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  • Question 1 - Angiotensin II acts to cause all but which one of the following effects:...

    Incorrect

    • Angiotensin II acts to cause all but which one of the following effects:

      Your Answer: Cause vasoconstriction of the renal arterioles

      Correct Answer: Inhibit release of ADH from the posterior pituitary gland

      Explanation:

      Angiotensin II acts to:Stimulate release of aldosterone from the zona glomerulosa of the adrenal cortex (which in turn acts to increase sodium reabsorption)Cause systemic vasoconstrictionCause vasoconstriction of the renal arterioles (predominant efferent effect thus intraglomerular pressure is stable or increased, thereby tending to maintain or even raise the GFR)Directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters)Stimulate synthesis and release of ADH from the hypothalamus and posterior pituitary respectivelyStimulate the sensation of thirstPotentiate sympathetic activity (positive feedback)Inhibit renin production by granular cells (negative feedback)

    • This question is part of the following fields:

      • Physiology
      • Renal
      32.6
      Seconds
  • Question 2 - A 66-year-old male is brought to your clinic by his wife with the...

    Incorrect

    • 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: Metastatic prostate cancer

      Correct 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
      324.3
      Seconds
  • Question 3 - A 60-year-old patient had a sudden onset of palpitations and shortness of breath....

    Correct

    • A 60-year-old patient had a sudden onset of palpitations and shortness of breath. He had a history of poorly controlled hypertension and ischemic heart disease. His ECG also shows atrial fibrillation. Based on the patient’s condition, which pharmacologic cardioversion would be best to use?

      Your Answer: Amiodarone

      Explanation:

      Chemical cardioversion, or pharmacologic cardioversion, is the treatment of abnormal heart rhythms using drugs. Flecainide and propafenone are examples of drugs used as chemical cardioverters. However, given the situation of the patient, these drugs are contraindicated for his ischaemic heart disease. Amiodarone is also an antiarrhythmic drug and is the best choice for this situation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      94.8
      Seconds
  • Question 4 - A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration...

    Correct

    • A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration is 1246 pg/mL.Glucagon is produced in which of the following cells? Select ONE answer only.

      Your Answer: Alpha-cells in the pancreas

      Explanation:

      Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline. Glucagon then causes:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      12.6
      Seconds
  • Question 5 - Which of the following study designs is considered the most appropriate to safely...

    Incorrect

    • Which of the following study designs is considered the most appropriate to safely determine whether an association exists between a well-established, commonly used, anti-hypertensive medication and causing type II diabetes mellitus?

      Your Answer: A double-blind randomised controlled trial

      Correct Answer: A meta-analysis

      Explanation:

      Evidence-based medicine may be defined as the systematic, quantitative, preferentially experimental approach to obtaining and using medical information. Therefore, meta-analysis, a statistical procedure that integrates the results of several independent studies, plays a central role in evidence-based medicine.Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis.

    • This question is part of the following fields:

      • Evidence Based Medicine
      31.4
      Seconds
  • Question 6 - A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense,...

    Incorrect

    • A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke. Branches of which of the following arteries are most likely implicated in the case?

      Your Answer: Posterior inferior cerebellar artery

      Correct Answer: Anterior spinal artery

      Explanation:

      Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      66.6
      Seconds
  • Question 7 - One of your patients has been infected by an obligate pathogen and presents...

    Incorrect

    • One of your patients has been infected by an obligate pathogen and presents with features of this condition.Which of these is an example of an obligate pathogen?

      Your Answer: Pseudomonas aeruginosa

      Correct Answer: Trepenoma pallidum

      Explanation:

      Treponema pallidum is an obligate pathogen. Obligate pathogens are almost always associated with disease and usually cannot survive outside of the body for long periods of time. Examples include and HIV.Staphylococcus aureus and Bacteroides fragilis are conditional pathogens. These are pathogens that usually cause disease only if certain conditions are met.Pneumocystis jiroveci and Pseudomonas aeruginosa, are opportunistic pathogens. These are pathogens that can only cause disease in an immunocompromised host or under unusual circumstances.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      12.2
      Seconds
  • Question 8 - Which of the following is true about the extensor carpi radialis longus? ...

    Incorrect

    • Which of the following is true about the extensor carpi radialis longus?

      Your Answer: It arises from the medial epicondyle of the humerus

      Correct Answer: It assists with abduction of the hand at the wrist

      Explanation:

      The majority of extensor carpi radialis longus originates from the lateral supracondylar ridge of humerus (distal third) and anterior aspect of the lateral intermuscular septum of the arm. A small portion of its fibres originate from the common extensor tendon attached to the lateral epicondyle of humerus. The fibres unite into a muscle belly which extends approximately to the middle of the forearm. The muscle belly is then replaced by a flat tendon that travels distally along the lateral surface of the radius, together with the tendon of extensor carpi radialis brevis. Both tendons course towards the radial styloid process, deep to the tendons of abductor pollicis longus and extensor pollicis brevis muscles. Proximal to the wrist, the tendons of extensor carpi radialis longus and brevis pass behind the radial styloid process within a common synovial sheath and continue along the radial groove deep to the extensor retinaculum of the wrist. At this level, the tendon of extensor carpi radialis longus is crossed by the tendon of extensor pollicis longus, after which it inserts on the posterior aspect of the base of the second metacarpal bone. Some tendon slips can insert into the first and third metacarpal bones.Extensor carpi radialis longus receives innervation from the radial nerve, with contributions mainly from spinal nerves C5-C8. The radial nerve is a branch of the brachial plexus.Extensor carpi radialis longus receives blood supply mainly from the radial artery. It directly supplies the distal part of the muscle, while the rest of the muscle receives blood from one of its radial recurrent branches. The brachial artery also supplies a small portion of the muscle via the radial collateral artery.Extensor carpi radialis longus primarily acts on the wrist joint to produce two major actions: (1) wrist extension by working synergistically with extensor carpi radialis brevis and extensor carpi ulnaris, and (2) hand abduction (radial deviation), with the help of flexor carpi radialis.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      53.9
      Seconds
  • Question 9 - Where does carbohydrate digestion begin: ...

    Correct

    • Where does carbohydrate digestion begin:

      Your Answer: Mouth

      Explanation:

      Carbohydrate digestion begins in the mouth, by alpha-amylase produced in saliva.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      5.2
      Seconds
  • Question 10 - Which of the following microbes binds strongly to CD4 antigen: ...

    Correct

    • Which of the following microbes binds strongly to CD4 antigen:

      Your Answer: HIV

      Explanation:

      HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.HIV is not a notifiable disease.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      8.8
      Seconds
  • Question 11 - You come across a 60-year-old woman with a history of chronic pancreatitis. Today...

    Correct

    • You come across a 60-year-old woman with a history of chronic pancreatitis. Today she is complaining of epigastric pain. She has blood tests done especially to review her cholecystokinin levels.Which of the following is a cholecystokinin (CCK) releasing site? 

      Your Answer: I-cells in the upper small intestine

      Explanation:

      The I-cells in the duodenum generate and release cholecystokinin (CCK), a peptide hormone. It has a crucial role in the digestion process as a hormonal regulator.CCK cells are concentrated in the proximal small intestine, and when food is consumed, the hormone is produced into the bloodstream. The presence of partly digested lipids and proteins in the duodenum is one of the most powerful stimulus for CCK synthesis.CCK’s key physiological effects include:Encourages the pancreas to release digesting enzymes into the small intestine.Stimulates gallbladder contraction and sphincter of Oddi relaxation, resulting in bile delivery into the duodenum.Gastric emptying is inhibited, and gastric acid output is reduced.Satiety induction is a process that involves inducing a feeling of fullness.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      105.2
      Seconds
  • Question 12 - All of the following statements are correct regarding the management of acute asthma...

    Incorrect

    • All of the following statements are correct regarding the management of acute asthma in adults except:

      Your Answer: Continuous salbutamol nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose of salbutamol.

      Correct Answer: Intravenous aminophylline has been shown to result in significant additional bronchodilation compared to standard care.

      Explanation:

      There usually isn’t any additional bronchodilation with intravenous (IV) aminophylline compared to standard care with inhaled bronchodilators and steroids. IV aminophylline may cause side effects such as arrhythmias and vomiting. However, some additional benefit may be gained in patients with near-fatal asthma or life-threatening asthma with a poor response to initial therapy (5 mg/kg loading dose over 20 minutes unless on maintenance oral therapy, then continuous infusion of 0.5 – 0.7 mg/kg/hr).

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      70
      Seconds
  • Question 13 - You are attending to a patient that has presented with a severe headache...

    Correct

    • You are attending to a patient that has presented with a severe headache in the Emergency Department. The patient has signs of cerebral oedema and raised intracranial pressure. You discuss the case with the on-call neurology registrar and decide to prescribe Mannitol. The nurse assisting you asks you to reconsider this management plan as she suspects the patient has a contraindication to Mannitol.Out of the following, what is a contraindication to mannitol?

      Your Answer: Severe cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure. It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Mannitol has several contraindications and some of them are listed below:1. Anuria due to renal disease2. Acute intracranial bleeding (except during craniotomy)3. Severe cardiac failure4. Severe dehydration5. Severe pulmonary oedema or congestion6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      8.4
      Seconds
  • Question 14 - A 62-year-old woman presents with cold sensitivity, tiredness, and weight gain. A series...

    Correct

    • A 62-year-old woman presents with cold sensitivity, tiredness, and weight gain. A series of blood tests done shows a grossly elevated TSH level and a diagnosis of hypothyroidism is made.What is the commonest cause of hypothyroidism worldwide?

