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Question 1
Correct
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A GP is considering prescribing a non-steroidal anti-inflammatory (NSAID) for pain relief for a patient with a knee injuryWhich of these statements about NSAIDs is NOT true?
Your Answer: Side effects are less commonly seen with indomethacin than naproxen
Explanation:Most NSAIDs act as non-selective inhibitors of the enzyme cyclo-oxygenase (COX). They inhibit both COX-1 and COX-2 isoenzymes. Only about 60% of patients will respond to any given NSAID.It can take 21 days of treatment for a clinically appreciable reduction in inflammation to be apparent. If no improvement is seen after 21 days, the NSAID should be changed.The use of NSAIDs in the 3rd trimester of pregnancy is associated with the following risks: delayed onset of labour, premature closure of ductus arteriosus and foetal kernicterus.Side effects are lowest in Ibuprofen and highest in indomethacin. so side effects are more commonly seen with indomethacin than naproxen.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 2
Correct
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All of the following are actions of insulin except:
Your Answer: Increased gluconeogenesis
Explanation:Major Actions of Insulin:↑ Glucose uptake into cells↑ Glycogenesis↓ Glycogenolysis↓ Gluconeogenesis↑ Protein synthesis↓ Protein degradation↑ Fat deposition↓ Lipolysis↓ Ketoacid production↑ K+ uptake into cellsMajor Actions of Glucagon:↓ Glycogenesis↑ Glycogenolysis↑ Gluconeogenesis↓ Fatty acid synthesis↑ Lipolysis↑ Ketoacid production
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 3
Correct
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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: Parathyroid hormone
Explanation:Parathyroid hormone (PTH), a polypeptide containing 84 amino acids, is the principal hormone that controls free calcium in the body.Its main actions are:Increases osteoclastic activity Increases plasma calcium concentrationDecreases renal phosphate reabsorptionDecreases plasma phosphate concentrationIncreases renal tubular reabsorption of calciumIncreases calcium and phosphate absorption in the small intestineIncreases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 4
Incorrect
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A 69-year-old man with a history of chronic anaemia is transfused. He takes bisoprolol and furosemide for his cardiac failure, and his most recent BNP was 123 pmol/l. He developed shortness of breath and his pre-existing peripheral oedema became worse 5 hours after transfusion was commenced. His BP rises to 170/105 mmHg and a repeat measurement of his BNP is 192 pmol/l.What is the most likely transfusion reaction to have occurred?
Your Answer: TRALI
Correct Answer: TACO
Explanation: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. Typical 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.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. TRALI (Transfusion Related Acute Lung Injury) is a clinical syndrome with abrupt onset of non-cardiogenic pulmonary oedema within 6 hours of transfusion not explained by another risk factor. Associated with the presence of antibodies in the donor blood to recipient leukocyte antigens. patients present with dyspnoea, hypertension, hypotension, acute leukopenia. 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.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.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 5
Correct
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You examine a resuscitated patient who has been diagnosed with ventricular tachycardia. The patient's hemodynamics are normal. You intended to prescribe amiodarone to him, but you can't because he has a contraindication.In these circumstances, which of the following is a contraindication to using amiodarone?
Your Answer: Sinus node disease
Explanation:Amiodarone is an anti-arrhythmic medication that can be used to treat both ventricular and atrial arrhythmias.The use of amiodarone is contraindicated in the following situations:Conduction disturbances that are severe (unless pacemaker fitted)Sinus node disease is a condition that affects the lymph nodes in (unless pacemaker fitted)Sensitivity to iodineBlockage of the Sino-atrial heart valve (except in cardiac arrest)Bradycardia in the sinuses (except in cardiac arrest)Thyroid disorders
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Correct
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Gastric emptying is increased by all of the following EXCEPT for:
Your Answer: Secretin
Explanation:Gastric emptying is increased by:Distension of the pyloric antrumA fall in the pH of chyme in the stomachParasympathetic stimulation (via vagus)GastrinThe hormones secretin, cholecystokinin and gastric inhibitory polypeptide (GIP) inhibit gastric emptying.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 7
Incorrect
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A lesion to which part of the optic radiation will result in contralateral homonymous inferior quadrantanopia?
