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Question 1
Correct
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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 2
Incorrect
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Which of the following is NOT an effect of gastrin:
Your Answer: Increased gastric motility
Correct Answer: Stimulation of insulin release
Explanation:Gastrin acts to:Stimulate acid secretion from parietal cells (both directly and indirectly by stimulating release of histamine from ECL cells)Stimulate pepsinogen secretion from chief cellsIncrease gastric motilityStimulate growth of gastric mucosa
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 3
Incorrect
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The movement of molecules across the cell membrane relies greatly on active transport.Which of the following statements about active transport is correct?
Your Answer: It is the movement of a substance from a high to a low concentration gradient
Correct Answer: Active transport occurs in glucose absorption from the gut
Explanation:The movement of a material against a concentration gradient, i.e. from a low to a high concentration, is known as active transport. Primary active transport is defined as active transport that involves the use of chemical energy, such as adenosine triphosphate (ATP). Secondary active transport occurs when an electrochemical gradient is used.The sodium-potassium pump, calcium ATPase pump, and proton pump are all key active transport systems that use ATP. An electrochemical gradient is used by the sodium-calcium co-transporter, which is an example of secondary active transport.The sodium-dependent hexose transporter SGLUT-1 transports glucose and galactose into enterocytes. Secondary active transport is exemplified here.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 4
Correct
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Intravenous glucose solutions are typically used in the treatment of all of the following situations except:
Your Answer: Hypokalaemia
Explanation:In hypokalaemia, initial potassium replacement therapy should not involve glucose infusions, as glucose may cause a further decrease in the plasma-potassium concentration. Glucose infusions are used for the other indications like diabetic ketoacidosis, hypoglycaemia, routine fluid maintenance in patients who are nil by mouth (very important in children), and in hyperkalaemia.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 5
Incorrect
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Platelet alpha granules release which of the following?
Your Answer: Ionised calcium
Correct Answer: Von Willebrand factor (VWF)
Explanation:There are three types of storage granules contained in platelets. These are dense granules which contain the following:-ATP -ADP -serotonin and calcium alpha granules containing clotting factors-von Willebrand factor (VWF)-platelet-derived growth factor (PDGF)- other proteins lysosomes containing hydrolytic enzymes.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 6
Incorrect
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The stomach G-cells are responsible for which of the following?Â
Your Answer: Protection of the stomach epithelium from acid
Correct Answer: Secretion of gastrin
Explanation:G-cells are a type of cell found in the stomach’s pyloric antrum, duodenum, and pancreas. The secretion of the peptide hormone gastrin is their major function.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 7
Correct
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In the resus area of your Emergency Department, you are called to a VF cardiac arrest.During an adult VF arrest, which of the following points should be treated with adrenaline?
Your Answer: After the 3 rd shock, once chest compressions have been resumed
Explanation:In non-shockable (PEA/asystole) cardiac arrests, adrenaline should be given as soon as circulatory access is gained. The dose is 1 mg via IV or IO (10 mL of 1:10,000 or 1 mL of 1:1000).Once chest compressions have been resumed after the third shock in a shockable (Vf/pVT) cardiac arrest, adrenaline should be administered. The dosage is one milligram (10 mL of 1:10,000 or 1 mL of 1:1000)It should be given every 3-5 minutes after that (i.e. alternate loops) and without interrupting chest compressions.Systemic vasoconstriction is caused by the alpha-adrenergic effects of adrenaline, which raises coronary and cerebral perfusion pressures.Adrenaline’s beta-adrenergic effects are inotropic (increased myocardial contractility) and chronotropic (increased heart rate), and they can increase coronary and cerebral blood flow. However, concomitant increases in myocardial oxygen consumption and ectopic ventricular arrhythmias (especially in the absence of acidaemia), transient hypoxemia due to pulmonary arteriovenous shunting, impaired microcirculation, and increased post-cardiac arrest myocardial dysfunction may offset these benefits.Although there is no evidence of long-term benefit from its use in cardiac arrest, the improved short-term survival reported in some studies justifies its use.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 8
Incorrect
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A patient with a wound infection on his right leg has reddening and oedema of the surrounding muscles. His condition has worsened considerably over the past few hours with the area now appearing blackened. There is also palpable crepitus under the skin. You suspect gas gangrene.Which statement about Clostridium perfringens is true?
