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Question 1
Correct
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In which of the following would you NOT typically see a neutropaenia:
Your Answer: Asplenism
Explanation:Causes of neutropaenia:Drug-induced (e.g. chemotherapy, chloramphenicol, co-trimoxazole, phenytoin, carbamazepine, carbimazole, furosemide, chloroquine, clozapine, some DMARDs)Benign (racial or familial)CyclicalImmune (e.g. SLE, Felty’s syndrome, hypersensitivity and anaphylaxis)LeukaemiaInfections (e.g. HIV, hepatitis, fulminant bacterial infection)General PancytopaeniaHypersplenism, aplastic anaemia, malignant infiltration of bone marrow, megaloblastic anaemia, chemotherapy, myelodysplasia
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 2
Correct
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Which of the following is the most common cause of hyperthyroidism:
Your Answer: Graves disease
Explanation:Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disease in which autoantibodies against TSH receptors are produced. These antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Therefore, the signs and symptoms of Graves disease are the same as those of hyperthyroidism, reflecting the actions of increased circulating levels of thyroid hormones: increased heat production, weight loss, increased 02 consumption and cardiac output and exophthalmos (bulging eyes, not drooping eyelids). TSH levels will be decreased (not increased) as a result of the negative feedback effect of increased T3 levels on the anterior pituitary.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 3
Correct
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Atrial natriuretic peptide (ANP) is primarily produced in response to:
Your Answer: An increase in intravascular fluid volume
Explanation:Atrial natriuretic peptide (ANP) is released from cardiac atrial muscle cells in response to atrial stretch caused by an increase in intravascular fluid volume and is also produced in collecting duct cells.Atrial natriuretic peptide acts to inhibit sodium reabsorption in the distal nephron.
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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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Coagulative necrosis is typically seen in which of the following:
Your Answer: Malignant hypertension
Correct Answer: Myocardial infarction
Explanation:Coagulative necrosis is the most common form of necrosis characterised by the loss of cell nuclei, but with general preservation of the underlying architecture. Dead tissue is macroscopically pale and firm. This is the classic pattern seen in myocardial infarction.Liquefactive necrosis leads to complete loss of cellular structure and conversion into a soft, semi-solid mass. This is typically seen in the brain following cerebral infarction.Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.Gangrenous necrosis is necrosis with putrefaction of tissues due to exposure to air (dry gangrene) or infection (wet gangrene).
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 5
Incorrect
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Approximately what percentage of filtered bicarbonate is reabsorbed in the proximal tubule:
Your Answer: 60 - 70%
Correct Answer: 0.8
Explanation:Bicarbonate is freely filtered at the glomerulus. Less than 0.1% of filtered bicarbonate is normally excreted in the urine (if plasma [HCO3-] increases, maximum tubular transport is exceeded and some HCO3-is excreted in urine). About 80% of bicarbonate is reabsorbed in the proximal tubule. For each H+secreted into the lumen, one Na+and one HCO3-are reabsorbed into the plasma. H+is recycled so there is little net secretion of H+at this stage. A further 10 – 15% of HCO3-is similarly reabsorbed in the thick ascending limb of the loop of Henle. In the early distal tubule, H+secretion is predominantly by Na+/H+exchange but more distally, the Na+gradient is insufficient so secretion is via H+ATPase and H+/K+ATPase in intercalated cells, which contain plentiful carbonic acid. As secreted H+is derived from CO2, new HCO3-is formed and returns to the blood.H+secretion is proportional to intracellular [H+] which itself is related to extracellular pH. A fall in blood pH will therefore stimulate renal H+secretion. In the proximal tubule secretion of H+serves to reclaim bicarbonate from glomerular filtrate so it is not lost, but in the distal nephron, secretion leads to net acid excretion and generation of new bicarbonate.
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This question is part of the following fields:
- Physiology
- Renal
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Question 6
Correct
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In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.Prolonged seizures last 5 minutes or more. Repeated seizures refer to 3 or more seizures in an hour.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 7
Incorrect
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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: Carbamazepine
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.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 8
Correct
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A blood culture was performed from a sample taken from a patient. It was noted that a Gram-positive coccus organism was grown.Among the following microorganisms, which is considered an example of a Gram-positive coccus?
