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Question 1
Incorrect
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Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed with psittacosis based on his symptoms and history of being a pigeon enthusiast. Which of the following is the causative bacteria of psittacosis?
Your Answer: Mycoplasma pneumoniae
Correct Answer: Chlamydia psittaci
Explanation:Chlamydia psittaci is a microorganism that is commonly found in birds. These bacteria can infect people and cause psittacosis. Psittacosis is an infectious disease that may cause high fever and pneumonia associated with headaches, altered mental state, and hepatosplenomegaly.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 2
Correct
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Which of the following medications can block the effect of adrenaline?
Your Answer: Beta-blockers
Explanation:Beta-blockers may reduce the response to adrenaline in the treatment of anaphylactic reactions. Noncardioselective beta-blockers in particular can antagonize the broncho dilating and cardio stimulatory effects of adrenaline by blocking beta-2 adrenergic receptors in the smooth muscles of the bronchial tree and in the heart muscles.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 3
Correct
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All these structures make up the portal triad EXCEPT?
Your Answer: Branches of the hepatic vein
Explanation:The portal triad, is made up of a portal arteriole (a branch of the hepatic artery), a portal venule (a branch of the hepatic portal vein) and a bile duct. Also contained within the portal triad are lymphatic vessels and vagal parasympathetic nerve fibres.Branches of the hepatic vein is not part of the portal triad
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 4
Correct
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What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient with suspected anaphylactic shock?
Your Answer: 500 micrograms intramuscularly
Explanation:1: 1000 Adrenaline solution dosage for children above the age of 12 and adults, including pregnant women (over 50 kg) is 0.50 mL, which is equivalent to 500 mcg of adrenaline.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 5
Incorrect
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An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.Which of the following valve disorders is an absolute contraindication to the use of GTN?
Your Answer: Aortic regurgitation
Correct Answer: Mitral stenosis
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine. Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are: 1. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)The nitrate drugs cause vasodilation via the action of nitric oxide. The contraindications to the use of nitrate are the following: 1. Allergy to nitrates2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil3. Right ventricular infarction4. Hypertrophic cardiomyopathy5. Cardiac tamponade6. Constrictive pericarditis7. Hypotensive conditions8. Hypovolaemia9. Marked anaemia10. Mitral stenosis11. Raised intracranial pressure due to cerebral haemorrhage or head trauma12. Toxic pulmonary oedema
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Incorrect
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Glucagon is the main catabolic hormone of the body and raises the concentration of glucose and fat in the bloodstream.Which pancreatic islet cells secretes glucagon?
Your Answer: Gamma
Correct Answer: Alpha
Explanation:Glucagon, secreted from the pancreatic islet alpha cells, is considered to be the main catabolic hormone of the body. It raises the concentration of glucose and fat in the bloodstreamThere are five different pancreatic islet cells:Alpha cells (20%) – produce glucagonBeta cells (70%) – produce insulin and amylinDelta cells (<10%) – produce somatostatinGamma cells (<5%) – produce pancreatic polypeptideEpsilon cells (<1%) – produce ghrelin
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 7
Correct
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What is the mechanism of action of captopril:
Your Answer: Angiotensin-converting enzyme inhibitor
Explanation:Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 8
Incorrect
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About case-control studies, one of the following is true.
Your Answer: They are usually more expensive to run than a randomised controlled trial
Correct Answer: They are suitable to be used in the study of rare diseases
Explanation:Case-control studies are suitable when investigating a rare disease or in cases where little is known about the disease and the proposed aetiological factor, as a preliminary study. They have the ability to look at multiple risk-factors (exposures) but can only look at a single outcome.In a case-control study, two groups of patients, one with the disease and one without, are compared on the basis of a proposed causative factor that occurred in the past. They are therefore a retrospective study and useful in hypothesis generation.Cohort studies are better at identifying rare exposures. One group with an exposure is compared to a control group without that exposure.Case-control studies are usually less expensive to run and also shorter in duration compared with prospective cohort studies.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 9
Correct
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Regarding gas gangrene, which of the following statements is CORRECT:
Your Answer: Infection is characterised by rapidly spreading tissue myonecrosis with crepitus.
