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Question 1
Incorrect
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Regarding the abductor digiti minimi, which of the following statements is false?
Your Answer: It is innervated by the deep branch of the ulnar nerve
Correct Answer: It assists with flexion of the fifth finger at the middle phalanx
Explanation:Abductor digiti minimi is a short intrinsic muscle of the hand. It belongs to the group of muscles collectively called hypothenar muscles due to their acting on the 5th finger. Besides abductor digiti minimi, other hypothenar muscles include flexor digiti minimi brevis and opponens digiti minimi.The main function of abductor digiti minimi involves abduction of the 5th finger, as well as flexion of its proximal phalanx. Along with other hypothenar muscles, this muscle forms the hypothenar eminence on the medial side of the palm.Like other hypothenar muscles, abductor digiti minimi receives nervous supply from the deep branch of the ulnar nerve, derived from root values C8 and T1.Abductor digiti minimi receives arterial blood supply from the palmar branch of ulnar artery, palmar digital artery, as well as branches of the ulnar side of the superficial palmar arch. The venous blood from the muscle is drained via the venous networks of the palm into the deep veins of the arm (vv. ulnares).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 2
Correct
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A 70-year-old man has severe diarrhoea one week after taking co-amoxiclav for a chest infection. The diarrhoea is yellow in colour and smell is offensive.What is the SINGLE MOST likely causative organism?
Your Answer: Clostridium difficile
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.About 80% of Clostridium difficile infections are seen in people over the age of 65 and its main clinical features are:Abdominal cramps, severe bloody and/or watery diarrhoea, offensive smelling diarrhoea, and fever.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 3
Incorrect
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A 17-year-old patient with a headache, fever, and a non-blanching rash is brought to the emergency room. Meningococcal infection is confirmed by a lumbar puncture. Neisseria meningitidis uses one of the following immune evasion mechanisms:
Your Answer: Produces exotoxin
Correct Answer: Secretes IgA protease
Explanation:Meningococci have 3 important virulence factors, as follows:Polysaccharide capsule – Individuals with immunity against meningococcal infections have bactericidal antibodies against cell wall antigens and capsular polysaccharides; a deficiency of circulating anti meningococcal antibodies is associated with the disease.Lipo-oligosaccharide endotoxin (LOS)Immunoglobulin A1 (IgA1)
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This question is part of the following fields:
- Microbiology
- Principles
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Question 4
Incorrect
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You are giving a teaching session to a group of final year medical students regarding lower limb neurology. Which of the following clinical features would be expected in an obturator nerve palsy:
Your Answer: Weakness of hip abduction
Correct Answer: Weakness of hip adduction
Explanation:Damage to the obturator nerve results in weak adduction of the hip with lateral swinging of the limb during walking due to unopposed abduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 5
Incorrect
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Which of the following is an example of discrete data:
Your Answer: Height
Correct Answer: Number of children
Explanation:Discrete data is quantitative data that can only take whole numerical values e.g. number of children, number of days missed from work.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 6
Correct
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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: 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.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 7
Incorrect
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Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer:
Correct Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 8
Incorrect
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Which of the following is NOT a common myeloma laboratory finding:
Your Answer:
Correct Answer: Elevated serum Bence-Jones protein
Explanation:Myeloma laboratory findings include:- The presence of a paraprotein in serum or urine (the paraprotein is IgG in 60 percent of cases, IgA in 20 percent, and light chain only in almost all the rest),- Increased serum immunoglobulin-free light chain proteins generated by plasma cells but not coupled with heavy chains – Reduced IgG, IgA, and IgM levels in the blood (immune paresis)- Anaemia, whether normochromic, normocytic, or macrocytic. – On a blood film, a Rouleaux formation has been marked. – In advanced illness, neutropenia and thrombocytopenia are common. – ESR is high. – Plasma cells in the bone marrow are overabundant, typically in aberrant forms. – Hypercalcemia- Creatinine levels are high. – Serum albumin levels are low in advanced illness. 60 percent of patients have osteolytic lesions, osteoporosis, or pathological fractures.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 9
Incorrect
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When there is the presence of distended and engorged veins in the umbilical area, which of the following portosystemic anastomoses has most likely occurred?
