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Question 1
Correct
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Which of the following ions is more abundant in extracellular fluid than in intracellular fluid:
Your Answer: Cl -
Explanation:Protein and phosphate are the primary intracellular anions, while chloride (Cl-) and bicarbonate are the predominant extracellular anions (HCO3-).
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 2
Incorrect
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Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?
Your Answer: Median
Correct Answer: Posterior
Explanation:The periurethral portion of the prostate gland increases in size during puberty and after the age of 55 years due to the growth of non-malignant cells in the transition zone of the prostate that surrounds the urethra. Most cancers develop in the posterior lobe, and cancers in this location may be palpated during a digital rectal examination (DRE).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 3
Incorrect
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Which of the following hormones regulates Na+reabsorption in the proximal tubule:
Your Answer: Aldosterone
Correct Answer: Angiotensin II
Explanation:Angiotensin II increases Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters).
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This question is part of the following fields:
- Physiology
- Renal
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Question 4
Incorrect
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A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the resuscitation area of the Emergency Department. A loading dose of IV aminophylline is administered and her symptoms begin to improve. You are asked to check her theophylline levels after an appropriate time period.How long should you wait before taking her blood sample be taken?
Your Answer: 1-2 hours
Correct Answer: 4-6 hours
Explanation:Plasma theophylline concentration is usually measured five days after starting oral treatment and three days after each dose adjustment. A blood sample to check theophylline concentration should usually be taken after 4-6 hours if an IV dose of aminophylline was given.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 5
Incorrect
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A 15-year-old boy was brought to the emergency room with complaints of a headache, stiffness of the neck, and photophobia. Upon observation, the following were noted: HR 124, BP 86/43, RR 30, SaO 95%, temperature 39.5 deg C. A recently developed non-blanching rash on his legs was also observed.What is most likely the causative agent of the case presented above?
Your Answer: Neisseria meningitidis group C
Correct Answer: Neisseria meningitidis group B
Explanation:The meningococcus is solely a human pathogen, and up to 50% of the population may carry meningococci in the nasopharynx. Factors that lead to invasion and production of disease include complex inter-relationships of genetic predisposition, host status, environmental conditions, and virulence of the organism.Meningococcal disease is the most common infectious cause of death in childhood in developed countries. It presents as septicaemia, meningitis, or a combination. Septicaemia is the more dangerous presentation, especially with septic shock; meningitis is more likely to lead to neurodevelopmental sequelae. Classic features of septicaemia are a non-blanching rash in a feverish, ill child.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 6
Correct
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Disease specific immunoglobulin is available for all of the following infectious diseases EXCEPT for:
Your Answer: Hepatitis A
Explanation:Disease specific immunoglobulins are available for:hepatitis Brabiestetanusvaricella-zosterNormal immunoglobulin can be used to confer protection against hepatitis A.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 7
Incorrect
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An 11-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent petechial rash on legs and arms. The GP administered a dose of antibiotics in the prehospital setting before transferring to the Emergency Department.Which of these would the GP have administered?
Your Answer: IM benzylpenicillin 300 mg
Correct Answer: IM benzylpenicillin 1.2 g
Explanation:General Practitioners are advised to give a single injection of benzylpenicillin by intravenous or intramuscular injection before transferring the patient urgently to the ED when bacterial meningitis is suspected.The recommended doses are:Infants under 1 year: 300 mgChildren ages 1 to 9 years: 600 mgChildren aged 10 years and over: 1.2gAdults: 1.2g
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 8
Incorrect
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Typically, granulomatous inflammation is associated with one of the following infections:
Your Answer: Gas gangrene
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
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 9
Incorrect
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Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is an increase in metabolic rate, the production of vasoactive metabolites increases. These metabolites act locally on the surrounding arterioles, causes vasodilation and an increase blood supply.Which of these metabolites is the most potent vasodilator in skeletal muscle?
Your Answer: CO 2
Correct Answer: K +
Explanation:Hyperaemia is the process where the body adjusts blood flow to meet the metabolic needs of different tissues in health and disease. Vasoactive mediators that take part in this process include K+, adenosine, CO2, H+, phosphates and H2O2. Although the mechanism is not clear, all these mediators likely contribute to some extent at different points.Specific organs are more sensitive to specific metabolites:K+ and adenosine are the most potent vasodilators in skeletal musclesCO2 and K+ are the most potent vasodilators in cerebral circulation.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 10
Correct
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Which 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: 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.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 11
Incorrect
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On her most recent blood tests, a 55 year-old female with a history of hypertension was discovered to be hypokalaemic. She is diagnosed with primary hyperaldosteronism.Which of the following is a direct action of aldosterone?
