following would you NOT expect from a deep fibular nerve palsy:

      Your Answer:

      Correct Answer: Loss of sensation over heel

      Explanation:

      Damage to the deep fibular nerve results in loss of dorsiflexion of the ankle, with resultant foot drop with high-stepping gait, loss of toe extension, weakness of foot inversion and loss of sensation over the webspace between the 1st and 2nd toes.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 8 - An 82-year-old woman was brought in an ambulance to the Emergency Department with...

    Incorrect

    • An 82-year-old woman was brought in an ambulance to the Emergency Department with a 1-hour history of left-sided weakness and dysphasia. A CT scan is performed, and primary intracerebral haemorrhage is excluded as a possible cause. She is prepared for thrombolysis when her blood pressure is recorded at 200/115 mmHg.Out of the following, which step would be the most appropriate as the next step in her management?

      Your Answer:

      Correct Answer: Labetalol 10 mg IV

      Explanation:

      A patient suffering from acute ischemic stroke can commonly present with hypertensive emergencies. Thrombolytic therapy is contraindicated in a patient with:1. Systolic blood pressure greater than 185 mmHg2. Diastolic blood pressure greater than 110 mmHgBut delaying thrombolytic therapy is associated with increased morbidity in patients with acute ischemic stroke. Managing high blood pressure in acute ischemic stroke requires a slower and more controlled reduction in BP. In the presence of an ischaemic stroke, rapid reduction of MAP can compromise blood flow, causing further ischemia and worsening of the neurological deficit.Intravenous labetalol is the agent of choice. The dose is 10 mg IV over 1-2 minutes. This dose can be repeated, or an infusion can be set up that runs at 2-8 mg/minute. Thrombolysis can be performed once the blood pressure is brought down to less than 180/105 mmHg.A nitrate infusion (for example, Isoket) can be used as an alternative in patients with contraindications to the use of beta-blockers (e.g., asthma, heart block, cardiac failure).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 9 - Regarding basophils, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding basophils, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: They are the second most common type of granulocyte.

      Explanation:

      Basophils are only occasionally seen in normal peripheral blood comprising < 1% of circulating white cells. However, they are the largest type of granulocyte. They have many dark cytoplasmic granules which overlie the nucleus and contain heparin and histamine. They have immunoglobulin E (IgE) attachment sites and their degranulation is associated with histamine release. Basophils are very similar in both appearance and function to mast cells.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 10 - All of the muscles of the tongue (other than the palatoglossus) are innervated...

    Incorrect

    • All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:

      Your Answer:

      Correct Answer: Hypoglossal nerve

      Explanation:

      All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

  • Question 11 - A patient presents to ED complaining of pins and needles over the lateral...

    Incorrect

    • A patient presents to ED complaining of pins and needles over the lateral three and a half digits. You suspect carpal tunnel syndrome. Which of the following clinical features would you most expect to see on examination:

      Your Answer:

      Correct Answer: Inability to touch the pad of the little finger with the thumb

      Explanation:

      Compression of the median nerve in the carpal tunnel will result in weakness and atrophy of the thenar muscles – resulting in weakness of opposition, abduction and flexion of the thumb at the metacarpophalangeal joint and anaesthesia or paraesthesia over the distribution of the palmar digital branch of the median nerve (skin over the palmar surface and fingertips of the lateral three and a half digits). The adductor pollicis muscle is innervated by the ulnar nerve, and abduction of the fingers is produced by the interossei, also innervated by the ulnar nerve. Flexion of the interphalangeal joint of the thumb is produced by the flexor pollicis longus, and flexion of the distal interphalangeal joint of the index finger is produced by the flexor digitorum profundus. Median nerve injury at the wrist will not affect the long flexors of the forearm as these are innervated by the anterior interosseous nerve which arises in the proximal forearm.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 12 - A 33 year old lady with a known nut allergy was having dinner...

    Incorrect

    • A 33 year old lady with a known nut allergy was having dinner at a Thai restaurant. She suddenly complained of lip and tongue swelling and difficulty breathing and is brought to ED by ambulance with suspected anaphylaxis. She received intramuscular adrenaline in the ambulance.The most appropriate doses of the second line treatments for anaphylaxis are which of the following?

      Your Answer:

      Correct Answer: 10 mg chlorphenamine and 200 mg hydrocortisone

      Explanation:

      Second line drugs to reduce the severity and duration of anaphylactic symptoms are intravenous or intramuscular chlorpheniramine and hydrocortisone. The recommended dose is 10 mg chlorpheniramine and 200 mg hydrocortisone in adults.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
      Seconds

  • Question 13 - CSF is reabsorbed from subarachnoid space via which of the following structures: ...

