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Question 1
Incorrect
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At the start of the cardiac cycle, towards the end of diastole, all of the following statements are true EXCEPT for:
Your Answer: The whole heart is relaxed.
Correct Answer: The semilunar valves are open.
Explanation:At the start of the cardiac cycle, towards the end of diastole, the whole of the heart is relaxed. The atrioventricular (AV) valves are open because the atrial pressure is still slightly greater than the ventricular pressure. The semilunar valves are closed, as the pressure in the pulmonary artery and aorta is greater than the ventricular pressures. The cycle starts when the sinoatrial node (SAN) initiates atrial systole.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 2
Correct
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How does dipyridamole mediate its antiplatelet effect:
Your Answer: It is a phosphodiesterase inhibitor.
Explanation:Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 3
Correct
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Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:
Your Answer: Local aminosalicylate
Explanation:Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 4
Incorrect
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A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.
Your Answer: Pulmonary capillary blood will have similar PO 2 and PCO 2
Correct Answer: Atelectasis is an example of a perfusion defect
Explanation:Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 5
Correct
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Which of the following is the most potent stimulus of fibrinolysis:
Your Answer: Tissue plasminogen activator
Explanation:Fibrinolysis is a normal haemostatic response to vascular injury. Plasminogen, a proenzyme in blood and tissue fluid, is converted to plasmin by activators either from the vessel wall (intrinsic activation) or from the tissues (extrinsic activation). The most important route follows the release of tissue plasminogen activator (TPA) from endothelial cells.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 6
Correct
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A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.Which of these statements describes the mechanism of action of corticosteroids in asthma?
Your Answer: Reduction of bronchial inflammation
Explanation:Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 7
Correct
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A 32-year-old man is dehydrated as he presents with severe vomiting and diarrhoea. He urgently requires resuscitation with intravenous fluid administration. He is also administered metoclopramide.Which of the following is the true mechanism of action of metoclopramide?
Your Answer: Dopamine receptor antagonism
Explanation:Metoclopramide is used to treat nausea and vomiting. It works by blocking the central and peripheral D2 (dopamine 2) receptors in the medullary chemoreceptor trigger zone in the vomiting centre (area postrema). It decreases the sensitivity of the visceral sensory nerves that transmit from the GI system to the vomiting centre. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate.At high doses, metoclopramide also blocks type-2 serotonin receptors though the effect is much weaker.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 8
Correct
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Regarding paracetamol, which of the following statements is CORRECT:
Your Answer: It has anti-pyretic action.
Explanation:Paracetamol is a non-opioid analgesic, similar in efficacy to aspirin, with antipyretic properties but no anti-inflammatory properties. It is well absorbed orally and does not cause gastric irritation. Paracetamol is a suitable first-line choice for most people with mild-to-moderate pain, and for combination therapy.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 9
Correct
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.Which of these anatomic structures is the deepest structure injured in the case above?
Your Answer: Transversalis fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:SkinFatty layer of the superficial fascia (Camper’s fascia)Membranous layer of the superficial fascia (Scarpa’s fascia)Aponeurosis of the external and internal oblique musclesRectus abdominis muscleAponeurosis of the internal oblique and transversus abdominisFascia transversalisExtraperitoneal fatParietal peritoneum
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 10
Incorrect
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While studying fluid homeostasis in the body, you encounter the term exudate. Exudate is a fluid that leaks out of the intravascular space due to changes in the permeability of the microcirculation secondary to inflammation. Which ONE of the following conditions would not be listed among the causes of an exudate?
Your Answer: Rheumatoid arthritis
Correct Answer: Myxoedema
Explanation:An exudate is an inflammatory fluid that leaks out of the intravascular space due to increased vascular permeability and intravascular pressure. It is mostly caused by local processes and can occur in the following conditions:1) Infection (e.g. pneumonia)2) Malignancy3) Pericarditis4) Collagen vascular diseases, e.g., Rheumatoid ArthritisMyxoedema is a state of severe hypothyroidism in which deposition of mucopolysaccharides occurs in the dermis. This causes a transudative effusion, typically in the pretibial region.
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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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A 64-year-old woman with a history of chronic breathlessness is referred for lung function testing.Which of the following statements regarding lung function testing is FALSE? Select ONE answer only.
Your Answer: In restrictive lung disease, the FVC is increased
Explanation:In restrictive lung disorders there is a reduction in the forced vital capacity (FVC) and the forced expiratory volume in one second (FEV1). The decline in the FVC is greater than that of the FEV1, resulting in preservation of the FEV1/FVC ratio (>0.7%).In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to 80% in the presence of symptomsModerate airflow obstruction = FEV1 of 50-79%Severe airflow obstruction = FEV1 of 30-49%Very severe airflow obstruction = FEV1<30%.Spirometry is a poor predictor of durability and quality of life in COPD but can be used as part of the assessment of severity.COPD can only be diagnosed on spirometry if the FEV1 is <80% and FEV1/FVC ratio is < 0.7.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 12
Correct
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A 71-year-old man treated with antibiotics for a chest infection returns with a profuse, offensive smelling diarrhoea. A diagnosis of Clostridium difficile diarrhoea is made after investigations.The action most effective at minimizing spread to other patients is?
Your Answer: Hand washing
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.Alcohol hand gel is not effective against Clostridium Difficile spores. Hand washing with soap and water is very essential for healthcare workers who come in contact with it.Wearing an apron and gloves, and isolation to a side room are important contact precautions. They are, however, ineffective if hand washing is neglected.Although oral vancomycin is the first-line treatment for C. difficile associated diarrhoea, it will not limit patient to patient spread.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 13
Correct
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Which of the following problems is associated with Helicobacter pylori infection?
Your Answer: Gastric malignancy
Explanation:Helicobacter pylori is a ubiquitous organism that is present in about 50% of the global population. Chronic infection with H pylori causes atrophic and even metaplastic changes in the stomach, and it has a known association with peptic ulcer disease. The most common route of H pylori infection is either oral-to-oral or faecal-to-oral contact.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 14
Incorrect
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A 70-year-old patient presents with a chronic digoxin overdose. She has vomited several times, is extremely tired, and her vision 'appears yellow,' according to her.Which of the following is a reason for this patient's use of Digifab?
Your Answer: Potassium level of 2.6 mmol/l
Correct Answer: Coexistent renal failure
Explanation:An antidote for digoxin overdose is digoxin-specific antibody (Digifab). It’s a lyophilized preparation of digoxin-immune ovine Fab immunoglobulin fragments that’s sterile, purified, and lyophilized. These fragments were extracted from the blood of healthy sheep that had been immunised with a digoxin derivative called digoxin-dicarboxymethoxylamine (DDMA), a digoxin analogue that contains the functionally important cyclopentaperhydrophenanthrene:lactone ring moiety coupled to keyhole limpet hemocyanin (KLH).Digifab has a higher affinity for digoxin than digoxin does for its sodium pump receptor, which is thought to be the site of its therapeutic and toxic effects. When given to a patient who is intoxicated, Digifab binds to digoxin molecules, lowering free digoxin levels and shifting the equilibrium away from binding to receptors, reducing cardio-toxic effects. The kidney and reticuloendothelial system then clear the Fab-digoxin complexes.The following summarises the indications for Digifab in acute and chronic digoxin toxicity:Acute digoxin toxicityChronic digoxin toxicityCardiac arrestLife-threatening arrhythmiaPotassium level > 5 mmol/l>10 mg digoxin ingested (adult)>4 mg digoxin ingested (child)Digoxin level > 12 ng/mlCardiac arrestLife-threatening arrhythmiaSignificant gastrointestinal symptomsSymptoms of digoxin toxicity
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 15
Correct
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Question 16
Incorrect
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You review a 37-year-old man with a history of intravenous drug abuse who admits to sharing needles in the past. He has a flu-like illness and a rash. Concerned he may be experiencing an HIV seroconversion illness, you order a test.Which of these tests is most reliably used to diagnose HIV at this stage?
Your Answer: CD4 count
Correct Answer: p24 antigen test
Explanation:Serum concentrations of the p24 antigen are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection. P24 is the viral protein that makes up most of the core of the HIV.ELISA and other antibody tests, though a very sensitive way of detecting the presence of HIV, cannot be used in the early stages of the disease. This is because of the window period of 6-12 weeks before antibodies are produced. These tests will be negative during a seroconversion illness.The ‘rapid HIV test’ is an HIV antibody test. It will also be negative during the ‘window period’ since it takes time for antibodies to be produced. It is called the ‘rapid test’ as it can detect antibodies in blood or saliva much quicker than the other antibody tests and results are often back within 20 minutes.CD4 and CD8 counts are usually normal in the early stages of the HIV infection and cannot be used in this case.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 17
Correct
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Which statement accurately describes the osmolality in the various parts of the Henle Loop?