Your Answer:
Correct Answer: Gas gangrene is caused by the release of an alpha-toxin
Explanation:Clostridium perfringens, a Gram-positive, anaerobic, spore forming rod-shaped, pathogenic bacterium is the most commonly associated with gas gangrene (85-90% of cases), although other species can also be implicated. Clostridium perfringens is capsulate and produces a range of toxins. Alpha-toxin is the most important and is the cause of gas gangrene.Gas gangrene develops when a devitalized wound becomes infected with Clostridium perfringens spores from the environment. The spores germinate and multiplies in the ischaemic conditions, releasing toxins, which further damage tissues.Usually, the clinical features of gas gangrene appear within 24 hours of injury.Clostridium perfringens spores are not destroyed by cooking. During slow cooling and unrefrigerated storage, they germinate to form vegetative cells.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 9
Incorrect
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A patient is sent in by her GP with suspected ectopic pregnancy. Tubal ectopic pregnancies occur most commonly in which part of the uterine tube:
Your Answer:
Correct Answer: Ampulla
Explanation:Ectopic pregnancy most commonly occurs in the ampulla (70% of cases).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Incorrect
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What is the average healing time for a femoral shaft fracture under normal circumstances? Choose ONE answer.
Your Answer:
Correct Answer: 12 weeks
Explanation:The process of fracture healing occurs naturally after traumatic bone disruption and begins with haemorrhage, then progresses through Inflammatory, reparative, and remodelling stagesAverage healing times of common fractures are:Femoral shaft: 12 weeksTibia: 10 weeksPhalanges: 3 weeksMetacarpals: 4-6 weeksDistal radius: 4-6 weeksHumerus: 6-8 weeks
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 11
Incorrect
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Question 12
Incorrect
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A 15-year-old male is admitted to a rehabilitation centre with a history of multiple strokes, myopathy and learning disabilities since childhood. He is under the care of a multidisciplinary team, and his genetic testing reports show the presence of a mitochondrial disorder. Which one of the following diseases does this patient most likely have?
Your Answer:
Correct Answer: MELAS
Explanation:Mitochondrial diseases are a group of disorders caused by dysfunctional mitochondria. Most cases are maternally inherited, as we inherit our mitochondrial DNA from our mothers only, although mutations in nuclear DNA cause some cases.Examples of Mitochondrial Diseases include:1. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)2. Mitochondrial epilepsy with ragged red fibres (MERRF)3. Leber’s hereditary optic neuropathy (LHON)4. Diabetes mellitus and deafness (DAD)5. Neuropathy, ataxia, retinitis pigmentosa, and ptosis (NARP)6. Leigh syndrome (subacute sclerosing encephalopathy). Red-green colour blindness and G6PD deficiency have an X-linked recessive pattern of inheritance. Tay-Sachs Disease and spinal muscular atrophy have an autosomal recessive pattern of inheritance.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 13
Incorrect
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Question 14
Incorrect
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Regarding co-amoxiclav, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Clavulanic acid acts to inhibit cross-linking of bacterial peptidoglycan polymers.
Explanation:Co-amoxiclav consists of amoxicillin with the beta-lactamase inhibitor clavulanic acid. Clavulanic acid itself has no significant antibacterial activity but, by inactivating beta-lactamases, it makes the combination active against beta-lactamase-producing bacteria that are resistant to amoxicillin.The most common adverse effects of co-amoxiclav include nausea, vomiting, skin rash and diarrhoea. Pseudomembranous colitis should be considered if a person develops severe diarrhoea during or after treatment with co-amoxiclav. Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav. An epidemiological study has shown that the risk of acute liver toxicity was about 6 times greater with co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 years and in men; these reactions have only rarely been reported in children. Jaundice is usually self-limiting and very rarely fatal.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 15
Incorrect
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Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is an increase in metabolic rate, the production of vasoactive metabolites increases. These metabolites act locally on the surrounding arterioles, causes vasodilation and an increase blood supply.Which of these metabolites is the most potent vasodilator in skeletal muscle?