    Incorrect

    • CSF is reabsorbed from subarachnoid space via which of the following structures:

      Your Answer:

      Correct Answer: Arachnoid granulations

      Explanation:

      From the subarachnoid cisterns in the subarachnoid space, CSF is reabsorbed via arachnoid granulations which protrude into the dura mater, into the dural venous sinuses and from here back into the circulation.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 14 - Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is...

    Incorrect

    • Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is an increase in metabolic rate, the production of vasoactive metabolites increases. These metabolites act locally on the surrounding arterioles, causes vasodilation and an increase blood supply.Which of these metabolites is the most potent vasodilator in skeletal muscle?

      Your Answer:

      Correct Answer: K +

      Explanation:

      Hyperaemia is the process where the body adjusts blood flow to meet the metabolic needs of different tissues in health and disease. Vasoactive mediators that take part in this process include K+, adenosine, CO2, H+, phosphates and H2O2. Although the mechanism is not clear, all these mediators likely contribute to some extent at different points.Specific organs are more sensitive to specific metabolites:K+ and adenosine are the most potent vasodilators in skeletal musclesCO2 and K+ are the most potent vasodilators in cerebral circulation.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      0
      Seconds

  • Question 15 - Many of the chemical digestion and absorption takes place in the small intestine....

    Incorrect

    • 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 lipids into fatty acid and glycerol?

      Your Answer:

      Correct Answer: Pancreatic lipase

      Explanation:

      The principal enzyme involved in lipid digestion is pancreatic lipase. It breaks down triglycerides into free fatty acids and monoglycerides. Pancreatic lipase works with the help of emulsifying agents secreted by the liver and the gallbladder. The main emulsifying agents are the bile acids, cholic acid and chenodeoxycholic acid. These are conjugated with the amino acids glycine and taurine to form bile salts. Bile salts are more soluble than bile acids and act as detergents to emulsify lipids. The free fatty acids and monoglycerides form tiny particles with these bile salts called micelles. The outer region of the micelle is water-attracting (hydrophilic), whereas the inner core is water-repelling (hydrophobic). This arrangement allows the micelles to enter the aqueous layers surrounding the microvilli and free fatty acids and monoglycerides to diffuse passively into the small intestinal cells.Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Chymotrypsin is a proteolytic enzyme that aids in digestion of proteinCarboxypeptidase hydrolyses the first peptide or amide bond at the carboxyl or C-terminal end of proteins and peptides

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      0
      Seconds

  • Question 16 - All of the following typically occurs as part of normal passive expiration except:...

    Incorrect

    • All of the following typically occurs as part of normal passive expiration except:

      Your Answer:

      Correct Answer: Contraction of the internal intercostal muscles

      Explanation:

      Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs. In expiration, several movements occur. There are:1. depression of the sternal ends of the ribs (‘pump handle’ movement), 2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and 3. elevation of the diaphragm. These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 17 - An analytical cohort study aimed to determine a relationship between intake of dietary...

    Incorrect

    • An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:No. of post-menopausal women who took Calcium: 500No. of post-menopausal women who took Calcium and suffered a hip fracture: 10No. of post-menopausal women who took placebo: 500No. of post-menopausal women who took placebo and suffered a hip fracture: 25Compute for the absolute risk in the placebo group.

      Your Answer:

      Correct Answer: 0.05

      Explanation:

      The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.AR = 25/500 = 0.05

    • This question is part of the following fields:

      • Evidence Based Medicine
      0
      Seconds

  • Question 18 - When the breast cancer of a 60-year old patient metastasizes and compresses the...

    Incorrect

    • When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?

      Your Answer:

      Correct Answer: Fifth cervical and fourth thoracic nerves

      Explanation:

      The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

  • Question 19 - The following statements about cross-sectional studies are true EXCEPT? ...

    Incorrect

    • The following statements about cross-sectional studies are true EXCEPT?

      Your Answer:

      Correct Answer: They can be used to determine the relative risk of a condition

      Explanation:

      The UK national census is an example of a cross-sectional study.Cross-sectional studies can be used to assess the prevalence of a condition, and support or refute inferences of cause and effect.Cross-sectional studies are observations of the frequency and characteristics of a disease in a given population at one particular point in time. Cross-sectional studies do not differentiate between cause and effect and also do not establish the sequence of events.Cross-sectional studies cannot be used to calculate the relative risk of a condition.

    • This question is part of the following fields:

      • Evidence Based Medicine
      0
      Seconds

  • Question 20 - A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You...

    Incorrect

    • A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You plan on using propofol as the sedative agent.Propofol works as a result of action on what type of receptor? Select ONE answer only.

      Your Answer:

      Correct Answer: Gamma-aminobutyric acid (GABA)

      Explanation:

      Propofol (2,6-diisopropylphenol) is a short-acting phenol derivative that is primarily used for the induction of anaesthesia.Its mechanism of action is unclear but is thought to act by potentiating the inhibitory neurotransmitters GABA and glycine, which enhances spinal inhibition during anaesthesia.The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.The main side effects of propofol are:Pain on injection (in up to 30%)HypotensionTransient apnoeaHyperventilationCoughing and hiccoughHeadacheThrombosis and phlebitis

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 21 - Which of the following is NOT a typical side effect of digoxin: ...

    Incorrect

    • Which of the following is NOT a typical side effect of digoxin:

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Digoxin does not cause hypokalaemia, but hypokalaemia does potentiate digoxin toxicity. The adverse effects of digoxin are frequently due to its narrow therapeutic window and include: Cardiac adverse effects – Sinoatrial and atrioventricular block, Premature ventricular contractions, PR prolongation and ST-segment depressionNausea, vomiting and diarrhoeaBlurred or yellow visionCNS effects – weakness, dizziness, confusion, apathy, malaise, headache, depression, psychosisThrombocytopenia and agranulocytosis (rare)Gynaecomastia in men in prolonged administration

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 22 - The cutaneous circulation's principal role is thermoregulation. This process is aided by the...

    Incorrect

    • The cutaneous circulation's principal role is thermoregulation. This process is aided by the existence of arteriovenous anastomoses.Which of the following anatomical areas has the greatest number of arteriovenous anastomoses? 

      Your Answer:

      Correct Answer: Pinna of the ear

      Explanation:

      Short vessels called arteriovenous anastomoses (AVAs) link tiny arteries and veins. They have a large lumen diameter. The strong and muscular walls allow AVAs to completely clog the vascular lumen, preventing blood flow from artery to vein (acting like a sphincter). When the AVAs open, they create a low-resistance connection between arteries and veins, allowing blood to flow into the limbs’ superficial venous plexuses. There is no diffusion of solutes or fluid into the interstitium due to their strong muscle walls.AVAs are densely innervated by adrenergic fibres from the hypothalamic temperature-regulation centre. High sympathetic output occurs at normal core temperatures, inducing vasoconstriction of the AVAs and blood flow through the capillary networks and deep plexuses. When the temperature rises, sympathetic output decreases, producing AVA vasodilation and blood shunting from the artery to the superficial venous plexus. Heat is lost to the environment as hot blood rushes near to the skin’s surface.AVAs are a specialized anatomical adaptation that can only be found in large quantities in the fingers, palms, soles, lips, and pinna of the ear.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
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  • Question 23 - All of the following statements are correct with regards to protection of the...

    Incorrect

    • All of the following statements are correct with regards to protection of the gastric mucosa except which of the following?

      Your Answer:

      Correct Answer: NSAIDs directly stimulate increased parietal cell acid production.

      Explanation:

      Prostaglandin production, which usually inhibits acid secretion and increases mucus and bicarbonate secretion, is inhibited by NSAIDs.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
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  • Question 24 - A dermatological examination on a patient presenting with a lump shows a small...

    Incorrect

    • A dermatological examination on a patient presenting with a lump shows a small visible skin elevation containing an accumulation of pus.Which one of these best describes the lump you have found on examination?

      Your Answer:

      Correct Answer: Pustule

      Explanation:

      A pustule is a small visible skin elevation containing an accumulation of pus. A carbuncle is a collection of individual boils clustered together. A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter. A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus. A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
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  • Question 25 - Which of the following is NOT a typical clinical feature of beta-thalassaemia major:...

    Incorrect

    • Which of the following is NOT a typical clinical feature of beta-thalassaemia major:

      Your Answer:

      Correct Answer: Increased bleeding tendency

      Explanation:

      Features include:- severe anaemia (becoming apparent at 3 – 6 months when the switch from gamma-chain to beta-chain production takes place)- failure to thrive- hepatosplenomegaly (due to excessive red cell destruction, extramedullary haemopoiesis and later due to transfusion related iron overload)- expansion of bones (due to marrow hyperplasia, resulting in bossing of the skull and cortical thinning with tendency to fracture)- increased susceptibility to infections (due to anaemia, iron overload, transfusion and splenectomy)- osteoporosis- hyperbilirubinaemia and gallstones- hyperuricaemia and gout- other features of haemolytic anaemia- liver damage and other features of iron overload

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 26 - Which of the following anatomic structures will gallstones most likely lodge into, and...

    Incorrect

    • Which of the following anatomic structures will gallstones most likely lodge into, and cause cholestasis?

      Your Answer:

      Correct Answer: Hartmann’s pouch

      Explanation:

      Hartmann’s pouch is a diverticulum that can occur at the neck of the gallbladder. It is one of the rarest congenital anomalies of the gallbladder. Hartmann’s gallbladder pouch is a frequent but inconsistent feature of normal and pathologic human gallbladders. It is caused by adhesions between the cystic duct and the neck of the gallbladder. As a result, it is classified as a morphologic rather than an anatomic entity.There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      0
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  • Question 27 - You suspect that your patient with polycystic kidney disease has developed a berry...

    Incorrect

    • You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?

      Your Answer:

      Correct Answer: Anterior communicating artery

      Explanation:

      One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm. A berry aneurysm is the most common type of brain aneurysm. The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 28 - A 2-day-old male is referred to a tertiary care hospital by the community...

    Incorrect

    • A 2-day-old male is referred to a tertiary care hospital by the community midwife after a home visit due to jaundice and dyspnoea. After history and examination, the relevant blood work is performed, and the baby is found to have conjugated hyperbilirubinemia. The paediatric team suspects a hepatic origin for jaundice based on the findings. Which one of the following aetiologies is the most likely cause of jaundice in this case?

      Your Answer:

      Correct Answer: Alpha 1-antitrypsin deficiency

      Explanation:

      The presence of dyspnoea makes alpha-1 antitrypsin deficiency the more likely diagnosis as biliary atresia does not cause respiratory symptoms. Deficiency of the enzyme alpha-1 antitrypsin causes uninhibited elastase activity and a decrease in elastic tissue. This causes liver cirrhosis leading to an elevation of conjugated bilirubin and emphysema in the lungs.Rhesus disease, hereditary spherocytosis and breast milk jaundice cause an elevation of unconjugated bilirubin thus ruling it out in this case. Breast milk jaundice occurs due to an inability of the newborn to metabolize the proteins in breast milk. Rhesus disease occurs when an Rh negative mother gives birth to an Rh positive baby. The jaundice would have been accompanied by anaemia and oedema. Hereditary spherocytosis occurs due to extravascular haemolysis as defective RBCs are removed by the spleen. The patient would present with jaundice, splenomegaly and possibly an aplastic crisis (if Parvovirus B19 infection).

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 29 - Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the...

    Incorrect

    • Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the other hand, calcium-induced calcium release (CICR) is a mechanism that is unique to Cardiac myocytes. The influx of calcium ions (Ca 2+) into the cell causes a 'calcium spark,' which causes more ions to be released into the cytoplasm.In CICR, which membrane protein in the sarcoplasmic reticulum is involved? 

      Your Answer:

      Correct Answer: Ryanodine receptor

      Explanation:

      Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.The release of Ca2+ from the sarcoplasmic reticulum is required for calcium-induced calcium release (CICR). This is mostly accomplished by ryanodine receptors (RyR) on the sarcoplasmic reticulum membrane; Ca2+ binds to RyR, causing additional Ca2+ to be released.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 30 - A 30-year-old man present to the ED with abdominal pain, nausea and vomiting....

    Incorrect

    • A 30-year-old man present to the ED with abdominal pain, nausea and vomiting. It has been present for the past two days.Which of the following statements regarding diarrhoea and vomiting is true?

      Your Answer:

      Correct Answer: E.Coli can cause diarrhoea and renal failure

      Explanation:

      Escherichia coli strain 0157 causes enterohaemorrhagic diarrhoea and can lead to renal failure, haemolytic anaemia and thrombocytopenia.Norwalk virus is an RNA virus.Although transmission of rotavirus is primarily through the faeco-oral route, airborne spread has been seen in some cases.Cryptosporidium are protozoa with acid fast walls and are resistant to both chlorine treatment and conventional filtering methods. There is no therapy effective in treating cryptosporidium diarrhoea as the protozoa is not susceptible to antibiotics.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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