Your Answer: The osmolality of fluid in the descending loop equals that of the peritubular fluid
Explanation:The Loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It consists of three major segments, including the descending thin limb, the ascending thin limb, and the ascending thick limb. These segments are differentiated based on structure, anatomic location, and function. The main function of the loop of Henle is to recover water and sodium chloride from urine. When fluid enters the loop of Henle, it has an osmolality of approximately 300 mOsm, and the main solute is sodium. The thin descending limb has a high water permeability but a low ion permeability. Because it lacks solute transporters, it cannot reabsorb sodium. Aquaporin 1 (AQP1) channels are used to passively absorb water in this area. The peritubular fluid becomes increasingly concentrated as the loop descends into the medulla, causing water to osmose out of the tubule. The tubular fluid in this area now equalizes to the osmolality of the peritubular fluid, to a maximum of approximately 1200 mOsm in a long medullary loop of Henle and 600 mOsm in a short cortical loop of Henle. The thin ascending limb is highly permeable to ions and impermeable to water. It allows the passive movement of sodium, chloride, and urea down their concentration gradients, so urea enters the tubule and sodium and chloride leave. Reabsorption occurs paracellularly due to the difference in osmolarity between the tubule and the interstitium. The thick ascending limb is also impermeable to water but actively transports sodium, potassium, and chloride out of the tubular fluid. The osmolality of the tubular fluid is lower compared to the surrounding peritubular fluid. This area is water impermeable. This results in tubular fluid leaving the loop of Henle with an osmolality of approximately 100 mOsm, which is lower than the osmolality of the fluid entering the loop, and urea being the solute.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 18
Incorrect
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Regarding bronchiolitis, which of the following statements is CORRECT:
Your Answer: It most commonly affects children aged 3 - 4 years.
Correct Answer: Chest x-ray may show hyperinflation and increased peribronchial markings.
Explanation:Acute bronchiolitis is caused most commonly by respiratory syncytial virus, occurring mostly in children aged 6 months to 2 years. Children with bronchiolitis are febrile and tachypnoeic with a dry cough and difficulty feeding. Examination may reveal chest hyperinflation, respiratory distress, wheezing and fine end-inspiratory crepitations. Chest x-ray may show hyperinflation and increased peribronchial markings (although CXR should only performed if there is diagnostic uncertainty or an atypical course). Treatment is usually supportive, aerosolized ribavirin is reserved for severely ill or immunocompromised patients.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 19
Incorrect
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A 55-year-old woman with a known history of bronchiectasis has lung function testing carried out and is found to have significant airways obstruction.Which of the following lung volumes or capacities is LEAST likely to be decreased in this case? Select ONE answer only.
Your Answer: Expiratory reserve volume
Correct Answer: Functional residual capacity
Explanation:Obstructive lung disorders are characterised by airway obstruction. Many obstructive diseases of the lung result from narrowing of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself.In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to 80% in the presence of symptomsModerate airflow obstruction = FEV1of 50-79%Severe airflow obstruction = FEV1of 30-49%Very severe airflow obstruction = FEV1<30%.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 20
Incorrect
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Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:
Your Answer: Hypokalaemia
Correct Answer: Hypocalcaemia
Explanation:Common side effects of thiazide diuretics include:Excessive diuresis, postural hypotension, dehydration, renal impairmentAcid-base and electrolyte imbalanceHypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosisMetabolic imbalanceHyperuricaemia and goutImpaired glucose tolerance and hyperglycaemiaAltered plasma-lipid concentrationsMild gastrointestinal disturbances
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 21
Incorrect
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Regarding gas gangrene, which of the following statements is CORRECT:
Your Answer: It typically occurs about 2 weeks after injury.
Correct 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 22
Incorrect
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Regarding the abductor pollicis longus, which of the following statements is true?
Your Answer: It arises from the lateral epicondyle of the elbow
Correct Answer: It extends the thumb at the carpometacarpal joint
Explanation:Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 23
Incorrect
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A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that she has a full, plethoric aspect to her face, as well as significant supraclavicular fat pads, when you examine her. She has previously been diagnosed with Cushing's syndrome.Cushing's syndrome is most commonly caused by which of the following?
Your Answer: Pituitary adenoma
Correct Answer: Iatrogenic administration of corticosteroids
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome. Cushing’s illness is the second most prevalent cause of Cushing’s syndrome. Cushing’s disease is distinct from Cushing’s syndrome in that it refers to a single cause of the illness, a pituitary adenoma that secretes high quantities of ACTH, which raises cortisol levels.Cushing’s syndrome has several endogenous sources, including:Cushing’s disease is caused by a pituitary adenoma.Adrenal adenoma Ectopic corticotropin syndrome, e.g. small cell cancer of the lungAdrenal carcinoma is a cancer of the adrenal gland.Hyperplasia of the adrenal glands
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 24
Correct
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A known epileptic is transported in status epilepticus by ambulance. On the way to the hospital, she took some diazepam.Which of the following statements about diazepam is correct?
Your Answer: It crosses into breast milk
Explanation:Diazepam boosts GABA’s effects, giving it sedative, hypnotic, anxiolytic, anticonvulsant, and muscle-relaxing properties. It can be administered orally, rectally, or intravenously.With a half-life of 20-100 hours, it is a long-acting benzodiazepine. Midazolam, oxazepam, and alprazolam are examples of short-acting benzodiazepines with a half-life of less than 12 hours (Xanax).If used in the presence of hepatic impairment, benzodiazepines can cause coma. If treatment is necessary, benzodiazepines with shorter half-lives should be used in lower doses. Diazepam is a sedative that crosses into breast milk and should be avoided by breastfeeding mothers.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 25
Correct
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A 25-year-old patient requires procedural sedation for reduction of an open fracture of his tibia and fibula. You plan on using ketamine as the sedative agent.Ketamine works as a result of action on what type of receptor? Select ONE answer only.
Your Answer: N-methyl-D-aspartate (NMDA)
Explanation:Ketamine is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties. When used correctly it is a very useful and versatile drug.Ketamine acts by non-competitive antagonism of the NMDA receptor Ca2+ channel pore and also inhibits NMDA receptor activity by interaction with the phencyclidine binding site.Ketamine can be used intravenously and intramuscularly. The intramuscular dose is 10 mg/kg, and when used by this route, it acts within 2-8 minutes and has a duration of action of 10-20 minutes. The intravenous dose is 1.5-2 mg/kg administered over a period of 60 seconds. When used intravenously, it acts within 30 seconds and has a duration of action of 5-10 minutes. Ketamine is also effective when administered orally, rectally, and nasally.Ketamine causes tachycardia, an increase in blood pressure, central venous pressure, and cardiac output, secondary to an increase in sympathetic tone. Baroreceptor function is well maintained, and arrhythmias are uncommon.The main disadvantage to the use of ketamine is the high incidence of hallucinations, nightmares, and other transient psychotic effects. These can be reduced by the co-administration of a benzodiazepine, such as diazepam or midazolam.The main side effects of ketamine are:Nausea and vomitingHypertensionNystagmusDiplopiaRash
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 26
Correct
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Regarding the lacrimal apparatus, which of the following statements is CORRECT:
Your Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
Explanation:Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 27
Incorrect
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Tiredness, night sweats, and easy bruising are symptoms of a 58-year-old woman. Splenomegaly is observed during the examination.Which of the following diagnoses is the SINGLE MOST LIKELY?
Your Answer: Non-Hodgkin lymphoma
Correct Answer: Chronic myeloid leukaemia (CML)
Explanation:CML is a myeloproliferative disorder characterised by an abnormal pluripotent haemopoietic stem cell. A cytogenetic abnormality known as the Philadelphia chromosome, which results from a reciprocal translocation between the long arms of chromosomes 9 and 22, causes more than 80% of cases of CML.CML is a disease that develops slowly over several years. This is known as the ‘chronic stage.’ This stage is usually asymptomatic, and 90 percent of patients are diagnosed at this point, with the disease being discovered frequently as a result of a routine blood test. During this stage, the bone marrow contains less than 10% immature white cells (blasts).When CML cells expand, symptoms typically begin to appear. The ‘accelerated stage’ is what it’s called. Approximately 10% of people are diagnosed at this point. During this stage, between 10% and 30% of blood cells in the bone marrow are blasts. During this stage, common clinical features include:Fatigue and exhaustionNight sweats and feverDistension of the abdomenPain in the left upper quadrant (splenic infarction)Splenomegaly (commonest examination finding)HepatomegalyBruising is simple.Gout is a type of arthritis that affects (rapid cell turnover)Hyperviscosity is a condition in which the viscosity of (CVA, priapism)A small percentage of patients experience a ‘blast crisis’ (blast stage). More than 30% of the blood cells in the bone marrow are immature blast cells at this stage. Patients with severe constitutional symptoms (fever, weight loss, bone pain), infections, and bleeding diathesis typically present at this stage.In CML, laboratory findings include:White cell count is abnormally high (often greater than 100 x 109/l).Increased number of immature leukocytes causes a left shift.Anaemia that is mild to moderately normochromic and normocytic.Platelets can be low, normal, or elevated, and the Philadelphia chromosome can be found in > 80% of patients. Serum uric acid and ALP levels are frequently elevated. Tyrosine kinase inhibitors (TKIs), such as imatinib and dasatinib, are the current mainstay of CML treatment. Allogenic bone marrow transplantation is now only used in cases where TKIs have failed to work.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 28
Correct
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A 32-year old male patient has been diagnosed with meningococcal meningitis and was given appropriate treatments. Because he is a family man, he fears that he might transmit the infection to the rest of his family members. The causative agent of meningococcal meningitis is spread via what mode of transmission?
