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  • Question 1 - Which of the following nerves innervates the gastrocnemius muscle? ...

    Incorrect

    • Which of the following nerves innervates the gastrocnemius muscle?

      Your Answer: Superficial peroneal nerve

      Correct Answer: Tibial nerve

      Explanation:

      The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      1
      Seconds

  • Question 2 - The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian...

    Incorrect

    • The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian man is 152/96 mmHg (ABPM).

      The first-line drug treatment for this patient would be which of the following? Please only choose ONE answer.

      Your Answer:

      Correct Answer: Amlodipine

      Explanation:

      An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.

      A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 59-year-old Caucasian man.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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      Seconds

  • Question 3 - The renin-angiotensin-aldosterone system (RAAS) controls blood pressure and fluid balance.

    Which of the following...

    Incorrect

    • The renin-angiotensin-aldosterone system (RAAS) controls blood pressure and fluid balance.

      Which of the following sites produces the most angiotensinogen? 

      Your Answer:

      Correct Answer: The liver

      Explanation:

      Angiotensinogen is an alpha-2-globulin generated predominantly by the liver and released into the blood. Renin, which cleaves the peptide link between the leucine and valine residues on angiotensinogen, converts it to angiotensin I.

      Angiotensinogen levels in the blood are raised by:
      Corticosteroid levels have risen.
      Thyroid hormone levels have risen.
      Oestrogen levels have risen.
      Angiotensin II levels have risen.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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  • Question 4 - A 66-year-old female with a history of stroke one year ago presents to...

    Incorrect

    • A 66-year-old female with a history of stroke one year ago presents to the Family Medicine clinic complaining of fatigue, weight loss, and tongue discolouration. On examination, she seems malnourished, her tongue is beefy red, and an ataxic gait pattern is noticed.

      Which ONE of the following conditions does this patient most likely have?

      Your Answer:

      Correct Answer: Vitamin B12 deficiency

      Explanation:

      A history of stroke and poor nutritional status points towards a nutritional deficiency as the most likely cause of her symptoms. The examination would differentiate between Vitamin B12 and Folic acid deficiency as in the former. The patient has a beefy red tongue and symptoms indicating peripheral nervous system involvement or subacute combined spinal cord degeneration. The patient may also have a lemon-yellow skin colour, loss of proprioception and vibratory sense and oral ulceration.

      Investigations in B12 deficiency can reveal the following:
      1. Macrocytic anaemia
      2. Neutropoenia
      3. Thrombocytopaenia
      4. Blood film: anisocytosis, poikilocytosis
      5. Low serum B12
      6. Raised serum bilirubin (haemolysis)
      7. Intrinsic factor antibodies
      8. Positive Schilling test

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 5 - Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: In relaxation, Ca 2+ is transported out of the cell using energy from a Na + gradient.

      Explanation:

      During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane which pumps one Ca2+ion out in exchange for three Na+ions in, using the Na+electrochemical gradient as an energy source. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Factors that affect intracellular [Ca2+] and hence cardiac contractility are called inotropes.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 6 - Regarding iron deficiency anaemia, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding iron deficiency anaemia, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Dietary insufficiency is the most common cause of iron deficiency anaemia in adult men in the UK.

      Explanation:

      Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia in adult men and postmenopausal women.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 7 - During bedside rounds, an 82-year old female in the Medicine Ward complains of...

    Incorrect

    • During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.

      Which of the following is expected to undergo atrophy in carpal tunnel syndrome?

      Your Answer:

      Correct Answer: The thenar eminence

      Explanation:

      Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.

      The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:
      L– lateral two lumbricals
      O– Opponens pollicis
      A– Abductor pollicis
      F– Flexor pollicis brevis

      In the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.

      Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds

  • Question 8 - You are seeing a child with known mitochondrial disease who has presented breathlessness...

    Incorrect

    • You are seeing a child with known mitochondrial disease who has presented breathlessness and cough. Which of the following best describes the function of mitochondria:

      Your Answer:

      Correct Answer: Energy production

      Explanation:

      Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.
      Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.
      Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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      Seconds

  • Question 9 - Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for: ...

    Incorrect

    • Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:

      Your Answer:

      Correct Answer: Hypocalcaemia

      Explanation:

      Common side effects of thiazide diuretics include:
      Excessive diuresis, postural hypotension, dehydration, renal impairment
      Acid-base and electrolyte imbalance
      Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosis
      Metabolic imbalance
      Hyperuricaemia and gout
      Impaired glucose tolerance and hyperglycaemia
      Altered plasma-lipid concentrations
      Mild gastrointestinal disturbances

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 10 - At rest, the left dome of the diaphragm normally reaches as high as...

    Incorrect

    • At rest, the left dome of the diaphragm normally reaches as high as which of the following:

      Your Answer:

      Correct Answer: Fifth intercostal space

      Explanation:

      At rest the right dome of the diaphragm lies slightly higher than the left; this is thought to be due to the position of the liver. In normal expiration, the normal upper limits of the superior margins are the fifth rib for the right dome, the fifth intercostal space for the left dome and the xiphoid process for the central tendon.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

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