Your Answer:
Correct Answer: Para-umbilical veins and inferior epigastric vein
Explanation:Caput medusae is a condition that consists of collateral veins radiating from the umbilicus and results from recanalization of the umbilical vein.Under normal conditions, the portal venous blood traverses the liver and drains into the inferior vena cava of the systemic venous circulation by way of the hepatic veins. This is the direct route. However, other, smaller communications exist between the portal and systemic systems, and they become important when the direct route becomes blocked. These communications are as follows:At the lower third of the oesophagus, the oesophageal branches of the left gastric vein (portal tributary) anastomose with the oesophageal veins draining the middle third of the oesophagus into the azygos veins (systemic tributary).Halfway down the anal canal, the superior rectal veins (portal tributary) draining the upper half of the anal canal anastomosis with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.The paraumbilical veins connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall (systemic tributaries). The paraumbilical veins travel in the falciform ligament and accompany the ligamentum teres.The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 10
Incorrect
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A 19-year-old with a longstanding history of asthma presents to the ED with worsening symptoms of cough and wheeze and a peak expiratory flow rate (PEFR) measurement is taken.Which statement concerning PEFR is true?
Your Answer:
Correct Answer: PEFR is dependent upon the patient's height
Explanation:The maximum flow rate generated during a forceful exhalation, after maximal inspiration is the peak expiratory flow rate (PEFR).PEFR is dependent upon initial lung volume. It is, therefore, dependant on patient’s age, sex and height.PEFR is dependent on voluntary effort and muscular strength of the patient.PEFR is decreased with increasing airway resistance, e.g. in asthma, and it correlates well with the forced expiratory volume in one second (FEV1) value measured in spirometry. This correlation decreases in patients with asthma as airflow decreases.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 11
Incorrect
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You've been requested to give a discussion to a group of medical students about cardiovascular physiology. One of them inquires about cardiac output and asks if you can explain it.Which of the following statements is correct?
Your Answer:
Correct Answer: An average resting cardiac output in a woman is 5 L/min
Explanation:The terminology cardiac output refers to the amount of blood pumped by the heart in one minute. Women’s rates are around 5 L/min, whereas men’s rates are somewhat higher, around 5.5 L/min.Cardiac output (CO) is calculated by multiplying stroke volume (SV) by heart rate (HR):CO = HR x SVAs a result, both stroke volume and heart rate are exactly proportional to cardiac output. There will be an increase in cardiac output if the stroke volume or heart rate increases, and a reduction in cardiac output if the stroke volume or heart rate lowers.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 12
Incorrect
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You have been called to review a patient and his management in the resuscitation room. A very sick patient has been started on mannitol in his treatment protocol. Out of the following, what is NOT an FDA-recognized indication for the use of mannitol?
Your Answer:
Correct Answer: Congestive cardiac failure
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure. Mannitol has four FDA approved uses clinically:1. Reduction of intracranial pressure and brain mass2. reduce intraocular pressure if this is not achievable by other means3. promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage4. promote diuresis to promote the excretion of toxic substances, materials, and metabolitesIt can be used in rhabdomyolysis-induced renal failure, especially in crush injuries. Mannitol reduces osmotic swelling and oedema in the injured muscle cells and helps restore skeletal muscle function. It is a low molecular weight compound and can be freely filtered at the glomerulus and not reabsorbed. This way 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 causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include: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
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 13
Incorrect
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You examine a 72-year-old man who has recently begun bumetanide treatment for worsening heart failure.Which of these statements about bumetanide is correct?
Your Answer:
Correct Answer: It has better intestinal absorption than furosemide
Explanation:Bumetanide is a loop diuretic that is used to treat congestive heart failure. It is frequently used in patients who have failed to respond to high doses of furosemide.It has a potency of about 40 times that of furosemide, with a 1 mg dose being roughly equivalent to a 40 mg dose of furosemide.Seizures are not known to be triggered by bumetanide. In fact, it lowers the concentration of neuronal chloride, making GABA’s action more depolarizing, and it’s currently being tested as an antiepileptic in the neonatal period.It takes effect after 1 hour of oral administration, and diuresis takes 6 hours to complete.Bumetanide absorbs much better in the intestine than furosemide. Because it has a higher bioavailability than furosemide, it is commonly used in patients with gut oedema.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 14
Incorrect
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer:
Correct Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 15
Incorrect
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A 58-year-old man with a traumatic brain injury is brought into the ER. A medical student asks you about the processes that occur in the brain following a traumatic injury.One of these best describes the central nervous systems response to injury.
Your Answer:
Correct Answer: Degeneration of the axon occurs proximally before it occurs distally
Explanation:Following neuronal injury, as seen in traumatic brain injury, the axon undergoes anterograde degeneration. Degradation starts from the cell body (proximally) and progresses distally. The axon becomes fragmented and degenerates. The brain shows no reactive changes to injury is incorrect. Following major injury such as stroke, the brain undergoes a process of liquefactive degeneration, which leaves cystic spaces within the brain.Axonal regeneration does not occur to any significant extent within the central nervous system unlike what is seen in the peripheral nervous system. Astrocytes undergo reactive gliosis, leaving behind a firm translucent tissue around sites of damage.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 16
Incorrect
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Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?
Your Answer:
Correct Answer: Auriculotemporal nerve
Explanation:Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 17
Incorrect
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Carbamazepine is contraindicated in which of the following:
Your Answer:
Correct Answer: Atrioventricular block
Explanation:Carbamazepine is contraindicated in:- People with known hypersensitivity to carbamazepine or structurally related drugs- People with atrioventricular block (may suppress AV conduction and ventricular automaticity)- People with a history of bone marrow depression (risk of agranulocytosis and aplastic anaemia)- People with a history of acute porphyrias- People taking a monoamine oxidase inhibitor (risk of serotonin syndrome)
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 18
Incorrect
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Which of the following is considered an example of an observational study?
Your Answer:
Correct Answer: Cohort study
Explanation:The two most common types of observational studies are cohort studies and case-control studies; a third type is cross-sectional studies.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 19
Incorrect
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A 17-year-old male presenting in the department has a history of C3 deficiency.C3 deficiency is associated with all of the following EXCEPT?
Your Answer:
Correct Answer: Hereditary angioedema
Explanation:C1-inhibitor deficiency is the cause of hereditary angioedema not C3 deficiency,All the other statements are correct
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 20
Incorrect
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An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with left-sided hemiplegia of the face, tongue, and limbs and right-sided deficits in motor eye activity. A CT scan was ordered and showed a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer:
Correct Answer: Basilar artery
Explanation:Weber syndrome is a midbrain stroke characterized by crossed hemiplegia along with oculomotor nerve deficits and it occurs with the occlusion of the median and/or paramedian perforating branches of the basilar artery. Typical clinical findings include ipsilateral CN III palsy, ptosis, and mydriasis (such as damage to parasympathetic fibres of CN III) with contralateral hemiplegia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 21
Incorrect
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A 40-year-old female presents to the orthopaedic clinic complaining of pain and limited range of motion in the right elbow for the past two days. On examination, the right elbow is extremely tender with erythema and warmth of the overlying skin due to acute inflammation. Which ONE of the following statements is true with regards to acute inflammation?
Your Answer:
Correct Answer: Neutrophils are activated and adhere to the endothelium as a result of interaction with endothelial cell adhesion molecules
Explanation:Acute inflammation is defined as inflammation occurring within minutes to hours in response to an injury lasting for less than two weeks. Acute inflammation Rapid onset (minutes to hours)Quick resolution (usually days)Chronic inflammationMay last weeks, months, or yearsThere are five cardinal signs of inflammation:1) Pain2) Redness3) Warmth4) Oedema5) Loss of functionDuring acute inflammation, neutrophils are activated and attracted to the site of inflammation in response to various interleukins and cytokines. This process takes place via the following mechanism:1) MarginationNeutrophils flow nearer the vessel wall rather than in the axial stream, which is referred to as margination2) Rolling along the surface of vascular endothelium3) Adhesion to the endothelium by interaction with adhesion molecules (ICAMS and VCAMS)4) Diapedesis is the movement of neutrophils from the endothelial cells into the interstitial space by squeezing through the gaps between adjacent endothelial cellsBradykinin and histamine are both responsible for vasodilation which causes oedema and decreases intravascular osmotic pressure.Neutrophils dominate early (2 days)- Live longer- Replicate in tissues
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 22
Incorrect
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A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is diagnosed with hyperaldosteronism.Which of these is the commonest cause of hyperaldosteronism?