Your Answer: Respiratory droplet route
Explanation:N. meningitidis, the causative agent of meningococcal meningitis, is considered both a commensal and a pathogen. It can be found in the surfaces of mucous membranes such as the nasopharynx and oropharynx. With this, it can be transmitted from a carrier to a new host via respiratory droplet secretions.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 29
Incorrect
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An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with left-sided hemiplegia of the face, tongue, and limbs and right-sided deficits in motor eye activity. A CT scan was ordered and showed a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer: Posterior cerebral artery
Correct Answer: Basilar artery
Explanation:Weber syndrome is a midbrain stroke characterized by crossed hemiplegia along with oculomotor nerve deficits and it occurs with the occlusion of the median and/or paramedian perforating branches of the basilar artery. Typical clinical findings include ipsilateral CN III palsy, ptosis, and mydriasis (such as damage to parasympathetic fibres of CN III) with contralateral hemiplegia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 30
Correct
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Regarding Clostridium perfringens, which of the following statements is CORRECT:
Your Answer: It can cause exotoxin-mediated food poisoning.
Explanation:Clostridium perfringens is an obligate anaerobe and has exotoxin mediated effects. It is the most common cause of gas gangrene. C. perfringens is also implicated in food poisoning, cellulitis, enteritis necrotican (life-threatening infection involving ischaemic necrosis of the jejunum), and rarely, CNS infections such as meningitis and encephalitis.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 31
Correct
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You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available.In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines?
Your Answer: Lidocaine
Explanation:If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 32
Incorrect
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Which of the following ions normally has the highest concentration in intracellular fluid:
Your Answer: PO 4 3-
Correct Answer: K +
Explanation:Potassium (K+) is the principal intracellular ion; approximately 4 mmol/L is extracellular (3%) and 140 mmol/L intracellular (97%).
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 33
Incorrect
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The following structures all lie anteriorly to the oesophagus EXCEPT for the:
Your Answer: Left recurrent laryngeal nerve
Correct Answer: Thoracic duct
Explanation:Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 34
Incorrect
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A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She states that she has also felt very itchy, particularly after a hot bath and that she is often dizzy and sweaty. On examination she appears plethoric and you note the presence of splenomegaly. Her blood tests today show that her haemoglobin level is 16.9 g/dl.What is the most likely diagnosis in this case? Select ONE answer only.
Your Answer: Haemochromatosis
Correct Answer: Polycythaemia vera
Explanation:Polycythaemia vera (PCV), which is also referred to as polycythaemia rubra vera, is a clonal haematological malignancy in which the bone marrow produces too many red blood cells. It may also result in the overproduction of white blood cells and platelets. It is most commonly seen in the elderly and the mean age at diagnosis is 65-74 years.Patients can be completely asymptomatic and it is often discovered as an incidental finding on a routine blood count. Approximately 1/3 of patients present with symptoms due to thrombosis, of these 3/4 have arterial thrombosis and 1/4 venous thrombosis. Features include stroke, myocardial infarction, deep vein thrombosis and pulmonary embolism.The other clinical features of PCV include:Plethoric appearanceLethargy and tirednessSplenomegaly (common)Pruritis (in 40% – particularly after exposure to hot water)Headaches, dizziness and sweating (in 30%)Gouty arthritis (in 20%)Budd-Chiari syndrome (in 5-10%)Erythromyalgia (in 18.5 g/dl in men, 16.5 g/dl in womenElevated red cell mass > 25% above mean normal predicted valuePresence of JAK2 mutationMinor criteria:Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic and megakaryocytic proliferationSerum erythropoietin level below normal rangeEndogenous erythroid colony formation in vitroThe main aim of treatment is to normalize the full blood count and prevent complications such as thrombosis. Venesection is the treatment of choice but hydroxyurea can also be used to help control thrombocytosis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 35
Correct
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A 23-year-old female has been prescribed a medication in the first trimester of pregnancy due to a life-threatening medical problem. After delivery, the foetus is found to have nasal hypoplasia, stippling of his bones and atrophy of bilateral optic discs along with growth retardation. Which ONE of the following drugs has this woman most likely received?
Your Answer: Warfarin
Explanation:Warfarin is teratogenic and can cause a host of abnormalities in the growing foetus. These include hypoplasia of the nasal bridge, stippling of the epiphyses, multiple ophthalmic complications, growth retardation, pectus carinatum, atrial septal defect, ventriculomegaly and a patent ductus arteriosus.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 36
Correct
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Which of the following is NOT a common side effect of amiodarone:
Your Answer: Blue/green teeth discolouration
Explanation:Common side effects of amiodarone include: Bradycardia, Nausea and vomiting, Thyroid disorders – hypothyroidism and hyperthyroidism, Persistent slate grey skin discoloration, Photosensitivity, Pulmonary toxicity (including pneumonitis and fibrosis), Hepatotoxicity, Corneal microdeposits (sometimes with night glare), Peripheral neuropathy and Sleep disorders.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 37
Correct
-
Gastrin release from antral G-cells is inhibited by all but which one of the following:
Your Answer: Vagal stimulation
Explanation:Gastrin secretion is inhibited by:Low gastric pH (negative feedback mechanism)SomatostatinSecretinGastric inhibitory polypeptide (GIP)Cholecystokinin
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 38
Correct
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A six-year-old boy presents with coryzal symptoms that have persisted for more than two weeks. He was born and raised in the Middle East. His mother claims he has been tired and has complained of various 'aches and pains.' On examination, you find splenomegaly and enlarged cervical lymph nodes. His legs and arms are covered in petechiae.In this case, what is the most likely diagnosis?
Your Answer: Acute lymphoblastic leukaemia (ALL)
Explanation:ALL is the most common leukaemia in children, with a peak incidence between the ages of 2 and 5.ALL has a wide range of clinical symptoms, but many children present with an acute illness that resembles coryza or a viral infection. ALL also has the following features:Weakness and sluggishness all overMuscle, joint, and bone pain that isn’t specificAnaemiaPetechiae and unexplained bruisingOedemaLymphadenopathyHepatosplenomegalyThe following are typical features of a full blood count in patients with ALL:Anaemia (normocytic or macrocytic)Leukopenia affects about half of the patients (WCC 4 x 109/l).Around 25% of patients have leucocytosis (WCC > 10 x 109/l).Around 25% of patients have hyperleukocytosis (WCC > 50 x 109/l).Thrombocytopaenia
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This question is part of the following fields:
- Haematology
- Pathology
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Question 39
Correct
-
Regarding flucloxacillin, which of the following statements is CORRECT:
Your Answer: It is resistant to bacterial beta-lactamases.
Explanation:Flucloxacillin is unique in that it is beta-lactamase stable and it can be used in infections caused by beta-lactamase producing staphylococci e.g. S. aureus. It is acid-stable and can therefore be given by mouth as well as by injection. It is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. The most common adverse effects of flucloxacillin include nausea, vomiting, skin rash, and diarrhoea. Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. First line treatment of animal and human bites is co-amoxiclav.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 40
Correct
-
Regarding Hodgkin lymphoma, which of the following statements is CORRECT:
Your Answer: Some patients may complain alcohol-induced nodal pain and pruritus
Explanation:Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 41
Incorrect
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Regarding iron deficiency anaemia, which of the following statements is INCORRECT:
Your Answer: Iron deficiency causes a hypochromic microcytic anaemia.