Explanation:Gas gangrene usually occurs within 3 days of injury, and is characterised by pain, rapidly spreading oedema, myositis, necrosis, palpable crepitus and systemic toxicity. Diagnosis is clinical and laboratory confirmation should not delay urgent surgical intervention. Hyperbaric oxygen therapy can be considered in addition to surgery and antibiotic therapy, to stop toxin production and inhibit bacteria from replicating and spreading (as Clostridium spp. are obligate anaerobes).
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 10
Correct
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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: 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 11
Correct
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Which of the following is NOT an indication for a H1 receptor antihistamine:
Your Answer: Gastroesophageal reflux disease
Explanation:Antihistamines are competitive inhibitors at the H1-receptor (in contrast to H2 receptor antagonists used to decrease gastric acid secretion in gastroesophageal reflux disease).Indications: Allergic rhinitis and conjunctivitisUrticarial rashes, pruritus, insect bites and stingsAngioedemaAnaphylaxis (second line adjunct to adrenaline)Nausea/vomiting and prevention of motion sicknessInsomnia
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 12
Incorrect
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A lesion to which part of the optic radiation will result in contralateral homonymous inferior quadrantanopia?
Your Answer: Left parietal 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 13
Incorrect
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A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.Which of the following nerves may most likely be affected?
Your Answer: The lower subscapular nerve
Correct Answer: The suprascapular nerve
Explanation:The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Incorrect
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An infection causes an Addisonian crisis in a male patient with a known history of Addison's disease.Which of the following is NOT a well-known symptom of an Addisonian crisis?
Your Answer: Metabolic acidosis
Correct Answer: Hyperglycaemia
Explanation:Although Addisonian crisis is a rare illness, it can be fatal if it is misdiagnosed. Hypoglycaemia and shock are the most common symptoms of an Addisonian crisis (tachycardia, peripheral vasoconstriction, hypotension, altered conscious level, and coma).Other clinical characteristics that may be present are:FeverPsychosisLeg and abdominal painDehydration and vomitingConvulsions
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 15
Correct
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A 6-year-old child presents with profuse watery diarrhoea and dehydration. Which of the following statements is considered correct regarding infective diarrhoea?
Your Answer: E.Coli can cause diarrhoea and renal failure
Explanation:E. coli may cause several different gastrointestinal syndromes. Based on virulence factors, clinical manifestation, epidemiology, and different O and H serotypes, there are five major categories of diarrheagenic E. coli, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroadherent, which includes diffusely adherent E. coli (DAEC) and enteroaggregative E. coli (EAEC). These five categories are sometimescollectively referred to as enterovirulent E. coli or diarrheagenic E. coli.Norwalk virus is part of the Caliciviridae family of viruses which are single-stranded RNA viruses and are the most common cause of infectious gastroenteritis in the US.Rotaviruses are the most common cause of viral gastroenteritisin infants and children. With the introduction in 2006 of a human-bovine rotavirus vaccine (RV5; RotaTeq, Merck), a delay in the onset of rotavirusseason was seen. RotaTeq is a series of three oral vaccines beginning at 6 to 12 weeks of age. A second vaccine, Rotarix (RV1; GlaxoSmithKline, Middlesex, England), was approved in June 2008.Cryptosporidium causes an illness characterized by abdominal cramping, watery diarrhoea, vomiting, fever, and anorexia. This organism is resistant to chlorine, so public swimming pools can be the source of an outbreak.G. lamblia has a worldwide distribution and has frequently been identified as the causative agent of outbreaks of gastroenteritis and traveller’s diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 16
Incorrect
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Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?
Your Answer: Further anticoagulation should be avoided until HIT has resolved.
Correct Answer: HIT typically develops 5-10 days after starting heparin.
