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Question 1
Correct
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Diabetic ketoacidosis is characterised by which of the following:
Your Answer: Hyperglycaemia, ketonaemia and acidosis
Explanation:DKA is characterised by the biochemical triad:1. Hyperglycaemia (> 11 mmol/L)2. Ketonaemia (> 3 mmol/L)3. Acidosis (pH < 7.3 +/- HCO3 < 15 mmol/L)
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 2
Incorrect
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Regarding renal clearance, which of the following statements is CORRECT:
Your Answer: Creatinine clearance is the gold standard for measurement of GFR.
Correct Answer: The MDRD equation uses plasma creatinine to estimate the GFR making an adjustment for age, sex and race.
Explanation:Clearance is defined as the volume of plasma that is cleared of a substance per unit time. Inulin clearance is the gold standard for measurement of GFR but creatinine clearance is typically used instead. Creatinine is freely filtered and not reabsorbed, but there is a little creatinine tubular secretion. In practice, GFR is usually estimated from the plasma creatinine using a formula e.g. the MDRD equation making an adjustment for age, sex and race.
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This question is part of the following fields:
- Physiology
- Renal
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Question 3
Incorrect
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Regarding the penis, which of the following statements is CORRECT:
Your Answer: Sensation to the penis is supplied by the genital branch of the genitofemoral nerve.
Correct Answer: The corpus spongiosum is ventral in the erect penis.
Explanation:Because the anatomical position of the penis is erect, the paired corpora cavernosa are defined as dorsal in the body of the penis and the single corpus spongiosum as ventral. The nerves and vessels lie superficial to the corpus cavernosum. The urethra lies within the corpus spongiosum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 4
Correct
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A patient presents to ED complaining of pins and needles over the lateral three and a half digits. You suspect carpal tunnel syndrome. Which of the following clinical features would you most expect to see on examination:
Your Answer: Inability to touch the pad of the little finger with the thumb
Explanation:Compression of the median nerve in the carpal tunnel will result in weakness and atrophy of the thenar muscles – resulting in weakness of opposition, abduction and flexion of the thumb at the metacarpophalangeal joint and anaesthesia or paraesthesia over the distribution of the palmar digital branch of the median nerve (skin over the palmar surface and fingertips of the lateral three and a half digits). The adductor pollicis muscle is innervated by the ulnar nerve, and abduction of the fingers is produced by the interossei, also innervated by the ulnar nerve. Flexion of the interphalangeal joint of the thumb is produced by the flexor pollicis longus, and flexion of the distal interphalangeal joint of the index finger is produced by the flexor digitorum profundus. Median nerve injury at the wrist will not affect the long flexors of the forearm as these are innervated by the anterior interosseous nerve which arises in the proximal forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Correct
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You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.
Your Answer: 25 mg
Explanation:Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:CorticosteroidPotency relative to hydrocortisonePrednisolone4 times more potentTriamcinolone5 times more potentMethylprednisolone5 times more potentDexamethasone25 times more potent
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 6
Correct
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A patient presents with a history of excessive thirst, urination and high fluid intake. His blood sugar is normal. You estimate his osmolarity as part of his work-up.Which of these equations can be used to estimate osmolarity?
Your Answer: 2 (Na + ) + 2 (K + ) + Glucose + Urea
Explanation:Osmolality and osmolarity are measurements of the solute concentration of a solution. Although the two terms are often used interchangeably, there are differences in the definitions, how they are calculated and the units of measurement used.Osmolarity, expressed as mmol/L, is an estimation of the osmolar concentration of plasma. It is proportional to the number of particles per litre of solution.Measured Na+, K+, urea and glucose concentrations are used to calculate the value indirectly.It is unreliable in pseudohyponatremia and hyperproteinaemia.The equations used to calculate osmolarity are:Osmolarity = 2 (Na+) + 2 (K+) + Glucose + Urea (all in mmol/L)OROsmolarity = 2 (Na+) + Glucose + Urea (all in mmol/L)Doubling of sodium accounts for the negative ions associated with sodium, and the exclusion of potassium approximately allows for the incomplete dissociation of sodium chloride.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 7
Incorrect
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The resting membrane potential of a neurone is usually about:
Your Answer: -55 mV
Correct Answer: -70 mV
Explanation:In most neurones the resting potential has a value of approximately -70 mV. The threshold potential is generally around -55 mV. Initial depolarisation occurs as a result of a Na+influx through ligand-gated Na+channels. Action potential is an all or nothing response; because the size of the action potential is constant, the intensity of the stimulus is coded by the frequency of firing of a neuron. Repolarisation occurs primarily due to K+efflux.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 8
Correct
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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 gastric ECL cells secrete which of the following substances?
Your Answer: Histamine
Explanation:Enterochromaffin-like cells (ECL cells) are a type of neuroendocrine cell located beneath the epithelium in the stomach glands. They’re most typically located near the parietal cells of the stomach. The ECL cells’ primary role is to produce histamine, which stimulates the formation of stomach acid by the parietal cells.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 9
Correct
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A 30-year-old woman was involved in a road traffic accident and had a class I haemorrhage.Which physiological parameter is consistent with a diagnosis of class I haemorrhage?
Your Answer: Increased pulse pressure
Explanation:There are 4 classes of haemorrhage. Classification is based on clinical signs and physiological parameters.In CLASS I:Blood loss (ml) is < or = 750Blood loss(% blood volume) < or = 15%Pulse rate (bpm) is 30Pulse pressure is normal or increasedSystolic BP is normalCNS/mental status patient is slightly anxious In CLASS II:Blood loss (ml) is 750 – 1500Blood loss(% blood volume) is 15 – 30%Pulse rate (bpm) is 100 – 120Respiratory rate is 20-30Urine output (ml/hr) is 20-30Pulse pressure is decreasedSystolic BP is normalCNS/mental status patient is mildly anxiousIn CLASS III:Blood loss (ml) is 1500 – 2000Blood loss(% blood volume) is 30- 40%Pulse rate (bpm) is 120 – 140Respiratory rate is 30-40Urine output (ml/hr) is 5-15Pulse pressure is decreasedSystolic BP is decreasedCNS/mental status patient is anxious, confusedIn CLASS IV:Blood loss (ml) is >2000Blood loss(% blood volume) is >40%Pulse rate (bpm) is >140Respiratory rate is >40Urine output (ml/hr) is negligiblePulse pressure is decreasedSystolic BP is decreasedCNS/mental status patient is confused, lethargic
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 10
Correct
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Which nerve innervates the brachioradialis muscle?
Your Answer: The radial nerve
Explanation:Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 11
Correct
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A 21 year old student presents to the emergency room with severe acute asthma. Salbutamol and ipratropium bromide nebuliser are prescribed. The most appropriate dose of salbutamol that should be prescribed initially for this patient is which of the following?
Your Answer: 5 mg every 15 - 30 minutes
Explanation:The first line treatment for acute asthma is high-dose inhaled short-acting beta2-agonists like salbutamol or terbutaline. Oxygen use should be reserved for hypoxemic patients in order to maintain oxygen saturations of 94 – 98%. In patients with moderate to severe asthma, a pressurised metered dose inhaler with spacer device is preferred (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). For patients with life-threatening features or poorly responsive severe asthma, the oxygen-driven nebuliser route is recommended (salbutamol 5 mg at 15 – 30 minute intervals). In patients with severe acute asthma that is poorly responsive to initial bolus dose, continuous nebulisation should be considered (salbutamol at 5 – 10 mg/hour). For those in whom inhaled therapy cannot be used reliably, the intravenous route is usually reserved.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 12
Incorrect
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A 24-year-old athlete drinks a 500 ml hypertonic sports drink before an endurance event he participates in.Which of the following effects will this cause?
Your Answer: No osmotic potential is generated between the interstitial fluid and cells
Correct Answer: The interstitial fluid becomes more concentrated
Explanation:Osmosis is the passive movement of water across a semipermeable membrane from a region of low solute concentration to a region of higher solute concentration.When hypertonic fluid is ingested:The plasma becomes CONCENTRATED. The cells lose water and shrinkThe intracellular fluid becomes more concentrated.Water and ions move freely from the plasma into the interstitial fluid and the interstitial fluid becomes more concentrated. The increased osmotic potential draws water out of the cells.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 13
Incorrect
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Which of the following statements about sickle cell disease is TRUE:
Your Answer: Aplastic crisis is classically precipitated by cytomegalovirus.
Correct 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 14
Correct
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Question 15
Incorrect
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Regarding the management of gout, which of the following statements is CORRECT:
Your Answer: Ibuprofen is the NSAID of choice in treating acute gout.
Correct Answer: Allopurinol may cause an acute attack of gout when first started.
Explanation:Allopurinol is a treatment for the prevention of gout. The initiation of treatment may precipitate an acute attack, and should be covered with an NSAID or colchicine, continued for at least one month after the hyperuricaemia has been corrected. Colchicine is not indicated for long term prevention of gout. NSAIDs are first line for acute gout; colchicine is an alternative in whom NSAIDs are contraindicated, not tolerated or ineffective (including in people taking anticoagulants). Ibuprofen is not recommended for acute gout, given it has only weak anti-inflammatory properties; naproxen, diclofenac or indometacin are indicated instead.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 16
Incorrect
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Regarding tapeworm, which of the following statements is CORRECT:
Your Answer: Tapeworm infection typically results in a severe iron-deficient anaemia.
Correct Answer: Diagnosis is by direct visualisation of characteristic eggs in the stool.
Explanation:Diagnosis of tapeworm is by direct visualisation of characteristic eggs in stool. Humans may be infected by pork or beef tapeworm. Treatment is with praziquantel or niclosamide. Specialist advice should be sought for the management of neurocysticercosis.Iron-deficiency anaemia is typically seen in hookworm infection. Threadworms migrate from the intestine at night to lay eggs on the perianal skin. Mebendazole is first line treatment for threadworms.
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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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Regarding a case-control study, which of the following statements is INCORRECT:
Your Answer: It is subject to recall bias.
Correct Answer: The usual outcome measure is the relative risk.
Explanation:A case-control study is a longitudinal, retrospective, observational study which investigates the relationship between a risk factor and one or more outcomes. This is done by selecting patients who already have a specific disease (cases), matching them to patients who do not (controls) and then collecting data from the patients to compare past exposure to a possible risk factor. The usual outcome measure is the odds ratio.
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 18
Correct
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Which of the following statements is true about percutaneous needle aspiration?
Your Answer: The needle should be inserted just above the upper border of the chosen rib
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 19
Incorrect
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You are reviewing a patient in the Emergency Department brought in by the ambulance team from a burning building. After examination, you decide to intubate the patient due to laryngeal oedema. The induction agent you are planning to use is propofol. Which one of the following statements about this medicine is TRUE?
Your Answer: It is thought to work by inhibiting GABA and glycine
Correct Answer: It decreases cardiac output by approximately 20%
Explanation:Propofol is a short-acting anaesthetic that is thought to work by potentiating GABA and glycine. It induces anterograde amnesia and anaesthetic effects and is used to induce anaesthesia, outpatient surgeries and preoperative sedation. The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.The main side effects of propofol are:Pain on injection (in up to 30%)HypotensionTransient apnoeaHyperventilationCoughing and hiccoughHeadacheThrombosis and phlebitis
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 20
Incorrect
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Which of the following ligaments supports the head of the talus?
Your Answer: Calcaneofibular ligament
Correct Answer: Spring ligament
Explanation:The spring-ligament complex is a significant medial arch stabilizer. The two important functions of this ligament include promoting the stability of the talonavicular joint by acting as a support for the talus head and by acting as a static support to maintain the medial longitudinal arch.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 21
Correct
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Dehydration causes a significant increase in the amount of this hormone?
Your Answer: Antidiuretic hormone
Explanation:Antidiuretic hormone induces the kidneys to release less water, resulting in reduced urine production. In the case of dehydration, ADH levels rise, resulting in a considerable decrease in urine output as well as an increase in plasma protein, blood Hct, and serum osmolality.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 22
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 23
Incorrect
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Which of the following globin chains makes up haemoglobin A2 (HbA2)?