Your Answer:
Correct Answer: K +
Explanation:Hyperaemia is the process where the body adjusts blood flow to meet the metabolic needs of different tissues in health and disease. Vasoactive mediators that take part in this process include K+, adenosine, CO2, H+, phosphates and H2O2. Although the mechanism is not clear, all these mediators likely contribute to some extent at different points.Specific organs are more sensitive to specific metabolites:K+ and adenosine are the most potent vasodilators in skeletal musclesCO2 and K+ are the most potent vasodilators in cerebral circulation.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 16
Incorrect
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An elderly man with chronic heart and lung disease develops Legionnaires' Disease. By what route was the infection most likely to have been acquired:
Your Answer:
Correct Answer: Inhalation of aerosolised contaminated water
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.The clinical features of the pneumonic form of Legionnaires’ disease include:Mild flu-like prodrome for 1-3 daysCough (usually non-productive and occurs in approximately 90%)Pleuritic chest painHaemoptysisHeadacheNausea, vomiting and diarrhoeaAnorexiaLegionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 17
Incorrect
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In all of the following conditions, lymphocytosis typically occurs except for:
Your Answer:
Correct Answer: Corticosteroid therapy
Explanation:In infants and young children, lymphocytosis often occurs in response to infections that would normally produce a neutrophil reaction in adults.Lymphocytosis occurs in:1. Viral infections (e.g. infectious mononucleosis, HIV, rubella, mumps, viral hepatitis, cytomegalovirus, herpes simplex or zoster)2. Bacterial infections (e.g. pertussis, tuberculosis, toxoplasmosis, syphilis)3. Chronic lymphoid leukaemias4. Acute lymphoblastic leukaemias5. Non-Hodgkin lymphoma6. Thyrotoxicosis
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 18
Incorrect
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Among the following infectious diseases, which is typically considered to have an incubation period of 3 weeks and longer?
Your Answer:
Correct Answer: Infectious mononucleosis
Explanation:Infectious mononucleosis is caused by Epstein-Barr virus (EBV). The incubation period for EBV varies from 2 weeks to 2 months.The usual incubation period for rubella is 14 days; with a range of 12 to 23 days.Gonorrhoea has a short incubation period of approximately 2 to 7 days.The mumps virus can be isolated from infected saliva and swabs rubbed over the Stensen’s duct from 9 days before onset of symptoms until 8 days after parotitis appears.Scarlet fever, which appears within 1 to 2 days after bacterial infection, is characterized by a diffuse red rash that appears on the upper chest and spreads to the trunk and extremities. The rash disappears over the next 5 to7 days and is followed by desquamation.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 19
Incorrect
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In inserting a nasogastric tube, which area is least likely to be a site of resistance when the tube goes from the nose to the stomach?
Your Answer:
Correct Answer: In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk
Explanation:In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk offers the least resistance when nasogastric tube is inserted from the nose to the stomach.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Incorrect
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Which of the following laboratory findings is NOT typical of Hodgkin lymphoma:
Your Answer:
Correct Answer: Basophilia
Explanation:Features may include:Normochromic normocytic anaemia is most common; bone marrow failure involvement is unusual in early disease, but if it occurs bone marrow failure may develop with leucoerythroblastic anaemiaOne-third of patients have a neutrophilia; eosinophilia is frequentAdvanced disease is associated with lymphopenia and loss of cell-mediated immunityPlatelet count is normal or increased in early disease and reduced in later stagesESR and CRP are usually raised (ESR is useful in monitoring disease progress)Serum LDH is raised initially in 30-40% of casesDiagnosis is made by histological examination of an excised lymph nodeThe distinctive multinucleate polypoid RS cell is central to the diagnosis of the four classic types of HL (95% of cases)
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This question is part of the following fields:
- Haematology
- Pathology
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Question 21
Incorrect
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A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitreOut of the following, which drug is most likely responsible for the baby's condition?
