-
Question 1
Incorrect
-
The renal team is currently prescribing erythropoietin to a patient with chronic kidney disease.Which of the following statements about erythropoietin is correct?
Your Answer: It is only produced in the kidney
Correct Answer: It protects red blood cell progenitors from apoptosis
Explanation:Erythropoietin is a glycoprotein hormone that regulates the formation of red blood cells (red cell production). It is mostly produced by interstitial fibroblasts in the kidney, which are located near the PCT. It is also produced in the liver’s perisinusoidal cells, however this is more common during the foetal and perinatal periods.The kidneys produce and secrete erythropoietin in response to hypoxia. On red blood cells, erythropoietin has two main effects:- It encourages stem cells in the bone marrow to produce more red blood cells.- It protects red blood cell progenitors and precursors from apoptosis by targeting them in the bone marrow.As a result of the increased red cell mass, the oxygen-carrying capacity and oxygen delivery increase.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 2
Incorrect
-
Which type of collagen is initially laid down in early wound healing:
Your Answer: II
Correct Answer: III
Explanation:Fibroblasts migrate to the wound (about 2 – 5 days after wounding), proliferate and secrete extracellular matrix comprising mainly collagen (type III) and fibronectin to plug the gap.
-
This question is part of the following fields:
- Pathology
- Wound Healing
-
-
Question 3
Incorrect
-
Given a patient with dislocation of the patella, which muscle is the most important to address during rehabilitation to prevent recurrent dislocation?
Your Answer: Sartorius
Correct Answer: Vastus medialis
Explanation:Patellar dislocation is a disabling musculoskeletal disorder which predominantly affects younger people who are engaged in multidirectional physically active pursuits. Conservative (non-operative) treatment is the treatment of choice for FTPD (first time patellar dislocation). Quadriceps strengthening exercises are considered one of the principal management aims for people following FTPD. A United Kingdom (UK) survey of physiotherapy practice has shown that quadriceps strengthening and specific-vastus medialis obliquus (VMO) or distal vastus medialis (VM) muscle strengthening or recruitment exercises were two of the most frequently used interventions for this population. Specific VM exercises are favoured in some quarters based on the assumption that the VM has an important role in preventing excessive lateral patellar translation.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 4
Incorrect
-
External haemorrhoids may cause anal pain. When explaining to your patient why it does so, which of the following nerves will you point out as being affected?
Your Answer: Pelvic splanchnic nerve
Correct Answer: Pudendal nerve
Explanation:The pain associated with external haemorrhoids is carried by a branch of the pudendal nerve, specifically the somatic fibres (S2-S4). It innervates the external anal sphincter and most of the skin over the perineum.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 5
Correct
-
Which of the following vitamins is not paired correctly with its deficiency syndrome:
Your Answer: Vitamin B12 - Wernicke-Korsakoff syndrome
Explanation:Clinical Effects of vitamin deficiency include:Vitamin C – ScurvyThiamine (Vitamin B1) – Beriberi/Wernicke-Korsakoff syndromeVitamin B12 – Megaloblastic anaemia/Subacute combined degeneration of spinal cordFolate – Megaloblastic anaemiaVitamin D – Osteomalacia/RicketsVitamin K – Defective clottingVitamin A – Blindness
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 6
Incorrect
-
A 50-year-old man has recently been on antibiotics for a chest infection. He suffers from COPD and is currently on Seretide inhalers, salbutamol, and Phyllocontin continus. Since commencing the antibiotics, he has developed nausea, vomiting and abdominal pain.Which of the following antibiotics has he MOST LIKELY been on for his chest infection?
Your Answer: Co-amoxiclav
Correct Answer: Erythromycin
Explanation:Phyllocontin continues contains aminophylline, a bronchodilator used in the management of asthma and COPD.The index patient is exhibiting symptoms of theophylline toxicity. This may have been triggered by the antibiotic he took. Macrolide antibiotics, like erythromycin and quinolone antibiotics, like ciprofloxacin and levofloxacin, increases the plasma concentration of theophyllines and can lead to toxicity.Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin. Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 7
Correct
-
Which statement concerning aerosol transmission is true?
Your Answer: They can be spread via ventilation systems in hospitals
Explanation:Aerosols are airborne particles less than 5 µm in size containing infective organisms. They usually cause infection of both the upper and/or lower respiratory tract.The organisms can remain suspended in the air for long periods and also survive outside the body. They can be transmitted through the ventilation systems and can spread over great distances. Some examples of organisms transmitted by the aerosol route include: Varicella zoster virus, Mycobacterium tuberculosis and measles virus
-
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
-
-
Question 8
Correct
-
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.
-
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
-
-
Question 9
Incorrect
-
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 12 mg IV
Correct 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.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 10
Correct
-
A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how to deal with her symptoms. In the first instance, the pharmacist advises her to take an over-the-counter antacid. She buys an antacid that contains aluminium hydroxide, which relieves her symptoms but has a negative side effect.She's most likely to have developed which of the following side effects?
Your Answer: Constipation
Explanation:Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.
-
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
-
-
Question 11
Correct
-
From which of the following cell types are platelets derived?
Your Answer: Megakaryocytes
Explanation:Synthesis of platelets occurs in the bone marrow by fragmentation of megakaryocytes cytoplasm, derived from the common myeloid progenitor cell. The average time for differentiation of the human stem cell to the production of platelets is about 10 days. The major regulator of platelet formation is thrombopoietin and 95% of this is produced by the liver. Normal platelet count is 150 – 450 x 109/L and the normal lifespan of a platelet is about 10 days. Usually about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 12
Correct
-
A 66-year-old male is brought to your clinic by his wife with the complaint of increasing confusion and disorientation over the past three days, along with decreased urination. She reports that he has been complaining of increasing pain in his back and ribs over the past three months. On examination, the patient looks anaemic, is not oriented in time, place and person and has tenderness on palpation of the lumbar spine and the 10th, 11th and 12th ribs. Blood tests show anaemia which is normocytic, normochromic, raised urea and creatinine and hypercalcemia. Which one of the following diagnoses is most likely in this case?
Your Answer: Multiple myeloma
Explanation:Multiple myeloma is a clonal abnormality affecting plasma cells in which there is an overproduction of functionless immunoglobulins. The most common patient complaint is bone pain, especially in the back and ribs. Anaemia and renal failure are common, along with hypercalcemia. Hypercalcemia may lead to an altered mental status, as in this case. Chronic lymphocytic leukaemia occurs due to the overproduction of lymphocytes, usually B cells. CLL may present with an asymptomatic elevation of B cells. Patients are generally more than 50 years old and present with non-specific fatigue and weight loss symptoms.There is no history of alcohol abuse in this case. Furthermore, patients with a history of alcohol abuse may have signs of liver failure, which are not present here. Metastatic prostate cancer would most often cause lower backache as it metastasises first to the lumbar spine via the vertebral venous plexus. A patient with Vitamin B12 deficiency would have anaemia, megaloblastic, hypersegmented neutrophils, and signs of peripheral neuropathy.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 13
Correct
-
Which of the following risk ratios indicates no difference in risk between two groups:
Your Answer: 1
Explanation:A risk ratio of 1 indicates no difference in risk between groups.If the risk ratio of an event is > 1, the rate of that event is increased in the exposed group compared to the control group.If the risk ratio is < 1, the rate of that event is reduced in the exposed group compared to the control group.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 14
Incorrect
-
You undertake a medication review for a patient on the Clinical Decision Unit. Among the drugs he is currently taking is simvastatin.Which of the following side effects is he LEAST likely to have developed? Select ONE answer only.