      Your Answer: Iodine deficiency

      Explanation:

      Hypothyroidism occurs when there is a deficiency of circulating thyroid hormones. It is commoner in women and is most frequently seen in the age over 60.Iodine deficiency is the commonest cause of hypothyroidism worldwide.In the UK and other developed countries, iodine deficiency is not a problem and autoimmune thyroiditis is the commonest cause.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      10.2
      Seconds
  • Question 15 - Renin is produced by which of the following: ...

    Incorrect

    • Renin is produced by which of the following:

      Your Answer: Extraglomerular mesangial cells

      Correct Answer: Granular cells in the wall of the afferent arteriole

      Explanation:

      Juxtaglomerular cells are specialised smooth muscle cells mainly in the walls of the afferent arterioles (and some in the efferent arterioles) which synthesise renin.

    • This question is part of the following fields:

      • Physiology
      • Renal
      29.9
      Seconds
  • Question 16 - The Philadelphia chromosome is a genetic abnormality associated primarily with which of the...

    Incorrect

    • The Philadelphia chromosome is a genetic abnormality associated primarily with which of the following malignancies:

      Your Answer: Chronic lymphocytic leukaemia

      Correct Answer: Chronic myeloid leukaemia

      Explanation:

      Chronic myeloid leukaemia (CML) is a clonal disorder of a pluripotent stem cell. The disease accounts for around 15% of leukaemias and may occur at any age. The diagnosis of CML is rarely difficult and is assisted by the characteristic presence of the Philadelphia (ph) chromosome. This disease occurs in either sex, most frequently between the ages of 40 and 60 years. In up to 50% of cases the diagnosis is made incidentally from a routine blood count. Leucocytosis is the main feature, with a complete spectrum of myeloid cells seen in the peripheral blood. The levels of neutrophils and myelocytes exceed those of blast cells and promyelocytes.Increased circulating basophils are a characteristic feature. Normochromic normocytic anaemia is usual. Platelet count may be increased (most frequently), normal or decreased. The clinical outlook is very good and 90% of patients can expect long-term control of disease.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      19
      Seconds
  • Question 17 - The proximal convoluted tubule (PCT) is the first part of the renal tubule...

    Incorrect

    • The proximal convoluted tubule (PCT) is the first part of the renal tubule and lies in the renal cortex. The bulk of reabsorption of solute occurs is the PCT and 100% of glucose is reabsorbed here.Which of the following is the mechanism of glucose reabsorption in the PCT?

      Your Answer: Facilitated diffusion

      Correct Answer: Secondary active transport

      Explanation:

      Glucose reabsorption occurs exclusively in the proximal convoluted tubule by secondary active transport through the Na.Glu co-transporters, driven by the electrochemical gradient for sodium. The co-transporters transport two sodium ions and one glucose molecule across the apical membrane, and the glucose subsequently crosses the basolateral membrane by facilitated diffusion.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      14.1
      Seconds
  • Question 18 - You are seeing a child with known mitochondrial disease who has presented breathlessness...

    Incorrect

    • You are seeing a child with known mitochondrial disease who has presented breathlessness and cough. Which of the following best describes the function of mitochondria:

      Your Answer:

      Correct Answer: Energy production

      Explanation:

      Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds
  • Question 19 - Which of the following immunoglobulins is most important for mast cell degranulation: ...

    Incorrect

    • Which of the following immunoglobulins is most important for mast cell degranulation:

      Your Answer:

      Correct Answer: IgE

      Explanation:

      IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds
  • Question 20 - Gentamicin is contraindicated in which of the following: ...

    Incorrect

    • Gentamicin is contraindicated in which of the following:

      Your Answer:

      Correct Answer: Myasthenia gravis

      Explanation:

      Gentamicin is the aminoglycoside of choice in the UK and is used widely for the treatment of serious infections. It has a broad spectrum but is inactive against anaerobes and has poor activity against haemolytic streptococci and pneumococci. When used for the blind therapy of undiagnosed serious infections it is usually given in conjunction with a penicillin or metronidazole (or both). The main toxic effects are nephrotoxicity and ototoxicity due to damage to the vestibulocochlear nerve (CN VIII).Gentamicin is contraindicated in myasthenia gravis and should be used with caution in renal disease which may result in accumulation and a greater risk of toxic side effects.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 21 - You review an 18-months-old child who seems to be having a reaction following...

    Incorrect

    • You review an 18-months-old child who seems to be having a reaction following an immunisation she took earlier in the day.Which statement concerning immunity and vaccination is true?

      Your Answer:

      Correct Answer: The strongest immunological response is seen with natural immunity

      Explanation:

      Vaccination induces ACTIVE adaptive immunity. Actively acquired immunity involves the development of an immune response either due to vaccination or natural exposure to a pathogen and leads to long-lasting resistance to infection.Immediate protection is achieved with injection of immunoglobulin. The protection is transient lasting only a few weeks and is useful as post-exposure prophylaxis. Passively acquired immunity usually leads to short-lasting resistance to infection because it does not involve a host immune response. With inactivated bacteria, a series of primary vaccinations is usually required to induce an adequate immune response. In most cases, boosters are required to sustain adequate immunity.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
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  • Question 22 - In a 7-year-old child with chickenpox, which of the following would you advise...

    Incorrect

    • In a 7-year-old child with chickenpox, which of the following would you advise the mother NOT to do?

      Your Answer:

      Correct Answer: Give ibuprofen for the fever

      Explanation:

      Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.Some recognized complications of chickenpox are:OrchitisHepatitisPneumoniaEncephalitisInfected spotsOtitis mediaMyocarditisGlomerulonephritisAppendicitisPancreatitisTreatment is symptomatic and includes using paracetamol to manage fever. There is a link between use of ibuprofen in patients with chicken-pox and necrotizing fasciitis so Ibuprofen should NOT be used. An emollient and antihistamine can be used to ease the itchy rash and oral hydration is encouraged.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds
  • Question 23 - A 32-old woman comes for a follow-up visit after being discharged on medications...

    Incorrect

    • A 32-old woman comes for a follow-up visit after being discharged on medications for her newly diagnosed epilepsy. She now complains of a tremor in her arm when she holds a tray in her hand. You examine the patient and notice she has developed postural tremors. Which of the following medications for epilepsy is most likely responsible for this tremor?

      Your Answer:

      Correct Answer: Sodium valproate

      Explanation:

      A postural tumour is observed when a person maintains a position against gravity, such as holding the arms outstretched. (The patient holding her tray against gravity) Sodium valproate is the most commonly prescribed medication for epilepsy. It is commonly associated with tremors as valproate-induced tremors occur in around 6-45% of patients. The tremors are commonly postural, but a resting tremor may also occur.Approximately 25% of patients taking sodium valproate are found to develop a tremor within 3-12 months of initiating therapy.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 24 - A 23-year-old male presents to his family physician with the complaint of repeated...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds
  • Question 25 - A patient presents with an adducted eye at rest which cannot abduct past...

    Incorrect

    • A patient presents with an adducted eye at rest which cannot abduct past the midline, which of the following cranial nerves is most likely to be affected:

      Your Answer:

      Correct Answer: Abducens nerve

      Explanation:

      Abducens nerve palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      0
      Seconds
  • Question 26 - A patent has weakness of humeral flexion and extension. A CT scan reveals...

    Incorrect

    • A patent has weakness of humeral flexion and extension. A CT scan reveals that he has suffered damage to the nerve that innervates pectoralis major.Pectoralis major receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Lateral and medial pectoral nerves

      Explanation:

      Pectoralis major is a thick, fan-shaped muscle situated in the chest. It makes up the bulk of the chest musculature in the male and lies underneath the breast in the female. It overlies the thinner pectoralis minor muscle.Superficial muscles of the chest and arm showing pectoralis major (from Gray’s Anatomy)Pectoralis major has two heads; the clavicular head and the sternocostal head. The clavicular head originates from the anterior border and medial half of the clavicle. The sternocostal head originates from the anterior surface of the sternum, the superior six costal cartilages and the aponeurosis of the external oblique muscle. It inserts into the lateral lip of the bicipital groove of the humerus.Pectoralis major receives dual innervation from the medial pectoral nerve and the lateral pectoral nerve.Its main actions are as follows:Flexes humerus (clavicular head)Extends humerus (sternocostal head)Adducts and medially rotates the humerusDraws scapula anteriorly and inferiorly

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 27 - Which of the following is NOT an effect of benzodiazepines: ...

    Incorrect

    • Which of the following is NOT an effect of benzodiazepines:

      Your Answer:

      Correct Answer: Analgesic effect

      Explanation:

      Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhance inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 28 - Which of the following diseases is caused by a build-up of lymphoblasts in...

    Incorrect

    • Which of the following diseases is caused by a build-up of lymphoblasts in the bone marrow?

      Your Answer:

      Correct Answer: Acute lymphoblastic leukaemia

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is a clonal (malignant) bone marrow disorder in which early lymphoid precursors multiply and replace the marrow’s normal hematopoietic cells. ALL is most common between the ages of 3 and 7, with 75 percent of cases occurring before the age of 6.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds
  • Question 29 - A CT pulmonary angiography of a patient with a massive pulmonary embolus will...

    Incorrect

    • A CT pulmonary angiography of a patient with a massive pulmonary embolus will most likely show which of the following signs?

      Your Answer:

      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
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  • Question 30 - Which of the following clinical features is NOT typical of a facial nerve...

