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Question 1
Correct
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A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:
Your Answer: Synchronised DC cardioversion
Explanation:All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 2
Incorrect
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Which of the following statements is true regarding the extensor pollicis longus?
Your Answer: It extends the thumb at the carpometacarpal joint
Correct Answer: It is innervated by the posterior interosseous nerve
Explanation:Extensor pollicis longus is part of the deep extensors of the forearm together with extensor pollicis brevis, abductor pollicis longus, extensor indicis and supinator muscles. It is located on the posterior aspect of forearm, extending from the middle third of the ulna, and adjacent interosseous membrane, to the distal phalanx of the thumb.Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).Extensor pollicis brevis receives its blood supply from the posterior interosseous artery and perforating branches of the anterior interosseous artery.The main action of extensor pollicis longus is extension of the thumb at the metacarpophalangeal and interphalangeal joints. Extension at the metacarpophalangeal joint occurs in synergy with extensor pollicis brevis muscle. When the thumb reaches the full extension or abduction, extensor pollicis longus can also assist in adduction of the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 3
Incorrect
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Common causes of exudates are infection, pericarditis, and malignancy.Which one statement about exudates is true?
Your Answer: The protein content is usually < 2.5 g/dL
Correct Answer: LDH levels are usually high
Explanation:An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.Exudates are cloudy. It has high LDH levels, serum protein ratio >0.5, protein content >2.9g/dl, specific gravity of >1.020 and a serum-ascites albumin gradient (SAAG) of <1.2g/dl.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 4
Correct
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A 68-year-old man has a very fast heartbeat' and is out of breath. He has had a heart transplant in the past. His electrocardiogram reveals supraventricular tachycardia.Which of the following is the most appropriate adenosine dose for him to receive as a first dose?
Your Answer: Adenosine 3 mg IV
Explanation:A rapid IV bolus of adenosine is given, followed by a saline flush. The standard adult dose is 6 mg, followed by 12 mg if necessary, and then another 12 mg bolus every 1-2 minutes until an effect is seen.Patients who have had a heart transplant, on the other hand, are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 5
Incorrect
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Funnel plots are typically used to display:
Your Answer: Correlation between two variables
Correct Answer: The existence of publication bias in meta-analysis
Explanation:Funnel plots are used to demonstrate the existence of publication bias in meta-analysis. Funnel plots are scatter plots of treatment effects estimated from individual studies on the x axis and some measure of study size on the y axis. Each point on the graph represents one of the studies. A symmetrical inverted funnel shape indicates an absence of publication bias. If there is publication bias, there will be asymmetry of the open wide end due to the absence of small negative results.
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 6
Correct
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Through which of the following anatomical structures does an indirect inguinal hernia pass?
Your Answer: External oblique
Explanation:Inguinal hernias are subdivided into direct and indirect.An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum.A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.The deep (internal) inguinal ring is located above and halfway between the pubic tubercle and the anterior superior iliac spine. This serves as the entrance to the inguinal canal. The superficial (external) inguinal ring lies immediately above and medial to the pubic tubercle. This triangular opening is a defect in the external oblique aponeurosis, and forms the exit of the inguinal canal.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 7
Incorrect
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A p value < 0.05 obtained from a study with a significance level (α) of 0.05, means all of the following, EXCEPT:
Your Answer: the result is statistically significant.
Correct Answer: the result is clinically significant.
Explanation:A p value < 0.05:is statistically significantmeans that the probability of obtaining a given result by chance is less than 1 in 20means the null hypothesis is rejectedmeans there is evidence of an association between a variable and an outcomeNote that this does not tell us whether the result is clinically significant.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 8
Correct
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What is the main mechanism of action of metoclopramide:
Your Answer: Dopamine antagonist
Explanation:Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 9
Correct
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A 2-day-old male is referred to a tertiary care hospital by the community midwife after a home visit due to jaundice and dyspnoea. After history and examination, the relevant blood work is performed, and the baby is found to have conjugated hyperbilirubinemia. The paediatric team suspects a hepatic origin for jaundice based on the findings. Which one of the following aetiologies is the most likely cause of jaundice in this case?