Your Answer: Cerebral ischaemia
Correct Answer: Syncope
Explanation:Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.The following are common or very common side effects of nitratesArrhythmiasAstheniaCerebral ischaemiaDizzinessDrowsinessFlushingHeadacheHypotensionNausea and vomitingDiarrhoea, syncope and cyanosis can occur, but these are rare side effects. Dry eyes, bradycardia and metabolic acidosis have not been reported.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 15
Incorrect
-
A CT pulmonary angiography of a patient with a massive pulmonary embolus will most likely show which of the following signs?
Your Answer: Increased anatomical dead space
Correct Answer: Increased alveolar dead space
Explanation:A CT pulmonary angiogram is an angiogram of the blood vessels of the lungs. It is a diagnostic imaging test used to check for pulmonary embolism. A pulmonary embolism is caused by a blood clot or thrombus that has become lodged in an artery in the lung and blocks blood flow to the lung. A patient with pulmonary embolism may feel an abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia. Also, pulmonary embolism can result in alveolar dead space. Dead space represents the volume of ventilated air that does not participate in gas exchange. The alveolar dead space is caused by ventilation/perfusion imbalances in the alveoli. It is defined as the sum of the volumes of alveoli that are ventilated but not perfused. Aside from pulmonary embolism, smoking, bronchitis, emphysema, and asthma are among the other causes of alveolar dead space. The other types of dead space are the following: Anatomical dead space is the portion of the airways that conducts gas to the alveoli. This is usually around 150 mL, and there is no possibility of gas exchange in these areas. Physiological dead space is the sum of anatomical and alveolar dead spaces. Physiological dead space can account for up to 30% of the tidal volume.
-
This question is part of the following fields:
- Physiology
- Respiratory Physiology
-
-
Question 16
Incorrect
-
Which of the following nerves supplies the abductor pollicis brevis?
Your Answer: The radial nerve
Correct Answer: The recurrent branch of the median nerve
Explanation:Abductor pollicis brevis is innervated by the recurrent (thenar) branch of median nerve (root value C8 and T1).
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 17
Correct
-
A 44 year old woman is brought to ED having fallen down the stairs and injured her right arm. On examination she is unable to abduct her arm normally, and has weakness of lateral rotation. She has sensory loss over the lateral aspect of her upper arm. Which of the following injuries is most likely to produce this pattern of injury:
Your Answer: Surgical neck of humerus fracture
Explanation:Damage to the axillary nerve will result in loss of abduction past about 15 degrees and weakness of lateral rotation due to paralysis of the deltoid and teres minor and loss of sensation over the regimental badge area on the upper lateral arm. The axillary nerve is most likely injured in fracture of the surgical neck of the humerus due to its course where it winds around this region together with the posterior humeral circumflex vessels.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 18
Incorrect
-
A 45-year-old man had a painless superficial inguinal lymphadenopathy. It was later found to be malignant. Which of the following parts of the body is most likely the origin of this cancerous lymph node?
Your Answer: Testes
Correct Answer: Anal canal
Explanation:A cancer of the anal canal below the pectinate line would spread to the superficial inguinal lymph nodes. Anal cancer often spreads through lymphatic drainage to the internal iliac lymph nodes in lesions above the pectinate line and to the superficial inguinal lymph nodes in lesions below the pectinate line.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 19
Correct
-
Regarding an avulsion fracture, a sudden contraction of which muscle may lead to fracture of the head of the fibula?
Your Answer: Biceps femoris
Explanation:Avulsion fractures of the fibular head are rare and are so-called the arcuate signal. The “arcuate signal” is used to describe an avulsed bone fragment related to the insertion site of the tendon of the biceps femoris associated with the arcuate complex, which consists of the fabellofibular, popliteofibular, and arcuate ligaments. Such lesions are typically observed in direct trauma to the knee with excessive varus and internal rotation forces or indirect trauma with the same direction of the force.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 20
Incorrect
-
In the Kaplan-Meier plot, which of the following labels should be applied to the X-axis?
Your Answer: Number of study participants
Correct Answer: Time in years
Explanation:Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death, is called as survival time and the analysis of group data as survival analysis. The graph plotted between estimated survival probabilities/estimated survival percentages (on Y axis) and time past after entry into the study (on X axis) consists of horizontal and vertical lines.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 21
Correct
-
Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.Which of the following drugs is most likely to have caused her symptoms?
Your Answer: Ramipril
Explanation:Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.Other medications that are less frequently linked to angioedema include:Angiotensin-receptor blockers (ARBs)Nonsteroidal anti-inflammatory drugs (NSAIDs)Bupropion (e.g. Zyban and Wellbutrin)Beta-lactam antibioticsStatinsProton pump inhibitorsThe majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 22
Correct
-
Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: ALL is the most common malignancy of childhood.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 23
Incorrect
-
Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:
Your Answer: Give 300 mg IV amiodarone after 3 shocks, and then every 3 - 5 minutes thereafter
Correct Answer: Give 300 mg IV amiodarone after 3 shocks
Explanation:After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 24
Correct
-
Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely caused by which of the following:
Your Answer: Diabetes mellitus
Explanation:Compressive causes of CN III palsy cause early pupillary dilatation because the parasympathetic fibres run peripherally in the nerve and are easily compressed. In diabetes mellitus the lesions are ischaemic rather than compressive and therefore typically affect the central fibres resulting in pupillary sparing.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 25
Incorrect
-
A trauma victim who has been intubated is tachycardic, hypotensive, and has a poor urine output. You feel she is dehydrated and decide to use a central venous catheter to help you manage her. As part of this, you keep an eye on the waveform of central venous pressure (CVP).Which of the following cardiac cycle phases corresponds to the CVP waveform's 'a wave'?
Your Answer: Late systole
Correct Answer: End diastole
Explanation:The pressure measured in the right atrium or superior vena cava is known as central venous pressure (CVP). In a spontaneously breathing subject, the usual CVP value is 0-8 cmH2O (0-6 mmHg).The structure of the CVP waveform is as follows:The CVP’s components are listed in the table below:Component of the waveformThe cardiac cycle phase.mechanical eventmechanical event Diastole Atrial contractiona wave C wave v waveEarly systoleThe tricuspid valve closes and bulges Late Systole Filling of the atrium with systolic blood x descenty descentMid systoleRelaxation of the atrium Early diastoleFilling of the ventricles at an early stage
-
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
-
-
Question 26
Correct
-
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.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 27
Correct
-
In which part of the gastrointestinal tract is Meckel's diverticulum commonly located?
