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Question 1
Correct
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A 24-year-old male presents to the Emergency Department with a three-day history of high-grade fever, headache and rash along with neck stiffness. On examination, Kernig's sign is positive, and you note a petechial rash over the trunk and limbs. Her vital signs show tachycardia and hypotension. Based on these findings, you diagnose sepsis secondary to meningitis. Which one of the following definitions of sepsis is currently accepted?
Your Answer: Life-threatening organ dysfunction caused by a dysregulated host response to infection
Explanation:In 2016 the SOFA guideline was introduced, also called the Sepsis-related Organ Failure Assessment, to make a sepsis diagnosis easier and prevent mortality. According to this guideline, sepsis was defined as a life-threatening organ dysfunction due to a dysregulated host response to infection. Septic shock was defined as a subset of sepsis in which the circulatory and metabolic abnormalities would lead to a greater risk of mortality than sepsis alone. Patients with septic shock would be clinically identified by a need for vasopressors to maintain MAP greater than 65 mmHg and serum lactate greater than two mmol/L.
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This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 2
Correct
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Which of the following statements is correct with regards to natural killer cells?
Your Answer: They are part of the innate immune system.
Explanation:Natural Killer (NK) Cells are lymphocytes in the same family as T and B cells, which come from a common progenitor. They are cytotoxic CD8 positive cells that do not have the T-cell receptor. They are very big cells with cytoplasmic granules and are designed to kill target cells with a low level of expression of HLA class I molecules. Examples include during a viral infection or on a malignant cell. NK cells display several receptors for HLA molecules on their surface, and when HLA is expressed on the target cell, these deliver an inhibitory signal into the NK cell. Absent HLA molecules on the target cell cause this inhibitory signal to get lost and as a result, the NK cell can then kill its target. Also, NK cells display antibody-dependent cell-mediated cytotoxicity, where antibody binds to antigen on the surface of the target cell. The NK cells then bind to the Fc portion of the bound antibody and kill the target cell.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 3
Correct
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The fluid in contact with a tube is dragged by frictional forces to the tube's sidewalls. This creates a velocity gradient in which the fluid flow is greatest in the tube's centre.Which of the following terms most accurately characterizes this flow pattern?
Your Answer: Laminar flow
Explanation:The fluid in contact with a tube is dragged by frictional forces at the tube’s sidewalls. This creates a velocity gradient in which the fluid flow is greatest in the tube’s centre.This is known as laminar flow, and it characterizes the flow in most circulatory and respiratory systems when they are at rest.The velocity of the fluid flow can fluctuate erratically at high velocities, particularly within big arteries and airways, disrupting laminar flow. As a result, resistance increases significantly.This is known as turbulent flow, and symptoms include heart murmurs and asthmatic wheeze.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 4
Incorrect
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Digoxin is contraindicated in all of the following EXCEPT for:
Your Answer: Wolff-Parkinson-White syndrome
Correct Answer: Asthma
Explanation:Digoxin is contraindicated in:Supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndromeVentricular tachycardia or fibrillationHeart conduction problems e.g. second degree or intermittent complete heart blockHypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure but should be used with caution)
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 5
Correct
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A 35-year-old man, who was feeling unwell after his return from a business trip, was diagnosed with a disease that is known to be transmitted by a vector. Among the following microorganisms, which of the following has a mode of transmission of being vector-borne?
Your Answer: Plasmodium falciparum
Explanation:Plasmodium falciparum is a parasite that is vector-borne which is transmitted by the female Anopheles mosquito.Bordetella pertussis is transmitted through the respiratory tract, via respiratory droplets or direct contact with infectious secretions.Mycobacterium tuberculosis is transmitted via inhalation of infected respiratory droplets.HIV may be transmitted via sexual contact, vertical transmission from mothers to infants, and among injection drug users sharing infected needles, as well as through transfusion of infected blood products.Treponema pallidum transmission normally occurs during direct sexual contact with an individual who has an active primary or secondary syphilitic lesion.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 6
Correct
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Regarding control of hospital acquired infection (HAI), which of the following statements is CORRECT:
Your Answer: Chlorhexidine is an anti-staphylococcal agent.