    Incorrect

    • Which of the following clinical features is NOT typical of a facial nerve palsy:

      Your Answer:

      Correct Answer: Inability to raise the eyelid

      Explanation:

      Facial nerve palsy can result in inability to close the eye due to paralysis of the orbicularis oculi muscle. Elevation of the eyelid in eye opening is a function of the levator palpebrae superioris muscle and the superior tarsal muscle, innervated by the oculomotor nerve and the sympathetic chain respectively.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      0
      Seconds
  • Question 31 - The role of the juxtaglomerular (granular) cells of the juxtaglomerular apparatus is: ...

    Incorrect

    • The role of the juxtaglomerular (granular) cells of the juxtaglomerular apparatus is:

      Your Answer:

      Correct Answer: Production of renin

      Explanation:

      Juxtaglomerular cells synthesise renin. These cells are specialised smooth muscle cells that are located in the walls of the afferent arterioles, and there are some in the efferent arterioles.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 32 - The big toe of a 59-year-old female is red, hot, and swollen. The patient is...

    Incorrect

    • The big toe of a 59-year-old female is red, hot, and swollen. The patient is diagnosed with acute gout. You intend to start her on a nonsteroidal anti-inflammatory medicine (NSAID). Her husband was diagnosed with a peptic ulcer, and she is apprehensive about the potential adverse effects of NSAIDs.Which of the following NSAIDs has the lowest chance of causing side effects? 

      Your Answer:

      Correct Answer: Ibuprofen

      Explanation:

      Non-steroidal anti-inflammatory medications (NSAIDs) have slight differences in anti-inflammatory activity, but there is a lot of diversity in individual response and tolerance to these treatments. Approximately 60% of patients will respond to any NSAID; those who do not respond to one may well respond to another. Pain relief begins soon after the first dose, and a full analgesic effect should be achieved within a week, whereas an anti-inflammatory effect may take up to three weeks to achieve (or to be clinically assessable). If the desired results are not reached within these time frames, another NSAID should be attempted.By inhibiting the enzyme cyclo-oxygenase, NSAIDs limit the generation of prostaglandins. They differ in their selectivity for inhibiting various types of cyclo-oxygenase; selective inhibition of cyclo-oxygenase-2 is linked to reduced gastrointestinal discomfort. Susceptibility to gastrointestinal effects is influenced by a number of different parameters, and an NSAID should be chosen based on the frequency of side effects.Ibuprofen is an anti-inflammatory, analgesic, and antipyretic propionic acid derivative. Although it has fewer side effects than other non-selective NSAIDs, its anti-inflammatory properties are less effective. For rheumatoid arthritis, daily doses of 1.6 to 2.4 g are required, and it is contraindicated for illnesses characterized by inflammation, such as acute gout.Because it combines strong efficacy with a low incidence of adverse effects, Naproxen is one of the top choices. It is more likely to cause negative effects than ibuprofen.Similar to ibuprofen, ketoprofen and diclofenac have anti-inflammatory characteristics, however they have additional negative effects.Indomethacin has a similar or better effect to naproxen, however it comes with a lot of side effects, such as headaches, dizziness, and gastrointestinal problems.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
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  • Question 33 - A dermatological examination of a patient presenting with a lump shows a visible...

    Incorrect

    • A dermatological examination of a patient presenting with a lump shows a visible collection of fluid measuring 0.3 cm in diameter.Which one of these best describes the lump you have found on examination?

      Your Answer:

      Correct Answer: Vesicle

      Explanation:

      A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus. A carbuncle is a collection of individual boils clustered together. A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter. A pustule is a small visible skin elevation containing an accumulation of pus.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 34 - Which of the following cytokines is important for the maintenance of granulomatous inflammation:...

    Incorrect

    • Which of the following cytokines is important for the maintenance of granulomatous inflammation:

      Your Answer:

      Correct Answer: TNF-alpha

      Explanation:

      Granulomatous inflammation is a distinctive pattern of chronic inflammation that is encountered in a limited number of infectious and some non-infectious conditions. Briefly, a granuloma is a cellular attempt to contain an offending agent that is difficult to eradicate. In this attempt, there is often strong activation of T lymphocytes leading to macrophage activation, which can cause injury to normal tissues. IL-1 is important in initiating granuloma formation, IL-2 can cause them to enlarge and TNF-α maintains them.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
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  • Question 35 - Which of the following is NOT a typical cerebellar sign: ...

    Incorrect

    • Which of the following is NOT a typical cerebellar sign:

      Your Answer:

      Correct Answer: Resting tremor

      Explanation:

      An intention tremor is characteristic of cerebellar dysfunction. Resting tremor may be seen in Parkinsonism.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 36 - Which of the following statements is true regarding the extensor pollicis longus? ...

    Incorrect

    • Which of the following statements is true regarding the extensor pollicis longus?

      Your Answer:

      Correct Answer: It is innervated by the posterior interosseous nerve

      Explanation:

      Extensor pollicis longus is part of the deep extensors of the forearm together with extensor pollicis brevis, abductor pollicis longus, extensor indicis and supinator muscles. It is located on the posterior aspect of forearm, extending from the middle third of the ulna, and adjacent interosseous membrane, to the distal phalanx of the thumb.Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).Extensor pollicis brevis receives its blood supply from the posterior interosseous artery and perforating branches of the anterior interosseous artery.The main action of extensor pollicis longus is extension of the thumb at the metacarpophalangeal and interphalangeal joints. Extension at the metacarpophalangeal joint occurs in synergy with extensor pollicis brevis muscle. When the thumb reaches the full extension or abduction, extensor pollicis longus can also assist in adduction of the thumb.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 37 - A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler...

    Incorrect

    • A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.Which of these statements describes the mechanism of action of corticosteroids in asthma?

      Your Answer:

      Correct Answer: Reduction of bronchial inflammation

      Explanation:

      Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 38 - The patients listed below have been diagnosed with a variety of ailments.In which...

    Incorrect

    • The patients listed below have been diagnosed with a variety of ailments.In which of the following situations would aspirin be an effective treatment option?

      Your Answer:

      Correct Answer: A 36-year-old with an acute migraine (dose of 900-1000 mg)

      Explanation:

      A study published in the Cochrane Database of Systematic Reviews in 2010 found that a single 1000-mg dose of aspirin is effective in treating acute migraine. It was discovered that 24 percent of aspirin users were pain-free after two hours, compared to 11 percent of placebo users. Because the BNF recommends a maximum dose of 900 mg for analgesia and most non-proprietary aspirin in the UK comes in a dose of 300 mg, a dose of 900 mg is frequently prescribed in the UK.Because aspirin is not recommended for children under the age of 16 due to the risk of Reye’s syndrome, it would be inappropriate to give it to the 12-year-old with the viral URTI.For uncomplicated dental pain, aspirin is an acceptable option, but not for patients who are taking warfarin. The combination of aspirin’s antiplatelet action and warfarin’s anticoagulation properties puts the patient at high risk of bleeding. Furthermore, aspirin can deplete the therapeutic levels of warfarin by displacing it from plasma proteins. It would be better to use another NSAID or analgesic.In gout, aspirin should be avoided because it reduces urate clearance in the urine and interferes with the action of uricosuric agents. Naproxen, diclofenac, and indomethacin are better options.Although aspirin is useful for inflammatory pains, the dose of aspirin required for an adequate analgesic effect in severe pain is associated with significant side effects. Naproxen would be a better first-line treatment option.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 39 - Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department...

    Incorrect

    • Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department by ambulance. Her heart rate is 180 beats per minute, and the rhythm strip shows supraventricular tachycardia. You intend to give adenosine.Which of the following is NOT a contraindication for adenosine use?

      Your Answer:

      Correct Answer: History of heart transplant

      Explanation:

      The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.Patients who have had a heart transplant 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. Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.The use of adenosine is contraindicated in the following situations:AsthmaCOPD (chronic obstructive pulmonary disease)Decompensated heart failure Long QT syndromeAV block in the second or third degreeSinusitis is a condition in which the sinuses become (unless pacemaker fitted)Hypotension that is severeIt has a half-life of less than 10 seconds and acts quickly within that time frame. The actions last between 10 and 20 seconds. Because of the short half-life of the drug, any side effects are usually only temporary. These are some of them:a feeling of impending doomFlushing of the faceDyspnoeaUncomfortable chestTastes metallic

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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      Seconds
  • Question 40 - When the pulmonary artery is completely blocked, what is the ventilation over perfusion...

    Incorrect

    • When the pulmonary artery is completely blocked, what is the ventilation over perfusion ratio for the area that it supplies?

      Your Answer:

      Correct Answer: Infinity

      Explanation:

      The ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching ventilation and perfusion. A pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. When a large pulmonary embolus completed blocked a pulmonary artery the alveoli were ventilated but not perfused at all, then the V/Q ratio would be infinity.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      0
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  • Question 41 - A 40-year-old man who has a history of asthma arrives at the emergency...

    Incorrect

    • A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?

      Your Answer:

      Correct Answer: Atenolol

      Explanation:

      Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels. This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific. They have a lower effect on airway resistance, although they are not without this adverse effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 42 - You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy...

    Incorrect

    • You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her with Cushing's syndrome.When would her random cortisol level likely be abnormal? 

      Your Answer:

      Correct Answer: 2400 hrs

      Explanation:

      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.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 43 - Regarding the resting membrane potential, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the resting membrane potential, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: The resting cell membrane is more permeable to K + ions than to Na + ions.

      Explanation:

      A membrane potential is a property of all cell membranes, but the ability to generate an action potential is only a property of excitable tissues. The resting membrane is more permeable to K+and Cl-than to other ions (and relatively impermeable to Na+); therefore the resting membrane potential is primarily determined by the K+equilibrium potential. At rest the inside of the cell is negative relative to the outside. In most neurones the resting potential has a value of approximately -70 mV.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 44 - A 33-year-old woman who is investigated for recurrent renal stones is discovered to...