Your Answer: Ileum
Explanation:Meckel’s diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the general population. Meckel’s diverticulum are designated true diverticula because their walls contain all the layers found in normal small intestine. Their location varies among individual patients, but they are usually found in the ileum within 100 cm of the ileocecal valve.Approximately 60% of Meckel’s diverticulum contain heterotopic mucosa, of which over 60% consist of gastric mucosa. Pancreatic acini are the next most common; others include Brunner’s glands, pancreatic islets, colonic mucosa, endometriosis, and hepatobiliary tissues.A useful, although crude, mnemonic describing Meckel’s diverticulum is the “rule of twos”: 2% prevalence, 2:1 male predominance, location 2 feet proximal to the ileocecal valve in adults, and half of those who are symptomatic are under 2 years of age.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 28
Correct
-
The functional residual capacity (FRC) will be increased in which of the following:
Your Answer: Emphysema
Explanation:Factors increasing FRC:EmphysemaAir trapping in asthmaAgeing (due to loss of elastic properties)Increasing height of patient
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 29
Incorrect
-
Excessive gastric acid output is detected in a patient with a history of recurrent stomach ulcers. It's possible that the patient has Zollinger-Ellison syndrome.Which of the following statements about stomach acid is correct?
Your Answer: It is secreted by chief cells
Correct Answer: The proton pump located in the canalicular membrane is vital to its secretion
Explanation:The stomach produces gastric acid, which is a digesting fluid. The stomach secretes about 2-3 litres every day. It is involved in tissue breakdown, the conversion of pepsinogen to active pepsin, and the creation of soluble salts with calcium and iron, and has a pH range of 1.5-3.5. It also serves as an immune system by destroying microbes.The following substances are found in gastric acid:WaterAcid hydrochloridePepsinogenmucous Intrinsic factorThe parietal cells in the proximal 2/3 (body) of the stomach release gastric acid. The concentration of hydrogen ions in parietal cell secretions is 1-2 million times that of blood. Chloride is released against both a concentration and an electric gradient, and active transport is required for the parietal cell to produce acid.The following is how stomach acid is secreted:1. Gastric acid secretion is dependent on the H+/K+ ATPase (proton pump) situated in the canalicular membrane. The breakdown of water produces hydrogen ions within the parietal cell. The hydroxyl ions produced in this reaction mix quickly with carbon dioxide to generate bicarbonate ions. Carbonic anhydrase is the enzyme that catalyses this process.2. In return for chloride, bicarbonate is carried out of the basolateral membrane. The ‘alkaline tide’ occurs when bicarbonate is released into the bloodstream, resulting in a modest rise in blood pH. The parietal cell’s intracellular pH is maintained by this procedure. Conductance channels carry chloride and potassium ions into the lumen of canaliculi.3. Through the action of the proton pump, hydrogen ions are pushed out of the cell and into the lumen in exchange for potassium; potassium is thus efficiently recycled.4. The canaliculi accumulate osmotically active hydrogen ions, which creates an osmotic gradient across the membrane, allowing water to diffuse outward.
-
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
-
-
Question 30
Correct
-
In the treatment of bradyarrhythmias with adverse characteristics or risk of asystole, what is the initial suggested dose of atropine?
Your Answer: 500 micrograms
Explanation:Atropine 500 mcg IV bolus should be administered if there are any adverse features or risk of asystole. If the reaction is not adequate, repeat the steps every 3 to 5 minutes up to a maximum dose of 3 mg. In the case of acute myocardial ischemia or myocardial infarction, atropine should be taken with caution since the increased heart rate may aggravate the ischemia or increase the size of the infarct.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 31
Incorrect
-
You examine a 78-year-old man who has been diagnosed with chronic lymphocytic leukaemia (CLL).What is the MAIN contributory factor in this condition's immunodeficiency?
Your Answer: Neutropenia
Correct Answer: Hypogammaglobulinemia
Explanation:Immunodeficiency is present in all patients with chronic lymphocytic leukaemia (CLL), though it is often mild and not clinically significant. Infections are the leading cause of death in 25-50 percent of CLL patients, with respiratory tract, skin, and urinary tract infections being the most common.Hypogammaglobulinemia is the most common cause of immunodeficiency in CLL patients, accounting for about 85 percent of all cases.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 32
Incorrect
-
A 10-year-old girl presents with polyuria, polydipsia, and stomach pain. She has a history of type I diabetes mellitus. On blood gas analysis, she has metabolic acidosis. Diabetic ketoacidosis (DKA) is diagnosed, and therapy is initiated. She becomes increasingly confused when intravenous fluids and insulin are administered.Which electrolyte imbalance is the MOST likely reason of the increased confusion
Your Answer: Hypoglycaemia
Correct Answer: Hyponatraemia
Explanation:Because of the shift of water from the intracellular to the extracellular compartment as a result of hyperglycaemia and increased plasma osmolality, dilutional hyponatraemia is common in diabetic ketoacidosis (DKA).If intravenous fluids are not delivered with caution, hyponatraemia might worsen, which can lead to increased degrees of disorientation. Hyponatraemia has also been linked to an increased risk of cerebral oedema, especially if blood glucose levels drop too quickly following treatment.Headache, recurrence of vomiting, irritability, Glasgow Coma Scale score, inappropriate heart rate slowing, and rising blood pressure are the most common causes of death in paediatric DKA, and children should be monitored for the symptoms mentioned above. To prevent this from developing, s low osmolarity normalization, attention to glucose and salt levels, as well as hydration over 48 hours, is necessary.
-
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
-
-
Question 33
Correct
-
Which of the following statements is correct regarding homeostasis?
Your Answer: In negative feedback mechanisms, effectors always act to move the variable in the opposite direction to the change that was originally detected.
Explanation:The vast majority of systems within the body work by negative feedback mechanisms. This negative feedback refers to the way that effectors act to move the variable in the opposite direction to the change that was originally detected. Because there is an inherent time delay between detecting a change in a variable and effecting a response, the negative feedback mechanisms cause oscillations in the variable they control. There is a narrow range of values within which a normal physiological function occurs and this is called the ‘set point’. The release of oxytocin in childbirth is an example of positive feedback.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 34
Correct
-
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.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 35
Incorrect
-
A 39-year-old woman's son with meningococcal meningitis was recently admitted to the Paediatric Intensive Care Unit. She is currently 22 weeks pregnant and is concerned about the possibility of her also contracting the disease as she cared closely for her son during his admission. Which antibiotic would be the MOST appropriate choice for chemoprophylaxis in this case?