Your Answer: Alpha 1-antitrypsin deficiency
Explanation:The presence of dyspnoea makes alpha-1 antitrypsin deficiency the more likely diagnosis as biliary atresia does not cause respiratory symptoms. Deficiency of the enzyme alpha-1 antitrypsin causes uninhibited elastase activity and a decrease in elastic tissue. This causes liver cirrhosis leading to an elevation of conjugated bilirubin and emphysema in the lungs.Rhesus disease, hereditary spherocytosis and breast milk jaundice cause an elevation of unconjugated bilirubin thus ruling it out in this case. Breast milk jaundice occurs due to an inability of the newborn to metabolize the proteins in breast milk. Rhesus disease occurs when an Rh negative mother gives birth to an Rh positive baby. The jaundice would have been accompanied by anaemia and oedema. Hereditary spherocytosis occurs due to extravascular haemolysis as defective RBCs are removed by the spleen. The patient would present with jaundice, splenomegaly and possibly an aplastic crisis (if Parvovirus B19 infection).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 10
Incorrect
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.Which of these anatomic structures is the deepest structure injured in the case above?
Your Answer: Rectus abdominis muscle
Correct Answer: Transversalis fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:SkinFatty layer of the superficial fascia (Camper’s fascia)Membranous layer of the superficial fascia (Scarpa’s fascia)Aponeurosis of the external and internal oblique musclesRectus abdominis muscleAponeurosis of the internal oblique and transversus abdominisFascia transversalisExtraperitoneal fatParietal peritoneum
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 11
Correct
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Regarding the abductor pollicis longus, which of the following statements is true?
Your Answer: It extends the thumb at the carpometacarpal joint
Explanation:Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Incorrect
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Which of the following statements regarding forest plots is true? Select ONE answer only.Which of the following statements regarding forest plots is true? Select ONE answer only.
Your Answer: The length of the horizontal lines emerging from the squares represents the standard deviation
Correct Answer: Larger studies are associated with smaller horizontal lines
Explanation:Forest plots are graphical displays designed to illustrate the relative strength of treatment effects in multiple individual studies addressing the same question.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 13
Incorrect
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A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes. The lymph from the testes will drain to which of the following nodes?
Your Answer: Deep inguinal lymph nodes
Correct Answer: Para-aortic lymph nodes
Explanation:Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.The scrotum is the one which drains into the nearby superficial inguinal nodes.The glans penis and clitoris drains into the deep inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 14
Incorrect
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Which of the following statements is correct regarding the lymphatic system?
Your Answer: The lymphatic system empties into the thoracic duct, which in turn empties into the jugular vein.
Correct Answer: Lymphatic vessels contain both smooth muscle and unidirectional valves.
Explanation:Fluid filtration out of the capillaries is usually slightly greater than fluid absorption into the capillaries. About 8 L of fluid per day is filtered by the microcirculation and returns to the circulation by the lymphatic system. Lymphatic capillaries drain into collecting lymphatics, then into larger lymphatic vessels. Both of these containing smooth muscle and unidirectional valves. From this point, lymph is propelled by smooth muscle constriction and vessel compression by body movements into afferent lymphatics. It then goes to the lymph nodes where phagocytes remove bacteria and foreign materials. It is here that most fluid is reabsorbed by capillaries, and the remainder returns to the subclavian veins via efferent lymphatics and the thoracic duct. The lymphatic system has a major role to play in the body’s immune defence and also has a very important role in the absorption and transportation of fats.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 15
Correct
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After collapsing in his nursing home, a 70-year-old man is brought into the ER. He has diabetes mellitus and is on medication for it. An RBS of 2.0 mmol/L (3.9-5.5 mmol/L) is recorded in the ER. Out of the following, which medication for diabetes mellitus is LEAST likely responsible for his hypoglycaemic episode?
Your Answer: Metformin
Explanation:Metformin is a biguanide used as the first-line to treat type 2 diabetes mellitus. It has a good reputation as it has an extremely low risk of causing hypoglycaemia compared to the other agents for diabetes. It does not affect the insulin secreted by the pancreas or increase insulin levels. Toxicity with metformin can, however, cause lactic acidosis with associated hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 16
Correct
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Hepatitis A is transmitted by which of the following routes:
Your Answer: Faecal-oral route
Explanation:Hepatitis A transmission is by the faecal-oral route; the virus is excreted in bile and shed in the faeces of infected people.
