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Question 1
Incorrect
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Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer: Hypoxia
Correct Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 2
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 3
Correct
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Which of the following is an example of discrete data:
Your Answer: Number of children
Explanation:Discrete data is quantitative data that can only take whole numerical values e.g. number of children, number of days missed from work.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 4
Correct
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Which of the following is the correct sequential order of the phases of healing:
Your Answer: Haemostasis, inflammation, proliferation, remodelling
Explanation:Acute wound healing has four main stages: haemostasis, inflammation, proliferation and remodelling.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 5
Correct
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A patient is referred for lung function tests on account of a history of breathlessness and cough.Which statement about lung volumes is correct?
Your Answer: The tidal volume is the volume of air drawn in and out of the lungs during normal breathing
Explanation:The tidal volume(TV) is the amount of air that moves in and out of the lungs with each respiratory cycle. In a healthy male, the usual volume is 0.5 L (,7 ml/kg body mass).The vital capacity(VC) is the maximum amount of air that can be exhaled following maximal inspiration. The usual volume in a healthy male is 4.5 L.The residual volume(RV) is the amount of air remaining in the lungs after maximum expiration. The usual volume in a healthy male is 1.0 L.The inspiratory reserve volume(IRV) is the maximum amount of air that can be breathed in forcibly after normal inspiration. The usual volume in a healthy male is 3.0 L.The expiratory reserve volume(ERV) is the volume of air that can be breathed out forcibly after normal expiration. The usual volume in a healthy male is 1.0 L.Total lung capacity(TLC) is the volume of air the lungs can accommodate. TLC = RV+VC. The usual volume in a healthy male is 5.5 L.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 6
Correct
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A 43 year old lady suffering with idiopathic thrombocytopenic purpura has a splenectomy. She is advised to get the Pneumococcal vaccine booster every 5 - 10 years as Streptococcus pneumoniae has which of the following properties that make her prone to infection to this organism?
Your Answer: It is encapsulated
Explanation:There is a lifelong susceptibility to increased risk of infection from a variety of organisms in patients with hyposplenism, especially in children under 5 years and those with sickle cell anaemia. Patients are most susceptible is to the encapsulated bacteria Streptococcus pneumoniae, Haemophilus influenzae type B and Neisseria meningitidis. Streptococcus pneumoniae is particular concerning as it can cause rapid and fulminant disease, which can be fatal. Malaria and animal bites that become infected also tend to be more severe.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 7
Correct
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Regarding inhaled corticosteroids, which of the following statements is INCORRECT:
Your Answer: Lower doses of inhaled corticosteroids may be required in smokers.
Explanation:Current and previous smoking reduces the effectiveness of inhaled corticosteroids and higher doses may be necessary.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 8
Correct
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On which of the following is preload primarily dependent?
Your Answer: End-diastolic volume
Explanation:Preload refers to the initial stretching of the cardiac myocytes before contraction. It is therefore related to muscle sarcomere length. The sarcomere length cannot be determined in the intact heart, and so, other indices of preload are used, like ventricular end-diastolic volume or pressure. The end-diastolic pressure and volume of the ventricles increase when venous return to the heart is increased, and this stretches the sarcomeres, which increase their preload.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 9
Incorrect
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A 71-year-old man treated with antibiotics for a chest infection returns with a profuse, offensive smelling diarrhoea. A diagnosis of Clostridium difficile diarrhoea is made after investigations.The action most effective at minimizing spread to other patients is?
Your Answer: Isolation to a side room
Correct Answer: Hand washing
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.Alcohol hand gel is not effective against Clostridium Difficile spores. Hand washing with soap and water is very essential for healthcare workers who come in contact with it.Wearing an apron and gloves, and isolation to a side room are important contact precautions. They are, however, ineffective if hand washing is neglected.Although oral vancomycin is the first-line treatment for C. difficile associated diarrhoea, it will not limit patient to patient spread.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 10
Incorrect
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Needle thoracentesis in a patient with tension pneumothorax is performed at which anatomical landmark?
Your Answer: 3rd intercostal space mid-axillary line
Correct Answer: 4-5th intercostal space mid-axillary line
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.
Cadaver studies have shown improved success in reaching the thoracic cavity when the fourth or fifth intercostal space mid-axillary line is used instead of the second intercostal space mid-clavicular line in adult patients. ATLS now recommends this location for needle decompression in adult patients.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 11
Incorrect
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In the small intestine, there is a deep gap between each villus that leads to the crypt of Lieberkühn, a tubular intestinal gland.What is the primary function of these glands?