Your Answer: Ceftriaxone
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin is recommended for use as meningococcal chemoprophylaxis in all age groups and in pregnancy, and is the most appropriate for this patient.However, rifampicin is the drug of choice for meningococcal chemoprophylaxis because it is licensed for chemoprophylaxis, but multiple doses are necessary and it is not readily available in community pharmacies. It also interacts with oral contraceptives.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 36
Correct
-
Which of the following is diagnostic for acute hepatitis B infection:
Your Answer: anti-HBc IgM
Explanation:Anti-HBc IgM antibodies are diagnostic for acute hepatitis B infection. Anti-HBc IgG antibodies indicate previous exposure, either chronic state or cleared infection. HBsAg is also positive in acute infection but is not diagnostic as this remains positive in chronic infection.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 37
Incorrect
-
Stimulation of J receptors located on alveolar and bronchial walls results in all of the following EXCEPT for:
Your Answer: Hypotension
Correct Answer: Tachycardia
Explanation:Juxtapulmonary or ‘J’ receptors are located on alveolar and bronchial walls close to the capillaries. Their afferents are small unmyelinated C-fibres or myelinated nerves in the vagus nerve. Activation causes depression of somatic and visceral activity by producing apnoea or rapid shallow breathing, a fall in heart rate and blood pressure, laryngeal constriction and relaxation of skeletal muscles via spinal neurones. J receptors are stimulated by increased alveolar wall fluid, pulmonary congestion and oedema, microembolism and inflammatory mediators. J receptors are thought to be involved in the sensation of dyspnoea in lung disease.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 38
Correct
-
Insulin is a very important peptide hormone produced by the islets of Langerhans in the pancreas.Insulin is synthesised by which of the following cell types within the islets of Langerhans? Select ONE answer only.
Your Answer: Beta cells
Explanation:Insulin is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas. Insulin is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds. Proinsulin is synthesised as a single-chain peptide. Within storage granules, a connecting peptide (C peptide) is removed by proteases to yield insulin. Insulin release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin, but most output is driven by the rise in plasma glucose concentration that occurs after a meal. The effects of insulin are mediated by the receptor tyrosine kinase.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 39
Correct
-
A 23-year-old has a known diagnosis of HIV. Blood is sent to the laboratory for tests.AIDS be diagnosed at a CD4 counts below?
Your Answer: 200 cells/mm 3
Explanation:A normal CD4 count ranges from 500-1000 cells/mm3.At CD4 count of less than 350 cells/mm3 treatment with anti-retroviral therapy should be considered.At a CD4 count of >200 cells/mm3 AIDS is diagnosed.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 40
Incorrect
-
Regarding the flexor digitorum profundus muscle, which of the following is true?
Your Answer: The entire muscle is innervated by the median nerve
Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve
Explanation:Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.Flexor digitorum profundus has a dual innervation:(1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);(2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 41
Correct
-
An unrelated medical condition brings a 28-year-old asthmatic man to the Emergency Department. When you look over his meds, you notice that he is taking Theophylline to help with his asthma.Which of the following medicines should you NOT prescribe?
Your Answer: Ciprofloxacin
Explanation:Ciprofloxacin is a cytochrome P450 enzyme inhibitor that raises theophylline levels in the blood. As a result, co-prescribing theophylline should be avoided.The medicines that typically impact theophylline’s half-life and plasma concentration are listed in the table below:Drugs that increase the levels of theophylline in the bloodDrugs that lower theophylline levels in the bloodCalcium channel blockers e.g. VerapamilFluconazoleCimetidineQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitalMacrolides, e.g. erythromycinPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 42
Correct
-
Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:
Your Answer: Local aminosalicylate
Explanation:Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 43
Incorrect
-
Regarding flucloxacillin, which of the following statements is CORRECT:
Your Answer: It is used first line for empirical treatment of infective endocarditis.
Correct Answer: It is resistant to bacterial beta-lactamases.
Explanation:Flucloxacillin is unique in that it is beta-lactamase stable and it can be used in infections caused by beta-lactamase producing staphylococci e.g. S. aureus. It is acid-stable and can therefore be given by mouth as well as by injection. It is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. The most common adverse effects of flucloxacillin include nausea, vomiting, skin rash, and diarrhoea. Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. First line treatment of animal and human bites is co-amoxiclav.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 44
Incorrect
-
A diagnosis of acute osteomyelitis was made on a patient with a known history of sickle cell disease. He has no joint prosthesis on in-dwelling metal work and no known drug allergies.Which of the following is most likely the causative agent of the case presented above?
Your Answer: Staphylococcus aureus
Correct Answer: Salmonella spp .
Explanation:Patients with sickle cell disease are prone to infection of the bone and bone marrow in areas of infarction and necrosis. Although Staphylococcus aureus is the most common cause of osteomyelitis in the general population, studies have shown that in patients with sickle cell disease, the relative incidence of Salmonella osteomyelitis is twice that of staphylococcal infection.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 45
Correct
-
Which of the following is NOT a typical clinical feature of diabetic ketoacidosis:
Your Answer: Cheyne–Stokes respiration
Explanation:Clinical features of DKA: Symptoms: Polyuria, polydipsia, thirst, lethargy, weight loss, nausea, vomiting, anorexia, abdominal pain, dehydration, headache, altered mental stateSigns: Dry mucous membranes, ketotic breath, tachycardia, hypotension, Kussmaul breathing, focal signs of precipitant e.g. infection
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 46
Correct
-
A 29-year-old man has been complaining about his recent headaches. Detailed history was taken and a neurological examination was performed.Which of the following cranial nerves is correctly paired with its lesion?