    Incorrect

    • A 33-year-old woman who is investigated for recurrent renal stones is discovered to have a markedly elevated parathyroid hormone (PTH) level.Which of the following would stimulate PTH release under normal circumstances? Select ONE answer only.

      Your Answer:

      Correct Answer: Decreased plasma calcium concentration

      Explanation:

      Parathyroid hormone (PTH) is a polypeptide containing 84 amino acids. It is the principal controller of free calcium in the body.PTH is synthesised by and released from the chief cells of the four parathyroid glands that are located immediately behind the thyroid gland.PTH is released in response to the following stimuli:Decreased plasma calcium concentrationIncreased plasma phosphate concentration (indirectly by binding to plasma calcium and reducing the calcium concentration)PTH release is inhibited by the following factors:Normal/increased plasma calcium concentrationHypomagnesaemiaThe main actions of PTH are:Increases plasma calcium concentrationDecreases plasma phosphate concentrationIncreases osteoclastic activity (increasing calcium and phosphate resorption from bone)Increases renal tubular reabsorption of calciumDecreases renal phosphate reabsorptionIncreases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 45 - You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus....

    Incorrect

    • You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?

      Your Answer:

      Correct Answer: Potentiates effect of GABA

      Explanation:

      Lorazepam is a type of benzodiazepine. Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 46 - You are treating a patient with a Clostridium difficile infection. His condition was...

    Incorrect

    • You are treating a patient with a Clostridium difficile infection. His condition was found to be antibiotic-associated. Which of the following pieces of advice on preventing the spread of this disease should you give this patient?

      Your Answer:

      Correct Answer: Washing hands with soap and water

      Explanation:

      Clostridium difficile (C. diff) can cause colitis, or inflammation of the colon. To prevent its spread, one should practice good hand hygiene, regularly clean areas of the home that may become contaminated with C. difficile, practice good hand hygiene, and clean surfaces, spills, and accidents.

    • This question is part of the following fields:

      • Microbiology
      • Principles
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  • Question 47 - A 12-year-old boy presents to you with a history of fever. A rash...

    Incorrect

    • A 12-year-old boy presents to you with a history of fever. A rash began as small red dots on the face, scalp, torso, upper arms and legs shortly afterwards and has now progressed to small blisters and pustules. You make a diagnosis of chickenpox.The following complications of chickenpox is the LEAST likely.

      Your Answer:

      Correct Answer: Bronchospasm

      Explanation:

      Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.Some recognized complications of chickenpox are:OrchitisHepatitisPneumoniaEncephalitisInfected spotsOtitis mediaMyocarditisGlomerulonephritisAppendicitisPancreatitis

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
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  • Question 48 - A diagnosis of acute osteomyelitis was made on a patient with a known...

    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:

      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
      0
      Seconds
  • Question 49 - A 23-year-old male is referred to your haematology clinic after an acute attack...

    Incorrect

    • A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago. Which ONE of the following options is FALSE with regards to this disorder?

      Your Answer:

      Correct Answer: Acute haemolysis can be triggered by cephalosporin antibiotics

      Explanation:

      Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.Triggers include: 1) Fava beans2) Sulphonamides3) Primaquine4) Anti-TB drugs5) Infections Most individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 50 - Nitrous oxide is associated with which of the following adverse effects: ...

    Incorrect

    • Nitrous oxide is associated with which of the following adverse effects:

      Your Answer:

      Correct Answer: Megaloblastic anaemia

      Explanation:

      Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
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  • Question 51 - At which opioid receptors do opioid analgesics act primarily? ...

    Incorrect

    • At which opioid receptors do opioid analgesics act primarily?

      Your Answer:

      Correct Answer: Mu

      Explanation:

      Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds
  • Question 52 - Arterial baroreceptors are located primarily in which of the following: ...

    Incorrect

    • Arterial baroreceptors are located primarily in which of the following:

      Your Answer:

      Correct Answer: Carotid sinus and aortic arch

      Explanation:

      Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds
  • Question 53 - Which of the following represents ventricular repolarisation on the ECG: ...

    Incorrect

    • Which of the following represents ventricular repolarisation on the ECG:

      Your Answer:

      Correct Answer: T wave

      Explanation:

      P wave = Atrial depolarisationQRS complex = Ventricular depolarisationT wave = Ventricular repolarisation

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds
  • Question 54 - Regarding local anaesthetics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding local anaesthetics, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Adrenaline should be used in digital nerve blocks to create a bloodless field.

      Explanation:

      It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in digits or appendages because of the risk of ischaemic necrosis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds
  • Question 55 - On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP...

    Incorrect

    • On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP reading of 152/96 mmHg (ABPM).Which of the following would be the patient's first-line drug treatment?

      Your Answer:

      Correct Answer: Ramipril

      Explanation:

      An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 48-year-old Afro-Caribbean man.An ACE inhibitor, such as ramipril, or a low-cost angiotensin-II receptor blocker (ARB), such as losartan, would be the most appropriate medication for a 48-year-old Caucasian man.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
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  • Question 56 - A patient presents to your Emergency Department with a laceration on their buttocks...

    Incorrect

    • A patient presents to your Emergency Department with a laceration on their buttocks requiring closure with sutures.What stage of wound healing is the first to reach completion?

      Your Answer:

      Correct Answer: Haemostasis

      Explanation:

      The stages of wound healing are: haemostasis, inflammatory, proliferative and remodelling (maturation) phases in that order. The first stage in the healing process of a laceration is haemostasis. Haemostasis is the process of the wound being closed by clotting. The inflammatory phase occurs just after and up to 48 hours after injury– Blood vessels dilate to allow white blood cells, antibodies, growth factors, enzymes and nutrients to reach the wounded area leading to the characteristic signs of inflammation seen. Epithelialisation and angiogenesis are not phases of wound healing but occur during the proliferative phase. This ia after haemolysis and inflammation phases have occurred.The maturation phase is the final phase and occurs when the wound has closed. It involves remodelling of collagen from type III to type I. Apoptosis remove unwanted cells, cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases. This can continues for up to 1 year after injury.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
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  • Question 57 - A patient with a diagnosis of HIV presents with a fever, sore throat,...

    Incorrect

    • A patient with a diagnosis of HIV presents with a fever, sore throat, and general malaise and you are concerned the patient may have an AIDS defining illness.Which one of these, according to the CDC definition, would mean a patient infected with HIV has AIDS?

      Your Answer:

      Correct Answer: CD4 T-cell percentage of total lymphocytes of less than 15%

      Explanation:

      According to the CDC definition, a patient co-infected with HIV can be diagnosed with AIDS if he or she has:A CD4 T-cell count of less than 200 cells/mm3 or;A CD4 T-cell percentage of total lymphocytes of less than 15% or;An AIDS defining infectionA Streptococcal throat infection is not an AIDS defining infection.A normal CD4 count ranges from 500-1000 cells/mm3. A CD4 (not CD8) count of less than 200 cells/mm3 is AIDS defining.The CD4 count can vary from day to day and depending upon the time that the blood test is taken. It can also be affected by the presence of other infections or illnesses. Treatment with anti-retroviral therapy should be considered at CD4 count of less than 350 cells/mm3.Serum concentrations of the p24 antigen (the viral protein that makes up most of the core of the HIV) are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds
  • Question 58 - A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening...

    Incorrect

    • A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that she has a full, plethoric aspect to her face, as well as significant supraclavicular fat pads, when you examine her. She has previously been diagnosed with Cushing's syndrome.Which of the following biochemical profiles best supports this diagnosis?

      Your Answer:

      Correct Answer: Hypokalaemic metabolic alkalosis

      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. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.A typical biochemical profile can help establish a diagnosis of Cushing’s syndrome. The following are the primary characteristics:HypokalaemiaAlkalosis metabolique

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 59 - Captopril should not be used if you have any of the following conditions:...

    Incorrect

    • Captopril should not be used if you have any of the following conditions:

      Your Answer:

      Correct Answer: Renal artery stenosis

      Explanation:

      Contraindications indications of Captopril include:- Bilateral renal artery stenosis- Hypersensitivity to ACE inhibitors- Anuria- History of ACEI-induced angioedema- Hereditary or idiopathic angioedema- Co-administration of Neprilysin inhibitors (e.g., sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan.If ACE inhibitors are used, they should be initiated only under specialist supervision and renal function should be monitored regularly. ACE inhibitors should also be used with particular caution in patients who may have undiagnosed and clinically silent renovascular disease. This includes patients with peripheral vascular disease or those with severe generalised atherosclerosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 60 - Thiopental sodium is contraindicated in which of the following: ...

    Incorrect

    • Thiopental sodium is contraindicated in which of the following:

      Your Answer:

      Correct Answer: Acute intermittent porphyrias

      Explanation:

      Barbiturates induce hepatic enzymes. The enzyme gamma aminolevulinic acid synthetase, which produces porphyrins, can be induced and in susceptible patients an attack of acute intermittent porphyria can occur. Thiopental is absolutely contraindicated in these patients.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 61 - A 54-year-old man with a long history of poorly controlled hypertension complains of...

    Incorrect

    • A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.Which of the following is the patient's preferred drug treatment?

      Your Answer:

      Correct Answer: 25% of the mean arterial pressure over the first hour

      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.Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 62 - A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon...

    Incorrect

    • A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon observation and examination, it was noted that he is febrile and Kernig's sign is positive. A diagnosis of meningitis was suspected and a lumbar puncture was to be performed.Which of the following statements regarding meningitis is true?