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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 ventricular myocytes, the plateau phase of the action potential comes about through which of the following:
Your Answer: Closing of voltage-gated Na + channels
Correct Answer: Opening of voltage-gated Ca 2+ channels
Explanation:After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 18
Correct
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In the treatment of hypertensive episodes in pheochromocytoma, which of the following medication types is administered as first-line management:
Your Answer: Alpha-blockers
Explanation:The first line of management in controlling blood pressure and preventing intraoperative hypertensive crises is to use a combination of alpha and beta-adrenergic inhibition. In phaeochromocytoma, alpha-blockers are used to treat hypertensive episodes in the short term. Tachycardia can be managed by the careful addition of a beta-blocker, preferably a cardioselective beta-blocker, once alpha blockade has been established. Long term management of pheochromocytoma involves surgery.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 19
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: Gonorrhoea
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 20
Correct
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Clostridium difficile primarily causes which of the following infectious diseases:
Your Answer: Pseudomembranous colitis
Explanation:Clostridium difficile causes pseudomembranous colitis, an acute inflammatory diarrhoeal disease and an important cause of morbidity and mortality in hospitals. Gas gangrene is primarily caused by Clostridium perfringens. Tetanus is caused by Clostridium tetani. Toxic shock syndrome may be caused by Staphylococcus aureus or Streptococcus pyogenes. Necrotising fasciitis is most commonly caused by Streptococcus pyogenes but has a multitude of causes.
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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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Regarding forest plots, which of the following is the purpose of this graph?
Your Answer: To graphically display the relative strength of multiple studies attempting to answer the same question
Explanation:The results of meta-analysis are often displayed graphically in a forest plot. A properly constructed forest plot is the most effective way to graphically display the relative strength of multiple studies attempting to answer the same question. A typical meta-analysis consists of three main objectives that include estimation of effect sizes from individual studies and a pooled summary estimate with their confidence intervals (CIs), heterogeneity among the studies, and any publication bias. The forest plot illustrates the first two of these objectives. Forest plots visualize the effect measure and CI of individual studies, which provide the raw data for the meta-analysis, as well the pooled-effect measure and CI. The individual studies also can be grouped in the forest plot by some of their characteristics for ease of interpretation such as by study size or year of publication. When comparing the outcomes between an intervention and a control group, dichotomous outcome variables are expressed as ratios (i.e. odds ratios, ORs or risk ratios, RRs), while for continuous outcomes, a weighted mean difference is reported.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 22
Incorrect
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All of the following statements are considered true regarding likelihood ratios, except:
Your Answer: They apply to a piece of diagnostic information
Correct Answer: If less than one, indicates that the information increases the likelihood of the suspected diagnosis
Explanation:The Likelihood Ratio (LR) is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.The LR is used to assess how good a diagnostic test is and to help in selecting an appropriate diagnostic tests or sequence of tests. They have advantages over sensitivity and specificity because they are less likely to change with the prevalence of the disorder, they can be calculated for several levels of the symptom/sign or test, they can be used to combine the results of multiple diagnostic test and they can be used to calculate post-test probability for a target disorder.A LR greater than 1 produces a post-test probability which is higher than the pre-test probability. An LR less than 1 produces a post-test probability which is lower than the pre-test probability. When the pre-test probability lies between 30 and 70 per cent, test results with a very high LR (say, above 10) rule in disease. An LR below 1 produces a post-test probability les than the pre-test probability. A very low LR (say, below 0.1) virtually rules out the chance that the patient has the disease.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 23
Incorrect
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The following structures all lie anteriorly to the oesophagus EXCEPT for the:
Your Answer: Left main bronchus
Correct Answer: Thoracic duct
Explanation:Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 24
Incorrect
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The transport of oxygen from maternal to fetal circulation is made possible by fetal haemoglobin. Which of the statements about fetal haemoglobin (HbF) is also correct?