Your Answer: The oculomotor nerve: the eye appears to look ‘down and out’
Explanation:The following are the lesions of the cranial nerves:1. Olfactory nerve (I)Reduced taste and smell, but not to ammonia which stimulates the pain fibres carried in the trigeminal nerve2. Optic nerve (II)Manifested by visual field defects, pupillary abnormalities, optic neuritis, optic atrophy, papilledema3. Oculomotor nerve (III)A fixed, dilated pupil which doesn’t accommodate, ptosis, complete internal ophthalmoplegia (masked by ptosis), unopposed lateral rectus causes outward deviation of the eye. If the ocular sympathetic fibres are also affected behind the orbit, the pupil will be fixed but not dilated.4. Trochlear nerve (IV)Diplopia due to weakness of downward and inward eye movement. The most common cause of a pure vertical diplopia. The patient tends to compensate by tilting the head away from the affected side.5. Trigeminal nerve (V)Reduced sensation or dysesthesia over the affected area. Weakness of jaw clenching and side-to-side movement. If there is a lower motor neuron (LMN) lesion, the jaw deviates to the weak side when the mouth is opened. There may be fasciculation of temporalis and masseter.6. Abducens nerve (VI)Inability to look laterally. The eye is deviated medially because of unopposed action of the medial rectus muscle.7. Facial nerve (VII)Facial weakness. In an LMN lesion the forehead is paralysed – the final common pathway to the muscles is destroyed; whereas the upper facial muscles are partially spared in an upper motor neurone (UMN) lesion because of alternative pathways in the brainstem. There appear to be different pathways for voluntary and emotional movement. CVAs usually weaken voluntary movement, often sparing involuntary movements (e.g., spontaneous smiling). The much rarer selective loss of emotional movement is called mimic paralysis and is usually due to a frontal or thalamic lesion.8. Vestibulocochlear nerve (VIII)Unilateral sensorineural deafness, tinnitus. Slow-growing lesions seldom present with vestibular symptoms as compensation has time to occur.9. Glossopharyngeal nerve (IX)Unilateral lesions do not cause any deficit because of bilateral corticobulbar connections. Bilateral lesions result in pseudobulbar palsy. These nerves are closely interlinked.10. Vagus nerve (X)Palatal weakness can cause ‘nasal speech’ and nasal regurgitation of food. The palate moves asymmetrically when the patient says ‘ahh’. Recurrent nerve palsy results in hoarseness, loss of volume and ‘bovine cough’.11. Accessory nerve (XI)Weakness and wasting of sternocleidomastoid and trapezius muscles12.Hypoglossal nerve (XII)An LMN lesion produces wasting of the ipsilateral side of the tongue, with fasciculation; and on attempted protrusion the tongue deviates towards the affected side, but the tongue deviates away from the side of a central lesion.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 47
Correct
-
Regarding aspirin at analgesic doses, which of the following statements is CORRECT:
Your Answer: It is contraindicated in patients with severe heart failure.
Explanation:Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 48
Correct
-
Which of the following statements about neutrophils is TRUE:
Your Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.
Explanation:Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 49
Correct
-
A 32-year-old woman diagnosed with hyperthyroidism has her T 4 levels grossly elevated and she is started on carbimazole.A release of which of the following from the hypothalamus is inhibited by increase in T4 levels?
Your Answer: Thyrotropin-releasing hormone
Explanation:A negative feedback mechanism involving the hypothalamic-pituitary-thyroid axis controls the release of T3 and T4 into the bloodstream. When metabolic rate is low or serum T3 and/or T4 levels are decrease, this triggers the secretion of thyrotropin-releasing hormone (TRH) from the hypothalamus.TRH goes to the anterior pituitary gland and stimulates secretion of thyroid-stimulating hormone (TSH). An increased serum level of T3 and T4 inhibits the release of TRH.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 50
Correct
-
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: 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.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 51
Correct
-
During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:L– lateral two lumbricalsO– Opponens pollicisA– Abductor pollicisF– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 52
Incorrect
-
Platelet alpha granules release which of the following?
Your Answer: Thromboxane A2
Correct Answer: Von Willebrand factor (VWF)
Explanation:There are three types of storage granules contained in platelets. These are dense granules which contain the following:-ATP -ADP -serotonin and calcium alpha granules containing clotting factors-von Willebrand factor (VWF)-platelet-derived growth factor (PDGF)- other proteins lysosomes containing hydrolytic enzymes.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 53
Correct
-
A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered. Out of the following, which parameter is MOST likely to change due to initiating insulin?
Your Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia. Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity. It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia.
-
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
-
-
Question 54
Incorrect
-
Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:
Your Answer: Boyle's law
Correct Answer: Dalton's law
Explanation:Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 55
Incorrect
-
You're a member of the cardiac arrest team, and you're helping to resuscitate an elderly gentleman who had collapsed at home. The team leader requests that you administer an adrenaline shot.Which of the following statements about adrenaline is FALSE?
Your Answer: It has approximately equal activity at both alpha- and beta receptors
Correct Answer: The IM dose in anaphylaxis is 1 ml of 1:1000
Explanation:Adrenaline (epinephrine) is a sympathomimetic amine that binds to alpha- and beta-adrenergic receptors and acts as an agonist. It is active at both alpha and beta receptors in roughly equal amounts.When taken orally, it becomes inactive. Subcutaneous absorption is slower than intramuscular absorption. In cardiac arrest, it is well absorbed from the tracheal mucosa and can be given through an endotracheal tube.At the adrenergic synapse, catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) metabolise it primarily. The inactive products are then passed through the kidneys and excreted in the urine.In adult cardiac arrest, the IV dose is 1 mg, which is equal to 10 ml of 1:10000 or 1 ml of 1:1000. In anaphylaxis, the IM dose is 0.5 ml of 1:1000. (500 mcg).In open-angle glaucoma, adrenaline causes mydriasis and lowers pressure.Adrenaline is used in cardiopulmonary resuscitation, the treatment of severe croup, and the emergency management of acute allergic and anaphylactic reactions (as a nebuliser solution).
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 56
Correct
-
Regarding antiemetics, which of the following statements is INCORRECT:
Your Answer: Of the antiemetics, cyclizine is most commonly associated with acute dystonic reactions.
Explanation:Cyclizine acts by inhibiting histamine pathways and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. Metoclopramide is a dopamine-receptor antagonist which acts both peripherally in the GI tract and centrally within the chemoreceptor trigger zone. Prochlorperazine is a dopamine-D2 receptor antagonist and acts centrally by blocking the chemoreceptor trigger zone. Metoclopramide and prochlorperazine are both commonly associated with extrapyramidal effects, such as acute dystonic reaction. Cyclizine may rarely cause extrapyramidal effects.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 57
Correct
-
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.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 58
Correct
-
One of the benefits of wound healing through first intention is:
Your Answer: Minimisation of scar tissue formation
Explanation:Primary wound healing, or healing by first intention, occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents. Healing by first intention can occur when the wound edges are opposed, the wound is clean and uninfected and there is minimal loss of cells and tissue i.e. surgical incision wound. The wound margins are joined by fibrin deposition, which is subsequently replaced by collagen and covered by epidermal growth.
-
This question is part of the following fields:
- Pathology
- Wound Healing
-
-
Question 59
Correct
-
A 47-year old male comes to the out-patient department for a painful, right-sided groin mass. Medical history reveals a previous appendectomy 10 years prior. On physical examination, the mass can be reduced superiorly. Also, the mass extends to the scrotum. The initial diagnosis is a hernia.Among the types of hernia, which is the most likely diagnosis of the case above?
Your Answer: Indirect inguinal hernia
Explanation:Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.Groin hernias are categorized into 2 main categories: inguinal and femoral.Inguinal hernias are further 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, and can be reduced superiorly then superolaterally. 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.A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 60
Incorrect
-
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.
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 61
Correct
-
Which of the following statements is correct with regards to immunoglobulin?
Your Answer: The isotype of immunoglobulin is determined by the heavy chain.