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.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 42
Correct
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A 6-year-old girl is brought into the paediatric emergency room by her mother in a state of high-grade fever and extreme irritability. She is also reluctant to urinate as it is associated with lower abdominal pain and stinging. She has no history of any UTIs requiring antibiotics in the past 12 months. The urine sensitivity test report is still unavailable. A clean catch urine sample is taken for urine dipstick, which reveals the presence of blood, protein, leukocytes and nitrites. Fresh blood tests were sent, and her estimated GFR is calculated to be 40 ml/minute. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer: Trimethoprim
Explanation:The NICE guidelines for children and young people under 16 years lower UTIs are:1. Get a urine sample before antibiotics are taken, and do a dipstick test OR send for culture and susceptibility2. Assess and manage children under 5 with lower UTI with fever as recommended in the NICE guideline on fever in under 5s.3. Prescribe an immediate antibiotic prescription and take into account the previous urine culture and susceptibility results, previous antibiotic use, which may have led to resistant bacteria4. If urine culture and susceptibility report is sent- Review the choice of antibiotic when the results are available AND- change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possibleThe choice of antibiotics for non-pregnant young people under 16 years with lower UTI is summarised below:1. Children under 3 months:- Refer to paediatric specialist and treat with intravenous antibiotic in line with NICE guideline on fever in under 5s2. Children over 3 months: – First-choice Nitrofurantoin – if eGFR >45 ml/minuteTrimethoprim – (if low risk of resistance*)- Second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice not suitable)Nitrofurantoin – if eGFR >45 ml/minute and not used as first-choiceAmoxicillin (only if culture results available and susceptible)Cefalexin
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 43
Incorrect
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A 19-year-old with a longstanding history of asthma presents to the ED with worsening symptoms of cough and wheeze and a peak expiratory flow rate (PEFR) measurement is taken.Which statement concerning PEFR is true?
Your Answer: PEFR is a useful measure in restrictive airways disease
Correct Answer: PEFR is dependent upon the patient's height
Explanation:The maximum flow rate generated during a forceful exhalation, after maximal inspiration is the peak expiratory flow rate (PEFR).PEFR is dependent upon initial lung volume. It is, therefore, dependant on patient’s age, sex and height.PEFR is dependent on voluntary effort and muscular strength of the patient.PEFR is decreased with increasing airway resistance, e.g. in asthma, and it correlates well with the forced expiratory volume in one second (FEV1) value measured in spirometry. This correlation decreases in patients with asthma as airflow decreases.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 44
Incorrect
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Which of the following statements regarding the infectivity periods of these corresponding diseases is correct?
Your Answer: Chickenpox is infectious from 2 days before the rash appears
Correct Answer: Rubella is infectious until 5 days after the rash appears
Explanation:Rubella can be contagious from 7 days before to 7 days after the rash appears.Patients with measles are contagious from 1-2 days before the onset of symptoms.A person with chickenpox is considered contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted (scabbed). The infectious period of mumps is considered from 2 days before to 5 days after parotitis onset.Hepatitis A is highly transmissible and has an average incubation period of 28 to 30 days (range 15–50 days). The maximum infectivity is during the second half of the incubation period (i.e. while asymptomatic) and most cases are considered non-infectious after the first week of jaundice.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 45
Incorrect
-
Which JVP waveform correlates to atrial systole?
Your Answer: The v wave
Correct Answer: The a wave
Explanation:JVP Waveform in Cardiac Cycle Physiology: a wave Right atrial contraction causes atrial systole (end diastole). the c wave During right isovolumetric ventricular contraction, the tricuspid valve bulges into the right atrium, resulting in isovolumetric contraction (early systole). descent by x Rapid ventricular ejection (mid systole) is caused by a combination of right atrial relaxation, tricuspid valve downward movement during right ventricular contraction, and blood ejection from both ventricles. the v-wave Ventricular ejection and isovolumetric relaxation (late systole) occur as a result of venous return filling the right atrium. y lineage Ventricular filling occurs when the tricuspid valve opens, allowing blood to flow rapidly from the right atrium to the right ventricle.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 46
Correct
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A 50-year-old woman has an anaphylactic reaction following accidental ingestion peanuts at a restaurant. She is a known hypertensive on atenolol 50 mg daily and BP is well controlled. She is also on amlodipine 5 mg daily. Two doses of IM adrenaline has been given without improvement.Which medication may prove helpful in this patient?
Your Answer: IM Glucagon
Explanation:Resistant to the effects of adrenaline in anaphylaxis is seen in patients taking beta-blockers.Glucagon can be used to overcome the effects of the beta-blockade if initial doses of adrenaline are unsuccessful in patients taking beta-blockers.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 47
Correct
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Regarding the routine childhood immunisation schedule, which of the following vaccines is given to preschool children (aged 3 years and 4 months):
Your Answer: Measles, mumps and rubella (MMR)
Explanation:The current UK childhood immunisation schedule is as follows:8 weeks:DTaP/IPV(polio)/Hib/Hep B (diptheria, tetanus, pertussis, polio,Haemophilus influenzatype b and hepatitis B) – 6-in-one injection (Infranix hexa);plus:Rotavirus gastroenteritis (Rotarix) – oral route (drops)Meningitis B (Bexsero)12 weeks:DTaP/IPV(polio)/Hib/Hep B – 2nddose: 6-in-one injection, 2nddose (Infranix hexa);plus:PCV (pneumococcal conjugate vaccine) – in a separate injection (Prevenar 13)Rotavirus gastroenteritis 2nddose (Rotarix) – oral route (drops)16 weeks:DTaP/IPV(polio)/Hib/Hep B – 3rddose: 6-in-one injection, 3rddose (Infranix hexa);plus:Meningitis B 2nddose (Bexsero)Between 12 and 13 months:Hib/Men C (combined as one injection) – 4th dose of Hib and 1stdose of Meningitis C (Menitorix);plus:MMR (measles, mumps and rubella) – combined as one injection (Priorix or M-M-RVAXPRO);plus:PCV (pneumococcal conjugate vaccine) – 2nddose in a separate injection (Prevenar 13);plus:Meningitis B 3rddose (Bexsero)From 2 to end of primary school:Nasal flu spray (Fluenz Tetra). For children aged 2,3 and 4, this is usually given in the GP surgery. Children in school years 1,2 and 3 may have this at school.3 years and 4 months:Pre-school booster of DTaP/IPV (polio) – 4-in-one injection (Repevax or Infanrix-IPV);plus:MMR – 2nd dose (Priorix or M-M-RVAXPRO) – in a separate injectionBetween 12 and 13 years:HPV (human papilloma virus types 6,11, 16 and 18) –twoinjections of Gardasil given. The second injection is given 6-24 months after the first one.14 years:Td/IPV (polio) booster – 3-in-one injection (Revaxis)Men ACWY: combined protection against meningitis A, C, W and Y (Nimenrix or Menveo)The BCG vaccination against tuberculosis is only offered to neonates in high-risk areas or with high-risk backgrounds. When required it is usually given before leaving the hospital soon after birth.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 48
Incorrect
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Which of the following ligaments supports the head of the talus?
Your Answer: Anterior talofibular ligament
Correct Answer: Spring ligament
Explanation:The spring-ligament complex is a significant medial arch stabilizer. The two important functions of this ligament include promoting the stability of the talonavicular joint by acting as a support for the talus head and by acting as a static support to maintain the medial longitudinal arch.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 49
Incorrect
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Where is angiotensin I primarily converted to angiotensin II:
Your Answer: Liver
Correct Answer: Lungs
Explanation:Angiotensin I is converted to angiotensin II by the removal of two C-terminal residues by the enzyme angiotensin-converting enzyme (ACE). This primarily occurs in the lungs, although it does also occur to a lesser degree in endothelial cells and renal epithelial cells.The main actions of angiotensin II are:Vasoconstriction of vascular smooth muscle (resulting in increased blood pressure)Vasoconstriction of the efferent arteriole of the glomerulus (resulting in an increased filtration fraction and preserved glomerular filtration rate)Stimulation of aldosterone release from the zona glomerulosa of the adrenal cortexStimulation of anti-diuretic hormone (vasopressin) release from the posterior pituitaryStimulation of thirst via the hypothalamusActs on the Na+/H+ exchanger in the proximal tubule of the kidney to stimulate Na+reabsorption and H+excretion
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This question is part of the following fields:
- Physiology
- Renal
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Question 50
Correct
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Which of the following is NOT a common side effect of adenosine:
Your Answer: Yellow vision
Explanation:Common side effects of adenosine include:ApprehensionDizziness, flushing, headache, nausea, dyspnoeaAngina (discontinue)AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur)
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 51
Correct
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The most common complication of paracetamol overdose is:
Your Answer: Hepatic failure
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 52
Correct
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A young pregnant woman is in the late stages of her pregnancy. She is administered a drug that results in her newborn being born with respiratory depression. The baby also suffers from neonatal withdrawal syndrome.Out of the following, which drug is most likely responsible for the baby's condition?