Explanation:Chlorhexidine is an anti-staphylococcal agent. Cleaning is the removal of foreign material from areas or objects to a point at which they are visually free from debris. Disinfection is the reduction in the number of infectious particles. Isopropyl alcohol is not effective against C. difficile spores. Autoclaving is a method of sterilisation.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 7
Correct
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The least likely feature of anaemia is:
Your Answer: Narrow pulse pressure
Explanation:Non-specific signs of anaemia include: 1. pallor of mucous membranes or nail beds (if Hb < 90 g/L), 2. tachycardia3. bounding pulse4. wide pulse pressure5. flow murmurs 6. cardiomegaly 7. signs of congestive cardiac failure (in severe cases)
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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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The 'pump handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The anterior ends of the ribs moving upwards and forwards
Explanation:Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, the anterior end moves upwards and forwards, moving the sternum upwards and forwards in turn. This ‘pump handle’ upwards and forwards movement changes the anteroposterior (AP) dimension of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 9
Correct
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A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago. Which ONE of the following options is FALSE with regards to this disorder?
Your Answer: Acute haemolysis can be triggered by cephalosporin antibiotics
Explanation:Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.Triggers include: 1) Fava beans2) Sulphonamides3) Primaquine4) Anti-TB drugs5) Infections Most individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 10
Correct
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Regarding the human cell, which of the following cell organelles is responsible for the production of ATP:
Your Answer: Mitochondria
Explanation:Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 11
Correct
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A 37-year-old man presents with breathlessness on exertion and dry cough, fever for the past 2 days and bilateral pleuritic chest pain. He had been diagnosed with HIV and commenced on HAART but due to side effects, his compliance has been poor over the last few months.On examination you note scattered crackles and wheeze bilaterally, cervical and inguinal lymphadenopathy, and oral thrush. At rest his oxygen saturation is 97% but this drops to 87% on walking. There is perihilar fluffy shadowing seen on his chest X-ray.Which of these organisms is the most likely causative organism?
Your Answer: Pneumocystis jirovecii
Explanation:All of the organisms listed above can cause pneumonia in immunocompromised individuals but the most likely cause in this patient is Pneumocystis jirovecii.It is a leading AIDS-defining infection in HIV-infected individuals and causes opportunistic infection in immunocompromised individuals. HIV patients with a CD4 count less than 200 cells/mm3 are more prone.The clinical features of pneumonia caused by Pneumocystis jirovecii are:Fever, chest pain, cough (usually non-productive), exertional dyspnoea, tachypnoea, crackles and wheeze.Desaturation on exertion is a very sensitive sign of Pneumocystis jirovecii pneumonia.Chest X-ray can show perihilar fluffy shadowing (as is seen in this case) but can also be normal.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 12
Correct
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Regarding the refractory period, which of the following statements is INCORRECT:
Your Answer: Action potentials can occur in the relative refractory period but the amplitude of the action potential is smaller.
Explanation:Following the action potential, Na+channels remain inactive for a time in a period known as the absolute refractory period where they cannot be opened by any amount of depolarisation. Following this there is a relative refractory period where the temporary hyperpolarisation (due to delayed closure of rectifier K+channels) makes the cell more difficult to depolarise and an action potential can be generated only in response to a larger than normal stimulus. The refractory period limits the frequency at which action potentials can be generated, and ensures that, once initiated, an action potential can travel only in one direction. An action potential is an all or nothing response so the amplitude of the action potential cannot be smaller.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 13
Incorrect
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Identify the type of graph described below:A graph wherein the frequency distribution is represented by adjoining vertical bars and cases are stacked in adjoining columns. It can be used for continuous quantitative data, such as to analyse outbreak data to show an epidemic curve.