Your Answer: Production of an acidic intestinal juice
Correct Answer: Production of an alkaline intestinal juice
Explanation:In the small intestine, there is a deep gap between each villus that leads to the crypt of Lieberkühn, a tubular intestinal gland. These glands create an alkaline intestinal juice that is a mixture of water and mucus with a pH of 7.4-7.8. Intestinal juice is released in a volume of 1-2 litres per day in response to distention of the small intestine or the irritating effects of chyme on the intestinal mucosa.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 12
Incorrect
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About what percentage of filtered Na+is reabsorbed in the loop of Henle:
Your Answer: 30 - 40%
Correct Answer: 25%
Explanation:About 25% of filtered sodium is reabsorbed in the the loop of Henle.
Water-impermeable ascending loop of Henle plays a central role in maintaining salt-water balance by creating the cortico-medullary osmotic gradient to set up urinary concentrating ability and reabsorbing approximately 25% of the filtered NaCl load.
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This question is part of the following fields:
- Physiology
- Renal
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Question 13
Incorrect
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Renal potassium excretion is promoted by all but which one of the following:
Your Answer: Aldosterone
Correct Answer: Increased intracellular magnesium
Explanation:Aldosterone: A rise in [K+] in the extracellular fluid of the adrenal cortex directly stimulates aldosterone release. Aldosterone promotes the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane, and also stimulates apical sodium and potassium channel activity, overall acting to increase sodium reabsorption and potassium secretion.pH changes: Potassium secretion is reduced in acute acidosis and increased in acute alkalosis. A higher pH increases the apical K+channel activity and the basolateral Na+/K+ATPase activity – both changes that promote K+secretion.Flow rates: Increased flow rates in the collecting duct reduce K+concentration in the lumen and therefore enhance K+secretion. Increased flow also activates BK potassium channels, and ENaC channels which promote potassium secretion and sodium reabsorption respectively.Sodium delivery: Decreased Na+delivery to the collecting ducts results in less Na+reabsorption and hence a reduced gradient for K+secretion.Magnesium: Intracellular magnesium can bind and block K+channels inhibiting K+secretion into the tubules. Therefore magnesium deficiency reduces this inhibitory effect and so allows more potassium to be secreted into tubules and can cause hypokalaemia.
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This question is part of the following fields:
- Physiology
- Renal
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Question 14
Correct
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Regarding flow through a tube, which of the following statements is CORRECT:
Your Answer: Polycythaemia will decrease the rate of blood flow through a vessel.
Explanation:Darcy’s law states that flow through a tube is dependent on the pressure differences across the ends of the tube (P1 – P2) and the resistance to flow provided by the tube (R). Resistance is due to frictional forces and is determined by the length of the tube (L), the radius of the tube (r) and the viscosity of the fluid flowing down that tube (V). The radius of the tube has the largest effect on resistance and therefore flow – this explains why smaller gauge cannulas with larger diameters have a faster rate of flow. Increased viscosity, as seen in polycythemia, will slow the rate of blood flow through a vessel.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 15
Correct
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Which of the following is an example of a vaccine produced by recombinant DNA technology:
Your Answer: Hepatitis B
Explanation:Hepatitis B vaccines are prepared from the viral surface antigen. The recombinant vaccine is now the most widely used vaccine and induces a sufficient antibody response in 90% of individuals.Indications for hepatitis B vaccination include:All health care professional’s working in the UKOther professions with occupational risks (foster carers, staff of custodial institutions, morticians etc)Babies of mothers with hepatitis B during pregnancyClose family contacts of a case or carrierIV drug abusersIndividuals with haemophiliaIndividuals with chronic renal failureSex workers and individuals with frequently changing sexual partnersThe vaccine should be stored between 2 and 8 degrees C as freezing destroys its efficacy. The vaccine is administered intramuscularly, either into the deltoid region (preferred) or anterolateral thigh. The buttock should be avoided as it reduces the efficacy of the vaccine.The standard regime is to give 3 doses of the vaccine, the 1stand 2ndone month apart and the 2ndand 3rdsix months apart. Antibody titres should be tested 2 to 4 months after the primary course.A peak titre above 100 mIU/ml is regarded as a good response and implies long-term immunity. A peak titre between 10-100 mIU/ml is regarded as a low response and a peak titre of less than 10mIU/ml is regarded as a poor response.There is no substantiated association between hepatitis B vaccination and Guillain-Barre syndrome.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 16
Correct
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Question 17
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 18
Correct
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You examine an elderly man who is experiencing chest pain. He doesn't recall all of his medications, but he does know that he takes a diuretic.The enzyme carbonic anhydrase is inhibited by which of the following diuretics?