Your Answer: Diazepam
Explanation:Benzodiazepines are used as a first-line treatment in breaking seizures and in status epilepticus as they are rapid-acting. Use of benzodiazepines in the late third-trimester or exposure during labour is associated with great risks to the foetus/neonate. Babies can exhibit either floppy infant syndrome, or marked neonatal withdrawal symptoms. Symptoms vary from mild sedation, hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. These symptoms have been reported to persist for periods from hours to months after birth. They also cross into breast milk and should be used with caution in breastfeeding mothers
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 53
Correct
-
An injury to which nerve affects innervation to the adductor portion of the adductor magnus?
Your Answer: Posterior branch of the obturator nerve
Explanation:The nerves that supply the adductor magnus muscle have an embryologic origin from the anterior divisions of the lumbosacral plexus and include the obturator nerve, posterior division (L2-4), and the tibial portion of the sciatic nerve (L4). It is innervated by the posterior division of the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 54
Correct
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A patient is diagnosed with a Klebsiella infection.Which SINGLE statement regarding Klebsiella infections is true?
Your Answer: Klebsiella spp are an important cause of ventilator-associated pneumonia
Explanation:Klebsiellais a genus of non-motile,Gram-negative, rod-shaped bacteriawith a prominent polysaccharide-based capsule. They are routinely found in the nose, mouth and gastrointestinal tract as normal flora, however, they can also behave as opportunistic pathogens.Infections with Klebsiella spp. areusually nosocomial. They are an important cause of ventilator-associated pneumonia (VAP), urinary tract infection, wound infection and bacteraemia. Outbreaks of infections with Klebsiellaspp. in high-dependency units have been described and are associated with septicaemia and high mortality rates. Length of hospital stay and performance of invasive procedures are risk factors forKlebsiellainfections.Primary pneumonia withKlebsiella pneumoniaeis a rare,severe, community-acquired infection associated with a poor outcome.Klebsiella rhinoscleromatis causes a progressive granulomatous infection of the nasal passages and surrounding mucous membranes. This infection is mainly seen in the tropics.Klebsiella ozanae is a recognised cause of chronic bronchiectasis.Klebsiella organisms are resistant to multiple antibiotics including penicillins. This is thought to be a plasmid-mediated property. Agents with high intrinsic activity againstKlebsiellapneumoniaeshould be selected for severely ill patients. Examples of such agents include third-generation cephalosporins (e.g cefotaxime), carbapenems (e.g. imipenem), aminoglycosides (e.g. gentamicin), and quinolones (e.g. ciprofloxacin). These agents may be used as monotherapy or combination therapy. Aztreonam may be used in patients who are allergic to beta-lactam antibiotics.Species with ESBLs (Extended spectrum beta-lactamase) are resistant to penicillins and also cephalosporins such as cefotaxime and ceftriaxone.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 55
Correct
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Parathyroid hormone is released by which of the following:
Your Answer: Chief cells of the parathyroid gland
Explanation:Parathyroid hormone (PTH) is a peptide hormone synthesised by the chief cells of the parathyroid glands, located immediately behind the thyroid gland. PTH is primarily released in response to decreasing plasma [Ca2+] concentration. PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.Parathyroid hormone (PTH) acts to increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane) and increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 56
Correct
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A 70-year-old patient develops bacteraemia following peripheral cannulation.Which of these bacteria is the most likely cause of the infection?
Your Answer: Staphylococcus epidermidis
Explanation:The commonest implicated organisms in hospital-acquired bacteraemia following cannulation are Staphylococcus aureus and Staphylococcus epidermidis. The risk is directly proportional to the length of time in-situ. Peripheral cannula should be replaced after 48 hours.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 57
Correct
-
Osteoclasts are a type of bone cell that are critical in the maintenance, repair and remodelling of bones.Which of the following inhibits osteoclast activity? Select ONE answer only.
Your Answer: Calcitonin
Explanation:Osteoclasts are a type of bone cell that breaks down bone tissue. This is a critical function in the maintenance, repair and remodelling of bones. The osteoclast disassembles and digests the composite of hydrated protein and minerals at a molecular level by secreting acid and collagenase. This process is known as bone resorption and also helps to regulate the plasma calcium concentration.Osteoclastic activity is controlled by a number of hormones:1,25-dihydroxycholecalciferol increases osteoclastic activityParathyroid hormone increases osteoclastic activityCalcitonin inhibits osteoclastic activityBisphosphonates are a class of drug that slow down and prevent bone damage. They are osteoclast inhibitors.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 58
Correct
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A patient presents to ED complaining of a purulent discharge, urethral discomfort and dysuria. You suspect gonorrhoea. Which of the following cell components produced by Neisseria gonorrhoeae is responsible for attachment to host cells:
Your Answer: Pili
Explanation:Infection of the genital mucosa by Neisseria gonorrhoeae involves attachment to and invasion of epithelial cells. Initial adherence of gonococci to columnar epithelial cells is mediated by type IV pili assembled from pilin subunit PilE proteins and pilus tip-associated PilC proteins, it then invades the epithelial layer, triggering a local acute inflammatory response.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 59
Correct
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Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 12 months:
Your Answer: Polio
Explanation:At 12 months the following vaccines are given:Hib (4th dose) and Meningococcal group CPneumococcal (13 serotypes) (2nd dose)Measles, mumps and rubellaMeningococcal group B (3rd dose)
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 60
Correct
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A dermatological examination of a patient who has presented with a lump shows a collection of boils clustered together.Which one of these best describes the lump you have found on examination?
Your Answer: Carbuncle
Explanation:A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus. A carbuncle is a collection of individual boils clustered together. A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter. A vesicle is a visible collection of clear fluid measuring less than 0.5 cm in diameter.A pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 61
Incorrect
-
Regarding protein digestion, which of the following statements is CORRECT:
Your Answer: Free amino acids are absorbed across the enterocyte apical membrane in exchange for Na+ ions being secreted out.
Correct Answer: Oligopeptides are broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on the brush border.
Explanation:Digestion of dietary protein begins in the stomach where pepsin hydrolyses protein to polypeptides, and continues in the duodenum where pancreatic proteases (trypsin and chymotrypsin) continue the process of hydrolysis forming oligopeptides. These are further broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on luminal membrane epithelial cells. Free amino acids are absorbed across the apical membrane by secondary active transport coupled with Na+transport into the cell. Amino acids cross the basal membrane into the capillaries by facilitated diffusion.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 62
Correct
-
A 30-year-old male presents with easy bruising and bleeding gums, feeling very tired lately, and recurrent chest infections over the past few months. He had glandular fever approximately 6 months ago and feels that his symptoms started after that. His full blood count today is as follows: Hb 6.3 g/dl (11.5-14 g/dl) MCV 90 fl (80-100 fl) WCC 2.0 x 10 9 /l (4-11 x 10 9 /l) Platelets 15 x 10 9 /l (150-450 x 10 9 /l)The SINGLE most likely diagnosis is?
Your Answer: Aplastic anaemia
Explanation:Aplastic anaemia is a life-threatening failure of haemopoiesis characterised by pancytopenia and hypocellular bone marrow. It is rare and patients present with features of recurrent infections secondary to (leukocytopenia), increased bleeding tendency (secondary to thrombocytopenia) and anaemia. In aplastic anaemia, there is damage to the bone marrow and the haematopoietic stems cells leading to pancytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 63
Correct
-
A 29 year old patient with known inflammatory bowel disease presents to ED with surgical complications following his recent ileocaecal resection. Removal of the terminal ileum may result in the malabsorption of which of the following:
Your Answer: Vitamin B12
Explanation:On ingestion, vitamin B12 is bound to R protein found in saliva and gastric secretions, which protects it from digestion in the stomach. Intrinsic factor is secreted by gastric parietal cells. Receptors for the IF-B12 complex are present in the membrane of epithelial cells of the terminal ileum, which bind the complex and allow uptake of vitamin B12 across the apical membrane by endocytosis. Vitamin B12 is then transported across the basal membrane into the portal blood where it is bound to transcobalamin II and processed by the liver. In pernicious anaemia, there are autoantibodies against gastric parietal cells and intrinsic factor, resulting in vitamin B12 deficiency anaemia.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 64
Correct
-
Which of the following is the most abundant immunoglobulin in plasma:
Your 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.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 65
Correct
-
What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 66
Correct
-
A patient with a recent diagnosis of Hepatitis B would like to find out further information regarding his diagnosis and prognosis. Which among the following statements is considered true regarding Hepatitis B?
Your Answer: 60-65% of patients that contract hepatitis B show subclinical disease
Explanation:As the immune response is activated, the virus is slowly cleared from the system, and most patients become non-infectious. In adults, about 50% of infections are asymptomatic; 20% to 30% of patients exhibit clinical jaundice but have a benign resolution of the infection. Therefore, about 80% of infections do not cause serious sequelae. The risk for chronic infection is inversely proportional to age at time of infection, with approximately 90% of infants and only 3% of adults developing a chronic infection. Individuals with a chronic infection have a higher risk of liver disease, such as cirrhosis or hepatic carcinoma.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 67
Incorrect
-
Which of the following statements is true regarding the extensor pollicis longus?