Your Answer:
Correct Answer: Lithium
Explanation:In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period. If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly. If given in the 2nd and 3rd-trimesters, there is a risk of the following:1. hypotonia2. lethargy3. feeding problems4. hypothyroidism5. goitre6. nephrogenic diabetes insipidus in the neonate
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 22
Incorrect
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You examine a 48-year-old woman's blood results and notice that her glucose level is elevated. When you tell her about it, she tells you that her doctor recently ran some tests and discovered that she has impaired glucose tolerance.Which of the following medications has not been linked to a reduction in glucose tolerance?
Your Answer:
Correct Answer: Amlodipine
Explanation:The following drugs have been linked to impaired glucose tolerance:Thiazide diuretics, e.g. BendroflumethiazideLoop diuretics, e.g. furosemideSteroids, e.g. prednisoloneBeta-blockers, e.g. atenolol
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 23
Incorrect
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Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms:
Your Answer:
Correct Answer: Binds to beta1-receptors and causes increased Ca2+ entry via L-type channels during the action potential
Explanation:Noradrenaline (the sympathetic neurotransmitter) is a positive inotrope; it binds to β1-adrenoceptors on the membrane and causes increased Ca2+entry via L-type channels during the AP and thus increases Ca2+release from the SR. Noradrenaline also increases Ca2+sequestration into the SR and thus more Ca2+is available for the next contraction. Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump which generates the Na+gradient required for driving the export of Ca2+; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction. Acidosis is negatively inotropic, largely because H+competes for Ca2+binding sites.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 24
Incorrect
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For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:
Your Answer:
Correct Answer: Synchronised DC shock
Explanation:If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 25
Incorrect
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Which of the following drugs is first line treatment for a stable regular broad-complex tachycardia:
Your Answer:
Correct Answer: Amiodarone
Explanation:A regular broad-complex tachycardia is likely to be ventricular tachycardia or a regular supraventricular rhythm with bundle branch block. A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours. If previously confirmed as SVT with bundle branch block, the patient should be treated as for narrow-complex tachycardia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 26
Incorrect
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Compression of this nerve can cause weakness in the left leg while walking and thigh adduction weakness at the hip joint.
Your Answer:
Correct Answer: Obturator nerve
Explanation:The obturator nerve is a sensory and motor nerve that emerges from the lumbar plexus and innervates the thigh. This nerve supplies motor innervation to the medial compartment of the thigh, making it necessary for thigh adduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 27
Incorrect
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Which of the following is NOT a typical clinical feature of osteomalacia:
Your Answer:
Correct Answer: Hypercalcaemia
Explanation:Features of osteomalacia include: Bone pain (particularly bone, pelvis, ribs)Neuromuscular dysfunction (particularly in the gluteal muscles, leading to waddling gaitPseudofractures on x-ray (looser zones)Elevated alkaline phosphatase, hypocalcaemia and low phosphate due to secondary hyperparathyroidism
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 28
Incorrect
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What type of visual field defect are you most likely to see in a lesion of the parietal optic radiation:
Your Answer:
Correct Answer: Contralateral homonymous inferior quadrantanopia
Explanation:A lesion of the parietal optic radiation will result in a contralateral homonymous inferior quadrantanopia.A lesion of the temporal optic radiation will result in a contralateral homonymous superior quadrantanopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 29
Incorrect
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Which of the following muscles is NOT involved in depression of the mandible:
Your Answer:
Correct Answer: Masseter
Explanation:Depression of the mandible is generated by the digastric, geniohyoid, mylohyoid and lateral pterygoid muscles on both side, assisted by gravity. The lateral pterygoid muscles are also involved as this movement also involves protraction of the mandible. The masseter muscle is a powerful elevator of the mandible.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 30
Incorrect
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A 60-year-old female has a past medical history of diverticular disease. She now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, after administering this treatment, the patient develops a side-effect to the medication. What side-effect of using hyoscine butyl bromide is she MOST likely to develop out of the following?
Your Answer:
Correct Answer: Dry mouth
Explanation:Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.It has the following side-effects:1. Constipation2. Dizziness3. Drowsiness4. Dry mouth5. Dyspepsia6. Flushing7. Headache8. Nausea and vomiting9. Palpitations10. Skin reactions11. Tachycardia12. Urinary disorders13. Disorders of vision
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