Explanation:The composition of immunoglobulin molecules is two identical heavy and two identical light chains. These chains are linked by disulphide bridges and are each have highly variable regions which give the immunoglobulin its specificity. In addition, they have constant regions and there is virtual complete correspondence in amino acid sequence in all antibodies of a given isotype. Five isotypes of immunoglobulin exist – these are IgG, IgA, IgM, IgE and IgD. They are determined by the heavy chain (gamma, alpha, mu, epsilon or delta respectively). The light chains are either kappa or lambda.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 62
Incorrect
-
The last two segments of the nephrons are the distal convoluted tubule (DCT) and collecting duct (CD).Which cell reabsorbs sodium more in the late DCT and CD?
Your Answer: Subsidiary cells
Correct Answer: Principal cells
Explanation:The main Na+ reabsorbing cells in the late distal convoluted tubule and collecting duct are the principal cells. These make up the majority of the tubular cells. The exchange is driven by the Na.K.ATPase pumps on the basolateral membrane.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 63
Correct
-
The interquartile range (IQ) is often displayed using which of the following:
Your Answer: Box and whisker plot
Explanation:A boxplot is a vertical or horizontal rectangle used to display the interquartile range, with the ends of the rectangle corresponding to the upper and lower quartiles of the data values. The box contains 50% of the data values. A line drawn through the rectangle corresponds to the median value. Whiskers, starting at the ends of the rectangle usually indicate the minimum and maximum values, therefore the entire box and whisker plot represents the range. Any outliers can be plotted independent of the box and whisker plot.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 64
Incorrect
-
The most important nerve for plantar flexion of the foot at the ankle joint is:
Your Answer: Superficial fibular nerve
Correct Answer: Tibial nerve
Explanation:Muscles of the posterior compartment of the leg, innervated by the tibial nerve, perform plantar flexion of the foot at the ankle joint. The fibularis longus (innervated by the superficial fibular nerve) assists in plantar flexion but is not the most important.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 65
Incorrect
-
Which of the following body location is the appropriate site to apply pressure when performing a carotid sinus massage?
Your Answer: Thyrohyoid membrane
Correct Answer: Thyroid cartilage
Explanation:The common carotid artery runs through the neck and divides into internal and external carotid arteries on both sides near the upper thyroid cartilage. In emergency situations, carotid sinus massage is also used to diagnose or treat paroxysmal supraventricular tachycardia. During the procedure, to maximize access to the carotid artery, the patient is put in a supine position with the neck extended (i.e. elevating the chin away from the chest). The carotid sinus is normally positioned inferior to the angle of the jaw, near the arterial impulse, at the level of the thyroid cartilage. For 5 to 10 seconds, pressure is administered to one carotid sinus. Although pulsatile pressure applied in a vigorous circular motion may be more effective, continuous pressure is preferred since it is more reproducible. If the predicted reaction is not obtained, the operation is repeated on the opposite side after a one- to two-minute wait.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 66
Incorrect
-
Which of the following statements is correct about the extensor digitorum muscle?
Your Answer: It receives its blood supply from the radial artery
Correct Answer: It extends the medial four digits at the metacarpophalangeal joints
Explanation:Extensor digitorum is a long muscle located in the posterior compartment of the forearm. Together with the extensor carpi ulnaris and extensor digiti minimi, extensor carpi radialis longus and brevis as well as the brachioradialis, it belongs to the group of superficial extensors of the forearm. These muscles can be easily palpated in the lateral aspect of the posterior forearm, especially during the extension of hand when they are contracted.Extensor digitorum runs from the lateral epicondyle of humerus to the medial four phalanges of the hand. In this way, it generates the pull for the extension of the four medial fingers in their metacarpophalangeal and both interphalangeal joints. Extensor digitorum also participates in the extension of the wrist.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 digitorum is vascularized by the branches of three different arteries: (1) posterior interosseous artery, (2) radial recurrent artery, and (3) anterior interosseous artery. Anterior and posterior interosseous arteries are the branches of the common interosseous artery that arises from the ulnar artery. The radial recurrent artery is a branch of the radial artery.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 67
Correct
-
Which of the following is a primary action of calcitonin:
Your Answer: Decreased bone resorption through inhibition of osteoclast activity
Explanation:Calcitonin is a 32 amino acid polypeptide that is primarily synthesised and released by the parafollicular cells (C-cells) of the thyroid gland in response to rising or high levels of plasma Ca2+ions. Its primary role is to reduce the plasma calcium concentration, therefore opposing the effects of parathyroid hormone.Secretion of calcitonin is stimulated by:- Increased plasma calcium concentration- Gastrin- Pentagastrin- The main actions of calcitonin are:- Inhibition of osteoclastic activity (decreasing calcium and phosphate resorption from bone)- Stimulation of osteoblastic activity- Decreases renal calcium reabsorption- Decreases renal phosphate reabsorption
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 68
Correct
-
Which one of the listed cells are typically found in a granuloma?
Your Answer: Epithelioid cells
Explanation:Typically, granuloma has Langhan’s cells (large multinucleated cells ) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.Antigen presenting monocytic cells found in the skin are known as Langerhan’s cells.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 69
Incorrect
-
The most common cause of anaemia worldwide is which of the following?
Your Answer: Vitamin B12 deficiency
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of microcytic anaemia and of any anaemia worldwide is iron deficiency anaemia.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 70
Correct
-
A 34-year-old man presented to the emergency room after being involved in a road traffic accident. Upon observation and examination, it was noted that he was hypotensive and has muffled heart sounds. It was suspected that he has pericardial effusion, so an emergency pericardiocentesis was to be performed.In performing pericardiocentesis for suspected pericardial effusion, which of the following anatomical sites are at risk of being punctured?
Your Answer: 1 cm below the left xiphocostal angle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 71
Correct
-
A patient noticed ankle swelling and has passed very little urine over the past 24 hours. He also has nausea and vomiting, reduced urine output and his blood results reveal a sudden rise in his creatinine levels over the past 48 hours. You make a diagnosis of acute kidney injury (AKI).Which one of these is a prerenal cause of AKI?
Your Answer: Cardiac failure
Explanation:The causes of AKI can be divided into pre-renal, intrinsic renal and post-renal causes. Majority of AKI developing in the community is due to a pre-renal causes (90% of cases).Pre-renal causes: Haemorrhage, severe vomiting or diarrhoea, burns, cardiac failure, liver cirrhosis, nephrotic syndrome, hypotension, severe cardiac failure, NSAIDs, COX-2 inhibitors, ACE inhibitors or ARBs, Abdominal aortic aneurysm, renal artery stenosis, hepatorenal syndrome, Intrinsic (renal) causes:Eclampsia, glomerulonephritis, thrombosis, haemolytic-uraemic syndrome, acute tubular necrosis (ATN), acute interstitial nephritis, drugs ( NSAIDs), infection or autoimmune diseases, vasculitis, polyarteritis nodosa, thrombotic microangiopathy, cholesterol emboli, renal vein thrombosis, malignant hypertensionPost-renal causes: Renal stones, Blood clot, Papillary necrosis, Urethral stricture, Prostatic hypertrophy or malignancy, Bladder tumour, Radiation fibrosis, Pelvic malignancy, Retroperitoneal fibrosis
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 72
Correct
-
A 45-year-old man, a known case of epilepsy, visits his neurologist with complaints of red, swollen gums.Which of the following medications is most likely responsible for his symptoms?