Your Answer: It extends the thumb at the carpometacarpal joint
Correct Answer: It is innervated by the posterior interosseous nerve
Explanation:Extensor pollicis longus is part of the deep extensors of the forearm together with extensor pollicis brevis, abductor pollicis longus, extensor indicis and supinator muscles. It is located on the posterior aspect of forearm, extending from the middle third of the ulna, and adjacent interosseous membrane, to the distal phalanx of the thumb.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 pollicis brevis receives its blood supply from the posterior interosseous artery and perforating branches of the anterior interosseous artery.The main action of extensor pollicis longus is extension of the thumb at the metacarpophalangeal and interphalangeal joints. Extension at the metacarpophalangeal joint occurs in synergy with extensor pollicis brevis muscle. When the thumb reaches the full extension or abduction, extensor pollicis longus can also assist in adduction of the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 68
Incorrect
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A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.Which of the following statements regarding the opponens pollicis muscle is considered correct?
Your Answer: It receives its blood supply from the deep palmar arch
Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint
Explanation:Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 69
Incorrect
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You examine a 73-year-old patient who is experiencing a worsening of his chronic heart failure. Bumetanide was recently prescribed for him.Which of the following statements about bumetanide is correct?
Your Answer: It is approximately 10 times more potent than furosemide
Correct Answer: It has better intestinal absorption than furosemide
Explanation:Bumetanide is a loop diuretic that inhibits sodium, chloride, and potassium reabsorption by acting on the Na.K.2Cl co-transporter in the ascending loop of Henlé. This reduces the osmotic gradient that forces water out of the collecting duct system and prevents the formation of a hypertonic renal medulla. This has a strong diuretic effect on the body.It’s primarily used in patients with heart failure who aren’t responding to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency.In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. Bumetanide is 40 times more potent than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide.Bumetanide also lowers the concentration of neuronal chloride, making GABA’s action more depolarizing. In the neonatal period, it is being studied as an antiepileptic.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 70
Correct
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You want to give colchicine to a patient who has acute gout. Which of the following is a contraindication to the use of colchicine?
Your Answer: Blood dyscrasias
Explanation:Colchicine is used to prevent or treat gout attacks (flares). It works by reducing swelling and the development of uric acid crystals, which cause pain in the affected joint(s). Colchicine should be avoided by patients who have blood dyscrasias or bone marrow disorders.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 71
Incorrect
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Which of the following is NOT an adverse effect associated with warfarin therapy:
Your Answer: Pancreatitis
Correct Answer: Neutropenia
Explanation:Adverse effects of warfarin:The most common adverse effect of warfarin is bleedingOther common adverse effects of warfarin include nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, and rashSkin necrosis is a rare but serious adverse effect of warfarin; treatment with warfarin should be stopped if warfarin related skin necrosis is suspectedCalciphylaxis is a rare, but a very serious condition that causes vascular calcification and cutaneous necrosis
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 72
Incorrect
-
For which of the following is micelle formation necessary to facilitate intestinal absorption?
Your Answer: Small peptides
Correct Answer: Vitamin D
Explanation:The arrangement of micelles is such that hydrophobic lipid molecules lie in the centre, surrounded by hydrophilic bile acids that are arranged in the outer region. This arrangement allows the entry of micelles into the aqueous layers surrounding the microvilli. As a result, the products of fat digestion (fatty acids and monoglycerides), cholesterol and fat-soluble vitamins (such as vitamin D) can then diffuse passively into the enterocytes. The bile salts are left within the lumen of the gut where they are reabsorbed from the ileum or excreted in faeces.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 73
Incorrect
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A somatostatinoma is diagnosed in a 74-year-old patient who has recently developed diabetes mellitus, recurrent episodes of gallstones, and Steatorrhoea. She also has a tumour in the head of her pancreas.Which of the following is the most likely effect of this tumour?
Your Answer: Increase glucagon release
Correct Answer: Inhibit gastric acid secretion
Explanation:Somatostatin-producing cells present in the pyloric antrum, duodenum, and pancreatic islets are known as D-cells or delta-cells. Somatostatin inhibits gastric acid secretion by acting directly on acid-producing parietal cells in the stomach via a G-protein coupled receptor.Somatostatin affects hormones in the following ways:Inhibits the anterior pituitary’s secretion of growth hormone.Inhibits the anterior pituitary’s secretion of thyroid-stimulating hormone.The secretion of various gastrointestinal hormones is inhibited (including gastrin, CCK, secretin, motilin, VIP and GIP) Reduces the rate at which the stomach empties.Inhibits the release of insulin and glucagon from the pancreas.The pancreas’ exocrine secretory activity is inhibited.Somatostatin can also slow the digestive process by suppressing the production of hormones such gastrin, secretin, and histamine, which reduces gastric acid secretion.A somatostatinoma is a cancerous tumour of the endocrine pancreas’ D-cells, which make somatostatin. Somatostatin inhibits pancreatic and gastrointestinal hormones when levels are high. The following clinical characteristics are related with somatostatinomas:Insulin secretion blockage causes diabetes mellitus.Gallstones by inhibition of CCK and secretin Steatorrhoea via inhibition of CCK and secretinHypochlorhydria is caused by the suppression of gastrin, a hormone that increases gastric acid output regularly.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 74
Incorrect
-
An 82 year old man taking warfarin as a maintenance medication comes in to your clinic because of an infection. Which antibiotic is the safest choice for this patient?
Your Answer: Co-trimodazole
Correct Answer: Cefalexin
Explanation:Alterations in the international normalized ratio (INR) brought about by the concurrent use of antibiotics and warfarin may result in either excessive clotting or excessive bleeding if they are deemed to have a high risk for interaction. As such, there should be careful consideration of the class of antibiotic to be used. Antibiotics from the following drug classes should generally be avoided as they have a high risk for interaction with warfarin, possible enhancing the anticoagulant effects of warfarin resulting in bleeding: Fluoroquinolones (e.g. ciprofloxacin, levofloxacin), Macrolides (e.g. clarithromycin, erythromycin, azithromycin), Nitroimidazoles (e.g. metronidazole), Sulphonamides (e.g. co-trimoxazole, a combination of trimethoprim and sulfamethoxazole), Trimethoprim, Tetracyclines (e.g. doxycycline). Low risk antibiotics that have low risk for interaction with warfarin includes cephalexin, from the cephalosporin class, and clindamycin which is a lincomycin.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 75
Incorrect
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A 60-year-old man with insulin-controlled diabetes mellitus asks you about how his ability to drive is affected. He owns a car as well as a motorcycle.Which of the following statements about driving with diabetes under insulin control is correct?
Your Answer: He must check his blood glucose levels no more than 60 minutes before the start of the journey
Correct Answer: He must monitor his blood glucose levels every 2 hours whilst driving
Explanation:The DVLA sends a detailed information sheet about their licence and driving to all drivers with diabetes mellitus. The primary danger of driving while diabetic is hypoglycaemia.The DVLA must be notified of the following diabetic patients:All of the drivers are on insulin. (Licenses are being reviewed more frequently.)Those who are at high risk of hypoglycaemia and have had more than one episode of severe hypoglycaemia in the previous year. (Severe hypoglycaemia is defined as requiring the assistance of another person to manage.)Those who are unaware of their hypoglycaemiaAnyone who has ever been in a car accident due to hypoglycaemiaAnyone with diabetic retinopathy who needs laser treatment (to both eyes or to a second eye if sight only in one eye)Patients with diabetes complications that impair their ability to drive.To drive, drivers with insulin-treated diabetes must meet the following requirements:They need to be aware of hypoglycaemia.They must not have had more than one episode of hypoglycaemia in the previous 12 months that necessitated the assistance of another person.They must check their blood glucose levels no later than 2 hours before the first journey.While driving, they must check their blood glucose levels every two hours.The visual acuity and visual field standards must be met.Any significant changes in their condition must be reported to the DVLA. Furthermore, on days when they are not driving, group 2 licence holders must test their blood glucose twice daily using a metre that can store three months’ worth of readings.In addition to this advice, the DVLA also offers the following advice to diabetic patients:When taking tablets that have the potential to cause hypoglycaemia (such as sulfonylureas and glinides), monitoring may be necessary if there has been more than one episode of severe hypoglycaemia.Drivers must show good control and be able to recognise hypoglycaemia.Verify that your vision meets the required standard.If a patient feels hypoglycaemic or has a blood glucose level of less than 4.0 mmol/L, they should not drive. Driving should not be resumed until blood glucose levels have returned to normal, which should take 45 minutes.If there are any warning signs, patients should carry rapidly absorbed sugar in their vehicle and stop, turn off the ignition, and eat it.If resuscitation is required, a card stating which medications they are taking should be carried.If hypoglycaemia causes an accident, a diabetic driver may be charged with driving under the influence of drugs.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 76
Correct
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You are attending to a patient that has presented with a severe headache in the Emergency Department. The patient has signs of cerebral oedema and raised intracranial pressure. You discuss the case with the on-call neurology registrar and decide to prescribe Mannitol. The nurse assisting you asks you to reconsider this management plan as she suspects the patient has a contraindication to Mannitol.Out of the following, what is a contraindication to mannitol?
