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  • Question 1 - A 6-year-old child with a few itchy honey crusted sores on her left...

    Incorrect

    • A 6-year-old child with a few itchy honey crusted sores on her left cheek is brought in by her mother. Following a thorough examination of the child, you diagnose impetigo and recommend a course of topical fusidic acid.

      Fusidic acid's mode of action is which of the following?

      Your Answer: Inhibition of DNA gyrase

      Correct Answer: Inhibition of protein synthesis

      Explanation:

      By binding EF-G-GDP, fusidic acid prevents both peptide translocation and ribosome disassembly, which slows protein synthesis. Because it has a novel structure and mechanism of action, it is unlikely to cause cross-resistance with existing antibiotics.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      3
      Seconds

  • Question 2 - 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 muscles

      CO2 and K+ are the most potent vasodilators in cerebral circulation.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      0
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  • Question 3 - A 29-year-old man presents with painful red eye with copious discharge and you...

    Incorrect

    • A 29-year-old man presents with painful red eye with copious discharge and you make a diagnosis of infective conjunctivitis following a history and an examination,.

      One of these is NOT an indication for an urgent ophthalmology referral in this patient.

      Your Answer:

      Correct Answer: Bilateral conjunctivitis

      Explanation:

      Urgent referral to ophthalmology is indicated if the patient with conjunctivitis has any of the following:

      Suspected gonococcal or chlamydial conjunctivitis
      Corneal involvement associated with soft contact lens use
      Severe disease indicated by presence of a pseudomembrane
      Conjunctivitis associated with rheumatoid arthritis or in immunocompromised patient. Ophthalmia neonatorum.
      Possible herpes infection.
      Had recent intraocular surgery. A red flag indicating a serious cause of red eye.
      Suspected periorbital or orbital cellulitis.

      Bilateral conjunctivitis is not an indication for urgent referral to ophthalmology.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 4 - A 54-year-old man with a long history of poorly controlled hypertension complains of...

    Incorrect

    • A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.

      Which of the following is the patient's preferred drug treatment?

      Your Answer:

      Correct Answer: 25% of the mean arterial pressure over the first hour

      Explanation:

      End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.

      Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.

      Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.

      The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.
      An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 5 - An X-ray of a 24-year-old female hockey player who arrives at the hospital...

    Incorrect

    • An X-ray of a 24-year-old female hockey player who arrives at the hospital with a left foot injury reveals an avulsion fracture of the fifth metatarsal tuberosity. Which of the following muscles is most likely responsible for the movement of the fractured fragment?

      Your Answer:

      Correct Answer: Fibularis brevis

      Explanation:

      An avulsion fracture of the base of the fifth metatarsal happens when the ankle is twisted inwards.

      When the ankle is twisted inwards a muscle called the fibularis brevis contracts to stop the movement and protect the ligaments of the ankle.

      The base of the fifth metatarsal is where this muscle is attached. The group of lateral leg muscles that function to plantarflex the foot includes the fibularis brevis and the fibularis longus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
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  • Question 6 - Which of the following cell types in the stomach secretes histamine? ...

    Incorrect

    • Which of the following cell types in the stomach secretes histamine?

      Your Answer:

      Correct Answer: Enterochromaffin-like cells

      Explanation:

      The parietal cells operate in close association with another type of cell called enterochromaffin-like cells (ECL cells), the primary function of which is to secrete histamine. The ECL cells lie in the deep recesses of the oxyntic glands and therefore release histamine indirect contact with the parietal cells of the glands.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 7 - A 28-year-old female arrives after taking an unknown chemical in excess. She is tired...

    Incorrect

    • A 28-year-old female arrives after taking an unknown chemical in excess. She is tired and her speech is slurred. The following are her observations and results: 
      HR 118, 
      BP 92/58, 
      SaO2 96%
      HR 118,  11/15  
      The following are the results  of his arterial blood gas (ABG):
      pH: 7.24 
      pO 2 : 9.4 
      kPa PCO2 : 3.3 
      kPa HCO 3 -: 22 mmol/l 
      Na + : 143 mmol/l 
      Cl – : 99 mmol/l 
      Lactate: 5 IU/l

      Which of the following statements about this patient is TRUE?