Your Answer: Staphylococcus aureus
Explanation:Bacillus cereus = Gram-positive bacillusNeisseria meningitidis = Gram-negative coccusSalmonella enterica & Escherichia coli = Gram-negative bacilliIn Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative. The Staphylococci that are associated with infections in humans are colonizers of various skin and mucosal surfaces. Because the carrier state is common among the human population, infections are frequently acquired when the colonizing strain gains entrance to a normally sterile site as a result of trauma or abrasion to the skin or mucosal surface.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 9
Incorrect
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Which of the following is NOT a typical clinical feature of beta-thalassaemia major:
Your Answer: Increased susceptibility to infection
Correct Answer: Increased bleeding tendency
Explanation:Features include:- severe anaemia (becoming apparent at 3 – 6 months when the switch from gamma-chain to beta-chain production takes place)- failure to thrive- hepatosplenomegaly (due to excessive red cell destruction, extramedullary haemopoiesis and later due to transfusion related iron overload)- expansion of bones (due to marrow hyperplasia, resulting in bossing of the skull and cortical thinning with tendency to fracture)- increased susceptibility to infections (due to anaemia, iron overload, transfusion and splenectomy)- osteoporosis- hyperbilirubinaemia and gallstones- hyperuricaemia and gout- other features of haemolytic anaemia- liver damage and other features of iron overload
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This question is part of the following fields:
- Haematology
- Pathology
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Question 10
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 11
Correct
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A 78-year-old male presents to the Orthopaedic clinic with lower back pain for the past month. His past medical history reveals a history of cancer. After examination, you diagnose Metastatic Spinal Cord Compression (MSCC). Which one of the following cancers is this patient most likely to have had?
Your Answer: Prostate cancer
Explanation:Compression of the thecal sac causes metastatic Spinal Cord Compression (MSCC) due to a Metastatic tumour and its components. It can cause symptoms of limb weakness, sensory disturbances and back pain depending on the extent and level of Compression. The most common source of a tumour causing MSCC is a prostate carcinoma that metastasized to the spinal cord via the vertebral venous plexus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 12
Correct
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Which of the following antibiotics is the first line of treatment for a patient who has been diagnosed with chlamydia infection?
Your Answer: Azithromycin
Explanation:The Centres for Disease Control and Prevention (CDC) recommends azithromycin, a single 1 g dose, and doxycycline, 100 mg bd for 7 days, as first-line medications for chlamydial infection treatment. Second-line medications (such as erythromycin, penicillins, and sulfamethoxazole) are less effective and have more side effects
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 13
Correct
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Which of the following nerves innervates the adductor brevis?
Your Answer: Obturator nerve
Explanation:Like the majority of the thigh adductors, adductor brevis is innervated by the obturator nerve. Obturator nerve is derived from the lumbar plexus (anterior branches of spinal nerves L2-L4).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 14
Correct
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Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:
Your Answer: Dalton's law
Explanation:Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 15
Correct
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You examine a child who has been admitted to the paediatric emergency department with a flu-like illness. His parents tell you that he was born with an inborn defect of steroid metabolism and that he was treated for it with hormone replacement therapy.Which of the following is classified as a steroid hormone?
Your Answer: Aldosterone
Explanation:Hormones can be classified into three categories depending on their chemical composition: amines, peptides (and proteins), and steroids. Amines are made up of single amino acids (for example, tyrosine), peptide hormones are made up of peptides (or proteins), and steroid hormones are made up of cholesterol.The table below lists some prominent instances of each of these three hormone classes:1. Peptide hormone: Adrenocorticotropic hormone (ACTH)Prolactin VasopressinOxytocin GlucagonInsulin SomatostatinCholecystokinin 2. Amine hormone:Adrenaline (epinephrine) Noradrenaline (norepinephrine)Dopamine3. Steroid hormone:Mineralocorticoids (e.g. aldosterone)Glucocorticoids (e.g. cortisol)ProgestogensAndrogensOestrogens
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 16
Correct
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What is the effect of activated vitamin D on the renal handling of calcium:
Your Answer: Increases calcium reabsorption in the distal tubule
Explanation:Activated vitamin D acts to:GUT:increase calcium and phosphate absorption in the small intestine (the main action)KIDNEYS:increase renal calcium reabsorption (in the distal tubule via activation of a basolateral Ca2+ATPase pump), increase renal phosphate reabsorption, inhibit 1-alpha-hydroxylase activity in the kidneys (negative feedback)PARATHYROID GLANDS:inhibit PTH secretion from the parathyroid glands
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 17
Correct
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Which of these is an example of ordinal data?