Your Answer:
Correct Answer: Secretion of H + into the distal convoluted tubule
Explanation:Aldosterone is a steroid hormone produced in the adrenal cortex’s zona glomerulosa. It is the most important mineralocorticoid hormone in the control of blood pressure. It does so primarily by promoting the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane of the nephron’s distal tubules and collecting ducts, as well as stimulating apical sodium and potassium channel activity, resulting in increased sodium reabsorption and potassium secretion. This results in sodium conservation, potassium secretion, water retention, and a rise in blood volume and blood pressure.Aldosterone is produced in response to the following stimuli:Angiotensin II levels have risen.Potassium levels have increased.ACTH levels have risen.Aldosterone’s principal actions are as follows:Na+ reabsorption from the convoluted tubule’s distal endWater resorption from the distal convoluted tubule (followed by Na+)Cl is reabsorbed from the distal convoluted tubule.K+ secretion into the convoluted distal tubule’s H+ secretion into the convoluted distal tubule’s
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 12
Incorrect
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Which ONE statement about homeostasis is true?
Your Answer:
Correct Answer: Negative feedback occurs via receptors, comparators and effectors
Explanation:Homeostasis is the property of a system in which variables are regulated so that internal conditions remain relatively constant and stable. Homeostasis is achieved by a negative feedback mechanism.Negative feedback occurs based upon a set point through receptors, comparators and effectors. The ‘set point’ is a NARROW range of values within which normal function occurs.The two body systems that regulate homeostasis are the Nervous system and the Endocrine system. The smooth muscle of the uterus becomes more active towards the end of pregnancy. This is a POSITIVE feedback.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 13
Incorrect
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A new chemotherapy drug is being tested. The intervention reduces the risk of death from 10 in 1000 to 5 in 1000. What is the number needed to treat to prevent one death:
Your Answer:
Correct Answer: 200
Explanation:Absolute risk reduction (ARR) of treatment = risk of death in control group – risk of death in treatment groupARR = (10/1000) – (5/1000) = 5/1000 = 0.005Number needed to treat (NNT) = 1/ARR = 1/0.005 = 200Therefore 200 people would need to be treated to prevent one extra death.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 14
Incorrect
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Gallstones are commonly found lodged in which of the following parts of the gallbladder?
Your Answer:
Correct Answer: Neck
Explanation:There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 15
Incorrect
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Which of the following best describes the mechanism of action of aspirin:
Your Answer:
Correct Answer: Cyclo-oxygenase (COX) inhibitor
Explanation:Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 16
Incorrect
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You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.Which of the following anti-D statements is correct?
Your Answer:
Correct Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks
Explanation:Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly. The following are examples of potentially sensitising events:BirthHaemorrhage during pregnancyMiscarriageEctopic pregnancyDeath within the wombAmniocentesisChorionic villus samplingTrauma to the abdomenThe sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 17
Incorrect
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Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:
Your Answer:
Correct Answer: The two variables are directly proportional
Explanation:A positive correlation coefficient means that the two variables are directly proportional e.g. height and weight in healthy growing children.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 18
Incorrect
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A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?
Your Answer:
Correct Answer: Cranial diabetes insipidus
Explanation:Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes. The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus. By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone. Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output. Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 19
Incorrect
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A 29 year old woman is unable to invert her foot after sustaining an injury to her leg playing water-polo. Which of the following nerves are most likely damaged:
Your Answer:
Correct Answer: Tibial and deep fibular nerve
Explanation:Inversion of the foot is primarily produced by the tibialis anterior and the tibialis posterior muscles, innervated by the deep fibular nerve and the tibial nerve respectively.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 20
Incorrect
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Regarding Clostridium tetani, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Metronidazole is usually the antibiotic of choice for tetanus infection.
Explanation:Clostridium tetani infection is predominantly derived from animal faeces and soil. Clostridium tetani has exotoxin-mediated effects, predominantly by tetanospasmin which inhibits the release of GABA at the presynaptic membrane throughout the central and peripheral nervous system. Metronidazole has overtaken penicillin as the antibiotic of choice for treatment of tetanus (together with surgical debridement, tetanus toxoid immunisation, and human tetanus immunoglobulin).
