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Question 1
Correct
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A 23 year old student presents to ED with a widespread maculopapular rash. She recently had a sore throat and was started on a course of antibiotics. The most likely antibiotic that she was prescribed is:
Your Answer: Amoxicillin
Explanation:Maculopapular rashes are commonly seen with ampicillin and amoxicillin. However they are not usually related to true penicillin allergy. Very often, they occur in patients with glandular fever and so, broad-spectrum penicillins should not be used blindly, for management and treatment of a sore throat. There is also an increased risk of rash in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 2
Correct
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By the third day of wound healing, which sort of inflammatory cell has predominated:
Your Answer: Macrophages
Explanation:The inflammatory phase of healing is sometimes called the lag phase because wound strength does not begin to return immediately. The inflammatory phase is completed within three days except in the presence of infection or other factors associated with impaired wound healing. Mononuclear leukocytes accumulate and are transformed into macrophages. The maturation of blood-derived monocytes into macrophages is heralded by several events, including secretion of vimentin, which is a structural filament protein involved in wound healing.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 3
Incorrect
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All of the following typically occurs as part of normal passive expiration except:
Your Answer: Elevation of the diaphragm
Correct Answer: Contraction of the internal intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs. In expiration, several movements occur. There are:1. depression of the sternal ends of the ribs (‘pump handle’ movement), 2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and 3. elevation of the diaphragm. These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 4
Correct
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A 10-year-old girl that appears systemically well presents with a honey-crusted scab close to the corner of her mouth and states that the area is slightly itchy but not painful. The diagnosis given was impetigo.What is most likely the mode of transmission of the causative agent of the said diagnosis?
Your Answer: Direct contact
Explanation:Impetigo is a common pyoderma that is most often seen in children. Historically, most cases were caused by group A streptococci (GAS; Streptococcus pyogenes), although S. aureus has become the predominant pathogen over the last 15 years.A bullous form of impetigo accounts for approximately 10% of cases. It is caused by strains of S. aureus that produce exfoliative toxins leading to the formation of bullae, which quickly rupture and form a transparent, light brown crust.Impetigo is spread mainly by person-to-person contact; it is rapidly spread through direct transmission. The diagnosis of impetigo can be made from a Gram stain and culture of the vesicular contents.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 5
Incorrect
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A patient suffers from an injury to his hip and thigh. As a consequence of his injury, the nerve that was damaged innervates the obturator externus muscle.In which of the following nerves is the obturator externus muscle innervated by?
Your Answer: The anterior division of the femoral nerve
Correct Answer: Posterior branch of the obturator nerve
Explanation:The obturator externus is innervated by the posterior branch of the obturator nerve, L2-L4.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 6
Correct
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Compliance is greater in all but which one of the following:
Your Answer: Pulmonary oedema
Explanation:Compliance changes at different lung volumes. Initially at lower lung volumes the compliance of the lung is poor and greater pressure change is required to cause a change in volume. This occurs if the lungs become collapsed for a period of time. At functional residual capacity (FRC) compliance is optimal since the elastic recoil of the lung tending towards collapse is balanced by the tendency of the chest wall to spring outwards. At higher lung volumes the compliance of the lung again becomes less as the lung becomes stiffer. At all volumes, the base of the lung has a greater compliance than the apex. Patients with emphysema have increased compliance. Compliance is affected by a person’s age, sex and height.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 7
Correct
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Which of the following statements is correct with regards to Hodgkin's lymphoma?
Your Answer: Most patients present with painless asymmetrical lymphadenopathy, with cervical nodes involved most commonly.
Explanation:Lymphoma is a cancer of the lymphatic system, which is part of the body’s germ-fighting network. They are a group of diseases that are caused by malignant lymphocytes. These malignant cells accumulate in lymph nodes and other lymphoid tissue, giving rise to the characteristic clinical feature of lymphadenopathy. They can be subdivided into Hodgkin lymphoma (HL) which are characterised by the presence of Reed-Sternberg cells, and non-Hodgkin lymphoma (NHL). Characteristics of HL include:1. can present at any age but is rare in children and has a peak incidence in young adults, 2. almost 2:1 male predominance. 3. presents with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. 4. cervical node involvement in 60-70% of cases, 5. axillary node involvement in 10-15% 6. inguinal node involvement in 6-12%. 7. modest splenomegaly during the course of the disease in 50% of patients8. may occasionally have liver enlargement9. bone marrow failure involvement is unusual in early disease. Approximately 85% of patients are cured, but the prognosis depends on age, stage and histology. Two well‐known but rare symptoms in HL are alcohol‐induced pain and pruritus.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 8
Correct
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In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.Prolonged seizures last 5 minutes or more. Repeated seizures refer to 3 or more seizures in an hour.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 9
Correct
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Which of the following is a contraindication for aspirin?