Your Answer: Disease staging system
Explanation:Categorical data or data that is ordered is Ordinal data e.g. disease staging system, pain scoring system.Disease staging system is the correct answer
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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 patient in a high-dependency unit complains of severe and painful muscle cramps. His total corrected plasma calcium level is 1.90 mmol/L.What is the most likely underlying cause?
Your Answer: Thiazide diuretics
Correct Answer: Rhabdomyolysis
Explanation:Hypocalcaemia occurs when there is abnormally low level of serum calcium ( >2.2 mmol/l) after correction for the serum albumin concentration.Rhabdomyolysis causes hyperphosphatemia, and this leads to a reduction in ionised calcium levels.Patients with rhabdomyolysis are commonly cared for in a high dependency care setting. Addison’s disease, hyperthyroidism, thiazide diuretics and lithium all cause hypercalcaemia.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 19
Correct
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A patient has suffered a nerve injury that has caused weakness of the pectoralis minor muscle.Pectoralis minor receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer: Medial pectoral nerve
Explanation:Pectoralis minor is a thin, triangular muscle that is situated in the upper chest. It is thinner and smaller than pectoralis major. It is innervated by the medial pectoral nerve.The origin of pectoralis minor is the 3rdto the 5thribs, near the costal cartilages. It inserts into the medial border and superior surface of the coracoid process of the scapula.The main action of pectoralis minor is to draw the scapula inferiorly and anteriorly against the thoracic wall. This serves to stabilise the scapula.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Correct
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All of the following typically occurs as part of normal inspiration except:
Your Answer: Contraction of the internal intercostal muscles
Explanation:Passive inspiration is a result of contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, several movements occur. These are:1. elevation of the sternal ends of the ribs (‘pump handle’ movement), 2. elevation of the lateral shafts of the ribs (‘bucket handle’ movement) 3. depression of the diaphragm. These result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. There is an increased intrathoracic volume and decreased intrathoracic pressure and 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 21
Correct
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A patient is sent in by her GP with suspected ectopic pregnancy. Tubal ectopic pregnancies occur most commonly in which part of the uterine tube:
Your Answer: Ampulla
Explanation:Ectopic pregnancy most commonly occurs in the ampulla (70% of cases).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 22
Correct
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Haemophilia B results from a deficiency in:
Your Answer: Factor IX
Explanation:Haemophilia B is a bleeding disorder caused by a deficiency of clotting factor IX. It is the second commonest form of haemophilia, and is rarer than haemophilia A. Haemophilia B tends to be similar to haemophilia A but less severe. The two disorders can only be distinguished by specific coagulation factor assays.The incidence is one-fifth of that of haemophilia A. Laboratory findings demonstrate prolonged APTT, normal PT and low factor IX.Haemophilia B inherited in an X-linked recessive fashion, affecting males born to carrier mothers.There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 23
Incorrect
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Compression of this nerve can cause weakness in the left leg while walking and thigh adduction weakness at the hip joint.
Your Answer: Superior gluteal nerve
Correct Answer: Obturator nerve
Explanation:The obturator nerve is a sensory and motor nerve that emerges from the lumbar plexus and innervates the thigh. This nerve supplies motor innervation to the medial compartment of the thigh, making it necessary for thigh adduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 24
Correct
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A 66-year-old female with a history of stroke one year ago presents to the Family Medicine clinic complaining of fatigue, weight loss, and tongue discolouration. On examination, she seems malnourished, her tongue is beefy red, and an ataxic gait pattern is noticed. Which ONE of the following conditions does this patient most likely have?
Your Answer: Vitamin B12 deficiency
Explanation:A history of stroke and poor nutritional status points towards a nutritional deficiency as the most likely cause of her symptoms. The examination would differentiate between Vitamin B12 and Folic acid deficiency as in the former. The patient has a beefy red tongue and symptoms indicating peripheral nervous system involvement or subacute combined spinal cord degeneration. The patient may also have a lemon-yellow skin colour, loss of proprioception and vibratory sense and oral ulceration. Investigations in B12 deficiency can reveal the following:1. Macrocytic anaemia2. Neutropoenia3. Thrombocytopaenia4. Blood film: anisocytosis, poikilocytosis5. Low serum B126. Raised serum bilirubin (haemolysis)7. Intrinsic factor antibodies8. Positive Schilling test
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This question is part of the following fields:
- Haematology
- Pathology
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Question 25
Incorrect
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A 70-year-old patient is diagnosed with Cushing's disease. She has a history of weight gain, hypertension, and easy bruising.In this patient, which of the following is the MOST LIKELY UNDERLYING CAUSE?
Your Answer: Iatrogenic administration of corticosteroids
Correct Answer: Pituitary adenoma
Explanation:Cushing’s syndrome is a collection of symptoms and signs caused by prolonged exposure to elevated levels of either endogenous or exogenous glucocorticoids.The most common cause of Cushing’s syndrome is the iatrogenic administration of corticosteroids. The second most common cause of Cushing’s syndrome is Cushing’s disease.Cushing’s disease should be distinguished from Cushing’s syndrome and refers to one specific cause of the syndrome, an adenoma of the pituitary gland that secretes large amounts of ACTH and, in turn, elevates cortisol levels. This patient has a diagnosis of Cushing’s disease, and this is, therefore, the underlying cause in this case.The endogenous causes of Cushing’s syndrome include:Pituitary adenoma (Cushing’s disease)Ectopic corticotropin syndrome, e.g. small cell carcinoma of the lungAdrenal hyperplasiaAdrenal adenomaAdrenal carcinoma
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 26
Incorrect
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Which statement about cross-sectional studies is true?
Your Answer: They are suitable for the study of rare diseases
Correct Answer: They can be used to assess the prevalence of a condition
Explanation:Cross-sectional studies can be used to assess the prevalence of a condition.Cross-sectional studies CANNOT be used to differentiate between cause and effect or establish the sequence of events.They can be used to study multiple outcomes but are NOT suitable for studying rare diseases.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 27
Incorrect
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An 82 year old man has fever, left sided abdominal and back pain and presents to the emergency room. Imaging reveals a large perinephric abscess. Which of the following most likely describes the fluid location:
Your Answer: Between the renal capsule and the perinephric fat
Correct Answer: Between the renal capsule and the renal fascia
Explanation:The perinephric fat is immediately external to the renal capsule and completely surrounds the kidney. The renal fascia surrounds the perinephric fat and the paranephric fat is external to the renal fascia. The location of a perinephric abscess is in the perinephric fat between the renal capsule and the renal fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 28
Incorrect
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Following an injury sustained during a rugby match, a 16-year-old boy is brought to the Emergency Department by his mother. His forearm appears to be deformed, and you believe he has a distal radius fracture. A numerical rating scale is used to assess his pain, and the triage nurse informs you that he is in moderate pain.'The RCEM guidance recommends which of the following analgesics for the treatment of moderate pain in a child of this age?