      Your Answer:

      Correct Answer: Her anion gap is elevated

      Explanation:

      The interpretation of arterial blood gas (ABG) aids in the measurement of a patient’s pulmonary gas exchange and acid-base balance.
      The normal values on an ABG vary a little depending on the analyser, but they are roughly as follows:
      Variable
      Range
      pH
      7.35 – 7.45
      PaO2
      10 – 14 kPa
      PaCO2
      4.5 – 6 kPa
      HCO3-
      22 – 26 mmol/l
      Base excess
      -2 – 2 mmol/l

      The patient’s history indicates that she has taken an overdose in this case. Because her GCS is 11/15 and she can communicate with slurred speech, she is clearly managing her own airway, there is no current justification for intubation.

      The following are the relevant ABG findings:

      Hypoxia (mild)
      pH has been lowered (acidaemia)
      PCO2 levels are low.
      bicarbonate in its natural state
      Lactate levels have increased

      The anion gap represents the concentration of all the unmeasured anions in the plasma. It is the difference between the primary measured cations and the primary measured anions in the serum. It can be calculated using the following formula:
      Anion gap = [Na+] – [Cl-] – [HCO3-]

      The reference range varies depending on the technique of measurement, but it is usually between 8 and 16 mmol/L.

      The following formula can be used to compute her anion gap:
      Anion gap = [143] – [99] – [22]
      Anion gap = 22

      As a result, it is clear that she has a metabolic acidosis with an increased anion gap.

      The following are some of the causes of type A and type B lactic acidosis:
      Type A lactic acidosis
      Type B lactic acidosis
      Shock (including septic shock)
      Left ventricular failure
      Severe anaemia
      Asphyxia
      Cardiac arrest
      CO poisoning
      Respiratory failure
      Severe asthma and COPD
      Regional hypoperfusion
      Renal failure
      Liver failure
      Sepsis (non-hypoxic sepsis)
      Thiamine deficiency
      Alcoholic ketoacidosis
      Diabetic ketoacidosis
      Cyanide poisoning
      Methanol poisoning
      Biguanide poisoning

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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  • Question 8 - Liquefactive necrosis is most commonly seen in which of the following conditions: ...

    Incorrect

    • Liquefactive necrosis is most commonly seen in which of the following conditions:

      Your Answer:

      Correct Answer: Ischaemic stroke

      Explanation:

      Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
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  • Question 9 - Regarding folate requirements, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding folate requirements, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Dietary folate is found particularly in leafy green vegetables and liver.

      Explanation:

      Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
      Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 10 - What type of visual field defect are you most likely to see in...

    Incorrect

    • What type of visual field defect are you most likely to see in a lesion of the parietal optic radiation:

      Your Answer:

      Correct Answer: Contralateral homonymous inferior quadrantanopia

      Explanation:

      A lesion of the parietal optic radiation will result in a contralateral homonymous inferior quadrantanopia.
      A lesion of the temporal optic radiation will result in a contralateral homonymous superior quadrantanopia.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 11 - Before a patient is discharged, you are asked to review them. He is...

    Incorrect

    • Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.

      Which of the following statements about aspirin's mechanism of action is correct?

      Your Answer:

      Correct Answer: Inhibition of cyclo-oxygenase

      Explanation:

      Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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      Seconds

  • Question 12 - A 32-year old male patient has been diagnosed with meningococcal meningitis and was...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 13 - Which of the following is NOT an advantage of a case-control study used...

