-
Question 1
Incorrect
-
A patients had a left Colles' fracture, which you were able to repair. It was their second fragility fracture this year, and you'd like to provide them some tips on how to keep their bones healthy.What percentage of the calcium in the body is kept in the bones? Only ONE response is acceptable.
Your Answer: 85%
Correct Answer: 99%
Explanation:Calcium is stored in bones for nearly all of the body’s calcium, but it is also found in some cells (most notably muscle cells) and the blood. The average adult diet comprises roughly 25 mmol of calcium per day, of which the body absorbs only about 5 mmol.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 2
Incorrect
-
Innate, or non-specific, immunity is the immune system we are born with.Which of the following is NOT an example of innate immunity? Select ONE answer only.
Your Answer: Natural killer cells
Correct Answer: T-lymphocytes
Explanation:Innate, or non-specific, immunity is the immune system we are born with.There are three aspects of innate immunity:1. Anatomical barriers, such as:The cough reflexEnzymes in tears and skin oilsMucus – which traps bacteria and small particlesSkinStomach acid2. Humoral barriers, such as:The complement systemInterleukin-13. Cellular barriers, such as:NeutrophilsMacrophagesDendritic cellsNatural killer cellsAntibody production is part of the specific, or inducible immune response. T-lymphocytesare responsible for the cell mediated immune response which is part of specific, or inducible immunity.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 3
Correct
-
A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?
Your Answer: Cranial diabetes insipidus
Explanation:Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes. The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus. By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone. Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output. Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 4
Correct
-
Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?
Your Answer: Axillary nodes
Explanation:Lymph is the fluid that flows through the lymphatic system. Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly. The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 5
Correct
-
In the treatment of bradyarrhythmias with adverse characteristics or risk of asystole, what is the initial suggested dose of atropine?
Your Answer: 500 micrograms
Explanation:Atropine 500 mcg IV bolus should be administered if there are any adverse features or risk of asystole. If the reaction is not adequate, repeat the steps every 3 to 5 minutes up to a maximum dose of 3 mg. In the case of acute myocardial ischemia or myocardial infarction, atropine should be taken with caution since the increased heart rate may aggravate the ischemia or increase the size of the infarct.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 6
Correct
-
Regarding control of hospital acquired infection (HAI), which of the following statements is CORRECT:
Your Answer: Chlorhexidine is an anti-staphylococcal agent.
Explanation:Chlorhexidine is an anti-staphylococcal agent. Cleaning is the removal of foreign material from areas or objects to a point at which they are visually free from debris.  Disinfection is the reduction in the number of infectious particles. Isopropyl alcohol is not effective against C. difficile spores. Autoclaving is a method of sterilisation.
-
This question is part of the following fields:
- Microbiology
- Principles
-
-
Question 7
Correct
-
Which of the following drugs decreases plasma-theophylline levels:
Your Answer: Carbamazepine
Explanation:Examples of enzyme-inhibiting drugs (raise plasma theophylline level):ErythromycinClarithromycinCiprofloxacinFluconazoleVerapamilAllopurinolCimetidineExamples of enzyme-inducing drugs (lower plasma theophylline level):PrimidonePhenobarbitalCarbamazepinePhenytoinRitonavirRifampicinSt John’s Wort
-
This question is part of the following fields:
- Pharmacology
- Respiratory
-
-
Question 8
Correct
-
EMLA cream is a topical local anaesthetic containing which of the following:
Your Answer: 50/50 mixture 2.5% lidocaine and 2.5% prilocaine
Explanation:EMLA cream, an effective topical local anaesthetic, is a 50/50 mixture of 2.5% prilocaine and 2.5% lidocaine.
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 9
Incorrect
-
The following are all examples of type IV hypersensitivity EXCEPT for:
Your Answer: Contact dermatitis
Correct Answer: Extrinsic allergic alveolitis
Explanation:Examples of type IV reactions includes:Contact dermatitisHashimoto’s thyroiditisPrimary biliary cholangitisTuberculin skin test (Mantoux test)Chronic transplant rejectionGranulomatous inflammation (e.g. sarcoidosis, Crohn’s disease)
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 10
Correct
-
Which of the following is NOT an effect of gastrin:
Your Answer: Stimulation of insulin release
Explanation:Gastrin acts to:Stimulate acid secretion from parietal cells (both directly and indirectly by stimulating release of histamine from ECL cells)Stimulate pepsinogen secretion from chief cellsIncrease gastric motilityStimulate growth of gastric mucosa
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 11
Incorrect
-
A patient is found to be anaemic. Which one of the following blood results would favour a diagnosis of anaemia of chronic disease rather than iron deficiency:
Your Answer: Low serum ferritin
Correct Answer: Low total iron binding capacity (TIBC)
Explanation:Anaemia of chronic disease is one of the most common causes of normocytic anaemia. The anaemia is usually mild (Hb > 90 g/L) and non-progressive. Anaemia of chronic disease is usually associated with low serum iron, low transferrin saturation, and a low total iron binding capacity (TIBC) with normal or raised ferritin which differentiates it from iron deficiency anaemia.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 12
Correct
-
A 30 year old man presents to ED after a road traffic accident. Free intraperitoneal fluid is found on FAST (Focussed assessment for sonography in trauma) done in the supine position. Which of these is most likely to be affected?
Your Answer: Hepatorenal recess
Explanation:Fluid accumulates most often in the hepatorenal pouch (of Morrison) in a supine patient. The hepatorenal pouch is located behind the liver and anterior to the right kidney and is the lowest space in the peritoneal cavity in the supine position.Although the vesicouterine and rectouterine spaces are also potential spaces for fluid accumulation, fluid accumulation in them occur in the erect position.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 13
Correct
-
The correct statement regarding the parasympathetic nervous system is which of the following?
Your Answer: Parasympathetic preganglionic neurones run in cranial nerves III, VII, IX and X.