Explanation:Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. HIT is frequently considered in the differential diagnosis of thrombocytopenia occurring in patients on heparin therapy. HIT is a challenging diagnosis because of routine heparin use in hospitalized patients, the common occurrence of thrombocytopenia. The process of heparin dependent IgG antibodies binding to heparin/platelet factor 4 complexes activates platelets and produces a hypercoagulable state. This syndrome typically develops 5-10 days (range 4-15 days) after heparin is commenced. It can occur with unfractionated heparin, low molecular weight heparin, or, rarely, fondaparinux. The diagnosis of HIT requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent platelet activating HIT antibodies. Discontinuation of heparin alone or initiation of a vitamin K antagonist alone like warfarin, is not sufficient to stop the development of thrombosis in patients with acute HIT. If there is moderate clinical suspicion for HIT, all sources of heparin must be discontinued and there must be consideration of anticoagulant treatment with a non-heparin drug.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 17
Correct
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In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.Prolonged seizures last 5 minutes or more. Repeated seizures refer to 3 or more seizures in an hour.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 18
Correct
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Which of the following clotting factors is NOT vitamin K-dependent:
Your Answer: V
Explanation:Fat-soluble vitamin K is obtained from green vegetables and bacterial synthesis in the gut. Deficiency may present in the newborn (haemorrhagic disease of the newborn) or in later life. Deficiency may be caused by an inadequate diet, malabsorption or inhibition of vitamin K by drugs such as warfarin. The activity of factors II, VII, IX and X are vitamin K dependent as well as that of protein C and protein S. Both PT and APTT are prolonged.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 19
Correct
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Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:
Your 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.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 20
Incorrect
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After collapsing in his nursing home, a 70-year-old man is brought into the ER. He is a known case of diabetes mellitus and is on medication for it. An RBS of 2.5 mmol/L (3.9-5.5 mmol/L) is recorded in the ER. Out of the following, which medication for diabetes mellitus is MOST likely responsible for his hypoglycaemic episode?
Your Answer: Sitagliptin
Correct Answer: Pioglitazone
Explanation:Pioglitazone is used to treat type 2 diabetes mellitus. It selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-γ) and to a lesser extent PPAR-α. Of the medications mentioned in this question, only pioglitazone is a recognized cause of hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 21
Correct
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Which of the following ions is more abundant in extracellular fluid than in intracellular fluid:
Your Answer: Cl -
Explanation:Protein and phosphate are the primary intracellular anions, while chloride (Cl-) and bicarbonate are the predominant extracellular anions (HCO3-).
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 22
Incorrect
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Anatomical barriers to infection include all of the following EXCEPT:
Your Answer: Commensal flora in the genitourinary tract
Correct Answer: Mucociliary escalator in the gastrointestinal tract
Explanation:Anatomical barriers to infection include:tight junctions between cells of the skin and mucosal membranesthe flushing action of tears, saliva and urinethe mucociliary escalator in the respiratory tract (together with the actions of coughing and sneezing)the acidic pH of gastric and vaginal secretionsthe acidic pH of the skin (maintained by lactic acid and fatty acids in sebum)enzymes such as lysozyme found in saliva, sweat and tearspepsin present in the stomachbiological commensal flora formed on the skin and the respiratory, gastrointestinal and genitourinary tracts which protect the host by competing with pathogenic bacteria for nutrients and attachment sites and by producing antibacterial substances
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This question is part of the following fields:
- Microbiology
- Principles
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Question 23
Incorrect
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When calculating the ventilation over perfusion ratio of a male patient, you should remember the ideal V/Q ratio for this patient to compare with his results. What is the approximate ventilation value for a healthy male patient?
Your Answer: 2.5 L/min
Correct Answer: 5 L/min
Explanation:The ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching ventilation and perfusion. The ideal V/Q ratio is 1. In an average healthy male, the ventilation value is approximately 5 L/min and the perfusion value is approximately 5 L/min. Any mismatch between ventilation and perfusion will be evident in the V/Q ratio. If perfusion is normal but ventilation is reduced, the V/Q ratio will be less than 1, whereas if ventilation is normal but perfusion is reduced, the V/Q ratio will be greater than 1. If the alveoli were ventilated but not perfused at all, then the V/Q ratio would be infinity.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 24
Incorrect
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A 59-year-old otherwise well woman presents with a history of polydipsia and polyuria. There is a past history of kidney stones, and blood tests done reveal the following: Na: 147 mmol/L (135-147 mmol/L) K: 4.0 mmol/L (3.5-5.5 mmol/L) Urea: 7.3 mmol/L (2.0-6.6 mmol/L) Creatinine: 126 mmol/L (75-125 mmol/L) Fasting blood glucose: 5.0 mmol/L (3.4-5.5 mmol/L) Corrected calcium: 3.21 mmol/L (2.05-2.60 mmol/L) Phosphate: 0.70 mmol/L (0.8-1.4 mmol/L) Parathyroid hormone: 189 ng/L (10-60 ng/L)The most likely diagnosis is?