    Incorrect

    • Which of the following is NOT an advantage of a case-control study used to identify past exposure to a risk factor in patients with a disease:

      Your Answer:

      Correct Answer: Can directly measure absolute and relative risk of a disease

      Explanation:

      Advantages:relatively quickrelatively cheap and easy to performparticularly suitable for studying associations between an exposure and an outcome when the outcome is uncommon or if the outcome occurs decades after exposurea wide range of risk factors can be investigated in each studyDisadvantages:subject to recall biasunlike in a whole population study, absolute risk cannot be quantifiedtemporal relationship between exposure and outcome can be difficult to establishunsuitable for rare risk factorsprone to confounding

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
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  • Question 14 - Which of the following pathogens is most commonly implicated in croup: ...

    Incorrect

    • Which of the following pathogens is most commonly implicated in croup:

      Your Answer:

      Correct Answer: Parainfluenza

      Explanation:

      Parainfluenza virus is the most commonly implicated infectious agent in croup.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 15 - Regarding haemophilia A, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding haemophilia A, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: In haemophilia both the APTT and PT are prolonged.

      Explanation:

      Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives.

      The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 16 - A 33-year-old woman who is investigated for recurrent renal stones is discovered to...

    Incorrect

    • A 33-year-old woman who is investigated for recurrent renal stones is discovered to have a markedly elevated parathyroid hormone (PTH) level.
      Which of the following would stimulate PTH release under normal circumstances? Select ONE answer only.

      Your Answer:

      Correct Answer: Decreased plasma calcium concentration

      Explanation:

      Parathyroid hormone (PTH) is a polypeptide containing 84 amino acids. It is the principal controller of free calcium in the body.
      PTH is synthesised by and released from the chief cells of the four parathyroid glands that are located immediately behind the thyroid gland.
      PTH is released in response to the following stimuli:
      Decreased plasma calcium concentration
      Increased plasma phosphate concentration (indirectly by binding to plasma calcium and reducing the calcium concentration)
      PTH release is inhibited by the following factors:
      Normal/increased plasma calcium concentration
      Hypomagnesaemia
      The main actions of PTH are:
      Increases plasma calcium concentration
      Decreases plasma phosphate concentration
      Increases osteoclastic activity (increasing calcium and phosphate resorption from bone)
      Increases renal tubular reabsorption of calcium
      Decreases renal phosphate reabsorption
      Increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)
      Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 17 - A 59-year-old man presents with increased sweating, weight loss, and palpitations. A...

    Incorrect

    • A 59-year-old man presents with increased sweating, weight loss, and palpitations. A series of blood tests done found a very low TSH level and a diagnosis of hyperthyroidism is made.

      What is the commonest cause of hyperthyroidism?

      Your Answer:

      Correct Answer: Graves’ disease

      Explanation:

      Hyperthyroidism results from an excess of circulating thyroid hormones. It is commoner in women, and incidence increases with age.

      Hyperthyroidism can be subclassified into:
      Primary hyperthyroidism – the thyroid gland itself is affected
      Secondary hyperthyroidism – the thyroid gland is stimulated by excessive circulating thyroid-stimulating hormone (TSH).

      Graves’ disease is the most common cause of hyperthyroidism (estimates are that it causes between 50 and 80% of all cases).

      Although toxic multinodular goitre, thyroiditis,TSH-secreting pituitary adenoma and drug-induced hyperthyroidism also causes hyperthyroidism, the commonest cause is Graves’ disease.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 18 - Which of the following is the most abundant immunoglobulin in plasma: ...

    Incorrect

    • Which of the following is the most abundant immunoglobulin in plasma:

      Your Answer:

      Correct Answer: IgG

      Explanation:

      IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
      IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
      IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 19 - Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:...

    Incorrect

    • Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:

      Your Answer:

      Correct Answer: The two variables are directly proportional

      Explanation:

      A positive correlation coefficient means that the two variables are directly proportional e.g. height and weight in healthy growing children.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
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  • Question 20 - A 28-year-old patient who has been in a car accident needs to be...

    Incorrect

    • A 28-year-old patient who has been in a car accident needs to be intubated using a rapid sequence induction. As an induction agent, you intend to use etomidate.

      Etomidate works by interacting with which type of receptor?

      Your Answer:

      Correct Answer: Gamma-aminobutyric acid (GABA)

      Explanation:

      Etomidate is a carboxylated imidazole derivative with a short half-life that is primarily used to induce anaesthesia.

      It is thought to modulate fast inhibitory synaptic transmission in the central nervous system by acting on GABA type A receptors.
      The dose for anaesthesia induction is 0.3 mg/kg. Etomidate takes 10-65 seconds to take effect after an intravenous injection, and it lasts 6-8 minutes. With repeated administration, the effects are non-cumulative.

      The relative cardiovascular stability of etomidate is noteworthy. During induction, it causes less hypotension than thiopental sodium and propofol. It’s also linked to a quick recovery without the hangover.

      Etomidate is a strong steroidogenesis inhibitor. The drug inhibits the enzymes responsible for adrenal 11 beta-hydroxylase and cholesterol cleavage, resulting in a decrease in cortisol and aldosterone synthesis for up to 24 hours after administration. It should not be used to maintain anaesthesia because of the adrenocortical suppression.

      Other side effects associated with etomidate use include:
      Vomiting and nausea
      The injection causes pain (in up to 50 percent )
      Phlebitis and thrombosis of the veins
      Heart block and arrhythmias
      Hyperventilation
      Apnoea and respiratory depression
      It has the potential to cause both hypo- and hypertension.
      Critically ill patients have a higher mortality rate.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 21 - A 17-year-old student presents with a headache and petechial rash. A diagnosis of...

    Incorrect

    • A 17-year-old student presents with a headache and petechial rash. A diagnosis of meningitis was suspected, with a causative agent of Neisseria meningitidis.

      Which of the following statements is considered correct regarding Neisseria meningitidis?

      Your Answer:

      Correct Answer: The antiphagocytic polysaccharide capsule is the main determinant of its pathogenicity

      Explanation:

      N. meningitidis is a Gram-negative cocci and can be found as a commensal as well as an invasive pathogen. It is an important etiologic agent of endemic and epidemic meningitis and meningococcaemia and rarely pneumonia, purulent arthritis, or endophthalmitis. N. meningitidis has also been recovered from urogenital and rectal sites as a result of oral-genital contact. Meningococcal carriage, usually involving nonencapsulated strains, may cause an increase in protective antibody against the pathogenic strains. Of the 12 meningococcal encapsulated serogroups, A, B, C, Y, and W-135 account for most cases of disease in the world. N. meningitidis possesses a polysaccharide capsule that is antiphagocytic and serves as an important virulence factor.

      It can be found on the mucosal surfaces of the nasopharynx and oropharynx in 30% of the human population. The organism is transmitted by close contact with respiratory droplet secretions from a carrier to a new host. Only a few newly colonized hosts develop meningococcal disease, with the highest incidence being found in infants and adolescents.

      The quadrivalent vaccine Menactra is a polysaccharide-protein conjugated vaccine with antigens to serogroups A, C, Y, and W-135. This conjugate vaccine is licensed for people 2 to 55 years old. This vaccine does not protect against meningitis caused by serogroup B because group B polysaccharide is a very poor immunogen in humans.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 22 - A 5 day old, full term neonate is with a unilateral purulent...

    Incorrect

    • A 5 day old, full term neonate is with a unilateral purulent eye discharge noticed earlier that day is brought in. On gram stain of the exudate, no bacteria are seen.

      What is the most likely causative pathogen?

      Your Answer:

      Correct Answer: Chlamydia trachomatis

      Explanation:

      Conjunctivitis occurring in the first 28 days of life (Ophthalmia neonatorum) is most commonly caused by Chlamydia trachomatis in the UK.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 23 - Which of the following best describes the popliteal artery's course? ...

    Incorrect

    • Which of the following best describes the popliteal artery's course?

      Your Answer:

      Correct Answer: After exiting the popliteal fossa terminates at the lower border of the popliteus muscle

      Explanation:

      The popliteal artery divides into the anterior and posterior tibial arteries at the lower border of the popliteus after exiting the popliteal fossa between the gastrocnemius and popliteus muscles.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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  • Question 24 - Which of the following statements is correct regarding the partial pressure of oxygen...

    Incorrect

    • Which of the following statements is correct regarding the partial pressure of oxygen during respiration?

      Your Answer:

      Correct Answer: Exhaled PO 2 > Alveolar PO 2

      Explanation:

      Because of humidification, inspired PO2 in the airways is less than inhaled PO2.
      Because of gas exchange, alveolar PO2 is less than inhaled or inspired PO2.
      Because of mixing with anatomical dead space (air that has not taken part in gas exchange, exhaled PO2 is greater than alveolar O2, and therefore that has relatively higher PO2 on the way out, but is less than inhaled or inspired PO2.
      Typical values for a resting young healthy male (in kPa) are shown below:
      -Inhaled air: PO221.2, PCO20.0
      -Inspired air in airways (after humidification): PO219.9, PCO20.0
      -Alveolar air (after equilibrium with pulmonary capillaries): PO213.3, PCO25.3
      -Exhaled air (after mixing with anatomical dead space air): PO215.5, PCO24.3

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 25 - Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT: ...

    Incorrect

    • Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: ALL is the most common malignancy of childhood.

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 26 - You see a patient in the Emergency Department with features consistent with a...

    Incorrect

    • You see a patient in the Emergency Department with features consistent with a diagnosis of type I diabetes mellitus.

      Which of these is MOST suggestive of type I diabetes mellitus?

      Your Answer:

      Correct Answer: History of recent weight loss

      Explanation:

      A history of recent weight loss is very suggestive of an absolute deficiency of insulin seen in type I diabetes mellitus.

      An age of onset of less than 20 years makes a diagnosis of type I diabetes mellitus more likely. However, an increasing number of obese children and young people are being diagnosed with type II diabetes.

      Microalbuminuria, peripheral neuropathy, and retinopathy all occur in both type I and type II diabetes mellitus. They are not more suggestive of type I DM.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 27 - A 50-year-old man has recently been on antibiotics for a chest infection. He...

    Incorrect

    • A 50-year-old man has recently been on antibiotics for a chest infection. He suffers from COPD and is currently on Seretide inhalers, salbutamol, and Phyllocontin continus. Since commencing the antibiotics, he has developed nausea, vomiting and abdominal pain.

      Which of the following antibiotics has he MOST LIKELY been on for his chest infection?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      Phyllocontin continues contains aminophylline, a bronchodilator used in the management of asthma and COPD.

      The index patient is exhibiting symptoms of theophylline toxicity. This may have been triggered by the antibiotic he took. Macrolide antibiotics, like erythromycin and quinolone antibiotics, like ciprofloxacin and levofloxacin, increases the plasma concentration of theophyllines and can lead to toxicity.

      Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin.
      Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 28 - Gastrin is secreted by which of the following cell types in the stomach:...

    Incorrect

    • Gastrin is secreted by which of the following cell types in the stomach:

      Your Answer:

      Correct Answer: G-cells

      Explanation:

      Gastrin is secreted by antral G-cells and acts on cholecystokinin B (CCKB) receptors.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 29 - Regarding red blood cell group antigens and antibodies, which of the following statements...

    Incorrect

    • Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Anti-D antibodies are usually IgG.

      Explanation:

      Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 30 - Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: They are contraindicated in paralytic ileus.

      Explanation:

      Antimuscarinics are contraindicated in paralytic ileus. Antimuscarinics reduce intestinal motility by blocking muscarinic acetylcholine receptors and relaxing smooth muscle. Hyoscine butylbromide is advocated as a gastrointestinal antispasmodic, but it is poorly absorbed and thus has limited clinical utility. Antimuscarinics cause a reduction in bronchial secretions (they can be used to this effect in palliative patients). Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
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