Explanation:The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2 molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 14
Incorrect
-
What is the mechanism of action of penicillin antibiotics:
Your Answer: Alterations of bacterial cell membranes
Correct Answer: Inhibition of bacterial cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 15
Correct
-
A 24-year-old male presents to the Emergency Department with a three-day history of high-grade fever, headache and rash along with neck stiffness. On examination, Kernig's sign is positive, and you note a petechial rash over the trunk and limbs. Her vital signs show tachycardia and hypotension. Based on these findings, you diagnose sepsis secondary to meningitis. Which one of the following definitions of sepsis is currently accepted?
Your Answer: Life-threatening organ dysfunction caused by a dysregulated host response to infection
Explanation:In 2016 the SOFA guideline was introduced, also called the Sepsis-related Organ Failure Assessment, to make a sepsis diagnosis easier and prevent mortality. According to this guideline, sepsis was defined as a life-threatening organ dysfunction due to a dysregulated host response to infection. Septic shock was defined as a subset of sepsis in which the circulatory and metabolic abnormalities would lead to a greater risk of mortality than sepsis alone. Patients with septic shock would be clinically identified by a need for vasopressors to maintain MAP greater than 65 mmHg and serum lactate greater than two mmol/L.
-
This question is part of the following fields:
- Pathology
- Pathology Of Infections
-
-
Question 16
Correct
-
Which of the following movements does the iliacus muscle produce?
Your Answer: Flexion of the thigh at the hip joint
Explanation:The iliacus flexes the thigh at the hip joint when the trunk is stabilised. It flexes the trunk against gravity when the body is supine.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 17
Correct
-
Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department by ambulance. Her heart rate is 180 beats per minute, and the rhythm strip shows supraventricular tachycardia. You intend to give adenosine.Which of the following is NOT a contraindication for adenosine use?
Your Answer: History of heart transplant
Explanation:The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg. Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.The use of adenosine is contraindicated in the following situations:AsthmaCOPD (chronic obstructive pulmonary disease)Decompensated heart failure Long QT syndromeAV block in the second or third degreeSinusitis is a condition in which the sinuses become (unless pacemaker fitted)Hypotension that is severeIt has a half-life of less than 10 seconds and acts quickly within that time frame. The actions last between 10 and 20 seconds. Because of the short half-life of the drug, any side effects are usually only temporary. These are some of them:a feeling of impending doomFlushing of the faceDyspnoeaUncomfortable chestTastes metallic
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 18
Correct
-
Calcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels. The phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.A phenylalkylamine calcium-channel blocker is, for example, which of the following?
Your Answer: Verapamil
Explanation:Calcium-channel blockers, also known as calcium antagonists, stop calcium from entering cells through the L-type calcium channel. This causes vascular smooth muscle in vessel walls to relax, resulting in a decrease in peripheral vascular resistance. They can be used for a variety of things, including:HypertensionAnginaAtrial fibrillationMigraineCalcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels.Dihydropyridines have a high vascular selectivity and lower systemic vascular resistance and blood pressure. As a result, they’re frequently used to treat hypertension. Modified release formulations are also used to treat angina, but their powerful systemic vasodilator and pressure-lowering effects can cause reflex cardiac stimulation, resulting in increased inotropy and tachycardia, which can counteract the beneficial effects of reduced afterload on myocardial oxygen demand.The suffix -dpine distinguishes dihydropyridines from other pyridines. Examples of dihydropyridines that are commonly prescribed include:AmlodipineFelodipineNifedipineNimodipineThe phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.Phenylalkylamines are less effective as systemic vasodilators because they are relatively selective for the myocardium. This group of drugs lowers myocardial oxygen demand and reverses coronary vasospasm, making them useful in the treatment of angina. They are also occasionally used to treat arrhythmias. A phenylalkylamine calcium-channel blocker like verapamil is an example.In terms of selectivity for vascular calcium channels, benzothiazepines fall somewhere between dihydropyridines and phenylalkylamines. They can lower arterial pressure without producing the same level of reflex cardiac stimulation as dihydropyridines because they have both cardiac depressant and vasodilator effects. Diltiazem is the only benzothiazepine currently in clinical use.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 19
Correct
-
A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.Peroneus longus is innervated by the superficial peroneal nerve.Peroneus tertius is innervated by the deep peroneal nerve.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 20
Correct
-
A 29 year old woman is unable to invert her foot after sustaining an injury to her leg playing water-polo. Which of the following nerves are most likely damaged:
Your Answer: Tibial and deep fibular nerve
Explanation:Inversion of the foot is primarily produced by the tibialis anterior and the tibialis posterior muscles, innervated by the deep fibular nerve and the tibial nerve respectively.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 21
Correct
-
Which of the following is NOT a heritable risk factor for venous thrombosis:
Your Answer: Von Willebrand disease
Explanation:Approximately one-third of patients who suffer DVT or PE have an identifiable heritable risk factor, although additional risk factors are usually present when they develop the thrombosis. The history of a spontaneous DVT in a close relative increases an individual’s risk of DVT even if no known genetic predisposition can be identified.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 22
Incorrect
-
Regarding myeloma, which of the following statements is CORRECT:
Your Answer: The paraprotein in myeloma is usually IgM.
Correct Answer: Myeloma is associated with marked rouleaux formation on blood film.
Explanation:98% of cases of myeloma occur over the age of 40 years with a peak incidence between 65 and 70 years. The disease is twice as common in black individuals compared to those of white or Asian origin. Laboratory findings include presence of a paraprotein in serum/urine (the paraprotein is IgG in 60% of cases, IgA in 20% and light chain only in almost all the rest) and marked Rouleaux formation on blood film. There is no cure for myeloma. The overall median survival is now 7-10 years and in younger (less than 50 years) patients it can be over 10 years.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 23
Correct
-
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
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 24
Correct
-
A 19-year-old student that has presented with a headache and a petechial rash is diagnosed with meningitis caused by Neisseria meningitidis.Which SINGLE statement regarding Neisseria meningitidis is true?