Your Answer: Severe cardiac failure
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure. It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Mannitol has several contraindications and some of them are listed below:1. Anuria due to renal disease2. Acute intracranial bleeding (except during craniotomy)3. Severe cardiac failure4. Severe dehydration5. Severe pulmonary oedema or congestion6. Known hypersensitivity to mannitol
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 77
Correct
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Which of the following causes the first heart sound?
Your Answer: Closing of the atrioventricular valves
Explanation:The heart sounds are as a result of the various parts of the cardiac cycle.Heart Sound – Phase of Cardiac Cycle – Mechanical Event:1st heart sound – Systole starts – there is closure of the atrioventricular (mitral & tricuspid) valves2nd heart sound – Systole ends – there is closure of the semilunar (aortic and pulmonary) valves3rd heart sound – Early diastole – this is caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase4th heart sound – Late diastole – this is caused by filling of an abnormally stiff ventricle in atrial systole
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 78
Incorrect
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A 28-year-old known intravenous drug user has a history of persistent high-fever. On examination you hear a harsh systolic murmur and the patient says a murmur has never been heard before in previous hospital visits. A diagnosis of endocarditis is suspect.Which of these antibacterial agents would be most appropriate to prescribe in this case?
Your Answer: Vancomycin and metronidazole
Correct Answer: Flucloxacillin and gentamicin
Explanation:Endocarditis is infective or non infective inflammation (marantic endocarditis) of the inner layer of the heart and it often involves the heart valves.Risk factors include:Prosthetic heart valvesCongenital heart defectsPrior history of endocarditisRheumatic feverIllicit intravenous drug useIn the presentation of endocarditis, the following triad is often quoted:Persistent feverEmbolic phenomenaNew or changing murmurFlucloxacillin and gentamicin are current recommended by NICE and the BNF for the initial ‘blind’ therapy in endocarditis.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 79
Incorrect
-
Which of the following clinical features is a feature of a chronic extravascular haemolytic anaemia:
Your Answer: Hypocellular bone marrow
Correct Answer: Gallstones
Explanation:Clinical features of haemolytic anaemia include:AnaemiaJaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)Pigment gallstonesSplenomegalyAnkle ulcersExpansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia majorAplastic crisis caused by parvovirus
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This question is part of the following fields:
- Haematology
- Pathology
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Question 80
Correct
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A 30-year-old rugby player suffers from an anterior cruciate ligament tear while pivoting to attempt to run around another player. An MRI was performed and showed that his injury caused two other structures in the knee joint to be injured. Which of the following structures is most likely also injured?
Your Answer: Medial meniscus
Explanation:The O’Donoghue unhappy triad or terrible triad often occurs in contact and non-contact sports, such as basketball, football, or rugby, when there is a lateral force applied to the knee while the foot is fixated on the ground. This produces an abduction-external rotation mechanism of injury.The O’Donoghue unhappy triad comprises three types of soft tissue injury that frequently tend to occur simultaneously in knee injuries. O’Donoghue described the injuries as: anterior cruciate ligament tear, medial collateral ligament injury, and medial meniscal tear (lateral compartment bone bruise).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 81
Incorrect
-
Which of the following is NOT a typical electrolyte disturbance caused by furosemide:
Your Answer: Hypokalaemia
Correct Answer: Hypercalcaemia
Explanation:Adverse effects of loop diuretics include:Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathyHyperglycaemiaAcute urinary retentionWater and electrolyte imbalanceHyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolismMetabolic alkalosisHyperuricaemiaBlood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)Visual disturbance, tinnitus and deafnessHypersensitivity reactions
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 82
Incorrect
-
A 36-year-old man presented to the emergency room with a two-week history of shortness of breath, fevers, and malaise. A chest X-ray was ordered and the results confirmed the diagnosis of a right middle lobe pneumonia. Which of the following structures of the heart lies closest to the consolidation?
Your Answer: Right ventricle
Correct Answer: Right atrium
Explanation:In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:Anterior (or sternocostal) – Right ventriclePosterior (or base) – Left atriumInferior (or diaphragmatic) – Left and right ventriclesRight pulmonary – Right atriumLeft pulmonary – Left ventricleThe silhouette sign of Felson is with respect to the right middle lobe. The right heart border should have a distinct appearance due to the right atrium abutting aerated right middle lobe. The consolidation in the right middle lobe has resulted in loss of this silhouette.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 83
Incorrect
-
A tumour is discovered behind the pectinate line during an examination of a 72-year-old patient with rectal bleeding. Which of the following is the lymphatic drainage of the pectinate line?
Your Answer: Deep inguinal nodes
Correct Answer: Superficial inguinal nodes
Explanation:The pectinate line is known as the watershed line because it divides the anal canal into two sections. Below the pectinate line, lymphatic drainage drains to the superficial inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 84
Incorrect
-
A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement of her blood glucose level is done and found to be grossly elevated. She is diagnosed with diabetic ketoacidosis. A fixed rate insulin infusion is given as part of her treatment.Which of these is an action of insulin?
Your Answer: Inhibits glycolysis
Correct Answer: Stimulates lipogenesis
Explanation:Insulin is an anabolic hormone. Its actions can be broadly divided into:Lipid metabolismProtein metabolism andCarbohydrate metabolismFor lipid metabolism, insulin:Stimulates lipogenesisInhibits lipolysis by lipaseFor carbohydrate metabolism, insulin:Decreases gluconeogenesisStimulates glycolysisPromotes glucose uptake in muscle and adipose tissuePromotes glycogen storageIncreases glycogenesisDecreases glycogenolysisProtein metabolism:Stimulates protein synthesisAccelerates net formation of proteinStimulates amino acid uptakeInhibits protein degradationInhibits amino acid conversion to glucose
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 85
Correct
-
Which of the following is an example of continuous data:
Your Answer: Height
Explanation:Continuous data is data where there is no limitation on the numerical value that the variable can take e.g. weight, height.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 86
Correct
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Which of the following statements is correct regarding gentamicin?
Your Answer: Gentamicin is ineffective against anaerobic bacteria.
Explanation:Gentamicin is the aminoglycoside of choice in the UK and is a parenterally administered, broad spectrum antibiotic typically used for moderate to severe gram negative infections. However, it is inactive against anaerobes. There is poor activity against haemolytic streptococci and pneumococci. It is usually given in conjunction with a penicillin or metronidazole (or both) when used for the blind treatment of undiagnosed serious infections. Nephrotoxicity and ototoxicity are the main toxic effects due to damage to the vestibulocochlear nerve (CN VIII).It is contraindicated in myasthenia gravis and should be used with great care in renal disease as it may result in accumulation and a higher risk of toxic side effects.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 87
Incorrect
-
The following statements concerning lung compliance is true EXCEPT?
Your Answer: Lung compliance is inversely proportional to stiffness and elastance
Correct Answer: Lung compliance is described by the equation: C = ∆ P/ ∆V, where C = compliance, P = pressure, and V = volume
Explanation:Lung compliance is the change in volume per unit change in distending pressure. It is calculated using the equation:Lung compliance = ΔV / ΔPWhere:ΔV is the change in volumeΔP is the change in pleural pressure.Lung compliance is inversely proportional to stiffness and elastance. It comprises static (no airflow) and dynamic (during continuous breathing) components. It is the slope of the pressure-volume curve.Lung compliance describes the distensibility of the lungs and the chest wall.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 88
Correct
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A 49-year-old man known sickle cell disease patient received a blood transfusion and developed a mild fever and dark urine 6 days after transfusion. His investigations show raised bilirubin, raised LDH, and a positive Direct Antiglobulin Test (DAT).Which transfusion reaction is most likely occurred?