Your Answer: Children under 16 years
Explanation:Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 10
Correct
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When there is the presence of distended and engorged veins in the umbilical area, which of the following portosystemic anastomoses has most likely occurred?
Your Answer: Para-umbilical veins and inferior epigastric vein
Explanation:Caput medusae is a condition that consists of collateral veins radiating from the umbilicus and results from recanalization of the umbilical vein.Under normal conditions, the portal venous blood traverses the liver and drains into the inferior vena cava of the systemic venous circulation by way of the hepatic veins. This is the direct route. However, other, smaller communications exist between the portal and systemic systems, and they become important when the direct route becomes blocked. These communications are as follows:At the lower third of the oesophagus, the oesophageal branches of the left gastric vein (portal tributary) anastomose with the oesophageal veins draining the middle third of the oesophagus into the azygos veins (systemic tributary).Halfway down the anal canal, the superior rectal veins (portal tributary) draining the upper half of the anal canal anastomosis with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.The paraumbilical veins connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall (systemic tributaries). The paraumbilical veins travel in the falciform ligament and accompany the ligamentum teres.The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 11
Correct
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A 26-year-old male presents to your clinic with the complaint of recurrent fevers over the past three months. On documentation of the fever, it is noted that the fever increases and decreases in a cyclical pattern over a 1-2 week period. After the appropriate investigations, a diagnosis of Pel-Ebstein fever is made. Which ONE of the following conditions is most likely to cause this patient's fever?
Your Answer: Hodgkin lymphoma
Explanation:The release of cytokines from Reed-Sternberg cells can cause fever in patients with Hodgkin lymphoma, which increases and decreases in a cyclical pattern of 1 to 2 weeks. This is called Pel-Ebstein or Ebstein-Cardarelli fever, specifically seen in Hodgkin lymphoma. The fever is always high grade and can reach 40 degrees or higher.Cyclical fever in other conditions is common but is not termed as Pel-Ebstein fever. This term is reserved only with Hodgkin lymphoma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 12
Correct
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Which of the following statements about sickle cell disease is TRUE:
Your Answer: Hand-foot syndrome is frequently a first presentation of the disease.
Explanation:Hand-foot syndrome in children is typically the first symptom of the disease, produced by infarction of the metaphysis of small bones. The disease is inherited as an autosomal recessive trait. By adulthood, the spleen has usually infarcted. Infection with the B19 parvovirus is usually followed by an aplastic crisis. Thrombocytopenia is caused by splenic sequestration.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 13
Correct
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Regarding antihistamines, which of the following statements is CORRECT:
Your Answer: Elderly patients and children are more susceptible to side effects.
Explanation:Elderly patients and children are more susceptible to side effects. Antihistamines are competitive inhibitors at the H1-receptor. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent. Antihistamines are used as a second line adjunct to adrenaline in anaphylaxis.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 14
Incorrect
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An 11-year-old girl presents with a 5-day history of persistent fever despite regular paracetamol, throbbing left ear pain, ear discharge and deafness. Her parents have observed that she is not her usual self, not eating well, and has been lethargic. On examination there is a tender swelling in the post auricular region on the left hand side.What is the most likely causative organism?
Your Answer: Staphylococcus aureus
Correct Answer: Streptococcus pneumonia
Explanation:Acute mastoiditis is a complication (rare) of acute otitis media (AOM) and the commonest causative organism is Streptococcus pneumoniae.Generally, acute mastoiditis presents with:PyrexiaRecent history of AOMMastoid swelling and erythemaOtalgiaOtorrhoea and perforation of tympanic membranePost-auricular painProtrusion of the ears
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 15
Correct
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Regarding anaemia, which of the following statements is INCORRECT:
Your Answer: Anaemia is usually associated with a decrease in red cell 2,3 - DPG.
Explanation:Anaemia is defined as a reduction in haemoglobin concentration below the normal range for the age and sex of the individual. Children tend to have lower haemoglobin than adults, and women tend to have lower haemoglobin than men. Anaemia may occur from an actual reduction in total circulating haemoglobin mass, or with an increase in plasma volume e.g. in pregnancy, causing a dilutional anaemia. After acute major blood loss, anaemia is not immediately apparent because total blood volume is reduced and it takes up to a day for plasma volume to be replaced and hence the degree of anaemia to become apparent. The initial clinical features in acute haemorrhage are therefore a result of reduction in blood volume rather than that of anaemia. When anaemia develops slowly, the associated symptoms are often very mild as the body has time to adapt to the fall in haemoglobin. This involves mechanisms such as an increase in red cell 2,3 -diphosphoglycerate (2,3 – DPG), which shifts the oxygen dissociation curve to the right, allowing enhanced delivery of O2 to the tissues, and an increase in stroke volume and heart rate.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 16
Correct
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A 12-year old boy is taken to the emergency room after accidentally falling off the monkey bars. Witnesses of the accident reported that, when the patient fell, he hit his right hand on a bar and a loud thump was heard. On examination, the hand is oedematous, tender and erythematous. On ultrasound, a rupture of the flexor carpi ulnaris is noted.Which of the following statements is true regarding the flexor carpi ulnaris?