Your Answer: Two beta and two gamma chains
Correct Answer: Two alpha chains and two delta chains
Explanation:Haemoglobin is a 64.4 kd tetramer consisting of two pairs of globin polypeptide chains: one pair of alpha-like chains, and one pair of non-alpha chains. The chains are designated by Greek letters, which are used to describe the particular haemoglobin (e.g., Hb A is alpha2/beta2).Two copies of the alpha-globin gene (HBA2, HBA1) are located on chromosome 16 along with the embryonic zeta genes (HBZ). There is no substitute for alpha globin in the formation of any of the normal haemoglobins (Hb) following birth (e.g., Hb A, Hb A2, and Hb F). Thus, absence any alpha globin, as seen when all 4 alpha-globin genes are inactive or deleted is incompatible with extrauterine life, except when extraordinary measures are taken. A homotetramer of only alpha-globin chains is not thought to occur, but in the absence of alpha chains, beta and gamma homotetramers (HbH and Bart’s haemoglobin, respectively) can be found, although they lack cooperativity and function poorly in oxygen transport. The single beta-globin gene (HBB) resides on chromosome 11, within a gene cluster consisting of an embryonic beta-like gene, the epsilon gene (HBE1), the duplicated and nearly identical fetal, or gamma globin genes (HBG2, HBG1), and the poorly expressed delta-globin gene (HBD). A heme group, consisting of a single molecule of protoporphyrin IX co-ordinately bound to a single ferrous (Fe2+) ion, is linked covalently at a specific site to each globin chain. If the iron is oxidized to the ferric state (Fe3+), the protein is called methaemoglobin.Alpha globin chains contain 141 amino acids (residues) while the beta-like chains contain 146 amino acids. Approximately 75 percent of haemoglobin is in the form of an alpha helix. The non helical stretches permit folding of the polypeptide upon itself. Individual residues can be assigned to one of eight helices (A-H) or to adjacent non helical stretches.Heme iron is linked covalently to a histidine at the eighth residue of the F helix (His F8), at residue 87 of the alpha chain and residue 92 of the beta chain. Residues that have charged side groups, such as lysine, arginine, and glutamic acid, lie on the surface of the molecule in contact with the surrounding water solvent. Exposure of the hydrophilic (charged) amino acids to the aqueous milieu is an important determinant of the solubility of haemoglobin within the red blood cell and of the prevention of precipitation.The haemoglobin tetramer is a globular molecule (5.0 x 5.4 x 6.4 nm) with a single axis of symmetry. The polypeptide chains are folded such that the four heme groups lie in clefts on the surface of the molecule equidistant from one another.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 24
Correct
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Captopril should not be used if you have any of the following conditions:
Your Answer: Renal artery stenosis
Explanation:Contraindications indications of Captopril include:- Bilateral renal artery stenosis- Hypersensitivity to ACE inhibitors- Anuria- History of ACEI-induced angioedema- Hereditary or idiopathic angioedema- Co-administration of Neprilysin inhibitors (e.g., sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan.If ACE inhibitors are used, they should be initiated only under specialist supervision and renal function should be monitored regularly. ACE inhibitors should also be used with particular caution in patients who may have undiagnosed and clinically silent renovascular disease. This includes patients with peripheral vascular disease or those with severe generalised atherosclerosis.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 25
Correct
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A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.Which of the following nerves may most likely be affected?
Your Answer: The suprascapular nerve
Explanation:The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 26
Correct
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What is the main mechanism of action of flecainide:
Your Answer: Blocks Na+ channels
Explanation:Flecainide inhibits the transmembrane influx of extracellular Na+ ions via fast channels on cardiac tissues resulting in a decrease in rate of depolarisation of the action potential, prolonging the PR and QRS intervals. At high concentrations, it exerts inhibitory effects on slow Ca2+ channels, accompanied by moderate negative inotropic effect.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 27
Correct
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A blood test of a 7-year-old child with a 6-day history of bloody diarrhoea reveals a low platelet count, anaemia, and impaired kidney function. What bacteria is suspected of causing such a condition?
Your Answer: Escherichia coli
Explanation:Escherichia coli produces shiga toxin that causes diarrhoea, hemorrhagic colitis, and haemolytic uremic syndrome. Haemolytic uremic syndrome is characterized by anaemia, thrombocytopenia, and acute renal failure. Transmission of E. coli is possible after consuming contaminated, undercooked drinks and foods. E. coli enters the body via the faecal-oral pathway.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 28
Correct
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A young farmer who is caught under farm machinery and suffering from a major crush injury is taken to the emergency department and requires a quick induction sequence. In this type of injury, which of the following anaesthetic medicines should be avoided?
Your Answer: Suxamethonium
Explanation:Suxamethonium is a neuromuscular blocker. It is contraindicated in patients who have experienced massive trauma, hyperkalemic, or burn injuries.
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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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When a child has chickenpox, how long should he or she be off from school?
Your Answer: Until all vesicles have crusted over
Explanation:To avoid the spread of infection, infected patients should be isolated. All lesions should be crusted over before children return to nursery or school, even if the standard exclusion time is 5 days.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 30
Incorrect
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A 24-year-old waiter cuts his hand on a dropped plate that smashed and damages the nerve that innervates opponens digiti minimi.The opponens digiti minimi muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer: The superficial branch of the ulnar nerve
Correct Answer: The deep branch of the ulnar nerve
Explanation:Opponens digiti minimi is a triangular-shaped muscle in the hand that forms part of the hypothenar eminence. It originates from the hook of the hamate bone and the flexor retinaculum and inserts into the medial border of the 5thmetacarpal.Opponens digiti minimi is innervated by the deep branch of the ulnar nerve and receives its blood supply from the ulnar artery.Opponens digiti minimi draws the fifth metacarpal bone anteriorly and rotates it, bringing the fifth digiti into opposition with the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY
