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Question 1
Incorrect
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A newborn baby girl is delivered vaginally to a 19-year old female, however with complications due to cephalopelvic disproportion. Upon examination by the attending paediatrician, there is a notable 'claw hand' deformity of the left, and sensory loss of the ulnar aspect of the left distal upper extremity.What is the most probable diagnosis of the case above?
Your Answer: Erb’s palsy
Correct Answer: Klumpke’s palsy
Explanation:Klumpke palsy, named after Augusta Dejerine-Klumpke, is a neuropathy involving the lower brachial plexus. In contrast, the more common Erb–Duchenne palsy involves the more cephalic portion of the brachial plexus C5 to C6. The brachial plexus is a bundle of individual nerves that exit between the anterior and middle scalene muscles in the anterior lateral and basal portion of the neck. Although the most common anatomical presentation of the brachial plexus is between the anterior and middle scalene, there are variations, with the most common being penetration of the anterior scalene. The main mechanism of injury to the lower brachial plexus is hyper-abduction traction, and depending on the intensity, it will lead to signs and symptoms consistent with a neurological insult.The most common aetiology resulting in Klumpke palsy is a hyper-abduction trauma to the arm that has enough intensity to traction the lower brachial plexus. Trauma during birth can cause brachial plexus injuries, but again hyper-abduction and traction forces to the upper extremity are usually present.The history presented by the patient usually depicts a long axis hyper-abduction traction injury with high amplitude and velocity. The typical patient presentation is a decrease of sensation along the medial aspect of the distal upper extremity along the C8 and T1 dermatome. The patient might also present myotome findings that can range from decreasing muscular strength to muscular atrophy and positional deformity. For example, if the neurological damage has led to muscular atrophy and tightening, the patient may present with a claw hand. This deformity presents a finger and wrist flexion. The patient may also describe the severe pain that starts at the neck and travels down the medial portion of the arm. One other sign of a lower brachial plexus injury is Horner syndrome; because of its approximation to the T1 nerve root, it may damage the cephalic sympathetic chain. If this happens, the patient will develop ipsilateral ptosis, anhidrosis, and miosis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 2
Incorrect
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Regarding the extensor carpi ulnaris muscle, which of the following statements is true?
Your Answer:
Correct Answer: It receives its blood supply from the ulnar artery
Explanation:Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 3
Incorrect
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Regarding the brachioradialis muscle, which of the following statements is true?
Your Answer:
Correct Answer: It assists with supination of the forearm at the radioulnar joints
Explanation:Brachioradialis is a fusiform muscle located in the lateral part of the posterior forearm. Along with extensor carpi radialis brevis and extensor carpi radialis longus, it comprises the radial group of forearm muscles, which belong to the superficial layer of posterior forearm muscles. Although anatomically part of the posterior forearm muscles, which are known to be forearm extensors, brachioradialis’ fibre orientation enables it to rather flex the forearm, and aids in supination of the forearm at the radioulnar joint.The brachioradialis muscle originates from the upper two-thirds of the lateral supracondylar ridge of humerus and the anterior surface of the lateral intermuscular septum of the arm. It slides over the lateral surface of the elbow joint, entering the anterolateral cubital area. The muscle fibres course inferiorly down the radial part of the anterior forearm, forming a thick tendon in approximately the middle of the forearm. This tendon then traverses the remainder of the forearm, inserting near the wrist, just proximal to the styloid process of radius.Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus. Blood supply to the brachioradialis muscle comes from branches of the radial artery, radial recurrent artery and the radial collateral branch of the deep brachial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Incorrect
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You intend to suture a hand wound with plain 1 percent lidocaine.In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?
Your Answer:
Correct Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 5
Incorrect
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Stimulation of J receptors located on alveolar and bronchial walls results in all of the following EXCEPT for:
Your Answer:
Correct Answer: Tachycardia
Explanation:Juxtapulmonary or ‘J’ receptors are located on alveolar and bronchial walls close to the capillaries. Their afferents are small unmyelinated C-fibres or myelinated nerves in the vagus nerve. Activation causes depression of somatic and visceral activity by producing apnoea or rapid shallow breathing, a fall in heart rate and blood pressure, laryngeal constriction and relaxation of skeletal muscles via spinal neurones. J receptors are stimulated by increased alveolar wall fluid, pulmonary congestion and oedema, microembolism and inflammatory mediators. J receptors are thought to be involved in the sensation of dyspnoea in lung disease.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 6
Incorrect
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A 45-year old man presented to the emergency room with complains of chest pain and breathlessness. Upon history taking and examination, it was discovered that he had a right-sided spontaneous pneumothorax and had a failed attempt at pleural aspiration. The pneumothorax is still considerable in size, but he remains breathless. A Seldinger chest drain was inserted but it started to drain frank blood shortly after. Which of the following complications is most likely to have occurred?
Your Answer:
Correct Answer: Intercostal artery laceration
Explanation:Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions. Traditional anatomy teaching describes the ICA as lying in the intercostal groove, protected by the flange of the rib. This is the rationale behind the recommendation to insert needles just above the superior border of the rib. Current recommendations for chest drain insertion suggest that drains should be inserted in the ‘safe triangle’ in order to avoid the heart and the mediastinum and be above the level of the diaphragm. The safe triangle is formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla. Imaging guidance also aids in the safety of the procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 7
Incorrect
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A 35-year-old man is feeling unwell following his return from a business trip. He is diagnosed with a vector transmitted disease.Which of these organisms is commonly spread by vector-borne transmission?