Your Answer: Intranasal diamorphine 0.1 mg/kg
Correct Answer: Oral codeine phosphate 1 mg/kg
Explanation:According to a 2018 audit conducted by the Royal College of Emergency Medicine (RCEM), the standard of care for children presenting to EDs with fractured limbs has deteriorated, with most patients waiting longer than ever before for pain relief. More than one-tenth of the children who came in with significant pain from a limb fracture received no pain relief at all.For all patients, including children, the Agency for Health Care Policy and Research (AHCPR) in the United States recommends using the ABCs of pain management:A – Ask about pain regularly. Assess pain systematically.B – Believe the patient and family in their reports of pain and what relieves it.C – Choose pain control options appropriate for the patient, family, and setting.D – Deliver interventions in a timely, logical, coordinated fashion.E – Empower patients and their families. Enable patients to control their course to the greatest extent possible.The RCEM guidelines recommend assessing a child’s pain within 15 minutes of arrival. This is a fundamental requirement. For the assessment of pain in children, a variety of rating scales are available; which one is used depends on the child’s age and ability to use the scale. These are some of them:Faces of Wong-Baker Scale for assessing painScale of numerical evaluationThe behavioural scale is a scale that measures how people behave.The RCEM has provided the following visual guide:The RCEM has established the following guidelines for when patients in severe pain should receive appropriate analgesia:100% within 60 minutes of arrival or triage, whichever is earliest75% within 30 minutes of arrival or triage, whichever is earliest50% within 20 minutes of arrival or triage, whichever is earliest
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 29
Correct
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Regarding calcium channel blockers, which of the following statements is CORRECT:
Your Answer: Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle causing vasodilation.
Explanation:Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle, causing relaxation and vasodilation (reduction in peripheral vascular resistance). They also block calcium channels within the myocardium and conducting tissues of the heart which produces a negative inotropic effect by reducing calcium influx during the plateau phase of the action potential. They have a variety of uses, including:HypertensionAnginaAtrial fibrillationMigraineCalcium channel blockers have been found to be moderately useful in the prevention of migraines. The best evidence is for this is with verapamil. This may be due to the prevention of the arteriolar constriction that is associated with migraine. They are commonly used for this elsewhere in the world but are not currently licensed for this use in the UK.The following are common side effects of all calcium-channel blockers:Abdominal painDizzinessDrowsinessFlushingHeadacheNausea and vomitingPalpitationsPeripheral oedemaSkin reactionsTachycardiaVerapamil is highly negatively inotropic and reduces cardiac output, slows the heart rate and may impair atrioventricular conduction. It may precipitate heart failure, exacerbate conduction disorders, and cause hypotension at high doses and should not be used with beta-blockers. Nifedipine has less myocardial effects than verapamil and has no antiarrhythmic properties but has more influence on the vessels. Nimodipine is used solely for the prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage.
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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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Which of the following is NOT a feature characteristic of intravascular haemolysis:
Your Answer: Haemoglobinaemia
Correct Answer: Bilirubinuria
Explanation:Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria
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This question is part of the following fields:
- Haematology
- Pathology
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Question 31
Incorrect
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A 40-year-old man has been admitted for alcohol detoxification. You are asked to review the patient's treatment chart and notice that he has been prescribed Pabrinex by one of your colleagues.Out of the following, which vitamin is not found in Pabrinex?
Your Answer: Vitamin B1
Correct Answer: Vitamin B12
Explanation:Pabrinex is indicated in patients that require rapid therapy for severe depletion or malabsorption of water-soluble vitamins B and C, particularly in alcoholism detoxification. Pabrinex has the following: 1. Thiamine (vitamin B1) 2. Riboflavin (vitamin B2)3. Nicotinamide (Vitamin B3, niacin and nicotinic acid)4. Pyridoxine (vitamin B6)5. Ascorbic acid (vitamin C)6. GlucoseSuspected or established Wernicke’s encephalopathy is treated by intravenous infusion of Pabrinex/ The dose is 2-3 pairs three times a day for three to five days, followed by one pair once daily for an additional three to five days or for as long as improvement continues.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 32
Correct
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Which of the following is NOT typically present in the nasopharyngeal flora:
Your Answer: Bacteroides spp.
Explanation:Bacteroides spp. are typically found in the normal flora of the lower gastrointestinal tract. Species commonly found in the flora of the nasopharynx include: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Corynebacterium spp., Moraxella spp. and Candida spp.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 33
Correct
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A 79-year-old male had a humeral shaft fracture during a road traffic accident and is being followed up in a fracture clinic. He complains of inability to use the limb 6 months after the injury. X-rays of that arm shows non union of his fracture.All the following are responsible for this non-union EXCEPT?