Your Answer: Right occipital lobe
Correct Answer: Right parietal lobe
Explanation:A visual loss in the lower left quadrant in both visual fields is an indication of an inferior homonymous. This is due to a lesion of the superior fibres of the optic radiation in the parietal lobe on the contralateral side of the visual pathway.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 8
Correct
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A novel anti-tuberculosis medicine was compared to standard treatment and shown to cut the risk of death from 30 to 10 per 1000 people. How many patients would need to be treated (number need to treat (NNT)) in order to prevent ten additional tuberculosis deaths:
Your Answer: 500
Explanation:The risk of mortality in the control group (usual therapy) minus the risk of death in the treatment group equals the absolute risk reduction (ARR) of treatment.30/1000 minus 10/1000 = 20/1000 = 0.02NNT = 1/ARR = 1/0.02 = 50As a result, 50 people would need to be treated in order to prevent one additional fatality, and 500 people would need to be treated in order to avoid 10 additional deaths.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 9
Incorrect
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During anaerobic respiration, what is the net generation of ATP molecules:
Your Answer: 10
Correct Answer: 2
Explanation:In anaerobic respiration, two ATP molecules are produced for every glucose molecule, as opposed to the 38 molecules of ATP produced in aerobic respiration.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 10
Correct
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Which of the following occurs at the transverse thoracic plane:
Your Answer: Bifurcation of the trachea
Explanation:A way to help remember the structures transected by the transverse thoracic plane is CLAPTRAP:C: cardiac plexusL: ligamentum arteriosumA: aortic arch (inner concavity)P: pulmonary trunkT: tracheal bifurcation (carina)R: right-to-left movement of the thoracic duct (posterior to the oesophagus)A: azygos vein drains into superior vena cavaP: pre-vertebral fascia and pre-tracheal fascia end
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 11
Incorrect
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Which of the following statements is correct about the extensor digitorum muscle?
Your Answer: It is innervated by the median nerve
Correct Answer: It extends the medial four digits at the metacarpophalangeal joints
Explanation:Extensor digitorum is a long muscle located in the posterior compartment of the forearm. Together with the extensor carpi ulnaris and extensor digiti minimi, extensor carpi radialis longus and brevis as well as the brachioradialis, it belongs to the group of superficial extensors of the forearm. These muscles can be easily palpated in the lateral aspect of the posterior forearm, especially during the extension of hand when they are contracted.Extensor digitorum runs from the lateral epicondyle of humerus to the medial four phalanges of the hand. In this way, it generates the pull for the extension of the four medial fingers in their metacarpophalangeal and both interphalangeal joints. Extensor digitorum also participates in the extension of the wrist.Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).Extensor digitorum is vascularized by the branches of three different arteries: (1) posterior interosseous artery, (2) radial recurrent artery, and (3) anterior interosseous artery. Anterior and posterior interosseous arteries are the branches of the common interosseous artery that arises from the ulnar artery. The radial recurrent artery is a branch of the radial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Correct
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Question 13
Incorrect
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A 63-year-old man presents with severe abdominal pain and vomiting of blood. An endoscopy was performed and a peptic ulcer was found to have eroded into an artery nearby.Which of the following most likely describes the location of the ulcer?
Your Answer: The greater curvature of the stomach
Correct Answer: The posterior duodenum
Explanation:The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, particularly gastric and duodenal ulcers. Duodenal ulcers are most commonly associated with bleeding compared with gastric ulcers. Posterior duodenal ulcers are considered to be the most likely to cause severe bleeding because of its proximity to the branches of the gastroduodenal artery (GDA).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 14
Incorrect
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The renal corpuscle, consisting of the Bowman's capsule and the glomerulus is found where in the kidney:
Your Answer: The renal pelvis
Correct Answer: The cortex
Explanation:All nephrons have their renal corpuscles in the renal cortex. Cortical nephrons have their renal corpuscles in the outer part of the cortex and relatively short loops of Henle. Juxtamedullary nephrons have their corpuscles in the inner third of the cortex, close to the corticomedullary junction, with long loops of Henle extending into the renal medulla.
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This question is part of the following fields:
- Physiology
- Renal
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Question 15
Incorrect
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A 32-year-old woman with a history of bipolar disorder exhibits lithium toxicity symptoms.Which of the following is the MOST LIKELY feature to be present?