Your Answer: Phenytoin
Explanation:Phenytoin is a commonly used antiepileptic drug. A well-recognized side-effect of phenytoin is gingival enlargement and occurs in about 50% of patients receiving phenytoin. It is believed that reduced folate levels may cause this, and evidence suggests that folic acid supplementation may help prevent this in patients starting phenytoin. As evidence suggests, drug-induced gingival enlargement may also improve by substituting with other anticonvulsant drugs and reinforcing a good oral hygiene regimen. Surgical excision of hyperplastic gingiva is often necessary to correct the aesthetic and functional impairment associated with this condition to manage it successfully.Phenytoin is also the only anticonvulsant therapy associated with the development of Dupuytren’s contracture.Other side effects are:1. Ataxia2. Drug-induced lupus3. Hirsutism4. Pruritic rash5. Megaloblastic anaemia6. Nystagmus
-
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
-
Question 73
Correct
-
You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.Which of the following anti-D statements is correct?
Your Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks
Explanation:Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly. The following are examples of potentially sensitising events:BirthHaemorrhage during pregnancyMiscarriageEctopic pregnancyDeath within the wombAmniocentesisChorionic villus samplingTrauma to the abdomenThe sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.
-
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
-
-
Question 74
Correct
-
A 72-year-old woman presents to your clinic with worsening oedema. She is a known case of ischaemic heart disease and heart failure.You decide to add a loop diuretic to her current drug regime to control the oedema. Of the following, what is a contraindication to using a loop diuretic?
Your Answer: Anuria
Explanation:Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:FurosemideBumetanideTorsemideEthacrynic AcidLoop diuretics inhibit the Na-K-Cl pump in the ascending loop of Henle, resulting in salt-water excretion. This relieves congestion and reduces oedema. The contra-indications to the use of loop diuretics are:1. Anuria2. Comatose and precomatose states associated with liver cirrhosis3. Renal failure due to nephrotoxic or hepatotoxic drugs4. Severe hypokalaemia5. Severe hyponatremia6. History of hypersensitivity to furosemide, bumetanide, or torsemide (or sulphonamides)The following conditions or states are not contraindications, but loop diuretics needs to be used cautiously in these conditions:1. Diabetes (but hyperglycaemia less likely than with thiazides)2. Gout3. Hypotension (correct before initiation of treatment)4. Hypovolaemia (Correct before initiation of treatment)
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 75
Correct
-
Regarding ACE inhibitors, which of the following statements is CORRECT:
Your Answer: Angiotensin-II receptor blockers are a useful alternative in patients who cannot tolerate ACE-inhibitors due a persistent cough.
Explanation:ACE inhibitors should be used with caution in patients of Afro-Caribbean descent who may respond less well; calcium channel blockers are first line for hypertension in these patients. ACE inhibitors have a role in the management of diabetic nephropathy. ACE inhibitors are contraindicated in pregnant women. ACE inhibitors inhibit the breakdown of bradykinin; this is the cause of the persistent dry cough. Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 76
Incorrect
-
Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:
Your Answer: It has a greater ability to inhibit factor Xa directly rather than inhibit antithrombin III.
Correct Answer: Its effects can be rapidly and completely reversed with protamine sulfate.
Explanation:Advantages of LMWHGreater ability to inhibit factor Xa directly, interacting less with platelets and so may have a lesser tendency to cause bleedingGreater bioavailability and longer half-life in plasma making once daily subcutaneous administration possibleMore predictable dose response avoiding the need for routine anticoagulant monitoringLower associated risk of heparin-induced thrombocytopenia or of osteoporosis
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 77
Incorrect
-
A 32 year old man is brought to ED having been thrown off his motorbike. Following initial resuscitation and ruling out life-threatening injuries, you establish the patient has weakness of hip flexion. Which of the following nerves has most likely been injured:
Your Answer: Obturator nerve
Correct Answer: Femoral nerve
Explanation:Flexion of the hip is produced by the iliacus, the psoas major, the sartorius, rectus femoris and the pectineus muscles. The femoral nerve innervates the iliacus, pectineus, sartorius and quadriceps femoris muscles, and supplies skin on the anterior thigh, anteromedial knee and medial leg.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 78
Correct
-
You are asked to review the blood results on a 56-year-old man who appears to be acutely unwell. His results show that he is neutropenic.Which ONE of the following is NOT a recognized cause of a neutropenia?
Your Answer: Hyposplenism
Explanation:Neutropenia is defined as a total neutrophil count of < 2.0 x 109/l.It can be caused by:Viral infectionsCollagen disease e.g. SLE and RAChemotherapy and radiotherapyHypersplenismMarrow infiltrationVitamin and folate deficiencyDrug reactionsDrugs that cause neutropenia include flecainide, phenytoin, carbimazole, indomethacin and co-trimoxazole.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 79
Incorrect
-
The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A CT head scan is performed, and the diagnosis of an ischaemic stroke is confirmed. Her blood pressure is currently very high, with the most recent measurement being 196/124 mmHg, according to the nurse in charge. While you wait for the stroke team to review her, she asks you to prescribe something to help lower the patient's blood pressure.Which of the following is the best drug treatment for this patient's BP reduction?
Your Answer: Glyceryl trinitrate
Correct Answer: Labetalol
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.In the setting of a stroke syndrome (i.e., in the presence of focal neurological deficits), hypertensive emergencies usually necessitate a slower and more controlled blood pressure reduction than in other situations. Rapid reduction of MAP in the presence of an ischaemic stroke can compromise blood flow, leading to further ischaemia and worsening of the neurological deficit. In this situation, intravenous labetalol is the drug of choice for lowering blood pressure.Significantly elevated blood pressure (>185/110 mmHg) is a contraindication to thrombolysis, but there is some evidence for controlling blood pressure before thrombolysis in exceptional circumstances, when it is only slightly above this threshold.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 80
Incorrect
-
A 59-year-old man presents to the emergency room with chest pain. The cardiology team recently discharged him. He underwent a procedure and was given several medications, including abciximab, during his stay. Which of the following statements about abciximab is correct?
Your Answer: It is a glycoprotein IIb/IIIa receptor agonist
Correct Answer: The platelet count should be checked 2-4 hours after starting treatment
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.It’s approved for use as a supplement to heparin and aspirin in high-risk patients undergoing percutaneous transluminal coronary intervention to prevent ischaemic complications. Only one dose of abciximab should be given (to avoid additional risk of thrombocytopenia).