Your Answer: Osteoporosis
Explanation:An imbalance between bone resorption and formation is Osteoporosis. In normal bone, formation and resorption are roughly equal, and the density of bone matrix remains constant but there is more resorption in osteoporosis and the matrix density reduces and bones become weaker. Fractures are more likely to occur but healing is unaffected. Non-union of a fracture occurs when the two sides of a fracture fail to unite after 6 months. Causes include: infection, movement at the fracture site, avascular necrosis, tissue interposed between the fracture and gross misalignment.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 34
Correct
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After collapsing in his nursing home, a 70-year-old man is brought into the ER. He has diabetes mellitus and is on medication for it. An RBS of 2.0 mmol/L (3.9-5.5 mmol/L) is recorded in the ER. Out of the following, which medication for diabetes mellitus is LEAST likely responsible for his hypoglycaemic episode?
Your Answer: Metformin
Explanation:Metformin is a biguanide used as the first-line to treat type 2 diabetes mellitus. It has a good reputation as it has an extremely low risk of causing hypoglycaemia compared to the other agents for diabetes. It does not affect the insulin secreted by the pancreas or increase insulin levels. Toxicity with metformin can, however, cause lactic acidosis with associated hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 35
Incorrect
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Which of the following best describes a natural killer cell:
Your Answer: A large phagocyte that is part of the innate immune system.
Correct Answer: A large granular lymphocyte that kills by inducing target cell apoptosis.
Explanation:Natural killer (NK) cells are cytotoxic CD8 positive cells that lack the T-cell receptor. They are large cells with cytoplasmic granules. NK cells are designed to kill target cells that have a low level of expression of HLA class I molecules, such as may occur during viral infection or on a malignant cell. NK cells do this by displaying several receptors for HLA molecules on their surface. When HLA is expressed on the target cell these deliver an inhibitory signal into the NK cell. When HLA molecules are absent on the target cell this inhibitory signal is lost and the NK cell can then kill its target. In addition, NK cells display antibody-dependent cell-mediated cytotoxicity. In this, antibody binds to antigen on the surface of the target cell and then NK cells 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 36
Correct
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A suspicious growth on the posterior tongue of a 40-year-old man was discovered by his dentist and was immediately referred for possible oral cancer. The lymph from the posterior tongue will drain to which of the following nodes?
Your Answer: Deep cervical nodes
Explanation:Lymph from the medial anterior two thirds of the tongue travels to the deep cervical lymph nodes.Lymph from the lateral anterior tongue goes to the submandibular nodes.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 37
Correct
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A 34-year-old male is brought into the Emergency Department by the paramedics after a road traffic accident. After a quick triage, you establish that he will need to be intubated, and you ask for some ketamine to be prepared. Which one of the following options regarding this drug is true?
Your Answer: It is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties
Explanation:Ketamine is a dissociative anaesthetic with analgesic, amnesic, and hypnotic effects. It is the only anaesthetic agent which causes all three of these effects.Ketamine exerts its action by non-competitive antagonism at the NMDA (N-methyl-D-aspartate) receptor. Due to its analgesic property, Ketamine is given so that patients do not retain memories of short term procedures. Ketamine is used for the induction and maintenance of anaesthesia in general surgery and for treating burn wounds, battlefield injuries, and children who cannot tolerate other anaesthetic or analgesic agents.It can be given by both intravenous and intramuscular routes. Ketamine causes cardiac stimulation by increasing the sympathetic tone. The major side effect is increased intracranial pressure as an increase in the sympathetic tone causes vasoconstriction and an increase in the MAP.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 38
Correct
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Clostridium difficile primarily causes which of the following infectious diseases:
Your Answer: Pseudomembranous colitis
Explanation:Clostridium difficile causes pseudomembranous colitis, an acute inflammatory diarrhoeal disease and an important cause of morbidity and mortality in hospitals. Gas gangrene is primarily caused by Clostridium perfringens. Tetanus is caused by Clostridium tetani. Toxic shock syndrome may be caused by Staphylococcus aureus or Streptococcus pyogenes. Necrotising fasciitis is most commonly caused by Streptococcus pyogenes but has a multitude of causes.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 39
Incorrect
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Which of the following ions normally has the highest concentration in intracellular fluid:
Your Answer: PO 4 3-
Correct Answer: K +
Explanation:Potassium (K+) is the principal intracellular ion; approximately 4 mmol/L is extracellular (3%) and 140 mmol/L intracellular (97%).