Your Answer: Lipo-oligosaccharide activates complement activation and cytokine release
Explanation:Neisseria meningitidisis is a Gram-negative diplococcusc that can cause meningococcal meningitis.Carriage of Neisseria meningitidisis very common and it exists in the normal flora in the nasopharynx in 5 – 15% of adults. Actual disease only develops in a very small percentage of individuals. Infection is most common in the winter months and epidemics tend to occur about once every 10 years.Most invasive infections are caused by serotypes A, B or C. In the UK, most cases of meningococcal septicaemia are caused byNeisseria meningitidisgroup B. The vaccination programme forNeisseria meningitidisgroup C has made this type much less common. A vaccine for group B disease has now been initiated in children.The main determinant of the pathogenicity of Neisseria meningitidisis the antiphagocytic polysaccharide capsule. Meningococci cross mucosal epithelium by endocytosis and the capsule allows survival in the bloodstream. Lipo-oligosaccharide activates complement activation and cytokine release, resulting in shock and disseminated intravascular coagulation (DIC).Theclinical featuresof meningococcal meningitis include:Non-blanching rashNeck stiffnessHeadachePhotophobiaAltered mental state (drowsiness, confusion)Focal neurological deficitsSeizuresSeptic shockThe diagnosis is usually made clinically and confirmed by culture of blood, aspirate from the rash and CSF. Rapid antigen detection or nucleic acid amplification testing (NAAT) on blood and CSF are both sensitive and reliable.Due to the potentially life-threatening nature of the disease treatment should not wait for laboratory confirmation and antibiotics should be started immediately. In the hospital setting IV ceftriaxone (2 g adult; 80 mg/kg child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the preferred agents. IM benzylpenicillin can be given as an alternative in the pre-hospital setting and chloramphenicol is a suitable alternative if there is a history of anaphylaxis to cephalosporins. Treatment does not eradicate carriage and the patient should be given ‘prophylaxis’ following recovery.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 25
Correct
-
A patient presents complaining of visual loss. On examination you note a contralateral homonymous hemianopia. Where is the most likely site of the lesion:
Your Answer: Optic tract
Explanation:At the optic chiasm, fibres from the medial (nasal) half of each retina crossover, forming the right and left optic tracts.The left optic tract contains fibres from the left lateral (temporal) retina and the right medial retina.The right optic tract contains fibres from the right lateral retina and the left medial retina.Each optic tract travels to its corresponding cerebral hemisphere to reach its lateral geniculate nucleus (LGN) located in the thalamus where the fibres synapse.A lesion of the optic tract will cause a contralateral homonymous hemianopia.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 26
Correct
-
Which one of these equations best defines lung compliance?
Your Answer: Change in volume / change in pressure
Explanation:Lung compliance is defined as change in volume per unit change in distending pressure. Lung compliance is calculated using the equation:Lung compliance = ΔV / ΔPWhere:ΔV is the change in volumeΔP is the change in pleural pressure.Static compliance is lung compliance in periods without gas flow, and is calculated using the equation:Static compliance = VT / Pplat − PEEPWhere:VT = tidal volumePplat = plateau pressurePEEP = positive end-expiratory pressure
-
This question is part of the following fields:
- Physiology
- Respiratory Physiology
-
-
Question 27
Correct
-
Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 2 months:
Your Answer: Meningococcal group C
Explanation:At 2 months the following vaccines are given: Diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (Hib) and hepatitis BRotavirus gastroenteritisMeningococcal group B
-
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
-
-
Question 28
Correct
-
Regarding the hard palate, which of the following statements is CORRECT:
Your Answer: Lymphatic vessels from the palate usually drain into deep cervical lymph nodes.
Explanation:Lymphatic vessels from the pharynx and palate drain into the deep cervical lymph nodes.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 29
Correct
-
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.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 30
Correct
-
The following structures all lie anteriorly to the oesophagus EXCEPT for the:
Your 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).
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 31
Correct
-
Regarding fat digestion, which of the following statements is CORRECT:
Your Answer: Lipids are reesterified in the smooth endoplasmic reticulum of the enterocyte.
Explanation:Fats are digested almost entirely in the small intestine and are only released from the stomach into the duodenum at the rate at which they can be digested (the presence of fatty acids and monoglycerides in the duodenum inhibits gastric emptying). In the duodenum fat is emulsified by bile acids, a process where larger lipid droplets are broken down into much smaller droplets providing a greater surface area for enzymatic digestion. Pancreatic lipase digests triglyceride into monoglycerides and free fatty acids. The products of fat digestion (fatty acids and monoglycerides), cholesterol and fat-soluble vitamins diffuse passively into the enterocytes. Once inside the epithelial cell, lipid is taken into the smooth endoplasmic reticulum where much of it is re esterified. Dietary and synthesised lipids are then incorporated into chylomicrons in the Golgi body, which are exocytosed from the basolateral membrane to enter lacteals.
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 32
Correct
-
One of these statements about significance tests is true.
Your Answer: A p value of less than 1 in 20 is considered ‘statistically significant’
Explanation:The p value is statistically significant when it is less than 0.05 (5% or 1 in 20).Statistical significance is not the same as clinical significance. The null hypothesis states that there is no difference between the groups.The power of a study is the probability of correctly rejecting the null hypothesis when it is false.A type I error occurs when the null hypothesis has been rejected when it is true. A type II error occurs when the null hypothesis has been accepted when it is actually false.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 33
Correct
-
All of the following are physiological effects of thyroid hormones except:
Your Answer: Increased glycogenesis
Explanation:Thyroid hormones have multiple physiological effects on the body. These include:1. Heat production (thermogenesis)2. Increased basal metabolic rate3. Metabolic effects: (a) Increase in protein turnover (both synthesis and degradation are increased, although overall effect is catabolic)(b) Increase in lipolysis(c)Increase in glycogenolysis and gluconeogenesis4. Enhanced catecholamine effect – Increase in heart rate, stroke volume and thus cardiac output5. Important role in growth and development
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 34
Incorrect
-
Which of the following is a common adverse effect of glucagon:
Your Answer: Hypoglycaemia
Correct Answer: Nausea
Explanation:Adverse effects include:Common: NauseaUncommon: VomitingRare: Abdominal pain, hypertension, hypotension, tachycardia
-
This question is part of the following fields:
- Endocrine
- Pharmacology
-
-
Question 35
Incorrect
-
Regarding the extensor carpi ulnaris muscle, which of the following statements is true?