Your Answer: It has a higher affinity for oxygen than myoglobin
Correct Answer: The oxygen dissociation curve for foetal haemoglobin is shifted to the left of that of adult haemoglobin
Explanation:Fetal haemoglobin is the most common type of haemoglobin found in the foetus during pregnancy. It transports oxygen from the maternal circulation to the fetal circulation. It can easily bind to oxygen from the maternal circulation because it has a high affinity for oxygen. From 10 to 12 weeks of pregnancy to the first six months after birth, the erythroid precursor cells produce fetal haemoglobin. In comparison to adult haemoglobin, fetal haemoglobin has two alpha and two gamma subunits, whereas adult haemoglobin has two alpha and two beta subunits in its major form. And, unlike adult haemoglobin, the oxygen dissociation curve of fetal haemoglobin is left-shifted. Myoglobin is an oxygen storage molecule with a very high affinity for oxygen. Only when the partial pressure of oxygen is exceeded does it release oxygen.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 25
Correct
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A patient presents to your Emergency Department with a laceration on their buttocks requiring closure with sutures.What stage of wound healing is the first to reach completion?
Your Answer: Haemostasis
Explanation:The stages of wound healing are: haemostasis, inflammatory, proliferative and remodelling (maturation) phases in that order. The first stage in the healing process of a laceration is haemostasis. Haemostasis is the process of the wound being closed by clotting. The inflammatory phase occurs just after and up to 48 hours after injury– Blood vessels dilate to allow white blood cells, antibodies, growth factors, enzymes and nutrients to reach the wounded area leading to the characteristic signs of inflammation seen. Epithelialisation and angiogenesis are not phases of wound healing but occur during the proliferative phase. This ia after haemolysis and inflammation phases have occurred.The maturation phase is the final phase and occurs when the wound has closed. It involves remodelling of collagen from type III to type I. Apoptosis remove unwanted cells, cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases. This can continues for up to 1 year after injury.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 26
Incorrect
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Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that can cause a catheter-related urinary tract infection (UTI)?
Your Answer: Listeria monocytogenes
Correct Answer: Pseudomonas aeruginosa
Explanation:Listeria monocytogenes is a gram-positive bacteria that does not produce spores. Staphylococcus aureus is a gram-positive bacteria, while Candida albicans is a gram-positive yeast with a single bud. Among the choices, gram-negative bacteria include only Klebsiella pneumoniae and Pseudomonas aeruginosa. Pseudomonas aeruginosa is an oxidase-positive bacterium, while Klebsiella pneumoniae is an oxidase-negative bacterium. P. aeruginosa can cause urinary tract infections (UTIs) and is spread through poor hygiene or contaminated medical equipment or devices, such as catheters that haven’t been fully sterilized.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 27
Correct
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A 62-year-old woman presents with cold sensitivity, tiredness, and weight gain. A series of blood tests done shows a grossly elevated TSH level and a diagnosis of hypothyroidism is made.What is the commonest cause of hypothyroidism worldwide?
Your Answer: Iodine deficiency
Explanation:Hypothyroidism occurs when there is a deficiency of circulating thyroid hormones. It is commoner in women and is most frequently seen in the age over 60.Iodine deficiency is the commonest cause of hypothyroidism worldwide.In the UK and other developed countries, iodine deficiency is not a problem and autoimmune thyroiditis is the commonest cause.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 28
Correct
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Carbon dioxide is transported in the blood approximately:
Your Answer: 60% as bicarbonate ions, 30% as carbamino compounds and 10% dissolved in plasma.
Explanation:Carbon dioxide is transported in the blood from tissues to the lungs in three ways as bicarbonate ions (60%), as carbamino compounds with proteins (30%) or simply dissolved in plasma (10%).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 29
Incorrect
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An 82 year old man has fever, left sided abdominal and back pain and presents to the emergency room. Imaging reveals a large perinephric abscess. Which of the following most likely describes the fluid location:
Your Answer: Between the renal fascia and the paranephric fat
Correct Answer: Between the renal capsule and the renal fascia
Explanation:The perinephric fat is immediately external to the renal capsule and completely surrounds the kidney. The renal fascia surrounds the perinephric fat and the paranephric fat is external to the renal fascia. The location of a perinephric abscess is in the perinephric fat between the renal capsule and the renal fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 30
Correct
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In adults in the United Kingdom, which of the following pathogens is the most likely cause of viral infectious gastroenteritis:
Your Answer: Norovirus
Explanation:Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhoea in community settings. In the United Kingdom, norovirus has become the most common cause of gastroenteritis in adults and children since the introduction of rotavirus vaccination.
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This question is part of the following fields:
- Microbiology
- Pathogens
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SESSION STATS - PERFORMANCE PER SPECIALTY