Your Answer: Delayed haemolytic reaction
Explanation:Delayed haemolytic transfusion reactions (DHTRs) commonly occurs 4-8 days after blood transfusion, but can occur up to a month after. Signs and symptoms include jaundice, fever, an inadequate rise in PCV, reticulocytosis, a positive antibody screen and a positive Direct Antiglobulin Test (Coombs test). DHTRs usually have a benign course and require no treatment but sometimes, life-threatening haemolysis with severe anaemia and renal failure can occur so haemoglobin levels and renal function should be monitored.Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.Febrile transfusion reaction presents with a 1 degree rise in temperature from baseline during transfusion. Patient may have chills and malaise. It is the most common transfusion reaction (1 in 8 transfusions) and is usually caused by cytokines released from leukocytes in transfused red cell or platelet components.Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.Graft versus host disease(GVHD) is an immune mediated condition that arises from a complex interaction between donor and recipients adaptive immunity. It presents as dermatitis, hepatitis and enteritis developing within 100 days after stem cell or bone marrow transplant.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 89
Correct
-
Which of the following best describes the therapeutic effect of calcium gluconate when used in treatment for hyperkalaemia:
Your Answer: Reduces cardiac cell membrane excitability
Explanation:Calcium resonium is an ion-exchange resin that exchanges sodium for potassium as it passes through the intestine, leading to excretion of potassium from the body. Salbutamol and insulin act to increase intracellular uptake of K+ via Na-K ATP pump. Sodium bicarbonate acts to correct acidosis and thus promotes intracellular uptake of K+. Calcium gluconate acts to protect the cardiac membrane and has no effect on serum K+ levels.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 90
Correct
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Which of the following is NOT a typical side effect of thiopental sodium:
Your Answer: Seizures
Explanation:Extravasation of thiopental during injection can lead to tissue damage. Accidental intra-arterial injection causes vasospasm and may lead to thrombosis and tissue necrosis. Other side effects include involuntary muscle movements on induction, cough and laryngospasm, arrhythmias, hypotension, headache and hypersensitivity reactions. Thiopental sodium has anticonvulsant properties and does not cause seizures.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 91
Correct
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A 40-year-old man complains of pain and redness in his lower thigh due to an insect bite. He was diagnosed with cellulitis. Select the first-line antibiotic for cellulitis.
Your Answer: Flucloxacillin
Explanation:Cellulitis is most commonly caused by bacteria from the group Aß-hemolytic streptococcus. Cellulitis can be caused by animal bites. For uncomplicated cellulitis, flucloxacillin is the first-line antibiotic. Because it is beta-lactamase stable, it is efficient against Staphylococcus aureus.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 92
Incorrect
-
A trauma victim who has been intubated is tachycardic, hypotensive, and has a poor urine output. You feel she is dehydrated and decide to use a central venous catheter to help you manage her. As part of this, you keep an eye on the waveform of central venous pressure (CVP).Which of the following cardiac cycle phases corresponds to the CVP waveform's 'a wave'?
Your Answer: Early diastole
Correct Answer: End diastole
Explanation:The pressure measured in the right atrium or superior vena cava is known as central venous pressure (CVP). In a spontaneously breathing subject, the usual CVP value is 0-8 cmH2O (0-6 mmHg).The structure of the CVP waveform is as follows:The CVP’s components are listed in the table below:Component of the waveformThe cardiac cycle phase.mechanical eventmechanical event Diastole Atrial contractiona wave C wave v waveEarly systoleThe tricuspid valve closes and bulges Late Systole Filling of the atrium with systolic blood x descenty descentMid systoleRelaxation of the atrium Early diastoleFilling of the ventricles at an early stage
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 93
Correct
-
A 20-year-old female presents with painful wrist following a fall while skating. X-rays shows fracture of the ulna.The initial phase of bone healing is?
Your Answer: Haematoma at the fracture site
Explanation:Haemorrhage occurs into the fracture site from the ruptured vessels in the bone marrow and those supplying the periosteum immediately after fracture. This hematoma formation is the first phase of bone healing.The 4 stages of bone healing are:Haematoma at the fracture site (provides a framework for healing)Callus formationLamellar bone formationRemodelling
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 94
Incorrect
-
After collapsing at home, a 62-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is rushed to resuscitation and placed on a cardiac monitor, which reveals ventricular tachycardia. An amiodarone infusion is set up.Which of these statements about amiodarone is correct?
Your Answer: Metabolism is increased by co-ingestion of grapefruit juice
Correct Answer: It is expressed in breast milk
Explanation:Antiarrhythmic drug amiodarone is used to treat both ventricular and atrial arrhythmias. It’s a class III antiarrhythmic that works by prolonging the repolarization phase of the cardiac action potential, where potassium permeability is normally high and calcium permeability is low.Dronedarone is sometimes used instead of amiodarone in certain situations. Although amiodarone is more effective than dronedarone, dronedarone has fewer side effects.Grapefruit juice inhibits the metabolism of amiodarone.The plasma half-life of amiodarone is very long, ranging from 2 weeks to 5 months. The half-life is about 2 months on average.Because amiodarone is excreted in breast milk, it should be avoided by breastfeeding mothers.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 95
Correct
-
A 27 year old woman presents to ED having sustained a deep laceration to the dorsum of her ring finger whilst cooking. Her proximal interphalangeal joint is fixed in flexion and the distal interphalangeal joint is hyperextended. Which of the following structures in the digit has most likely been injured:
Your Answer: Insertion of the central slip of the extensor tendon
Explanation:Damage to the central slip of the extensor digitorum tendon would result in loss of extension at the proximal interphalangeal joint resulting in a fixed flexion deformity of this joint, and hyperextension of the distal interphalangeal joint due to a loss of balancing forces. This is called the Boutonniere deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 96
Correct
-
An 11-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent petechial rash on legs and arms. The GP administered a dose of antibiotics in the prehospital setting before transferring to the Emergency Department.Which of these would the GP have administered?
Your Answer: IM benzylpenicillin 600 mg
Explanation:General Practitioners are advised to give a single injection of benzylpenicillin by intravenous or intramuscular injection before transferring the patient urgently to the ED when bacterial meningitis is suspected.The recommended doses are:Infants under 1 year: 300 mgChildren ages 1 to 9 years: 600 mgChildren aged 10 years and over: 1.2gAdults: 1.2g
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 97
Correct
-
A 27-year-old female is brought to the Emergency Department by ambulance with extensive bleeding from her upper arm following a fall from a bicycle onto a fence. On inspection her biceps brachii muscle has been lacerated.How will the muscle heal from this injury? Select ONE answer only.
Your Answer: Satellite cells will produce a small number of regenerated myocytes
Explanation:Muscle heals with fibrous tissue to form a scar. Once cut, it will never regain its previous bulk or power. Within the scar a small number of myocytes (muscle cells) may be seen, which are formed from satellite cells but they contribute little to the function of the muscle overall.In more widespread ischaemic injury, such as critical ischaemic limb due to arterial compromise, or in compartment syndrome, damaged myocytes are replaced diffusely with fibrous tissue. This fibrous tissue contracts and reduces movement, and in extreme cases can pull the limb into abnormal positions such as in Volkmann’s ischaemic contracture of the forearm.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 98
Correct
-
You are instructed by a senior to administer Mannitol to an RTA patient with increased intracranial pressure. Mannitol is a low molecular weight compound that freely filters at the glomerulus and is not reabsorbed.Out of the following, which is a contraindication to the use of mannitol?
Your Answer: Severe pulmonary oedema
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure. It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Mannitol has several contraindications and some of them are listed below:1. Anuria due to renal disease2. Acute intracranial bleeding (except during craniotomy)3. Severe cardiac failure4. Severe dehydration5. Severe pulmonary oedema or congestion6. Known hypersensitivity to mannitol
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 99
Incorrect
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A 22 year old professional athlete sustains an inversion injury to her left ankle during the 800m. Which of the following ligaments is most likely injured:
Your Answer: Posterior talofibular ligament
Correct Answer: Anterior talofibular ligament
Explanation:Inversion injuries at the ankle in plantarflexion (such as when wearing high heels) are common, and typically result in damage to the lateral collateral ligament of the ankle, made up of the anterior talofibular, the calcaneofibular and the posterior talofibular ligaments. The anterior talofibular and the calcaneofibular ligaments are most commonly injured, and the posterior talofibular ligament rarely. The spring ligament supports the head of the talus, the deltoid ligament supports the medial aspect of the ankle joint, and the long and short plantar ligaments are involved in maintaining the lateral longitudinal arch of the foot.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 100
Correct
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From which of the following cell types are platelets derived?
Your Answer: Megakaryocytes
Explanation:Synthesis of platelets occurs in the bone marrow by fragmentation of megakaryocytes cytoplasm, derived from the common myeloid progenitor cell. The average time for differentiation of the human stem cell to the production of platelets is about 10 days. The major regulator of platelet formation is thrombopoietin and 95% of this is produced by the liver. Normal platelet count is 150 – 450 x 109/L and the normal lifespan of a platelet is about 10 days. Usually about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