Your Answer: It arises from the medial epicondyle of the elbow
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.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 36
Correct
-
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: 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.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 37
Correct
-
A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The stomach G-cells are responsible for which of the following?Â
Your Answer: Secretion of gastrin
Explanation:G-cells are a type of cell found in the stomach’s pyloric antrum, duodenum, and pancreas. The secretion of the peptide hormone gastrin is their major function.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion
-
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
-
-
Question 38
Correct
-
A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination. The brachial pulse can be best palpated at ?
Your Answer: In the antecubital fossa, medial to the tendon of the biceps brachii
Explanation:The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 39
Incorrect
-
Digoxin is predominantly used for which of the following:
Your Answer: Acute treatment of new-onset fast atrial fibrillation
Correct Answer: Rate control in persistent and permanent atrial fibrillation
Explanation:Digoxin is most useful for controlling the ventricular response in persistent and permanent atrial fibrillation and atrial flutter. Digoxin is usually only effective for controlling the ventricular rate at rest, and should therefore only be used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation. It is now rarely used for rapid control of heart rate, as even with intravenous administration, response may take many hours. Digoxin is reserved for patients with worsening or severe heart failure due to left ventricular systolic dysfunction refractory to combination therapy with first-line agents. Digoxin is contraindicated in supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 40
Incorrect
-
A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?
Your Answer: Malignant hypertension
Correct Answer: None of the other options
Explanation:Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:Coronary artery disease (CAD) Coronary artery disease (CAD) Second stage of labourHypertension that is uncontrolledSevere Ventricular arrhythmias
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 41
Correct
-
Which of the following is most likely to cause a homonymous hemianopia:
Your Answer: Posterior cerebral artery stroke
Explanation:A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 42
Correct
-
You are giving a presentation on the immune system as part of your peer-to-peer teaching sessions. Yu are currently discussing phagocytes. Macrophages are derived from which of the following cells:
Your Answer: Monocytes
Explanation:Monocytes spend only a short time in the marrow and, after circulating for 20-40 hours, leave the blood to enter the tissues where they become macrophages. Macrophages form the reticuloendothelial system in the liver, spleen and lymph nodes. The lifespan of macrophages may be as long as several months or even years. In tissues the macrophages become self-replicating without replenishment from the blood. They assume specific functions in different tissues e.g. dendritic cells which are involved in antigen presentation to T-cells. Macrophages may be activated by cytokines such as IFN-gamma, contact with complement or direct contact with the target cell through leucocyte adhesion molecules.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 43
Correct
-
A 50-year-old woman has an anaphylactic reaction following accidental ingestion peanuts at a restaurant. She is a known hypertensive on atenolol 50 mg daily and BP is well controlled. She is also on amlodipine 5 mg daily. Two doses of IM adrenaline has been given without improvement.Which medication may prove helpful in this patient?
Your Answer: IM Glucagon
Explanation:Resistant to the effects of adrenaline in anaphylaxis is seen in patients taking beta-blockers.Glucagon can be used to overcome the effects of the beta-blockade if initial doses of adrenaline are unsuccessful in patients taking beta-blockers.
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 44
Correct
-
Carbamazepine is indicated for all of the following EXCEPT for:
Your Answer: Myoclonic seizures
Explanation:Carbamazepine is a drug of choice for simple and complex focal seizures and is a first-line treatment option for generalised tonic-clonic seizures. It is also used in trigeminal neuralgia and diabetic neuropathy. Carbamazepine may exacerbate tonic, atonic, myoclonic and absence seizures and is therefore not recommended if these seizures are present.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 45
Correct
-
A patient with diplopia is found to have eye deviation downwards and outwards. The likely nerves that are affected are:
Your Answer: Oculomotor nerve
Explanation:The results of an oculomotor (CN III) nerve palsy are a depressed and abducted (down and out) eye, ptosis, diplopia, and a fixed and dilated pupil.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 46
Correct
-
A 70 year old man who has a previous history of small cell lung cancer was found to have severe hyponatraemia on a recent blood test and he is sent to the emergency room. In the nephron, where is the likely cause of this abnormality?
Your Answer: Distal nephron
Explanation:In the cancer patient, hyponatremia is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH). This develops more frequently with small cell lung cancer (SCLC) than with other malignancies. The pathogenesis of this is as a result of the process whereby ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, resulting in elevation of cAMP levels. Increased cAMP levels cause fusion of intracellular vesicles with the apical membrane. There are water channels called aquaporins in their membranes of these vesicles, and these increase the water permeability, thus facilitating increased water reabsorption and urine concentration. Thus, by increasing water retention, ADH causes blood to be diluted, which then decreases the concentration of solutes like sodium.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 47
Correct
-
An 80-year-old patient with a history of chronic heart failure presents to you. Examination reveals widespread oedema.Which statement about plasma oncotic pressure (Ï€ p ) is true?
Your Answer: The influence of π p on fluid movement is negligible if the capillary reflection co-efficient is 0.1
Explanation:Plasma oncotic pressure (πp) is typically 25-30 mmHg. 70% of π p is generated by albumin so Hypoalbuminemia will decrease π pThe osmotic power of albumin is enhanced by the Gibbs-Donnan effect.The influence of π p on fluid movement is negligible if the capillary reflection coefficient is 0.1. Another way of saying a vessel is highly permeable is saying the reflection coefficient is close to 0.
-
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
-
-
Question 48
Incorrect
-
Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT:
Your Answer: It most commonly follows ingestion of uncooked poultry.
Correct Answer: Infection usually requires antibiotic treatment.