      Your Answer:

      Correct Answer: The dura mater is the outermost layer

      Explanation:

      Meningitis is defined as the inflammation of the meninges due to an infection caused by a bacteria or a virus. Symptoms usually include stiffness of the neck, headache, and fever. There are 3 meningeal layers that surround the spinal cord and they are the dura mater, arachnoid matter, and pia mater. The dura mater is the outermost and thickest layer out of all the 3 layers. The arachnoid atter is the middle layer, and is very thin.The third and deepest meningeal layer is the pia mater that is bound tightly to the surface of the spinal cord.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 63 - Regarding the UK routine childhood immunisation schedule which of the following vaccines is...

    Incorrect

    • Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 12 months:

      Your Answer:

      Correct Answer: Polio

      Explanation:

      At 12 months the following vaccines are given:Hib (4th dose) and Meningococcal group CPneumococcal (13 serotypes) (2nd dose)Measles, mumps and rubellaMeningococcal group B (3rd dose)

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
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  • Question 64 - Bordetella pertussis is spread via which of the following routes: ...

    Incorrect

    • Bordetella pertussis is spread via which of the following routes:

      Your Answer:

      Correct Answer: Respiratory droplet route

      Explanation:

      Bordetella pertussis is a Gram negative coccobacillus that causes whooping cough. B. pertussis is spread via the respiratory droplet route and expresses fimbriae that aid their adhesion to the ciliated epithelium of the upper respiratory tract, and produce a number of exotoxins, causing the characteristic thickened bronchial secretions, paralysis of cilia and lymphocytosis.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
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  • Question 65 - Campylobacter jejuni is primarily spread via which of the following routes: ...

    Incorrect

    • Campylobacter jejuni is primarily spread via which of the following routes:

      Your Answer:

      Correct Answer: Faecal-oral route

      Explanation:

      Campylobacter spp. are a common cause of acute infective gastroenteritis, particularly in children, with Campylobacter jejuni responsible for 90% of Campylobacter gastroenteritis. Infection typically follows ingestion of contaminated meat (most frequently undercooked poultry), unpasteurised milk or contaminated water, following which the microorganism invades and colonises the mucosa of the small intestine.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 66 - Typically, granulomatous inflammation is associated with one of the following infections: ...

    Incorrect

    • Typically, granulomatous inflammation is associated with one of the following infections:

      Your Answer:

      Correct Answer: Tuberculosis

      Explanation:

      Granulomatous inflammation is typically seen when an infective agent with a digestion-resistance capsule (e.g. Mycobacterium tuberculosis) or a piece of inert foreign material (such as suture or glass) is introduced into the tissue. A transient acute inflammatory response occurs and when this is ineffective in eradicating the stimulus, chronic inflammation occurs.Tuberculosis is the prototype of the granulomatous diseases, but sarcoidosis, cat-scratch disease, lymphogranuloma inguinale, leprosy, brucellosis, syphilis, some mycotic infections, berylliosis, reactions of irritant lipids, and some autoimmune diseases are also included

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
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  • Question 67 - Tiredness, night sweats, and easy bruising are symptoms of a 58-year-old woman. Splenomegaly...

    Incorrect

    • Tiredness, night sweats, and easy bruising are symptoms of a 58-year-old woman. Splenomegaly is observed during the examination.Which of the following diagnoses is the SINGLE MOST LIKELY?

      Your Answer:

      Correct Answer: Chronic myeloid leukaemia (CML)

      Explanation:

      CML is a myeloproliferative disorder characterised by an abnormal pluripotent haemopoietic stem cell. A cytogenetic abnormality known as the Philadelphia chromosome, which results from a reciprocal translocation between the long arms of chromosomes 9 and 22, causes more than 80% of cases of CML.CML is a disease that develops slowly over several years. This is known as the ‘chronic stage.’ This stage is usually asymptomatic, and 90 percent of patients are diagnosed at this point, with the disease being discovered frequently as a result of a routine blood test. During this stage, the bone marrow contains less than 10% immature white cells (blasts).When CML cells expand, symptoms typically begin to appear. The ‘accelerated stage’ is what it’s called. Approximately 10% of people are diagnosed at this point. During this stage, between 10% and 30% of blood cells in the bone marrow are blasts. During this stage, common clinical features include:Fatigue and exhaustionNight sweats and feverDistension of the abdomenPain in the left upper quadrant (splenic infarction)Splenomegaly (commonest examination finding)HepatomegalyBruising is simple.Gout is a type of arthritis that affects (rapid cell turnover)Hyperviscosity is a condition in which the viscosity of (CVA, priapism)A small percentage of patients experience a ‘blast crisis’ (blast stage). More than 30% of the blood cells in the bone marrow are immature blast cells at this stage. Patients with severe constitutional symptoms (fever, weight loss, bone pain), infections, and bleeding diathesis typically present at this stage.In CML, laboratory findings include:White cell count is abnormally high (often greater than 100 x 109/l).Increased number of immature leukocytes causes a left shift.Anaemia that is mild to moderately normochromic and normocytic.Platelets can be low, normal, or elevated, and the Philadelphia chromosome can be found in > 80% of patients. Serum uric acid and ALP levels are frequently elevated. Tyrosine kinase inhibitors (TKIs), such as imatinib and dasatinib, are the current mainstay of CML treatment. Allogenic bone marrow transplantation is now only used in cases where TKIs have failed to work.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 68 - Which of the following statements is correct with regards to natural killer cells?...

    Incorrect

    • Which of the following statements is correct with regards to natural killer cells?

      Your Answer:

      Correct Answer: They are part of the innate immune system.

      Explanation:

      Natural Killer (NK) Cells are lymphocytes in the same family as T and B cells, which come from a common progenitor. They are cytotoxic CD8 positive cells that do not have the T-cell receptor. They are very big cells with cytoplasmic granules and are designed to kill target cells with a low level of expression of HLA class I molecules. Examples include during a viral infection or on a malignant cell. NK cells display several receptors for HLA molecules on their surface, and when HLA is expressed on the target cell, these deliver an inhibitory signal into the NK cell. Absent HLA molecules on the target cell cause this inhibitory signal to get lost and as a result, the NK cell can then kill its target. Also, NK cells display antibody-dependent cell-mediated cytotoxicity, where antibody binds to antigen on the surface of the target cell. The NK cells then bind to the Fc portion of the bound antibody and kill the target cell.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 69 - You review a 37-year-old man with a history of intravenous drug abuse who...

    Incorrect

    • You review a 37-year-old man with a history of intravenous drug abuse who admits to sharing needles in the past. He has a flu-like illness and a rash. Concerned he may be experiencing an HIV seroconversion illness, you order a test.Which of these tests is most reliably used to diagnose HIV at this stage?

      Your Answer:

      Correct Answer: p24 antigen test

      Explanation:

      Serum concentrations of the p24 antigen are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection. P24 is the viral protein that makes up most of the core of the HIV.ELISA and other antibody tests, though a very sensitive way of detecting the presence of HIV, cannot be used in the early stages of the disease. This is because of the window period of 6-12 weeks before antibodies are produced. These tests will be negative during a seroconversion illness.The ‘rapid HIV test’ is an HIV antibody test. It will also be negative during the ‘window period’ since it takes time for antibodies to be produced. It is called the ‘rapid test’ as it can detect antibodies in blood or saliva much quicker than the other antibody tests and results are often back within 20 minutes.CD4 and CD8 counts are usually normal in the early stages of the HIV infection and cannot be used in this case.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 70 - The renin-angiotensin-aldosterone system (RAAS) controls blood pressure and fluid balance.Which of the following...

    Incorrect

    • The renin-angiotensin-aldosterone system (RAAS) controls blood pressure and fluid balance.Which of the following sites produces the most angiotensinogen? 

      Your Answer:

      Correct Answer: The liver

      Explanation:

      Angiotensinogen is an alpha-2-globulin generated predominantly by the liver and released into the blood. Renin, which cleaves the peptide link between the leucine and valine residues on angiotensinogen, converts it to angiotensin I.Angiotensinogen levels in the blood are raised by:Corticosteroid levels have risen.Thyroid hormone levels have risen.Oestrogen levels have risen.Angiotensin II levels have risen.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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  • Question 71 - The extensor digitorum longus is supplied by which nerve? ...

    Incorrect

    • The extensor digitorum longus is supplied by which nerve?

      Your Answer:

      Correct Answer: Deep peroneal nerve

      Explanation:

      The extensor digitorum longus is innervated by the deep fibular nerve (L5, S1), a branch of the common fibular nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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  • Question 72 - The enzyme protein gastric lipase is responsible for the breakdown of lipids in...

    Incorrect

    • The enzyme protein gastric lipase is responsible for the breakdown of lipids in the stomach.Which of the following cell types secretes gastric lipase? 

      Your Answer:

      Correct Answer: Chief cells

      Explanation:

      Gastric lipase, commonly known as LIPF, is an acidic lipase released by gastric chief cells, which are found deep within the stomach lining’s mucosal layer. It’s an enzymatic protein that’s in charge of fat digestion in the stomach.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
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  • Question 73 - Funnel plots are typically used to display: ...

    Incorrect

    • Funnel plots are typically used to display:

      Your Answer:

      Correct Answer: The existence of publication bias in meta-analysis

      Explanation:

      Funnel plots are used to demonstrate the existence of publication bias in meta-analysis. Funnel plots are scatter plots of treatment effects estimated from individual studies on the x axis and some measure of study size on the y axis. Each point on the graph represents one of the studies. A symmetrical inverted funnel shape indicates an absence of publication bias. If there is publication bias, there will be asymmetry of the open wide end due to the absence of small negative results.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
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  • Question 74 - A 57-year old man presented himself to the emergency room with persistent cough....