Your Answer: Forest plot
Correct Answer: Histogram
Explanation:A histogram is used to demonstrate the distribution of continuous quantitative data. It is a very familiar graphical display device for representing the distribution of a single batch of data. The range of the data is divided into class intervals or bins, and the number of values falling into each interval is counted. The histogram then consists of a series of rectangles whose widths are defined by the class limits implied by the binwidths, and whose heights depend on the number of values in each bin. Histograms quickly reveal such attributes of the data distribution as location, spread, and symmetry. If the data are multimodal (i.e., more than one “hump” in the distribution of the data), this is quickly evident as well.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 14
Correct
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Regarding dermatophytes, which of the following statement is CORRECT:
Your Answer: Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings.
Explanation:Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings depending on the site of infection. The lesions of ringworm typically have a dark outer ring with a pale centre. Tinea capitis is ringworm affecting the head and scalp. Spread is via direct skin contact. Treatment is usually topical, oral antifungals are reserved for refractory infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 15
Incorrect
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Cardiac myocytes are connected to each other by which of the following:
Your Answer: Tight junctions
Correct Answer: Intercalated discs
Explanation:Adjacent cardiac myocytes are connected to each other by intercalated discs. The intercalated discs provide both a structural attachment by ‘glueing’ cells together at desmosomes and an electrical contact made up of proteins called connexons, called a gap junction, which essentially creates a low-resistance pathway between cells.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 16
Correct
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You see a patient in the ED with photophobia, petechial rash, headache and neck stiffness, and suspect a diagnosis of meningococcal meningitis.What is the most appropriate initial management?
Your Answer: Give ceftriaxone 2 g IV
Explanation:Treatment should be commenced with antibiotics immediately before laboratory confirmation due to the potentially life-threatening nature of the disease.In a hospital setting, 2g of IV ceftriaxone (80 mg/kg for a child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the drugs of choice. In the prehospital setting, IM benzylpenicillin can be given as an alternative.
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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 of the following best describes the mechanism of action of aspirin:
Your Answer: Cyclo-oxygenase (COX) inhibitor
Explanation:Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 18
Correct
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Which of the following is an action of glucagon:
Your Answer: Stimulates glycogenolysis
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline. Glucagon then causes:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 19
Correct
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A 35-year-old man is feeling unwell following his return from a business trip. He is diagnosed with a vector transmitted disease.Which of these organisms is commonly spread by vector-borne transmission?
Your Answer: Borrelia burgdorferi
Explanation:Borrelia burgdorferiis, primarily spread by ticks and lice, is a zoonotic, vector-borne organism that causes Lyme disease.Neisseria meningitidis and Bordetella pertussis are droplet borne infections (airborne particle > 5 µm)Vibrio cholerae and Ascaris lumbricoides are spread by the faeco-oral route
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 20
Correct
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Regarding Helicobacter pylori, which of the following statements is INCORRECT:
Your Answer: It is found as part of normal colonic flora.
Explanation:Helicobacter pyloriis a Gram-negative, helix shaped (curved rod), microaerophilic bacterium. It typically has 4-6 lophotrichous flagellae and is therefore highly motile. It has an outer membrane consisting of phospholipids and lipopolysaccharide.Helicobacter pyloriIs found in the upper gastrointestinal tract of approximately 50% of the population.Colonization withHelicobacter pyloriconfers a 10-20% lifetime risk of developing peptic ulcers and a 1-2% lifetime risk of developing gastric cancer.There is a strong association between mucosa-associated lymphoid tissue (MALT) lymphoma andHelicobacter pyloricolonization.The most reliable method for testing for colonization withHelicobacter pyloriis by biopsy during endoscopy and histological examination.Typically eradication requires a 14-day course of triple therapy with amoxicillin, clarithromycin and a proton pump inhibitor. Metronidazole is also often used as an alternative antibiotic in a triple therapy regime.Serum antibody levels fall slowly and therefore cannot be used to accurately assess eradication. Either of the 13C-urea breath test or the stool antigen test are viable options for assessing successful eradication.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Correct
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Which of the following muscles inserts into the patella?