Your Answer: Acetazolamide
Explanation:Acetazolamide is a non-competitive, reversible inhibitor of carbonic anhydrase found in the cytosol of cells and on the brush border of the proximal convoluted tubule. Bicarbonate and hydrogen ions are converted to carbonic acid by carbonic anhydrase, which then converts carbonic acid to carbon dioxide and water. As a result, acetazolamide reduces the availability of hydrogen ions, causing sodium and bicarbonate ions to accumulate in the renal tubule, resulting in diuresis.The mechanism of action of the various types of diuretics is summarised below:1) Loop diuretics, e.g. furosemide, bumetanideAct on the Na.K.2Cl co-transporters in the ascending loop of Henlé to inhibit sodium, chloride and potassium reabsorption.2) Thiazide diuretics, e.g. Bendroflumethiazide, hydrochlorothiazideAct on the Na.Cl co-transporter in the distal convoluted tubule to inhibit sodium and chloride reabsorption.3) Osmotic diuretics, e.g. mannitolIncreases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect.4) Aldosterone antagonists, e.g. spironolactoneActs in the distal convoluted tubule as a competitive aldosterone antagonist resulting in inhibition of sodium reabsorption and increasing potassium reabsorption.5) Carbonic anhydrase inhibitors, e.g. acetazolamideInhibit the enzyme carbonic anhydrase preventing the conversion of bicarbonate and hydrogen ions into carbonic acid.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 19
Incorrect
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Question 20
Correct
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A 70-year-old patient diagnosed with Cushing's syndrome, has a history of weight gain, hypertension, and easy bruising.Which of the following statements about Cushing's syndrome is NOTÂ true?Â
Your Answer: Menorrhagia is a common feature
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids.Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome.Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep. The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.Insulin resistance causes hyperglycaemia, which is a frequent symptom. Insulin resistance can produce acanthosis nigricans in the axilla and around the neck, as well as other skin abnormalities.In contrast to menorrhagia, elevated testosterone levels are more likely to produce amenorrhoea or oligomenorrhoea. Infertility in women of reproductive age can also be caused by high androgen levels.A dexamethasone suppression test or a 24-hour urine free cortisol collection can both be used to establish the existence of Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 21
Incorrect
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A 40-year-old man has been admitted for alcohol detoxification. You are asked to review the patient's treatment chart and notice that he has been prescribed Pabrinex by one of your colleagues.Out of the following, which vitamin is not found in Pabrinex?
Your Answer: Vitamin C
Correct Answer: Vitamin B12
Explanation:Pabrinex is indicated in patients that require rapid therapy for severe depletion or malabsorption of water-soluble vitamins B and C, particularly in alcoholism detoxification. Pabrinex has the following: 1. Thiamine (vitamin B1) 2. Riboflavin (vitamin B2)3. Nicotinamide (Vitamin B3, niacin and nicotinic acid)4. Pyridoxine (vitamin B6)5. Ascorbic acid (vitamin C)6. GlucoseSuspected or established Wernicke’s encephalopathy is treated by intravenous infusion of Pabrinex/ The dose is 2-3 pairs three times a day for three to five days, followed by one pair once daily for an additional three to five days or for as long as improvement continues.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 22
Incorrect
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Regarding airway resistance, which of the following statements is INCORRECT:
Your Answer: Sympathetic stimulation and adrenaline cause bronchodilation mediated by beta2-adrenoceptors.
Correct Answer: In the lower respiratory tract, airway resistance is mostly determined by the smallest bronchioles.
Explanation:Airway resistance is primarily determined by the airway radius according to Poiseuille’s law, and whether the flow is laminar or turbulent. The major site of airway resistance is the medium-sized bronchi. The smallest airways would seem to offer the highest resistance, but they do not because of their branching parallel arrangement.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 23
Correct
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Innate, or non-specific, immunity is the immune system we are born with.Which of the following is NOT an example of innate immunity? Select ONE answer only.