    Incorrect

    • A 57-year old man presented himself to the emergency room with persistent cough. During history taking, a record of his previous sputum sample was seen and the report stated that it tested positive for AFB (acid-fast bacilli). What is the most likely pathogen?

      Your Answer:

      Correct Answer: Mycobacterium tuberculosis

      Explanation:

      M. tuberculosis is the causative agent of pulmonary tuberculosis (TB). The most commonly used diagnostic test for the diagnosis of pulmonary TB is the direct sputum smear microscopy (DSSM) wherein the presence of acid-fast bacilli (AFB) is tested. The most common method is the hot method or also known as Ziehl-Neelsen method. This is a staining method special for Mycobacteria species because they are known to be acid-fast which means that they are not easily decolorized by acid alcohol. Once the DSSM tests positive for acid-fast bacilli, this indicates possible infection with tuberculosis. The gold standard for diagnosis is still culture but Mycobacteria species are slow-growers that is why DSSM is considered the best diagnostic method. A positive AFB smear and correlation with symptoms is usually used by physicians to create a final diagnosis of pulmonary tuberculosis.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 75 - A 27-year-old man was sent to the emergency department by ambulance with suspected...

    Incorrect

    • A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?

      Your Answer:

      Correct Answer: 500 micrograms of adrenaline intramuscularly

      Explanation:

      Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils. If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution). In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh. Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 76 - A 40-year-old male visits his family physician with the complaint of a high-grade...

    Incorrect

    • A 40-year-old male visits his family physician with the complaint of a high-grade fever for the past five days. A complete blood count report shows the presence of neutrophilia. Which one of the following facts regarding neutrophilia is accurate?

      Your Answer:

      Correct Answer: It can be caused by eclampsia

      Explanation:

      A total neutrophil count of greater than 7.5 x 109/L is called neutrophilia. Typhoid fever usually causes leukopenia or neutropenia. Both localised and generalised bacterial infections can cause neutrophilia. Metabolic disorders such as – gout- eclampsia- uraemia can also cause neutrophilia. Acute neutrophilia, in which immature neutrophils can be seen, is referred to as a left shift and can be seen in conditions such as appendicitis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 77 - Regarding defaecation, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding defaecation, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Colonic mass movement occurs shortly after a meal due to distension of the stomach and duodenum.

      Explanation:

      Colonic mass movement describes the intense contraction that begins halfway along the transverse colon and pushes the intestinal contents in the proximal colon towards the rectum. It occurs shortly after a meal due to distension of the stomach and duodenum as part of the gastrocolic reflex and if faeces is present in the rectum, stimulates the urge to defecate. Distention of the rectum causes firing of afferent cholinergic parasympathetic fibres. The internal sphincter is made up of circular smooth muscle innervated by the autonomic fibres, and the more distal external sphincter is composed of striated muscle innervated by motor fibres from the pudendal nerve. During defaecation, relaxation of pelvic muscles straightens the rectum.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 78 - The fracture of the medial epicondyle will cause damage to the ulnar nerve....

    Incorrect

    • The fracture of the medial epicondyle will cause damage to the ulnar nerve. Which of the following motions would be impaired by this type of injury?

      Your Answer:

      Correct Answer: Adduction of the thumb

      Explanation:

      Fracture of the medial epicondyle is most likely to result in damage to the ulnar nerve. The three hypothenar muscles, two medial lumbricals, seven interossei, the adductor pollicis, and the deep head of the flexor pollicis brevis are all innervated by the deep branch of the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 79 - A 63 year old lady presents to ED with a persistent cough and...

    Incorrect

    • A 63 year old lady presents to ED with a persistent cough and red currant jelly sputum. She has a history of chronic alcohol abuse and has an X-ray which demonstrates a cavitating pneumonia. The most likely causative pathogen is:

      Your Answer:

      Correct Answer: Klebsiella pneumoniae

      Explanation:

      One of the results of Klebsiella pneumoniae is pneumonia that is usually a very severe infection. It is characterised by thick, bloody sputum (red currant jelly sputum), and is associated with complications like lung abscess, cavitation, necrosis, empyema and pleural effusions.

    • This question is part of the following fields:

      • Infections
      • Microbiology
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  • Question 80 - Compliance is greater in all but which one of the following: ...

    Incorrect

    • Compliance is greater in all but which one of the following:

      Your Answer:

      Correct Answer: Pulmonary oedema

      Explanation:

      Compliance changes at different lung volumes. Initially at lower lung volumes the compliance of the lung is poor and greater pressure change is required to cause a change in volume. This occurs if the lungs become collapsed for a period of time. At functional residual capacity (FRC) compliance is optimal since the elastic recoil of the lung tending towards collapse is balanced by the tendency of the chest wall to spring outwards. At higher lung volumes the compliance of the lung again becomes less as the lung becomes stiffer. At all volumes, the base of the lung has a greater compliance than the apex. Patients with emphysema have increased compliance. Compliance is affected by a person’s age, sex and height.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 81 - Regarding forest plots, which of the following is the purpose of this graph?...

    Incorrect

    • Regarding forest plots, which of the following is the purpose of this graph?

      Your Answer:

      Correct Answer: To graphically display the relative strength of multiple studies attempting to answer the same question

      Explanation:

      The results of meta-analysis are often displayed graphically in a forest plot. A properly constructed forest plot is the most effective way to graphically display the relative strength of multiple studies attempting to answer the same question. A typical meta-analysis consists of three main objectives that include estimation of effect sizes from individual studies and a pooled summary estimate with their confidence intervals (CIs), heterogeneity among the studies, and any publication bias. The forest plot illustrates the first two of these objectives. Forest plots visualize the effect measure and CI of individual studies, which provide the raw data for the meta-analysis, as well the pooled-effect measure and CI. The individual studies also can be grouped in the forest plot by some of their characteristics for ease of interpretation such as by study size or year of publication. When comparing the outcomes between an intervention and a control group, dichotomous outcome variables are expressed as ratios (i.e. odds ratios, ORs or risk ratios, RRs), while for continuous outcomes, a weighted mean difference is reported.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 82 - You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble...

    Incorrect

    • You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble breathing after eating peanuts. Which of the following diagnostic tests will confirm this?

      Your Answer:

      Correct Answer: Mast cell tryptase

      Explanation:

      The concentration of serum tryptase rises in anaphylaxis and anaphylactoid responses. Because tryptase is a significant component of mast cell granules, mast cell degranulation causes elevated tryptase levels in the blood. Although tryptase levels are not always high during anaphylaxis, it is considered a particular marker.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 83 - Regarding red blood cell group antigens and antibodies, which of the following statements...

    Incorrect

    • Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Anti-D antibodies are usually IgG.

      Explanation:

      Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 84 - A 16-year old boy is brought to the emergency room after suffering a...

    Incorrect

    • A 16-year old boy is brought to the emergency room after suffering a traffic accident. Upon examination, there is noted ipsilateral loss of proprioception and vibration, ipsilateral motor loss, and contralateral loss of pain and temperature sensation. A spinal cord injury is given as a diagnosis.Which of the following is the most probable cause of this manifestation?

      Your Answer:

      Correct Answer: Brown-Séquard syndrome

      Explanation:

      Brown-Sequard Hemicord Syndrome consists of ipsilateral weakness (corticospinal tract) and loss of joint position and vibratory sense (posterior column), with contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex, are unilateral. Partial forms are more common than the fully developed syndrome.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 85 - All of the following statements are incorrect about insulin except: ...

    Incorrect

    • All of the following statements are incorrect about insulin except:

      Your Answer:

      Correct Answer: Proinsulin is cleaved into insulin and C peptide.

      Explanation:

      Proinsulin is synthesised as a single-chain peptide. A connecting peptide (C peptide) within storage granules is removed by proteases to yield insulin. Insulin:1. is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds. 2. is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas. 3. release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin. However, most output is driven by the rise in plasma glucose concentration that occurs after a meal. 4. effects are mediated by the receptor tyrosine kinase.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 86 - A 52-year-old man develops pneumonia 3 days following an admission for investigation of...

    Incorrect

    • A 52-year-old man develops pneumonia 3 days following an admission for investigation of chest pain. He has coarse left basal crackles and evidence of consolidation in the left lower lobe of chest X-ray. He has no known drug allergies.According to the latest NICE guidelines, which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.

      Your Answer:

      Correct Answer: Co-amoxiclav

      Explanation:

      Nosocomial infections are defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital. Annually, this results in 5000 deaths with a cost to the National Health Service of a billion pounds. On average, a patient with hospital acquired infection spent 2.5-times longer in hospital, incurring additional costs of £3000 more than an uninfected patient. Intensive care units (ICU) have the highest prevalence of hospital-acquired infections in the hospital setting.The current recommendations by NICE and the BNF on the treatment of hospital acquired pneumonia are:Early onset infection(less than 5 days after admission to hospital): co-amoxiclav or cefuroxime for 7 daysLate-onset infection(more than 5 days after admission to hospital): an antipseudomonal penicillin (e.g. piperacillin with tazobactam), a broad-spectrum cephalosporin (e.g. ceftazidime), or a quinolone (e.g. ciprofloxacin)If the patient developed a hospital-acquired pneumonia within 5 days of admission – co-amoxiclav would be the most appropriate choice.If the patient has developed a hospital-acquired pneumonia > 5 days after admission – ciprofloxacin would be the most appropriate choice from the list of options available.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
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  • Question 87 - Haemoptysis, weight loss, and night sweats are symptoms of a patient. You believe...

    Incorrect

    • Haemoptysis, weight loss, and night sweats are symptoms of a patient. You believe you've been diagnosed with tuberculosis. He works at an asylum seeker hostel, but due to a contraindication, he did not receive a BCG vaccination when he first started there.Which of the following patient groups would the BCG vaccine be safe to administer?

      Your Answer:

      Correct Answer: The patient is asplenic

      Explanation:

      In patients with asplenia, all vaccines, whether live or inactivated, are recommended.Anaphylaxis following any vaccination is a contraindication to receiving that vaccine again.The BCG vaccine is a live vaccine. The following situations are generally contraindicated for live vaccinations:PregnancyHIV infection can be asymptomatic or symptomatic.If it’s been less than three weeks since the last live vaccine (although two live vaccinations can be given together at different sites of the body)Other illnesses that wreak havoc on the immune systemMalignancies of the blood

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
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  • Question 88 - Which of the following is NOT a typical electrolyte disturbance caused by furosemide:...

    Incorrect

    • Which of the following is NOT a typical electrolyte disturbance caused by furosemide:

      Your Answer:

      Correct Answer: Hypercalcaemia

      Explanation:

      Adverse effects of loop diuretics include:Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathyHyperglycaemiaAcute urinary retentionWater and electrolyte imbalanceHyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolismMetabolic alkalosisHyperuricaemiaBlood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)Visual disturbance, tinnitus and deafnessHypersensitivity reactions

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 89 - Regarding apoptosis, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding apoptosis, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.

      Explanation:

      Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
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      Seconds
  • Question 90 - You examine a 73-year-old patient who is experiencing a worsening of his chronic...

    Incorrect

    • You examine a 73-year-old patient who is experiencing a worsening of his chronic heart failure. Bumetanide was recently prescribed for him.Which of the following statements about bumetanide is correct?

      Your Answer:

      Correct Answer: It has better intestinal absorption than furosemide

      Explanation:

      Bumetanide is a loop diuretic that inhibits sodium, chloride, and potassium reabsorption by acting on the Na.K.2Cl co-transporter in the ascending loop of Henlé. This reduces the osmotic gradient that forces water out of the collecting duct system and prevents the formation of a hypertonic renal medulla. This has a strong diuretic effect on the body.It’s primarily used in patients with heart failure who aren’t responding to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency.In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. Bumetanide is 40 times more potent than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide.Bumetanide also lowers the concentration of neuronal chloride, making GABA’s action more depolarizing. In the neonatal period, it is being studied as an antiepileptic.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 91 - The renal team is currently prescribing erythropoietin to a patient with chronic kidney...

    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:

      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
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  • Question 92 - Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: In relaxation, Ca 2+ is transported out of the cell using energy from a Na + gradient.

      Explanation:

      During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane which pumps one Ca2+ion out in exchange for three Na+ions in, using the Na+electrochemical gradient as an energy source. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Factors that affect intracellular [Ca2+] and hence cardiac contractility are called inotropes.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 93 - A 70-year old male is taken to the Emergency Room after suffering a...

    Incorrect

    • A 70-year old male is taken to the Emergency Room after suffering a traumatic fall while showering. Upon physical examination, the attending physician noted a hyperextended neck, 1/5 muscle strength in both upper extremities, 4/5 muscle strength in both lower extremities, and variable loss in sensation. The patient is placed in the wards for monitoring. For the next 24 hours, anuria is noted.Which of the following spinal cord injuries is the most likely diagnosis?

      Your Answer:

      Correct Answer: Central cord syndrome

      Explanation:

      Central cord syndrome is the most common type of incomplete cord injury and almost always occurs due to a traumatic injury. It results in motor deficits that are worse in the upper extremities as compared to the lower extremities. It may also cause bladder dysfunction (retention) and variable sensory deficits below the level of injury.The majority of these patients will be older and present with symptoms after a fall with hyperextension of their neck. On examination, patients will have more significant strength impairments in the upper extremities (especially the hands) compared to the lower extremities. Patients often complain of sensory deficits below the level of injury, but this is variable. Pain and temperature sensations are typically affected, but the sensation of light touch can also be impaired. The most common sensory deficits are in a cape-like distribution across their upper back and down their posterior upper extremities. They will often have neck pain at the site of spinal cord impingement.Bladder dysfunction (most commonly urinary retention) and priapism can also be signs of upper motor neuron dysfunction. The sacral sensation is usually preserved, but the clinician should assess the rectal tone to evaluate the severity of the compression.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 94 - Regarding cortical areas, which one is found in the posterior part of the...

    Incorrect

    • Regarding cortical areas, which one is found in the posterior part of the inferior frontal gyrus?

      Your Answer:

      Correct Answer: Broca’s area

      Explanation:

      Broca’s area is involved in the expressive aspects of spoken and written language (production of sentences constrained by the rules of grammar and syntax). It corresponds to the opercular and triangular parts of the inferior frontal gyrus (BA 44 and 45). These areas are defined by two rami (branches) of the lateral sulcus (one ascending, one horizontal) which ‘slice into’ the inferior frontal gyrus. In keeping with its role in speech and language, Broca’s area is immediately anterior to the motor and premotor representations of the face, tongue and larynx. A homologous area in the opposite hemisphere is involved in non-verbal communication such as facial expression, gesticulation and modulation of the rate, rhythm and intonation of speech.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 95 - Regarding hypernatraemia, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding hypernatraemia, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: In acute severe hypernatraemia, seizures and intracranial vascular haemorrhage can occur as a result of brain cell lysis.

      Explanation:

      Acute severe hypernatraemia is a medical emergency and requires inpatient management in a high dependency setting. Seizures and intracranial vascular haemorrhage as a result of brain cell crenation can occur. The cause is most commonly excessive water loss and the key aspect of treatment is aggressive fluid replacement (typically with normal saline as this is relatively hypotonic). If urine osmolality is low, diabetes insipidus (DI )should be considered and a trial of synthetic ADH given. In patients with known DI, it is essential to ensure synthetic ADH is given parenterally and that close fluid balance is observed.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 96 - The most common source of healthcare-associated bacteraemia is: ...

    Incorrect

    • The most common source of healthcare-associated bacteraemia is:

      Your Answer:

      Correct Answer: Intravenous cannula

      Explanation:

      Healthcare-associated bacteraemia is most commonly caused by intravenous access. Any intravenous device that is left in place for a long time increases the risk of infection. It allows bacteria like Staphylococcus aureus and Staphylococcus epidermidis to enter the body.

    • This question is part of the following fields:

      • Microbiology
      • Principles
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  • Question 97 - Which of the following pathogens is the common cause of diarrhoea in a...

    Incorrect

    • Which of the following pathogens is the common cause of diarrhoea in a patient who has had a prolonged course of a broad spectrum of antibiotics?

      Your Answer:

      Correct Answer: Clostridium difficile

      Explanation:

      Clostridium difficile is the most likely cause of diarrhoea after a long course of broad-spectrum antibiotic treatment. Clostridium difficile-associated diarrhoea appeared to be linked to an increase in the usage of third-generation cephalosporins.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 98 - Digoxin is contraindicated in all of the following EXCEPT for: ...

    Incorrect

    • Digoxin is contraindicated in all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Asthma

      Explanation:

      Digoxin is contraindicated in:Supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndromeVentricular tachycardia or fibrillationHeart conduction problems e.g. second degree or intermittent complete heart blockHypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure but should be used with caution)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 99 - Digoxin is predominantly used for which of the following: ...

    Incorrect

    • Digoxin is predominantly used for which of the following:

      Your Answer:

      Correct Answer: Rate control in persistent and permanent atrial fibrillation

      Explanation:

      Digoxin is most useful for controlling the ventricular response in persistent and permanent atrial fibrillation and atrial flutter. Digoxin is usually only effective for controlling the ventricular rate at rest, and should therefore only be used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation. It is now rarely used for rapid control of heart rate, as even with intravenous administration, response may take many hours. Digoxin is reserved for patients with worsening or severe heart failure due to left ventricular systolic dysfunction refractory to combination therapy with first-line agents. Digoxin is contraindicated in supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 100 - Which of the following factors decreases insulin secretion: ...

    Incorrect

    • Which of the following factors decreases insulin secretion:

      Your Answer:

      Correct Answer: Catecholamines

      Explanation:

      Factors that increase insulin secretion:↑ Blood glucose↑ Amino acids↑ Fatty acidsGlucagonSecretinAcetylcholineFactors that decrease insulin secretion:↓ Blood glucoseSomatostatinCatecholamines

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 101 - Where is angiotensin I primarily converted to angiotensin II: ...

    Incorrect

    • Where is angiotensin I primarily converted to angiotensin II:

      Your Answer:

      Correct Answer: Lungs

      Explanation:

      Angiotensin I is converted to angiotensin II by the removal of two C-terminal residues by the enzyme angiotensin-converting enzyme (ACE). This primarily occurs in the lungs, although it does also occur to a lesser degree in endothelial cells and renal epithelial cells.The main actions of angiotensin II are:Vasoconstriction of vascular smooth muscle (resulting in increased blood pressure)Vasoconstriction of the efferent arteriole of the glomerulus (resulting in an increased filtration fraction and preserved glomerular filtration rate)Stimulation of aldosterone release from the zona glomerulosa of the adrenal cortexStimulation of anti-diuretic hormone (vasopressin) release from the posterior pituitaryStimulation of thirst via the hypothalamusActs on the Na+/H+ exchanger in the proximal tubule of the kidney to stimulate Na+reabsorption and H+excretion

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 102 - Mannitol is primarily indicated for which of the following: ...

    Incorrect

    • Mannitol is primarily indicated for which of the following:

      Your Answer:

      Correct Answer: Cerebral oedema

      Explanation:

      Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. Mannitol is a low molecular weight compound and is, therefore, freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain-barrier (BBB).