Explanation:Campylobacter jejuni is the primary human pathogen, typically causing dysentery (bloody diarrhoea illness) following ingestion of contaminated meat, especially poultry. Infection is typically self-limiting and does not require antibiotic therapy. Campylobacter gastroenteritis is associated with the immune-mediated complications of Guillain-Barre syndrome, reactive arthritis and Reiter’s syndrome.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 49
Correct
-
Regarding the trachea, which of the following statements is INCORRECT:
Your Answer: A cricothyrotomy involves making an opening in the neck inferior to the cricoid cartilage.
Explanation:A cricothyrotomy involves making an opening in the median cricothyroid ligament (the medial part of the cricothyroid membrane), between the cricoid cartilage below and the thyroid cartilage above.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 50
Correct
-
You are about to give an antimuscarinic agent to a 55 year-old male patient. Which of the following conditions will make you with stop the administration, since it is a contraindication to antimuscarinic agents?
Your Answer: Prostatic enlargement
Explanation:Antimuscarinic medications may impair the contractility of bladder smooth muscle, resulting in acute urine retention in men with BPH, and should be avoided or used with caution.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 51
Incorrect
-
Which of these statements about experimental studies is true?
Your Answer: They must be blinded
Correct Answer: Randomisation serves to remove potential bias
Explanation:In experimental studies, the researcher introduces an intervention and studies the effect. The study subjects are allocated into different groups by the investigator through the use of randomisation. Randomisation serves to remove any potential bias.A cohort study is a form of longitudinal, observational study that follows a group of patients (the cohort) over a period of time to monitor the effects of exposure to a proposed aetiological factor upon them.A case-control study is a type observational study. Here, patients who have developed a disease are identified and compared on the basis of proposed causative factors that occurred in the past, to a control group.Clinical trials are experimental studies. Examples include: double blind, single blind, and unblinded studies(both patient and researcher are aware of the treatment they receive)
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 52
Correct
-
Injury to which nerve can lead to weakness or paralysis of the brachialis muscle?
Your Answer: The musculocutaneous nerve
Explanation:The brachialis muscle is a prime flexor of the forearm at the elbow joint. It is fusiform in shape and located in the anterior (flexor) compartment of the arm, deep to the biceps brachii. The brachialis is a broad muscle, with its broadest part located in the middle rather than at either of its extremities. It is sometimes divided into two parts, and may fuse with the fibres of the biceps brachii, coracobrachialis, or pronator teres muscles. It also functions to form part of the floor of the cubital fossa.The brachialis is primarily supplied by the musculocutaneous nerve (C5, C6). In addition, a small lateral portion of the muscle is innervated by the radial nerve (C7).
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 53
Correct
-
Which of these organisms is commonly spread by droplet transmission?
Your Answer: Neisseria meningitidis
Explanation:Droplets are airborne particles greater than 5 µm in size. Droplet transmission occurs during talking, coughing and sneezing where respiratory droplets are generated.Examples of organisms transmitted by the droplet route include:Neisseria meningitidisRespiratory syncytial virusParainfluenza virusBordetella pertussisInfluenza virusPoliovirus and Rotavirus are transmitted by the faeco-oral routeHepatitis B is transmitted by Sexual routeStaphylococcus aureus is transmitted by direct contact
-
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
-
-
Question 54
Correct
-
A patent has weakness of humeral flexion and extension. A CT scan reveals that he has suffered damage to the nerve that innervates pectoralis major.Pectoralis major receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer: Lateral and medial pectoral nerves
Explanation:Pectoralis major is a thick, fan-shaped muscle situated in the chest. It makes up the bulk of the chest musculature in the male and lies underneath the breast in the female. It overlies the thinner pectoralis minor muscle.Superficial muscles of the chest and arm showing pectoralis major (from Gray’s Anatomy)Pectoralis major has two heads; the clavicular head and the sternocostal head. The clavicular head originates from the anterior border and medial half of the clavicle. The sternocostal head originates from the anterior surface of the sternum, the superior six costal cartilages and the aponeurosis of the external oblique muscle. It inserts into the lateral lip of the bicipital groove of the humerus.Pectoralis major receives dual innervation from the medial pectoral nerve and the lateral pectoral nerve.Its main actions are as follows:Flexes humerus (clavicular head)Extends humerus (sternocostal head)Adducts and medially rotates the humerusDraws scapula anteriorly and inferiorly
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 55
Correct
-
A 59-year-old otherwise well woman presents with a history of polydipsia and polyuria. There is a past history of kidney stones, and blood tests done reveal the following: Na: 147 mmol/L (135-147 mmol/L) K: 4.0 mmol/L (3.5-5.5 mmol/L) Urea: 7.3 mmol/L (2.0-6.6 mmol/L) Creatinine: 126 mmol/L (75-125 mmol/L) Fasting blood glucose: 5.0 mmol/L (3.4-5.5 mmol/L) Corrected calcium: 3.21 mmol/L (2.05-2.60 mmol/L) Phosphate: 0.70 mmol/L (0.8-1.4 mmol/L) Parathyroid hormone: 189 ng/L (10-60 ng/L)The most likely diagnosis is?
Your Answer: Primary hyperparathyroidism
Explanation:​Primary hyperparathyroidism the commonest cause of hypercalcaemia. It is commonest in women aged 50 to 60.The commonest cause of primary hyperparathyroidism is a solitary adenoma of the parathyroid gland (approximately 85% of cases). Primary hyperparathyroidism may present with features of hypercalcaemia such as polyuria, polydipsia, renal stones, bone and joint pain, constipation, and psychiatric disorders.In primary Hyperparathyroidism:PTH is elevatedCalcium is elevatedPhosphate is loweredIn secondary Hyperparathyroidism:PTH is elevatedCalcium is low or low-normalPhosphate is raised in CRFIn tertiary Hyperparathyroidism:PTH is elevatedCalcium is elevatedPhosphate is lowered in CRF
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 56
Correct
-
A 62-year-old woman presents with cold sensitivity, tiredness, and weight gain. A series of blood tests done shows a grossly elevated TSH level and a diagnosis of hypothyroidism is made.What is the commonest cause of hypothyroidism worldwide?