Before using, it is recommended that baseline prothrombin time, activated clotting time, activated partial thromboplastin time, platelet count, haemoglobin, and haematocrit be measured. 12 and 24 hours after starting treatment, haemoglobin and haematocrit should be measured again, as should platelet count 2-4 hours and 24 hours after starting treatment.
When used for high-risk patients undergoing angioplasty, the EPIC trial found that abciximab reduced the risk of death, myocardial infarction, repeat angioplasty, bypass surgery, and balloon pump insertion.The use of abciximab is contraindicated in the following situations:
Internal bleeding is present.
Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
Stroke in the previous two yearsIntracranial tumour
Aneurysm or arteriovenous malformation
Haemorrhagic diathesis
Vasculitis
Retinopathy caused by hypertension
The following are some of the most common abciximab side effects:
Manifestations of bleeding
Bradycardia
Back ache
Pain in the chest
Vomiting and nausea
Pain at the puncture site
Thrombocytopenia
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 81
Incorrect
-
A 59-year-old woman presents with a history of tiredness and weight gain and a diagnosis of hypothyroidism is suspected.Which of these changes is likely to appear first in primary hypothyroidism?
Your Answer: Reduced thyroid-stimulating hormone (TSH)
Correct Answer: Increased thyroid-stimulating hormone (TSH)
Explanation:The earliest biochemical change seen in hypothyroidism is an increase in thyroid-stimulating hormone (TSH) levels.Triiodothyronine (T3) and thyroxine (T4) levels are normal in the early stages.TBG levels are generally unchanged in primary hypothyroidism.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 82
Incorrect
-
Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:
Your Answer: ITP is the most common cause of isolated thrombocytopaenia without anaemia or neutropaenia.
Correct Answer: ITP is classically associated with massive splenomegaly.
Explanation:Chronic ITP is a relatively common disorder. The highest incidence is in women aged 15 – 50 years. It is the most common cause of thrombocytopaenia without anaemia or neutropaenia. It is usually idiopathic but it may been seen in association with other conditions. Platelet autoantibodies (usually IgG) result in the premature removal of platelets from the circulation by macrophages of the reticuloendothelial system. In many causes the antibody is directed against the glycoprotein IIb/IIIa or Ib complex. The normal platelet lifespan of 10 days is reduced to a few hours. Total megakaryocyte mass and platelet turnover are increased to approximately five times normal. Despite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged. In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 83
Correct
-
Regarding aciclovir, which of the following statements is INCORRECT:
Your Answer: Aciclovir eradicates herpes simplex virus from the body.
Explanation:Aciclovir is active against herpesviruses but does not eradicate latent virus.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 84
Correct
-
A 24-year-old female visits her family physician to complain of painless lumps in her neck. Her physician notes several enlarged, rubbery, non-tender cervical lymph nodes on examination. He immediately refers the patient for a lymph node biopsy, the results of which show the presence of Reed-Sternberg cells. What is the diagnosis in this case based on the above scenario?
Your Answer: Hodgkin’s lymphoma
Explanation:The presence of Reed-Sternberg cells is pathognomonic for Hodgkin’s Lymphoma, which is a disease-causing neoplastic transformation of lymphocytes. There is a bimodal age distribution with peaks in the 20s and 60s. Patients typically present with enlarged, rubbery, non-tender lymph nodes. Symptoms such as fever, night sweats and weight loss may be present. Pain after alcohol consumption is a pathognomonic sign of Hodgkin’s lymphoma, it is, however, not a ‘B’ symptom. It is rare though, only occurring in 2-3% of patients with Hodgkin’s lymphoma.The Ann Arbour clinical staging is as follows:Stage I: one involved lymph node groupStage II two involved lymph node groups on one side of the diaphragmStage III: lymph node groups involved on both sides of the diaphragmStage IV: Involvement of extra-nodal tissues, such as the liver or bone marrowDiagnosis is made by lymph node biopsy, which should be taken from a sufficiently large specimen or excisional biopsy, as opposed to a fine needle biopsy. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs. In non-Hodgkin’s lymphoma, Reed-Sternberg cells are not present. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 85
Correct
-
Which of the following side effects is most likely caused by erythromycin:
Your Answer: QT - prolongation
Explanation:The side effects of erythromycin include abdominal pain, anaphylaxis, cholestatic hepatitis, confusion, diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss, headache, hypertrophic pyloric stenosis, hypotension, Interstitialnephritis, mild allergic reactions, nausea, nervous system effects,including seizures, pain, pruritus, pseudomembranous colitis, QT prolongation, rash, skin eruptions, tinnitus, urticaria, ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 86
Correct
-
Regarding shingles, which of the following statements is CORRECT:
Your Answer: You can catch chickenpox from a patient with shingles.
Explanation:After primary infection, VZV remains latent in sensory ganglia and in about 20% of patients will reactivate resulting in shingles, a painful vesicular rash in the related dermatome. Shingles usually affects older people and the immunocompromised. Shingles lesions are infectious to non-immune individuals who are at risk of developing chickenpox. Shingles can not be contracted directly from chickenpox, or from other cases of shingles. Shingles is treated with systemic antiviral treatment to reduce the severity and duration of pain, reduce complications, and reduce viral shedding.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 87
Incorrect
-
Parathyroid hormone is released by which of the following:
Your Answer: Posterior pituitary gland
Correct Answer: Chief cells of the parathyroid gland
Explanation:Parathyroid hormone (PTH) is a peptide hormone synthesised by the chief cells of the parathyroid glands, located immediately behind the thyroid gland. PTH is primarily released in response to decreasing plasma [Ca2+] concentration. PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.Parathyroid hormone (PTH) acts to increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane) and increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 88
Correct
-
Gallstones are commonly found lodged in which of the following parts of the gallbladder?
Your Answer: Neck
Explanation:There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 89
Incorrect
-
Gastric emptying is inhibited by all of the following EXCEPT for:
Your Answer: An increase in the osmolality of chyme in the duodenum
Correct Answer: Parasympathetic stimulation
Explanation:Gastric emptying is decreased by: Enterogastric inhibitory reflexes stimulated by – Distension of the duodenum, The presence of fats in the duodenum (by stimulating release of cholecystokinin), A fall in the pH of chyme in the duodenum, An increase in the osmolality of chyme in the duodenum, Irritation of the mucosal lining of the duodenum, Hormones: Cholecystokinin, Secretin
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 90
Correct
-
Atrial natriuretic peptide (ANP) is primarily produced in response to:
Your Answer: An increase in intravascular fluid volume
Explanation:Atrial natriuretic peptide (ANP) is released from cardiac atrial muscle cells in response to atrial stretch caused by an increase in intravascular fluid volume and is also produced in collecting duct cells.Atrial natriuretic peptide acts to inhibit sodium reabsorption in the distal nephron.
-
This question is part of the following fields:
- Physiology
- Renal
-
SESSION STATS - PERFORMANCE PER SPECIALTY