Your Answer:
Correct Answer: Adrenal adenoma
Explanation:When there are excessive circulating levels of aldosterone, hyperaldosteronism occurs. There are two main types of hyperaldosteronism:Primary hyperaldosteronism (,95% of cases)Secondary hyperaldosteronism (,5% of cases)Primary causes of hyperaldosteronism include:Adrenal adenoma (Conn’s syndrome) Adrenal hyperplasiaAdrenal cancerFamilial aldosteronismSecondary causes of hyperaldosteronism include:DrugsObstructive renal artery disease Renal vasoconstrictionOedematous disorders syndrome Adrenal adenoma is the commonest cause of hyperaldosteronism (seen in ,80% of all cases).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 23
Incorrect
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A 20-year-old patient had sustained a supracondylar fracture due to falling from a skateboard. The frequency of acute nerve injuries accompanying supracondylar humeral fractures ranges from 10 to 20%. The most common complication is injury to which nerve?
Your Answer:
Correct Answer: Median nerve
Explanation:According to various studies, the frequency of acute nerve damage associated with supracondylar humeral fractures in children ranges from 10% to 20%. Median nerve injury and anterior interosseous nerve injury are the most common consequences. Damage to this nerve indicated weakening or abnormal extension of the index finger’s distal interphalangeal joint and the thumb’s interphalangeal joint. The absence of sensibility is a distinguishing attribute. A surgical neck humerus fracture may cause injury to the axillary nerve. A midshaft humerus fracture might cause injury to the radial nerve. A medial epicondylar fracture might cause injury to the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 24
Incorrect
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A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. Which of these blood vessels has most likely been occluded?
Your Answer:
Correct Answer: Posterior inferior cerebellar artery
Explanation:Posterior inferior cerebellar artery (PICA) occlusion is characterised by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. PICA occlusion causes infarction of the posterior inferior cerebellum, inferior cerebellar vermis and lateral medulla.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 25
Incorrect
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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.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 26
Incorrect
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A patient presents to ED complaining of pins and needles over the lateral three and a half digits. You suspect carpal tunnel syndrome. Which of the following clinical features would you most expect to see on examination:
Your Answer:
Correct Answer: Inability to touch the pad of the little finger with the thumb
Explanation:Compression of the median nerve in the carpal tunnel will result in weakness and atrophy of the thenar muscles – resulting in weakness of opposition, abduction and flexion of the thumb at the metacarpophalangeal joint and anaesthesia or paraesthesia over the distribution of the palmar digital branch of the median nerve (skin over the palmar surface and fingertips of the lateral three and a half digits). The adductor pollicis muscle is innervated by the ulnar nerve, and abduction of the fingers is produced by the interossei, also innervated by the ulnar nerve. Flexion of the interphalangeal joint of the thumb is produced by the flexor pollicis longus, and flexion of the distal interphalangeal joint of the index finger is produced by the flexor digitorum profundus. Median nerve injury at the wrist will not affect the long flexors of the forearm as these are innervated by the anterior interosseous nerve which arises in the proximal forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 27
Incorrect
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A clinical audit cycle comprises of 5 steps. Each of these processes are listed below:Which is the correct order that these should occur?1. Observation of practice and collection of data2. Identification of the problem3. Implementation of change4. Definition of criteria and setting of standards5. Analysis of data and comparison of performance with the criteria and standards
Your Answer:
Correct Answer: 2,4,1,5,3
Explanation:An audit assesses if a certain aspect of health care is attaining a recognized standard. This lets care providers and patients know where their service is doing well, and where there could be improvements. The aim is to achieve quality improvement and improve outcomes for patients.Audits are a quality improvement measure and one of the 7 pillars of clinical governance. It allows organizations to continually work toward improving quality of care by showing them where they are falling short, allows them to implement improvements, and reaudit or close the audit cycle to see if beneficial change has taken place.Clinical audits are a cycle with several steps:1. Identification of the problem2. Definition of criteria and setting of standards3. Observation of practice and collection of data4. Analysis of data and comparison of performance with the criteria and standards5. Implementation of change
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This question is part of the following fields:
- Evidence Based Medicine
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Question 28
Incorrect
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Which of the following infections is vancomycin most likely prescribed for?
Your Answer:
Correct Answer: Clostridium difficile colitis
Explanation:125 mg PO q6hr for 10 days is indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhoea
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 29
Incorrect
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Which of the following nerves innervates the gastrocnemius muscle?
Your Answer:
Correct Answer: Tibial nerve
Explanation:The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Incorrect
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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.
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This question is part of the following fields:
- General Pathology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