Your Answer: It acts to adduct the hand at the wrist joint
Explanation:Flexor carpi ulnaris is a fusiform muscle located in the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, along with pronator teres, palmaris longus, flexor digitorum superficialis and flexor carpi radialis. Flexor carpi ulnaris is the most medial of the superficial flexors.Innervation of the flexor carpi ulnaris muscle is from the brachial plexus via the ulnar nerve (C7-T1).Flexor carpi ulnaris receives its arterial blood supply via three different routes. Proximally, a branch of the posterior ulnar recurrent artery supplies the muscle as it passes between the humeral and ulnar heads. Branches of the ulnar artery supply the middle and distal parts of the muscle, with an accessory supply also present distally via the inferior ulnar collateral artery.Due to its position and direction in the forearm, flexor carpi ulnaris can move the hand sideways as well as flexing it. Contracting with flexor carpi radialis and palmaris longus, flexor carpi ulnaris produces flexion of the hand at the wrist joint. However, when it contracts alongside the extensor carpi ulnaris muscle in the posterior compartment, their counteracting forces produce adduction of the hand at the wrist, otherwise known as ulnar deviation or ulnar flexion
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Correct
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Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:
Your Answer: The two variables are directly proportional
Explanation:A positive correlation coefficient means that the two variables are directly proportional e.g. height and weight in healthy growing children.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 18
Correct
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Which of the following does not increase renal phosphate excretion?
Your Answer: Vitamin D
Explanation:PO43-renal excretion is regulated several mechanisms. These include:-parathyroid hormone – increases excretion by inhibiting reabsorption in the proximal tubule-acidosis – increases excretion-glucocorticoids – increases excretion-calcitonin – increases excretion-activated vitamin D – decreases excretion by increasing reabsorption in the distal tubule
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This question is part of the following fields:
- Physiology
- Renal
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Question 19
Incorrect
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The proximal convoluted tubule (PCT) is the first part of the renal tubule and lies in the renal cortex. The bulk of reabsorption of solute occurs is the PCT and 100% of glucose is reabsorbed here.Which of the following is the mechanism of glucose reabsorption in the PCT?
Your Answer: Facilitated diffusion
Correct Answer: Secondary active transport
Explanation:Glucose reabsorption occurs exclusively in the proximal convoluted tubule by secondary active transport through the Na.Glu co-transporters, driven by the electrochemical gradient for sodium. The co-transporters transport two sodium ions and one glucose molecule across the apical membrane, and the glucose subsequently crosses the basolateral membrane by facilitated diffusion.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 20
Incorrect
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After an accidental fall, a 75-year-old patient complains of neck pain and weakness in his upper limbs. Select the condition that most likely caused the neck pain and weakness of the upper limbs of the patient.
Your Answer: Anterior cord syndrome
Correct Answer: Central cord syndrome
Explanation:The cervical spinal cord is the section of the spinal cord that goes through the bones of the neck. It is injured incompletely in the central cord syndrome (CCS). This will result in arm weakness more than leg weakness.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 21
Correct
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A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.Which of the following statements about corticotropin-releasing hormone is correct?
Your Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus
Explanation:Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 22
Incorrect
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Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:
Your Answer: Ca 2+ release from the sarcoplasmic reticulum is stimulated directly by a Na + influx.
Correct Answer: In relaxation, Ca 2+ is transported out of the cell using energy from a Na + gradient.
Explanation:During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane which pumps one Ca2+ion out in exchange for three Na+ions in, using the Na+electrochemical gradient as an energy source. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Factors that affect intracellular [Ca2+] and hence cardiac contractility are called inotropes.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 23
Incorrect
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A 28-year-old female arrives after taking an unknown chemical in excess. She is tired and her speech is slurred. The following are her observations and results: HR 118, BP 92/58, SaO2 96%HR 118, 11/15 The following are the results of his arterial blood gas (ABG):pH: 7.24 pO 2 : 9.4 kPa PCO2 : 3.3 kPa HCO 3 -: 22 mmol/l Na + : 143 mmol/l Cl – : 99 mmol/l Lactate: 5 IU/lWhich of the following statements about this patient is TRUE?