Your Answer: Iodine deficiency
Explanation:Hypothyroidism occurs when there is a deficiency of circulating thyroid hormones. It is commoner in women and is most frequently seen in the age over 60.Iodine deficiency is the commonest cause of hypothyroidism worldwide.In the UK and other developed countries, iodine deficiency is not a problem and autoimmune thyroiditis is the commonest cause.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 57
Incorrect
-
What is the main mechanism of action of dopamine as an inotropic sympathomimetic:
Your Answer: Alpha1-receptor agonist
Correct Answer: Beta1-receptor agonist
Explanation:Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 58
Correct
-
A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:
Your Answer: Decreased bradykinin breakdown
Explanation:Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 59
Incorrect
-
If a patient dislocated his right shoulder and has been referred to the orthopaedic outpatient department for a follow-up after a successful reduction, which of the following is the most important position for him to avoid holding his arm in until he is seen in the clinic?
Your Answer: Arm held flexed across abdomen palm up
Correct Answer: Arm at 90 degrees to side with palm up
Explanation:The arm should be placed in a poly-sling that should be worn for about two weeks. A physiotherapist may give gentle movements for the arm to help in reducing stiffness and in relieving the pain. It is important that the patient must avoid positions that could cause re-dislocation.The most important position to avoid is the arm being held out at 90 degrees to the side with the palm facing upwards, especially if a force is being applied.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 60
Correct
-
Osteoclasts are a type of bone cell that are critical in the maintenance, repair and remodelling of bones.Which of the following inhibits osteoclast activity? Select ONE answer only.
Your Answer: Calcitonin
Explanation:Osteoclasts are a type of bone cell that breaks down bone tissue. This is a critical function in the maintenance, repair and remodelling of bones. The osteoclast disassembles and digests the composite of hydrated protein and minerals at a molecular level by secreting acid and collagenase. This process is known as bone resorption and also helps to regulate the plasma calcium concentration.Osteoclastic activity is controlled by a number of hormones:1,25-dihydroxycholecalciferol increases osteoclastic activityParathyroid hormone increases osteoclastic activityCalcitonin inhibits osteoclastic activityBisphosphonates are a class of drug that slow down and prevent bone damage. They are osteoclast inhibitors.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 61
Correct
-
Which of the following is first-line for management of status epilepticus:
Your Answer: Intravenous lorazepam
Explanation:First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 62
Correct
-
A patient with a history of worsening chronic breathlessness on exertion undergoes lung function testing. The results demonstrate an FEV 1 that is 58% predicted and an FEV 1 /FVC ratio less than 0.7.Which of the following is the most likely diagnosis? Select ONE answer only.
Your Answer: COPD
Explanation:Obstructive lung disorders are characterised by airway obstruction. Many obstructive diseases of the lung result from narrowing of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself.In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to <0.7.Types of obstructive lung disorders include:Chronic obstructive pulmonary disease (COPD)AsthmaBronchiectasis
-
This question is part of the following fields:
- Physiology
- Respiratory Physiology
-
-
Question 63
Incorrect
-
In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic disrupts cell membrane function.Which of the following antimicrobial drugs is prescribed to this patient?
Your Answer: Flucloxacillin
Correct Answer: Nystatin
Explanation:Nystatin binds ergosterol (unique to the fungi cell membrane) and forms membrane pores that allow K+ leakage, acidification, and subsequent death of the fungus.Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors. Flucloxacillin inhibits the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria. Trimethoprim inhibits bacterial dihydrofolate reductase.Isoniazid decreases the synthesis of mycolic acids in mycobacteria.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 64
Correct
-
Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 65
Correct
-
The sensation produced by touching the arm with a vibrating tuning fork during a neurological examination is mediated by which of the following spinal tracts:
Your Answer: Posterior column
Explanation:Fine-touch, proprioception and vibration sensation are mediated by the posterior column-medial lemniscus pathway.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 66
Incorrect
-
You see a 63-year-old man with a history of melaena and epigastric discomfort. For a few months, he's been taking aspirin.Which of the following statements about aspirin's mechanism of action is correct?
Your Answer: COX-1 inhibition is primarily responsible for its anti-inflammatory effects
Correct Answer: It inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day)
Explanation:Aspirin inhibits cyclo-oxygenase irreversibly by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2. The production of prostaglandin and thromboxane is reduced as a result. As a result, platelet activation and aggregation are reduced. A single dose of aspirin has a half-life of 7-10 days, which is the time it takes for the bone marrow to produce new platelets.Aspirin only inhibits COX-1, the enzyme that produces thromboxane A2, at low doses (75 mg per day), and thus has a primarily anti-thrombotic effect.Aspirin inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day). COX-2 is involved in the production of prostaglandins, so it has an anti-inflammatory effect at these concentrations.Aspirin, when used as an antipyretic for a viral illness in children, can cause Reye’s syndrome. Reye’s syndrome is a potentially fatal liver disease that causes encephalopathy and liver failure.The inability of aspirin to reduce platelet production of thromboxane A2, and thus platelet activation and aggregation, is known as aspirin resistance. Although the exact frequency and mechanism of aspirin resistance are unknown, it is thought to affect about 1% of users. Women are more likely than men to experience this phenomenon.According to new research, taking aspirin on a regular basis lowers the risk of colorectal cancer. It may also protect against cancers of the breast, bladder, prostate, and lungs.
-
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
-
Question 67
Correct
-
Which of the following clinical features would you NOT expect to see in a tibial nerve palsy:
Your Answer: Weakened eversion of the foot
Explanation:Damage to the tibial nerve results in loss of plantarflexion of the ankle and weakness of inversion of the foot resulting in a shuffling gait, clawing of the toes and loss of sensation in its cutaneous distribution.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 68
Correct
-
Which of the following statements about propofol is TRUE:
Your Answer: Propofol has some antiemetic action.
Explanation:Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 69
Correct
-
Which ONE statement about homeostasis is true?