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 103 - Regarding cytotoxic T cells, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cytotoxic T cells, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: They kill target cells by inducing cell apoptosis.

      Explanation:

      CD8+ T-cells (Cytotoxic T cells)Recognise antigen only in association with HLA Class I molecules (found on all nucleated cells; present endogenous antigens such as those found in cells infected by viruses or intracellular bacteria.)Comprise about 25% of peripheral T-cellsResponsible for cytotoxic killing of target cells

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 104 - On which of the following is preload primarily dependent? ...

    Incorrect

    • On which of the following is preload primarily dependent?

      Your Answer:

      Correct 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 105 - A 55-year-old woman with history of gastritis and reflux esophagitis tested positive for...

    Incorrect

    • A 55-year-old woman with history of gastritis and reflux esophagitis tested positive for Helicobacter pylori infection. Which of the following statements regarding Helicobacter pylori is considered true?

      Your Answer:

      Correct Answer: It is helix shaped

      Explanation:

      Helicobacter pylori is a curved or helix-shaped, non-spore forming, Gram-negative, microaerophilic bacteria. It is motile, having multiple flagella at one pole. It has a lipopolysaccharide component in its outer membrane.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 106 - You review a sick patient in resus who has been prescribed mannitol as...

    Incorrect

    • You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.Which SINGLE statement regarding mannitol is true?

      Your Answer:

      Correct Answer: It is irritant to veins and causes phlebitis

      Explanation:

      Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:Decreasing the rate of CSF formation,and;Withdrawing extracellular fluid from the brain across the BBBOther uses of mannitol include:Short-term management of glaucomaTreatment of rhabdomyolysisPreserve renal function in peri-operative jaundiced patientsTo initiate diuresis in transplanted kidneysBowel preparation prior to colorectal proceduresThe recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:AnuriaIntracranial bleeding (except during craniotomy)Severe cardiac failureSevere dehydrationSevere pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 107 - Which of the following clotting factors is NOT vitamin K-dependent: ...

    Incorrect

    • Which of the following clotting factors is NOT vitamin K-dependent:

      Your Answer:

      Correct Answer: V

      Explanation:

      Fat-soluble vitamin K is obtained from green vegetables and bacterial synthesis in the gut. Deficiency may present in the newborn (haemorrhagic disease of the newborn) or in later life. Deficiency may be caused by an inadequate diet, malabsorption or inhibition of vitamin K by drugs such as warfarin. The activity of factors II, VII, IX and X are vitamin K dependent as well as that of protein C and protein S. Both PT and APTT are prolonged.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 108 - A 40-year-old woman presents with retrosternal central chest pain that she has been...

    Incorrect

    • A 40-year-old woman presents with retrosternal central chest pain that she has been complaining about for the past two days. Upon deep inspiration and while lying flat, the pain worsens but relieved by sitting forwards. The pain radiates to both of her shoulders. The result of her ECG shows widespread concave ST-elevation and PR depression. A diagnosis of pericarditis is suspected. Which of the following nerves is responsible for the pattern of her pain?

      Your Answer:

      Correct Answer: Phrenic nerve

      Explanation:

      Pericarditis is inflammation of the pericardial sac and is the most common pathologic process involving the pericardium. Frequently, pericardial inflammation can be accompanied by increased fluid accumulation within the pericardial sac forming a pericardial effusion, which may be serous, hemorrhagic or purulent depending on aetiology.The classic presentation is with chest pain that is central, severe, pleuritic (worse on deep inspiration) and positional (improved by sitting up and leaning forward). The pain may also be radiating and may involve the ridges of the trapezius muscle if the phrenic nerve is inflamed as it traverses the pericardium.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 109 - A 26 year old male presents to emergency room with a 2 day...

    Incorrect

    • A 26 year old male presents to emergency room with a 2 day history of burning pain when passing urine, accompanied by a green urethral discharge. Gonorrhoea is suspected. The first line antibiotic for this condition is which of the following?

      Your Answer:

      Correct Answer: Ceftriaxone

      Explanation:

      When there is a high suspicion of gonorrhoea from clinical features, empiric treatment should be commenced whilst waiting for laboratory confirmation. The first line treatment for uncomplicated anogenital and pharyngeal disease includes ceftriaxone 500 mg IM (single dose) + azithromycin 1 g orally as a single dose. This covers concomitant chlamydia infection. For all people who have been treated for gonorrhoea, a test of cure is recommended

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 110 - The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the...

    Incorrect

    • The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the postsynaptic cell responds to the neurotransmitter.Which of the following enzymes catalyses the breakdown of noradrenaline?

      Your Answer:

      Correct Answer: Catechol-O-methyltransferase (COMT)

      Explanation:

      The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the post-synaptic cell responds to the neurotransmitter. This can be accomplished in a variety of ways:Re-uptakeBreakdownDiffusionSerotonin is an example of a neurotransmitter that is uptake. Serotonin is absorbed back into the presynaptic neuron via the serotonin transporter (SERT), which is found in the presynaptic membrane. Re-uptake neurotransmitters are either recycled by repackaging into vesicles or broken down by enzymes.Specific enzymes found in the synaptic cleft can also break down neurotransmitters. The following enzymes are examples of these enzymes:Acetylcholinesterase (AChE) catalyses the acetylcholine breakdown (ACh)The enzyme catechol-O-methyltransferase (COMT) catalyses the breakdown of catecholamines like adrenaline , dopamine and noradrenaline. The breakdown of catecholamines, as well as other monoamines like serotonin, tyramine, and tryptamine, is catalysed by monoamine oxidases (MOA).Diffusion of neurotransmitters into nearby locations can also be used to eliminate them.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 111 - Which of the following intravenous induction drugs results in the highest drop in...

    Incorrect

    • Which of the following intravenous induction drugs results in the highest drop in blood pressure:

      Your Answer:

      Correct Answer: Propofol

      Explanation:

      Propofol’s most frequent side effect is hypotension, which affects 17% of paediatric patients and 26% of adults. This is attributable to systemic vasodilation as well as a decrease in preload and afterload. Propofol has a little negative inotropic impact as well. The drop in blood pressure is dosage-dependent and is more noticeable in the elderly, thus this should be expected.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 112 - Which of the following is true regarding respiration? ...

    Incorrect

    • Which of the following is true regarding respiration?

      Your Answer:

      Correct Answer: The diaphragm is responsible for abdominal breathing

      Explanation:

      The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 113 - Which of the following conditions manifests hyperkalaemia as one of its symptoms? ...

    Incorrect

    • Which of the following conditions manifests hyperkalaemia as one of its symptoms?

      Your Answer:

      Correct Answer: Congenital adrenal hyperplasia

      Explanation:

      Plasma potassium greater than 5.5 mmol/L is hyperkalaemia or elevated plasma potassium level. Among the causes of hyperkalaemia include congenital adrenal hyperplasia. Congenital adrenal hyperplasia is a general term referring to autosomal recessive disorders involving a deficiency of an enzyme needed in cortisol and/or aldosterone synthesis. The level of cortisol and/or aldosterone deficiency affects the clinical manifestations of congenital adrenal hyperplasia. When it involves hypoaldosteronism, it can result in hyponatremia and hyperkalaemia. While hypercortisolism can cause hypoglycaemia.The other causes of hyperkalaemia may include renal failure, excess potassium supplementation, Addison’s disease (adrenal insufficiency), renal tubular acidosis (type 4), rhabdomyolysis, burns, trauma, Tumour lysis syndrome, acidosis, and medications such as ACE inhibitors, angiotensin receptor blockers, NSAIDs, beta-blockers, digoxin, and suxamethonium. Bartter’s syndrome is characterized by hypokalaemic alkalosis with normal to low blood pressure. Type 1 and 2 renal tubular acidosis both cause hypokalaemia. Gitelman’s syndrome is a defect of the distal convoluted tubule of the kidney. It causes metabolic alkalosis with hypokalaemia and hypomagnesemia. And excessive liquorice ingestion causes hypermineralocorticoidism and hypokalaemia as well. Thus, among the choices, only congenital adrenal hyperplasia can cause hyperkalaemia.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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  • Question 114 - A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen...

    Incorrect

    • A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen on the way to hospital. What percentage of patients with anaphylactic reaction suffer a biphasic response?.

      Your Answer:

      Correct Answer: 20%

      Explanation:

      About 20% of patients that suffer an anaphylactic reaction suffer a biphasic response 4-6 hours after the initial response (sometimes up to 72 hours after).

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 115 - You see a patient in the ED with photophobia, petechial rash, headache and...

    Incorrect

    • You see a patient in the ED with photophobia, petechial rash, headache and neck stiffness, and suspect a diagnosis of meningococcal meningitis.What is the most appropriate initial management?

      Your Answer:

      Correct Answer: Give ceftriaxone 2 g IV

      Explanation:

      Treatment should be commenced with antibiotics immediately before laboratory confirmation due to the potentially life-threatening nature of the disease.In a hospital setting, 2g of IV ceftriaxone (80 mg/kg for a child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the drugs of choice. In the prehospital setting, IM benzylpenicillin can be given as an alternative.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 116 - At rest, saliva is produced predominantly by which of the following: ...

    Incorrect

    • At rest, saliva is produced predominantly by which of the following:

      Your Answer:

      Correct Answer: Submandibular gland

      Explanation:

      At rest, most saliva is produced by the submandibular gland (65%). When stimulated by the autonomic nervous system, about 50% of saliva is produced by the parotid gland with only 30% produced by the submandibular gland.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 117 - A 32 year old man is brought to ED having been thrown off...

    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:

      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.