Your Answer: T-lymphocytes
Explanation:Innate, or non-specific, immunity is the immune system we are born with.There are three aspects of innate immunity:1. Anatomical barriers, such as:The cough reflexEnzymes in tears and skin oilsMucus – which traps bacteria and small particlesSkinStomach acid2. Humoral barriers, such as:The complement systemInterleukin-13. Cellular barriers, such as:NeutrophilsMacrophagesDendritic cellsNatural killer cellsAntibody production is part of the specific, or inducible immune response. T-lymphocytesare responsible for the cell mediated immune response which is part of specific, or inducible immunity.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 24
Incorrect
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Which of the following clinical features is most suggestive of a lesion of the occipital lobe:
Your Answer: Conjugate eye deviation
Correct Answer: Homonymous hemianopia
Explanation:Homonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. It is caused by lesions of the retrochiasmal visual pathways, ie, lesions of the optic tract, the lateral geniculate nucleus, the optic radiations, and the cerebral visual (occipital) cortex
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 25
Correct
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A 32 year old woman presents with episodes of flushing, headaches and palpitations. On examination her blood pressure is significantly elevated. Which of the following is the most likely diagnosis:
Your Answer: Pheochromocytoma
Explanation:Phaeochromocytomas are catecholamine-secreting tumours which occur in about 0.1% of patients with hypertension. In about 90% of cases they arise from the adrenal medulla. The remaining 10%, which arise from extra-adrenal chromaffin tissue, are termed paragangliomas. Common presenting symptoms include one or more of headache, sweating, pallor and palpitations. Less commonly, patients describe anxiety, panic attacks and pyrexia. Hypertension, whether sustained or episodic, is present in at least 90% of patients. Left untreated phaeochromocytoma can occasionally lead to hypertensive crisis, encephalopathy, hyperglycaemia, pulmonary oedema, cardiac arrhythmias, or even death.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 26
Correct
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A 59-year-old man is complaining of pain in his perineal area, a recent onset of urinary frequency and urgency, fever, chills, and muscle aches. He has a long history of nocturia and terminal dribbling. On rectal examination you find an exquisitely tender prostate.Which of these antibacterial agents would be most appropriate in this case?
Your Answer: Ciprofloxacin for 14 days
Explanation:An acute focal or diffuse suppurative inflammation of the prostate gland is called acute bacterial prostatitis.According to the National Institute for Health and Care Excellence (NICE), acute prostatitis should be suspected in a man presenting with:A feverish illness of sudden onset which may be associated with rigors, arthralgia, or myalgia; Irritative urinary voiding symptoms; acute urinary retention; perineal or suprapubic pain and an exquisitely tender prostate on rectal examination.Treatment of acute prostatitis as recommended by NICE and the BNFare:Ciprofloxacin or ofloxacin for 14 daysAlternatively, trimethoprim can be used. Duration of treatment is still 14 days
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 27
Correct
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Which family of receptors does the glucagon receptor belong?
Your Answer: G-protein coupled receptors
Explanation:Glucagon binds to class B G-protein coupled receptors and activates adenylate cyclase, increasing cAMP intracellularly. This activates protein kinase A. Protein kinase A phosphorylates and activates important enzymes in target cells.
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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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A 69-year-old man presents with a painful groin swelling on the right side. The suspected diagnosis is an inguinal hernia.Which of the following examination features make it more likely to be an indirect inguinal hernia?
Your Answer: It can be controlled by pressure over the deep inguinal ring
Explanation:The reduced indirect inguinal hernia can be controlled by pressure over the internal ring; a direct inguinal hernia cannot.An indirect inguinal hernia can be reduced superiorly then superolaterally, while a direct inguinal hernia can be reduced superiorly then posteriorly.An indirect inguinal hernia takes time to reach full size, but a direct inguinal hernia appears immediately upon standing.Indirect inguinal hernias are seen as elliptical swelling, while direct inguinal hernias appear as symmetric, circular swelling.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 29
Incorrect
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Which of the following muscles is most responsible for thigh extension at the hip joint?
Your Answer: Hamstrings, gluteus medius and gluteus minimus
Correct Answer: Hamstrings and gluteus maximus
Explanation:For hip extension, the gluteus maximus and hamstring muscles work together. To compensate for gluteus maximus weakness, the hamstring frequently acts as the primary hip extensor.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Correct
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A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia. Which one of the following disorders is this patient most likely to have?
Your Answer: Paroxysmal nocturnal haemoglobinuria
Explanation:Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight. Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections. Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections. Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