Your Answer: Syndrome of inappropriate antidiuresis
Correct Answer: Clonus
Explanation:Lithium toxicity manifests itself in the following ways:AtaxiaClonusComaConfusionConvulsionsDiarrhoeaIncreased muscle toneNausea and vomitingNephrogenic diabetes insipidusRenal failureTremor
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 16
Incorrect
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The syndrome of inappropriate antidiuresis due to excessive antidiuretic hormone (ADH) secretion is diagnosed in a male patient with a history of recurrent hyponatraemia.Which of the following produces ADH?
Your Answer: Posterior pituitary
Correct Answer: Hypothalamus
Explanation:Antidiuretic hormone (ADH), commonly known as vasopressin, is a peptide hormone that controls how much water the body retains.It is produced in the magnocellular and parvocellular neurosecretory cells of the paraventricular nucleus and supraoptic nucleus in the hypothalamus from a prohormone precursor. It is subsequently carried to the posterior pituitary via axons and stored in vesicles.The secretion of ADH from the posterior pituitary is regulated by numerous mechanisms:Increased plasma osmolality: Osmoreceptors in the hypothalamus detect an increase in osmolality and trigger ADH release.Stretch receptors in the atrial walls and big veins detect a decrease in atrial pressure as a result of this (cardiopulmonary baroreceptors). ADH release is generally inhibited by atrial receptor firing, but when the atrial receptors are stretched, the firing reduces and ADH release is promoted.Hypotension causes baroreceptor firing to diminish, resulting in increased sympathetic activity and ADH release.An increase in angiotensin II stimulates angiotensin II receptors in the hypothalamus, causing ADH production to increase.The main sites of action for ADH are:The kidney is made up of two parts. ADH’s main job is to keep the extracellular fluid volume under control. It increases permeability to water by acting on the renal collecting ducts via V2 Receptors (via a camp-dependent mechanism). This leads to a decrease in urine production, an increase in blood volume, and an increase in arterial pressure as a result.Vascular system: Vasoconstriction is a secondary function of ADH. ADH causes vasoconstriction via binding to V1 Receptors on vascular smooth muscle (via the IP3 signal transduction pathway). An increase in arterial pressure occurs as a result of this.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 17
Correct
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In all of the following conditions, lymphocytosis typically occurs except for:
Your Answer: Corticosteroid therapy
Explanation:In infants and young children, lymphocytosis often occurs in response to infections that would normally produce a neutrophil reaction in adults.Lymphocytosis occurs in:1. Viral infections (e.g. infectious mononucleosis, HIV, rubella, mumps, viral hepatitis, cytomegalovirus, herpes simplex or zoster)2. Bacterial infections (e.g. pertussis, tuberculosis, toxoplasmosis, syphilis)3. Chronic lymphoid leukaemias4. Acute lymphoblastic leukaemias5. Non-Hodgkin lymphoma6. Thyrotoxicosis
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 18
Correct
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Which nerve innervates the brachioradialis muscle?
Your Answer: The radial nerve
Explanation:Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Correct
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Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given:
Your Answer: At a concentration of 1 unit/mL at a fixed rate of 0.1 units/kg/hour
Explanation:An intravenous insulin infusion should be started at a concentration of 1 unit/mL, at a fixed rate of 0.1 units/kg/hour. Established subcutaneous long-acting insulin therapy should be continued concomitantly. Blood ketone and blood glucose concentrations should be checked hourly and the insulin infusion rate adjusted accordingly. Blood ketone concentration should fall by at least 0.5 mmol/litre/hour and blood glucose concentration should fall by at least 3 mmol/litre/hour.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 20
Correct
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A 66-year-old male was admitted from the Emergency Department due to severe pain in the left forearm and hand, refractory to pain medication along with pallor and hypothermia of the affected limb. Ultrasound doppler showed an arterial embolism. Circulation was restored after vascular surgery, but there was extensive, irreversible muscle damage. How will the muscle heal from an injury of this type?
Your Answer: Diffuse formation of fibrous tissue
Explanation:Once muscle tissue is damaged, there will be healing via diffuse formation of fibrous tissue, especially due to the widespread ischemia. Callus formation takes place in the healing of bone, not muscle. Organised scar formation occurs when a lacerated wound is approximated by sutures so that primary intention wound healing can occur. Liquefaction degeneration occurs following ischemia in the brain. Volkmann’s ischemic contracture may occur, but it is not the primary type of healing that will take place but rather the effect of the fibrous scar formation.
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This question is part of the following fields:
- General Pathology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