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 40
Correct
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Which of the following is NOT a typical feature of benzodiazepine toxicity:
Your Answer: Hyperventilation
Explanation:Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 41
Correct
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CSF is reabsorbed from subarachnoid space via which of the following structures:
Your Answer: Arachnoid granulations
Explanation:From the subarachnoid cisterns in the subarachnoid space, CSF is reabsorbed via arachnoid granulations which protrude into the dura mater, into the dural venous sinuses and from here back into the circulation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 42
Incorrect
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Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer: The intervertebral disc consists of an outer layer called the fibrous pulposus.
Correct Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.
Explanation:A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 43
Correct
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A p value < 0.05 obtained from a study with a significance level (α) of 0.05, means all of the following, EXCEPT:
Your Answer: the result is clinically significant.
Explanation:A p value < 0.05:is statistically significantmeans that the probability of obtaining a given result by chance is less than 1 in 20means the null hypothesis is rejectedmeans there is evidence of an association between a variable and an outcomeNote that this does not tell us whether the result is clinically significant.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 44
Incorrect
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The following structures all lie anteriorly to the oesophagus EXCEPT for the:
Your Answer: Trachea
Correct Answer: Thoracic duct
Explanation:Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 45
Correct
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Adenosine has a half-life of approximately:
Your Answer: 8 - 10 seconds
Explanation:Adenosine stimulates A1-adenosine receptors and opens acetylcholine sensitive K+ channels, increasing K+ efflux. This hyperpolarises the cell membrane in the atrioventricular node and, by inhibiting the calcium channels, slows conduction in the AVN. As it has a very short duration of action (half-life only about 8 – 10 seconds), most side effects are short lived.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 46
Correct
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Which of the following statements about neutrophils is TRUE:
Your Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.
Explanation:Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 47
Correct
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Regarding acute idiopathic thrombocytopaenic purpura (ITP), which of the following statements is CORRECT:
Your Answer: Over 80% of children recover without treatment.
Explanation:Acute ITP is most common in children. In approximately 75% of cases, the episode follows vaccination or infection such as chicken pox or glandular fever. Most cases are caused by non-specific immune complex attachment to platelets. Acute ITP usually has a very sudden onset and the symptoms usually disappear in less than 6 months (often within a few weeks). It is usually a self-limiting condition and over 80% of children recover without treatment; in 5 – 10% of cases a chronic form of the disease develops.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 48
Correct
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A 22-year-old man comes to the emergency department with a human bite injury to his hand received from a punch during a fight 3 hours earlier outside a bar. On closer inspection, you discover bite marks on his first and second knuckles. Which of the following is the best treatment option for this patient:
Your Answer: Oral co-amoxiclav for 7 days
Explanation:Even if there is no evidence of infection, prophylactic antibiotics should be administered for all human bite wounds that are less than 72 hours old. The first-line therapy is 7 days of co-amoxiclav. In penicillin-allergic people, metronidazole + doxycycline is an option. Streptococcus spp., Staphylococcus aureus, Haemophilus spp., Eikenella corrodens, Bacteroides spp., and other anaerobes are the most prevalent organisms found in human bites.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 49
Correct
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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: 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.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 50
Correct
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A 26-year-old woman is currently 9 weeks pregnant. Upon interview and history taking, she mentioned that she visited a friend whose child had just been diagnosed with slapped cheek disease.If the mother contracts an illness during pregnancy, which among the following is not known to cause fetal abnormalities?
Your Answer: Hepatitis A
Explanation:Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)toxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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