Your Answer:
Correct Answer: Borrelia burgdorferi
Explanation:Borrelia burgdorferiis, primarily spread by ticks and lice, is a zoonotic, vector-borne organism that causes Lyme disease.Neisseria meningitidis and Bordetella pertussis are droplet borne infections (airborne particle > 5 µm)Vibrio cholerae and Ascaris lumbricoides are spread by the faeco-oral route
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 8
Incorrect
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Which of the following muscles are primarily involved in passive inspiration:
Your Answer:
Correct Answer: Diaphragm and external intercostal muscles
Explanation:Passive inspiration is produced by contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, elevation of the sternal ends of the ribs (‘pump handle’ movement), elevation of the lateral shafts of the ribs (‘bucket handle’ movement) and depression of the diaphragm result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in an increased intrathoracic volume and decreased intrathoracic pressure and thus air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 9
Incorrect
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Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.Which of the following statements about aspirin's mechanism of action is correct?
Your Answer:
Correct Answer: Inhibition of cyclo-oxygenase
Explanation:Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 10
Incorrect
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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.
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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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An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:No. of patients who took Ticagrelor: 300No. of patients who took Ticagrelor and suffered a stroke: 30No. of patients who took Warfarin: 500No. of patients who took Warfarin and suffered a stroke: 20Compute for the risk ratio of a stroke.
Your Answer:
Correct Answer: 2.5
Explanation:Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).RR = ART/ARCRR = (30/300) / (20/500)RR = 2.5Recall that:If RR < 1, then the intervention reduces the risk of the outcome.If RR = 1, then the treatment has no effect on the outcome.If RR > 1, then the intervention increases the risk of the outcome.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 12
Incorrect
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All of the following are actions of insulin except:
Your Answer:
Correct Answer: Increased gluconeogenesis
Explanation:Major Actions of Insulin:↑ Glucose uptake into cells↑ Glycogenesis↓ Glycogenolysis↓ Gluconeogenesis↑ Protein synthesis↓ Protein degradation↑ Fat deposition↓ Lipolysis↓ Ketoacid production↑ K+ uptake into cellsMajor Actions of Glucagon:↓ Glycogenesis↑ Glycogenolysis↑ Gluconeogenesis↓ Fatty acid synthesis↑ Lipolysis↑ Ketoacid production
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 13
Incorrect
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Which of the following side effects is most likely caused by erythromycin:
Your Answer:
Correct Answer: QT - prolongation
Explanation:The side effects of erythromycin include abdominal pain, anaphylaxis, cholestatic hepatitis, confusion, diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss, headache, hypertrophic pyloric stenosis, hypotension, Interstitialnephritis, mild allergic reactions, nausea, nervous system effects,including seizures, pain, pruritus, pseudomembranous colitis, QT prolongation, rash, skin eruptions, tinnitus, urticaria, ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 14
Incorrect
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A 35-year-old man, who was feeling unwell after his return from a business trip, was diagnosed with a disease that is known to be transmitted by a vector. Among the following microorganisms, which of the following has a mode of transmission of being vector-borne?
Your Answer:
Correct Answer: Plasmodium falciparum
Explanation:Plasmodium falciparum is a parasite that is vector-borne which is transmitted by the female Anopheles mosquito.Bordetella pertussis is transmitted through the respiratory tract, via respiratory droplets or direct contact with infectious secretions.Mycobacterium tuberculosis is transmitted via inhalation of infected respiratory droplets.HIV may be transmitted via sexual contact, vertical transmission from mothers to infants, and among injection drug users sharing infected needles, as well as through transfusion of infected blood products.Treponema pallidum transmission normally occurs during direct sexual contact with an individual who has an active primary or secondary syphilitic lesion.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 15
Incorrect
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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.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 16
Incorrect
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A 66-year-old male was admitted from the Emergency Department due to severe pain in the left forearm and hand, refractory to pain medication along with pallor and hypothermia of the affected limb. Ultrasound doppler showed an arterial embolism. Circulation was restored after vascular surgery, but there was extensive, irreversible muscle damage. How will the muscle heal from an injury of this type?
Your Answer:
Correct Answer: Diffuse formation of fibrous tissue
Explanation:Once muscle tissue is damaged, there will be healing via diffuse formation of fibrous tissue, especially due to the widespread ischemia. Callus formation takes place in the healing of bone, not muscle. Organised scar formation occurs when a lacerated wound is approximated by sutures so that primary intention wound healing can occur. Liquefaction degeneration occurs following ischemia in the brain. Volkmann’s ischemic contracture may occur, but it is not the primary type of healing that will take place but rather the effect of the fibrous scar formation.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 17
Incorrect
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer:
Correct Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 18
Incorrect
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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.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 19
Incorrect
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A 68-year-old man with BPH presents to the emergency department in significant pain secondary to urinary retention. What is the location of the neuronal cell bodies that are responsible for urinary bladder discomfort sensation?
Your Answer:
Correct Answer: Dorsal root ganglia of spinal cord levels S2, S3 and S4
Explanation:The activation of stretch receptors with visceral afferents relayed through the pelvic nerve plexus and into the pelvic splanchnic nerves causes bladder pain. The sensory fibres of spinal nerves S2 – S4 enter the dorsal root ganglia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 20
Incorrect
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A patient presents with a lump for a dermatological examination. There is a circumscribed skin elevation measuring 0.3 cm in diameter seen on examination.Which one of these best describes the lump you have found on examination?
Your Answer:
Correct Answer: Papule
Explanation:A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter. A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless. A bulla is a visible collection of clear fluid measuring greater 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 pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