Your Answer: Negative feedback occurs via receptors, comparators and effectors
Explanation:Homeostasis is the property of a system in which variables are regulated so that internal conditions remain relatively constant and stable. Homeostasis is achieved by a negative feedback mechanism.Negative feedback occurs based upon a set point through receptors, comparators and effectors. The ‘set point’ is a NARROW range of values within which normal function occurs.The two body systems that regulate homeostasis are the Nervous system and the Endocrine system. The smooth muscle of the uterus becomes more active towards the end of pregnancy. This is a POSITIVE feedback.
-
This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
-
-
Question 70
Correct
-
A 29 year old man presents to ED followed an alleged assault whilst out drinking. He received blunt trauma to his right axilla. He is complaining of difficulty abducting his right arm above the level of his shoulder, and on inspection, the inferior angle of his right scapula protrudes more than that of his left scapula. Which of the following nerves has most likely been affected:
Your Answer: Long thoracic nerve
Explanation:Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle causing difficulty abducting the upper limb above 90 degrees and giving a ‘winged ‘ scapula appearance where the medial border, particularly the inferior angle, of the scapula moves laterally and posteriorly away from the thoracic wall (this becomes more pronounced if the patient presses the upper limb against a wall).
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 71
Correct
-
Bordetella pertussis causes which of the following infectious diseases:
Your Answer: Whooping cough
Explanation:Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 72
Correct
-
Regarding co-amoxiclav, which of the following statements is INCORRECT:
Your Answer: Clavulanic acid acts to inhibit cross-linking of bacterial peptidoglycan polymers.
Explanation:Co-amoxiclav consists of amoxicillin with the beta-lactamase inhibitor clavulanic acid. Clavulanic acid itself has no significant antibacterial activity but, by inactivating beta-lactamases, it makes the combination active against beta-lactamase-producing bacteria that are resistant to amoxicillin.The most common adverse effects of co-amoxiclav include nausea, vomiting, skin rash and diarrhoea. Pseudomembranous colitis should be considered if a person develops severe diarrhoea during or after treatment with co-amoxiclav. Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav. An epidemiological study has shown that the risk of acute liver toxicity was about 6 times greater with co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 years and in men; these reactions have only rarely been reported in children. Jaundice is usually self-limiting and very rarely fatal.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 73
Correct
-
A 22 year old professional athlete sustains an inversion injury to her left ankle during the 800m. Which of the following ligaments is most likely injured:
Your Answer: Anterior talofibular ligament
Explanation:Inversion injuries at the ankle in plantarflexion (such as when wearing high heels) are common, and typically result in damage to the lateral collateral ligament of the ankle, made up of the anterior talofibular, the calcaneofibular and the posterior talofibular ligaments. The anterior talofibular and the calcaneofibular ligaments are most commonly injured, and the posterior talofibular ligament rarely. The spring ligament supports the head of the talus, the deltoid ligament supports the medial aspect of the ankle joint, and the long and short plantar ligaments are involved in maintaining the lateral longitudinal arch of the foot.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 74
Correct
-
Which of the following pathogens is the common cause of diarrhoea in a patient who has had a prolonged course of a broad spectrum of antibiotics?
Your Answer: Clostridium difficile
Explanation:Clostridium difficile is the most likely cause of diarrhoea after a long course of broad-spectrum antibiotic treatment. Clostridium difficile-associated diarrhoea appeared to be linked to an increase in the usage of third-generation cephalosporins.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 75
Correct
-
What is the direct mechanism of action of digoxin as a positive inotrope:
Your Answer: Inhibition of Na+/K+ ATPase pump
Explanation:Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 76
Incorrect
-
A patient presents with a history of excessive thirst, urination and high fluid intake. His blood sugar is normal. You estimate his osmolarity as part of his work-up.Which of these equations can be used to estimate osmolarity?
Your Answer: 2 (Na + ) + K + - (Glucose + Urea)
Correct Answer: 2 (Na + ) + 2 (K + ) + Glucose + Urea
Explanation:Osmolality and osmolarity are measurements of the solute concentration of a solution. Although the two terms are often used interchangeably, there are differences in the definitions, how they are calculated and the units of measurement used.Osmolarity, expressed as mmol/L, is an estimation of the osmolar concentration of plasma. It is proportional to the number of particles per litre of solution.Measured Na+, K+, urea and glucose concentrations are used to calculate the value indirectly.It is unreliable in pseudohyponatremia and hyperproteinaemia.The equations used to calculate osmolarity are:Osmolarity = 2 (Na+) + 2 (K+) + Glucose + Urea (all in mmol/L)OROsmolarity = 2 (Na+) + Glucose + Urea (all in mmol/L)Doubling of sodium accounts for the negative ions associated with sodium, and the exclusion of potassium approximately allows for the incomplete dissociation of sodium chloride.
-
This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
-
-
Question 77
Incorrect
-
Which of these is an example of ordinal data?
Your Answer: Gender
Correct 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
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 78
Correct
-
The cutaneous circulation is responsible for the skin's blood supply. Because the skin is not a highly metabolically active tissue with low energy requirements, its blood supply differs from that of other tissues. Instead of capillaries, some of the circulating blood volume in the skin passes through arteriovenous anastomoses (AVAs).Which of the following statements regarding arteriovenous anastomoses is correct?
Your Answer: AVAs are innervated by sympathetic fibres originating from the hypothalamus
Explanation:Short vessels called arteriovenous anastomoses (AVAs) link tiny arteries and veins. They have a large lumen diameter. The strong and muscular walls allow AVAs to completely clog the vascular lumen, preventing blood flow from artery to vein (acting like a sphincter). When the AVAs open, they create a low-resistance connection between arteries and veins, allowing blood to flow into the limbs’ superficial venous plexuses. There is no diffusion of solutes or fluid into the interstitium due to their strong muscle walls.AVAs are densely innervated by adrenergic fibres from the hypothalamic temperature-regulation centre. High sympathetic output occurs at normal core temperatures, inducing vasoconstriction of the AVAs and blood flow through the capillary networks and deep plexuses. When the temperature rises, sympathetic output decreases, producing AVA vasodilation and blood shunting from the artery to the superficial venous plexus. Heat is lost to the environment as hot blood rushes near to the skin’s surface.AVAs are a specialized anatomical adaptation that can only be found in large quantities in the fingers, palms, soles, lips, and pinna of the ear.