Your Answer: Her anion gap is normal
Correct Answer: Her anion gap is elevated
Explanation:The interpretation of arterial blood gas (ABG) aids in the measurement of a patient’s pulmonary gas exchange and acid-base balance. The normal values on an ABG vary a little depending on the analyser, but they are roughly as follows:Variable RangepH 7.35 – 7.45PaO2 10 – 14 kPaPaCO2 4.5 – 6 kPaHCO3- 22 – 26 mmol/lBase excess -2 – 2 mmol/lThe patient’s history indicates that she has taken an overdose in this case. Because her GCS is 11/15 and she can communicate with slurred speech, she is clearly managing her own airway, there is no current justification for intubation.The following are the relevant ABG findings:Hypoxia (mild)pH has been lowered (acidaemia)PCO2 levels are low.bicarbonate in its natural stateLactate levels have increasedThe anion gap represents the concentration of all the unmeasured anions in the plasma. It is the difference between the primary measured cations and the primary measured anions in the serum. It can be calculated using the following formula:Anion gap = [Na+] – [Cl-] – [HCO3-]The reference range varies depending on the technique of measurement, but it is usually between 8 and 16 mmol/L.The following formula can be used to compute her anion gap:Anion gap = [143] – [99] – [22]Anion gap = 22As a result, it is clear that she has a metabolic acidosis with an increased anion gap.The following are some of the causes of type A and type B lactic acidosis:Type A lactic acidosisType B lactic acidosisShock (including septic shock)Left ventricular failureSevere anaemiaAsphyxiaCardiac arrestCO poisoningRespiratory failureSevere asthma and COPDRegional hypoperfusionRenal failureLiver failureSepsis (non-hypoxic sepsis)Thiamine deficiencyAlcoholic ketoacidosisDiabetic ketoacidosisCyanide poisoningMethanol poisoningBiguanide poisoning
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 24
Correct
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Regarding the varicella zoster virus, which of the following statements is CORRECT:
Your Answer: Contracting chickenpox infection while pregnant is associated with a higher risk of developing varicella pneumonitis.
Explanation:Chickenpox infection in neonates, adults/adolescents and pregnant women is associated with more severe disease. Varicella zoster pneumonitis typically occurs in pregnant women or immunocompromised individuals and is associated with a high mortality. A live attenuated-virus vaccine is available and recommended for non-immune healthcare workers but is not part of the routine childhood immunisation schedule. Antiviral treatment is not typically recommended in childhood chickenpox but is indicated for shingles.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 25
Incorrect
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Which of the following corticosteroids has the most potent mineralocorticoid effect:
Your Answer: Dexamethasone
Correct Answer: Fludrocortisone
Explanation:Fludrocortisone has the most potent mineralocorticosteroid activity, making it ideal for mineralocorticoid replacement in adrenal insufficiency.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 26
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 27
Correct
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Question 28
Incorrect
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Which of the following statements about propofol is TRUE:
Your Answer: If accidentally injected outside a vein it can cause tissue necrosis.
Correct Answer: Propofol has some antiemetic action.
Explanation:Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 29
Correct
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Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.Which enzyme hydroxylates 25-hydroxycholecalciferol to form 1,25-dihydroxycholecalciferol?
Your Answer: 1-alpha-hydroxylase
Explanation:The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.In the presence of UVB light, 7-dehydrocholesterol is converted to cholecalciferol in the epidermal layer of the skin, resulting in 1,25-dihydroxycholecalciferol.Cholecalciferol is then converted to 25-hydroxycholecalciferol in the endoplasmic reticulum of liver hepatocytes by 25-hydroxylase (calcifediol).Finally, 1-alpha-hydroxylase converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol in the kidney. The key regulatory point in the formation of 1,25-dihydroxycholecalciferol is 1-alpha-hydroxylase, which is induced by parathyroid hormone or hypophosphatemia.The following are the primary effects of 1,25-dihydroxycholecalciferol:Calcium and phosphate absorption in the small intestine is increased.Calcium reabsorption in the kidneys is increased.Increases phosphate reabsorption in the kidneys.Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback)
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 30
Correct
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A 23-year-old has a known diagnosis of HIV. Blood is sent to the laboratory for tests.AIDS be diagnosed at a CD4 counts below?
Your Answer: 200 cells/mm 3
Explanation:A normal CD4 count ranges from 500-1000 cells/mm3.At CD4 count of less than 350 cells/mm3 treatment with anti-retroviral therapy should be considered.At a CD4 count of >200 cells/mm3 AIDS is diagnosed.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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SESSION STATS - PERFORMANCE PER SPECIALTY