Your Answer: The quadriceps femoris complex
Explanation:The quadriceps femoris muscle translates to “four-headed muscle” from Latin. It bears this name because it consists of four individual muscles; rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. Out of all four muscles, only the rectus femoris crosses both the hip and knee joints. The others cross only the knee joint. These muscles differ in their origin, but share a common quadriceps femoris tendon which inserts into the patella. The function of the quadriceps femoris muscle is to extend the leg at the knee joint and to flex the thigh at the hip joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 22
Incorrect
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If the afferent arteriole's diameter is smaller than the efferent arteriole's diameter in the glomerulus:
Your Answer: The glomerular filtration rate will increase
Correct Answer: The net filtration pressure will decrease
Explanation:The relative resistance of the afferent and efferent arterioles substantially influences glomerular capillary hydrostatic pressure and consequently GFR. Filtration is forced through the filtration barrier due to high pressure in the glomerular capillaries. Afferent arteriolar constriction lowers this pressure while efferent arteriolar constriction raises it.
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This question is part of the following fields:
- Physiology
- Renal
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Question 23
Correct
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A patient is sent in to ED by her GP with hyponatraemia and hyperkalaemia. There is most likely to be a deficiency in which of the following hormones:
Your Answer: Aldosterone
Explanation:A deficiency of aldosterone, as seen in adrenal insufficiency, can result in hyponatraemia and hyperkalaemia.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 24
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: ALL is the most common malignancy of childhood.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 25
Incorrect
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Question 26
Correct
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A 28-year-old patient is intubated and has a central venous catheter inserted after being diagnosed with septic shock. You keep track of her central venous pressure.The normal value for central venous pressure is which of the following?
Your Answer: 0-8 cmH 2 O
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).At the conclusion of expiration, the CVP should be measured with the patient resting flat. The catheter’s tip should be at the intersection of the superior vena cava and the right atrium. An electronic transducer is installed and zeroed at the level of the right atrium to measure it (usually in the 4th intercostal space in the mid-axillary line).CVP is a good predictor of preload in the right ventricle. Hypovolaemia is indicated by a volume challenge of 250-500 mL crystalloid eliciting an increase in CVP that is not sustained for more than 10 minutes.CVP is influenced by a number of factors, including:Mechanical ventilation (and PEEP)Pulmonary hypertensionPulmonary embolismHeart failurePleural effusionDecreased cardiac outputCardiac tamponadeCVP is reduced by the following factors:Distributive shockNegative pressure ventilationHypovolaemiaDeep inhalation
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 27
Correct
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Regarding threadworms, which of the following statements is CORRECT:
Your Answer: First line treatment of threadworms is with mebendazole.
Explanation:First line treatment of threadworms is with mebendazole, with treatment of the whole family, and a repeat treatment after 2 weeks. Threadworms live in the large bowel, but direct multiplication of worms does not occur here. Threadworms most commonly infect children, and may be symptomatic or cause pruritus ani.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 28
Incorrect
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Which of the following statements is incorrect regarding the electron transfer system?
Your Answer: The electron transfer system stage produces most of the energy produced in cellular respiration.
Correct Answer: The electron transfer system occurs in anaerobic respiration.
Explanation:The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 29
Incorrect
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The QRS duration of a broad-complex tachyarrhythmia is:
Your Answer: Greater than 0.12 s
Correct Answer: Greater than or equal to 0.12 s
Explanation:It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 30
Incorrect
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A patient was diagnosed with Erb's palsy as a result of a brachial plexus injury sustained in a car accident and, as a result, suffers from left arm paralysis. The following muscles are affected by the injury, except
Your Answer: Deltoid
Correct Answer: Trapezius
Explanation:Damage to the C5 and C6 nerve roots causes Erb’s palsy. The spinal accessory nerve (CN XI) innervates the trapezius muscle, thus you would not expect this muscle to be impacted. The trapezius is a muscle that runs from the base of the neck across the shoulders and into the centre of the back.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY
