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Question 1
Incorrect
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A newborn baby is referred by the community midwife who is concerned the baby is jaundiced because of the yellow appearance of his eyes and skin following a postnatal home visit. The jaundice is visible in the baby’s feet making her worried.
Jaundice are visible in the extremities of neonates at what approximate threshold bilirubin level?Your Answer: 100 μmol/L
Correct Answer: 255 μmol/L
Explanation:Newborn babies have a higher concentration of red blood cells with shorter lifespan leading to higher bilirubin levels than in adults. This condition is short-lived and harmless but with potential serious causes that need to be assessed for if present.
The most obvious physical sign of jaundice is a yellow discolouration of the sclera, skin and mucous membranes. At a bilirubin level of 35 μmol/L or higher, the eye is affected. The bilirubin level will need to be higher than 255 μmol/L for the feet and extremities to be affected.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 2
Incorrect
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Which of the following is NOT a typical side effect of opioid analgesics:
Your Answer:
Correct Answer: Diarrhoea
Explanation:All opioids have the potential to cause:
Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
Cardiovascular effects – Peripheral vasodilation, postural hypotension
Dependence and tolerance -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 3
Incorrect
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A 52-year-old man develops pneumonia 3 days following an admission for investigation of chest pain. He has coarse left basal crackles and evidence of consolidation in the left lower lobe of chest X-ray. He has no known drug allergies.
According to the latest NICE guidelines, which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.Your Answer:
Correct Answer: Co-amoxiclav
Explanation:Nosocomial infections are defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital. Annually, this results in 5000 deaths with a cost to the National Health Service of a billion pounds. On average, a patient with hospital acquired infection spent 2.5-times longer in hospital, incurring additional costs of £3000 more than an uninfected patient. Intensive care units (ICU) have the highest prevalence of hospital-acquired infections in the hospital setting.
The current recommendations by NICE and the BNF on the treatment of hospital acquired pneumonia are:
Early onset infection(less than 5 days after admission to hospital): co-amoxiclav or cefuroxime for 7 days
Late-onset infection(more than 5 days after admission to hospital): an antipseudomonal penicillin (e.g. piperacillin with tazobactam), a broad-spectrum cephalosporin (e.g. ceftazidime), or a quinolone (e.g. ciprofloxacin)
If the patient developed a hospital-acquired pneumonia within 5 days of admission – co-amoxiclav would be the most appropriate choice.
If the patient has developed a hospital-acquired pneumonia > 5 days after admission – ciprofloxacin would be the most appropriate choice from the list of options available. -
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 4
Incorrect
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A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered.
Out of the following, which parameter is MOST likely to change due to initiating insulin?Your Answer:
Correct Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia.
Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity.
It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L
If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 5
Incorrect
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Carbon dioxide is transported in the blood approximately:
Your Answer:
Correct Answer: 60% as bicarbonate ions, 30% as carbamino compounds and 10% dissolved in plasma.
Explanation:Carbon dioxide is transported in the blood from tissues to the lungs in three ways as bicarbonate ions (60%), as carbamino compounds with proteins (30%) or simply dissolved in plasma (10%).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 6
Incorrect
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An 18-year-old student presents with a 1-week history of sore throat, low grade fever, and malaise. Upon history taking, she noted that she had a fine rash over her body a week ago that quickly fades. Further examination and observation was done and the presence of mild splenomegaly was noted. Her test shows positive for heterophile antibody test, suspecting a diagnosis of infectious mononucleosis.
Which of the following characteristics is mostly associated with the diagnosis of infectious mononucleosis?Your Answer:
Correct Answer: Atypical lymphocytes
Explanation:Epstein-Barr virus causes infectious mononucleosis which is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue and fever.
It is accompanied by atypical large peripheral blood lymphocytes. These atypical lymphocytes, also known as Downey cells, are actually activated CD8 T lymphocytes, most of which are responding to EBV-infected cells.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Incorrect
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An injury to which nerve affects innervation to the adductor portion of the adductor magnus?
Your Answer:
Correct Answer: Posterior branch of the obturator nerve
Explanation:The nerves that supply the adductor magnus muscle have an embryologic origin from the anterior divisions of the lumbosacral plexus and include the obturator nerve, posterior division (L2-4), and the tibial portion of the sciatic nerve (L4). It is innervated by the posterior division of the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Incorrect
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A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.
Which of the following statements about corticotropin-releasing hormone is correct?
Your Answer:
Correct Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus
Explanation:Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.
The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.
Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 9
Incorrect
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A patients had a left Colles' fracture, which you were able to repair. It was their second fragility fracture this year, and you'd like to provide them some tips on how to keep their bones healthy.
What percentage of the calcium in the body is kept in the bones?
Only ONE response is acceptable.Your Answer:
Correct Answer: 99%
Explanation:Calcium is stored in bones for nearly all of the body’s calcium, but it is also found in some cells (most notably muscle cells) and the blood. The average adult diet comprises roughly 25 mmol of calcium per day, of which the body absorbs only about 5 mmol.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 10
Incorrect
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A 32 year old man is brought to ED having been thrown off his motorbike. Following initial resuscitation and ruling out life-threatening injuries, you establish the patient has weakness of hip flexion. Which of the following nerves has most likely been injured:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the hip is produced by the iliacus, the psoas major, the sartorius, rectus femoris and the pectineus muscles. The femoral nerve innervates the iliacus, pectineus, sartorius and quadriceps femoris muscles, and supplies skin on the anterior thigh, anteromedial knee and medial leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 11
Incorrect
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You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her with Cushing's syndrome.
When would her random cortisol level likely be abnormal?
Your Answer:
Correct Answer: 2400 hrs
Explanation:Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep.
The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 12
Incorrect
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External haemorrhoids may cause anal pain. When explaining to your patient why it does so, which of the following nerves will you point out as being affected?
Your Answer:
Correct Answer: Pudendal nerve
Explanation:The pain associated with external haemorrhoids is carried by a branch of the pudendal nerve, specifically the somatic fibres (S2-S4).
It innervates the external anal sphincter and most of the skin over the perineum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 13
Incorrect
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Gastric emptying is increased by all of the following EXCEPT for:
Your Answer:
Correct Answer: Secretin
Explanation:Gastric emptying is increased by:
Distension of the pyloric antrum
A fall in the pH of chyme in the stomach
Parasympathetic stimulation (via vagus)
Gastrin
The hormones secretin, cholecystokinin and gastric inhibitory polypeptide (GIP) inhibit gastric emptying. -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 14
Incorrect
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A 32-year old male patient has been diagnosed with meningococcal meningitis and was given appropriate treatments. Because he is a family man, he fears that he might transmit the infection to the rest of his family members.
The causative agent of meningococcal meningitis is spread via what mode of transmission?Your Answer:
Correct Answer: Respiratory droplet route
Explanation:N. meningitidis, the causative agent of meningococcal meningitis, is considered both a commensal and a pathogen. It can be found in the surfaces of mucous membranes such as the nasopharynx and oropharynx. With this, it can be transmitted from a carrier to a new host via respiratory droplet secretions.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 15
Incorrect
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Which of the following is NOT a common myeloma laboratory finding:
Your Answer:
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. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 16
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 concentration
Decreases renal phosphate reabsorption
Decreases plasma phosphate concentration
Increases renal tubular reabsorption of calcium
Increases calcium and phosphate absorption in the small intestine
Increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 17
Incorrect
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An 82 year old man taking warfarin as a maintenance medication comes in to your clinic because of an infection. Which antibiotic is the safest choice for this patient?
Your Answer:
Correct Answer: Cefalexin
Explanation:Alterations in the international normalized ratio (INR) brought about by the concurrent use of antibiotics and warfarin may result in either excessive clotting or excessive bleeding if they are deemed to have a high risk for interaction. As such, there should be careful consideration of the class of antibiotic to be used.
Antibiotics from the following drug classes should generally be avoided as they have a high risk for interaction with warfarin, possible enhancing the anticoagulant effects of warfarin resulting in bleeding: Fluoroquinolones (e.g. ciprofloxacin, levofloxacin), Macrolides (e.g. clarithromycin, erythromycin, azithromycin), Nitroimidazoles (e.g. metronidazole), Sulphonamides (e.g. co-trimoxazole, a combination of trimethoprim and sulfamethoxazole), Trimethoprim, Tetracyclines (e.g. doxycycline).
Low risk antibiotics that have low risk for interaction with warfarin includes cephalexin, from the cephalosporin class, and clindamycin which is a lincomycin.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 18
Incorrect
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A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve injury. Which of the following will confirm the presence of an ulnar nerve injury?
Your Answer:
Correct Answer: Claw hand appearance
Explanation:An ulnar injury may result in abnormal sensations in the little finger and ring finger, usually on the palm side, weakness, and loss of coordination of the fingers.
A claw like deformity of the hand and wrist is present. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve are also possible.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
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 20
Incorrect
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Which of the following terms describes the proportion of individuals with a negative test result who actually do not have a disease:
Your Answer:
Correct Answer: Negative predictive value
Explanation:Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.
NPV = d/(c+d) -
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 21
Incorrect
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A 52-year-old female visits the Emergency Department complaining of an acute worsening of her asthma symptoms. A detailed history reveals that she took one of her brother's heart pills without a prescription as she was experiencing palpitations and thought it would cure her. Her shortness of breath was suddenly exacerbated after ingesting this medicine.
Which one of the following medications has this woman most likely consumed?Your Answer:
Correct Answer: Propranolol
Explanation:Propranolol, like other non-selective beta-blockers, is contraindicated in patients with asthma. These drugs can cause acute bronchospasm, therefore worsening symptoms, especially in high doses. However, there has been some recent evidence that long-term use of selective beta-blockers in mild or moderate asthma patients can be safe.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 22
Incorrect
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What is the main mechanism of action of metoclopramide:
Your Answer:
Correct Answer: Dopamine antagonist
Explanation:Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 23
Incorrect
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What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer:
Correct Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will 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 24
Incorrect
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Regarding ampicillin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.
Explanation:Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections.
Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased 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 25
Incorrect
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Caseous necrosis is typically seen in which of the following:
Your Answer:
Correct Answer: Tuberculosis
Explanation:Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 26
Incorrect
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A 49-year-old man known sickle cell disease patient received a blood transfusion and developed a mild fever and dark urine 6 days after transfusion. His investigations show raised bilirubin, raised LDH, and a positive Direct Antiglobulin Test (DAT).
Which transfusion reaction is most likely occurred?Your Answer:
Correct Answer: Delayed haemolytic reaction
Explanation:Delayed haemolytic transfusion reactions (DHTRs) commonly occurs 4-8 days after blood transfusion, but can occur up to a month after. Signs and symptoms include jaundice, fever, an inadequate rise in PCV, reticulocytosis, a positive antibody screen and a positive Direct Antiglobulin Test (Coombs test). DHTRs usually have a benign course and require no treatment but sometimes, life-threatening haemolysis with severe anaemia and renal failure can occur so haemoglobin levels and renal function should be monitored.
Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.
Febrile transfusion reaction presents with a 1 degree rise in temperature from baseline during transfusion. Patient may have chills and malaise. It is the most common transfusion reaction (1 in 8 transfusions) and is usually caused by cytokines released from leukocytes in transfused red cell or platelet components.
Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.
Graft versus host disease(GVHD) is an immune mediated condition that arises from a complex interaction between donor and recipients adaptive immunity. It presents as dermatitis, hepatitis and enteritis developing within 100 days after stem cell or bone marrow transplant.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Incorrect
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Which of the following muscles is least likely to be involved in forceful expiration:
Your Answer:
Correct Answer: External intercostal muscles
Explanation:Forceful expiration is primarily produced by the deeper thoracic muscles (internal and innermost intercostal muscles, subcostals and transversus thoracis) aided by contraction of the abdominal wall muscles which increase intra-abdominal pressure thus further reducing the volume of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 28
Incorrect
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Salivary glands produce saliva which is mostly water, but it also contains a range of essential chemicals such as mucus, electrolytes, antibiotic agents, and enzymes.
Which of the following is a carbohydrate-digesting enzyme found in saliva?
Your Answer:
Correct Answer: Amylase
Explanation:The acinar cells of the parotid and submandibular glands release amylase. Amylase begins starch digestion before food is even eaten, and it works best at a pH of 7.4.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 29
Incorrect
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The most important nerves for inversion of the foot are:
Your Answer:
Correct Answer: Tibial and deep fibular nerve
Explanation:Inversion of the foot is achieved by the tibialis anterior which is innervated by the deep fibular nerves, and the tibialis posterior muscles which is innervated by the tibial nerve respectively.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Incorrect
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Which of the following is a contraindication to using nitrous oxide:
Your Answer:
Correct Answer: Raised intracranial pressure
Explanation:Nitrous oxide should not be utilized in patients with an air-containing confined area because it diffuses into these spaces, causing a rise in pressure. This includes circumstances like pneumothorax, intracranial air after a head injury, imprisoned air from a recent undersea dive, a recent intraocular gas injection, or intestinal blockage. Nitrous oxide increases cerebral blood flow and should be avoided in individuals who have or are at risk of having high intracranial pressure.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