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Incorrect
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EMLA cream is a topical local anaesthetic containing which of the following:
Your Answer:
Correct Answer: 50/50 mixture 2.5% lidocaine and 2.5% prilocaine
Explanation:EMLA cream, an effective topical local anaesthetic, is a 50/50 mixture of 2.5% prilocaine and 2.5% lidocaine.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 22
Incorrect
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Which of the following is NOT a notifiable disease:
Your Answer:
Correct 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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 23
Incorrect
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Aside from the inability to extend the leg above the knee, which of the following clinical symptoms should you anticipate seeing in a patient who had a pelvic and right leg injury as well as femoral nerve damage?
Your Answer:
Correct Answer: Loss of sensation over the anterior thigh
Explanation:The femoral nerve runs down the front of the leg from the pelvis. It gives the front of the thigh and a portion of the lower leg sensation. Extension of the leg at the knee joint, flexion of the thigh at the hip are produced by muscles that is primarily innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 24
Incorrect
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Regarding antacids, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Antacids are contraindicated in hypophosphataemia.
Explanation:Antacids are contraindicated in hypophosphataemia. Liquid preparations are more effective than tablet preparations. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are best taken when symptoms occur or are expected, usually between meals and at bedtime. Antacids should preferably not be taken at the same time as other drugs since they may impair absorption.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 25
Incorrect
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Which of the following is NOT a typical feature of lithium toxicity:
Your Answer:
Correct Answer: Miosis
Explanation:Features of toxicity include:Increasing gastrointestinal disturbances (vomiting, diarrhoea, anorexia)Visual disturbancesPolyuria and incontinenceMuscle weakness and tremorTinnitusCNS disturbances (dizziness, confusion and drowsiness increasing to lack of coordination, restlessness, stupor)Abnormal reflexes and myoclonusHypernatraemiaWith severe overdosage (serum-lithium concentration > 2 mmol/L) seizures, cardiac arrhythmias (including sinoatrial block, bradycardia and first-degree heart block), blood pressure changes, electrolyte imbalance, circulatory failure, renal failure, coma and sudden death may occur.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 26
Incorrect
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You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?
Your Answer:
Correct Answer: Anterior communicating artery
Explanation:One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm. A berry aneurysm is the most common type of brain aneurysm. The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 27
Incorrect
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A 32-year-old woman suffers a deep wound to her thigh while she was climbing over a barbed wire fence. As a consequence of her injury, the nerve that was severed innervates the gracilis muscle.In which of the following nerves is the gracilis muscle innervated by?
Your Answer:
Correct Answer: Anterior branch of the obturator nerve
Explanation:The gracilis muscles is innervated by the anterior branch of the obturator nerve (L2-L4).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 28
Incorrect
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Which of the following features of cell damage tends to be reversible:
Your Answer:
Correct Answer: Swelling of endoplasmic reticulum and some mitochondria
Explanation:Features of cell damage that tend to be reversible include: swelling of endoplasmic reticulum and some mitochondrialoss of ribosomescell stress responseFeatures of cell damage that tend to be irreversible include: loss of nucleolus, no ribosomes, swelling of all mitochondria, nuclear condensation, membrane blebs and holes, lysosome rupture, fragmentation of all inner membranes, nuclear breakup
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 29
Incorrect
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The QRS duration of a broad-complex tachyarrhythmia is:
Your Answer:
Correct Answer: Greater than or equal to 0.12 s
Explanation:It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 30
Incorrect
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Regarding Clostridium tetani, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Infection is predominantly derived from animal faeces and soil.
Explanation:Clostridium tetaniis a Gram positive, rod shaped, obligate anaerobic bacterium.The incubation period is quoted as anywhere between 4-21 days and can occur after several months but symptoms usually occur within the first 7 days after exposure.Approximately 80% of patients develop generalised tetanus. The commonest presenting feature of generalised tetanus is trismus (lockjaw), occurring in approximately 75% of affected individuals. Other clinical features include:Facial spasms (risus sardonicus)Opisthotonus (characteristic body shape during spasms)Neck stiffnessDysphagiaCalf and pectoral muscle rigidityFeverHypertensionTachycardiaSpasms can occur frequently and last for several minutes, they can continue to occur for up to 4 weeks. Current mortality rates are between 10 and 15%.Tetanic spasms are caused by the exotoxin tetanospasmin. The effects of tetanolysin are not fully understood but it is not believed to have clinical significance.Localised tetanus is a rare form of the disease, occurring in around 1% of affected individuals. Patients have persistent contraction of muscles in the same anatomic area as the injury. It may precede generalised tetanus.
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This question is part of the following fields:
- Microbiology
- Pathogens
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SESSION STATS - PERFORMANCE PER SPECIALTY