Your Answer: Secondary hyperparathyroidism
Correct Answer: Primary hyperparathyroidism
Explanation:Primary hyperparathyroidism the commonest cause of hypercalcaemia. It is commonest in women aged 50 to 60.The commonest cause of primary hyperparathyroidism is a solitary adenoma of the parathyroid gland (approximately 85% of cases). Primary hyperparathyroidism may present with features of hypercalcaemia such as polyuria, polydipsia, renal stones, bone and joint pain, constipation, and psychiatric disorders.In primary Hyperparathyroidism:PTH is elevatedCalcium is elevatedPhosphate is loweredIn secondary Hyperparathyroidism:PTH is elevatedCalcium is low or low-normalPhosphate is raised in CRFIn tertiary Hyperparathyroidism:PTH is elevatedCalcium is elevatedPhosphate is lowered in CRF
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 25
Correct
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Myocardial contractility is best correlated with the intracellular concentration of:
Your Answer: Ca2+
Explanation:Contractility of myocardial cells depends on the intracellular [Ca2+], which is regulated by Ca2+entry across the cell membrane during the plateau of the action potential and by Ca2+uptake into and release from the sarcoplasmic reticulum (SR).
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 26
Incorrect
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Which statement concerning aerosol transmission is true?
Your Answer: They are not able to remain suspended in the air
Correct Answer: They can be spread via ventilation systems in hospitals
Explanation:Aerosols are airborne particles less than 5 µm in size containing infective organisms. They usually cause infection of both the upper and/or lower respiratory tract.The organisms can remain suspended in the air for long periods and also survive outside the body. They can be transmitted through the ventilation systems and can spread over great distances. Some examples of organisms transmitted by the aerosol route include: Varicella zoster virus, Mycobacterium tuberculosis and measles virus
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 27
Incorrect
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Surface area of the absorptive surface in the small intestine is increased by all but which of the following:
Your Answer: Plicae circulares
Correct Answer: Teniae coli
Explanation:Factors increasing the surface area include:The small intestine is very long – about 5 m in length.The inner wall of the small intestine is covered by numerous folds of mucous membrane called plicae circulares.The lining of the small intestine is folded into many finger-like projections called villi.The surface of the villi is covered with a layer of epithelial cells which, in turn, have many small projections called microvilli that project towards the lumen of the intestine (forming the brush border).
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 28
Incorrect
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A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs. Which one is a nucleic acid synthesis inhibitor?
Your Answer: Gentamicin
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.The following is a summary of the many modes of action of various types of antimicrobial agents:Action Mechanisms- Examples:Cell wall production is inhibitedVancomycinVancomycinCephalosporinsThe function of the cell membrane is disrupted NystatinPolymyxinsAmphotericin B Inhibition of protein synthesisChloramphenicolMacrolidesAminoglycosidesTetracyclinesNucleic acid synthesis inhibitionQuinolonesTrimethoprimRifampicin5-nitroimidazolesSulphonamidesAnti-metabolic activityIsoniazid
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 29
Incorrect
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Digoxin exhibits its positive inotropic effect by which of the following mechanisms:
Your Answer: Inhibits the Ca2+ ATPase pump on the sarcoplasmic reticulum
Correct Answer: Inhibits the Na+/K+ pump on the myocyte membrane
Explanation:Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump (Na+/K+ATPase) which generates the Na+gradient required for driving the export of Ca2+by Na+/Ca2+exchange; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 30
Incorrect
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Regarding Clostridium difficile, which of the following statements is CORRECT:
Your Answer:
Correct Answer: It is normally found in gut flora.
Explanation:C. difficile is normally found in the gut flora but its growth is normally suppressed by more dominant anaerobes. It has exotoxin-mediated effects causing profuse diarrhoea. Oral clindamycin (a broad spectrum antibiotic) is commonly implicated in precipitating C. difficile colitis; first line treatment is with oral metronidazole. Tetanolysin is a toxin produced by Clostridium tetani bacteria.
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This question is part of the following fields:
- Microbiology
- Pathogens
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SESSION STATS - PERFORMANCE PER SPECIALTY