-
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
-
-
Question 79
Correct
-
Regarding the abductor digiti minimi, which of the following statements is false?
Your 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).
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 80
Correct
-
Which of the following cervical nerves is likely to be affected if your patient is complaining of elbow extension weakness and loss of sensation in her middle finger? She also has pain and tenderness in her cervical region, which is caused by a herniated disc, all after a whiplash-type injury in a car accident.
Your Answer: C7
Explanation:A C7 spinal nerve controls elbow extension and some finger extension. Damage to this nerve can result in a burning pain in the shoulder blade or back of the arms. The ability to extend shoulders, arms, and fingers may also be affected. Dexterity may also be compromised in the hands or fingers.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 81
Incorrect
-
A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.Which of the following is NOT an action of the gluteus maximus muscle? Select ONE answer only.
Your Answer: Steadying of the thigh
Correct Answer: Hip abduction
Explanation:Gluteus maximus is the main extensor muscle of the hip and assists with lateral rotation of the thigh at the hip joint. It also acts as a hip adductor, steadies the thigh, and assists in raising the trunk from a flexed position.Gluteus maximus is innervated by the inferior gluteal nerve.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 82
Incorrect
-
On her most recent blood tests, a 55 year-old female with a history of hypertension was discovered to be hypokalaemic. She  is diagnosed with primary hyperaldosteronism.Which of the following is a direct action of aldosterone?
Your Answer: Reabsorption of Na + into the proximal convoluted tubule
Correct Answer: Secretion of H + into the distal convoluted tubule
Explanation:Aldosterone is a steroid hormone produced in the adrenal cortex’s zona glomerulosa. It is the most important mineralocorticoid hormone in the control of blood pressure. It does so primarily by promoting the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane of the nephron’s distal tubules and collecting ducts, as well as stimulating apical sodium and potassium channel activity, resulting in increased sodium reabsorption and potassium secretion. This results in sodium conservation, potassium secretion, water retention, and a rise in blood volume and blood pressure.Aldosterone is produced in response to the following stimuli:Angiotensin II levels have risen.Potassium levels have increased.ACTH levels have risen.Aldosterone’s principal actions are as follows:Na+ reabsorption from the convoluted tubule’s distal endWater resorption from the distal convoluted tubule (followed by Na+)Cl is reabsorbed from the distal convoluted tubule.K+ secretion into the convoluted distal tubule’s H+ secretion into the convoluted distal tubule’sÂ
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 83
Correct
-
A 25 year old man presents to the emergency room with abdominal pain, vomiting and constipation. A CT scan is done which is suggestive of Meckel's diverticulum. Where does the blood supply of the Meckel's diverticulum originate?
Your Answer: Superior mesenteric artery
Explanation:Meckel’s diverticulum has certain classic characteristics.1. It lies on the antimesenteric border of the middle-to-distal ileum2. It is approximately 2 feet proximal to the ileocaecal junction3. It appears as a blind-ended tubular outpouching of bowel4. It is about 2 inches long, 5. It occurs in about 2% of the population, 6. It may contain two types of ectopic tissue (gastric and pancreatic). 7. The diverticulum is supplied by the superior mesenteric artery.8. Proximal to the major duodenal papilla the duodenum is supplied by the gastroduodenal artery (branch of the coeliac trunk)9. Distal to the major duodenal papilla it is supplied by the inferior pancreaticoduodenal artery (branch of superior mesenteric artery).10. The arterial supply to the jejunoileum is from the superior mesenteric artery.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 84
Correct
-
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.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 85
Incorrect
-
Regarding bile, which of the following statements is INCORRECT:
Your Answer: The bile acid-independent fraction of bile is made at the time it is required.
Correct Answer: The sphincter of Oddi contracts to force bile from the gallbladder into the duodenum.
Explanation:Bile is secreted by hepatocytes. It is isotonic and resembles plasma ionically. This fraction of bile is called the bile acid-dependent fraction. As it passes along the bile duct, the bile is modified by epithelial cells lining the duct by the addition of water and bicarbonate ions; this fraction is called the bile acid-independent fraction. Overall, the liver can produce 500 – 1000 mL of bile per day. The bile is either discharged directly into the duodenum or stored in the gallbladder. The bile acid-independent fraction is made at the time it is required i.e. during digestion of chyme. The bile acid-dependent fraction is made when the bile salts are returned from the GI tract to the liver, and is then stored in the gallbladder until needed. The gallbladder not only stores bile but concentrates it by removing non-essential solutes and water, leaving bile acids and pigments, mainly by active transport of Na+into the intercellular spaces of the lining cells which, in turn, draws in water, HCO3-and Cl-from the bile and into the extracellular fluid. Within a few minutes of a meal, particularly when fatty foods have been consumed, the gallbladder contracts and releases bile into the bile duct. The sphincter of Oddi is relaxed, allowing the bile to pass into the duodenum through the ampulla of Vater.
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 86
Incorrect
-
A 60-year-old man comes to your department with complaints of epigastric pain. There is a history of rheumatoid arthritis and he has been taking ibuprofen 200 mg TDS for the last 2 weeks.The following scenarios would prompt you to consider the co-prescription of a PPI for gastroprotection with NSAIDs EXCEPT?
Your Answer: Co-prescription of fluoxetine
Correct Answer: Long-term use for chronic back pain in a patient aged 30
Explanation:The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:Aged 65 or older- Using maximum recommended dose of an NSAID- History of peptic ulcer or GI bleeding- Concomitant use of: antidepressants like SSRIs and SNRIs, Corticosteroids, anticoagulants and low dose aspirin- Long-term NSAID usage for: long-term back pain if older than 45 and patients with OA or RA at any ageThe maximum recommended dose of ibuprofen is 2.4 g daily and this patient is on 400 mg of ibuprofen TDS.
-
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
-
-
Question 87
Correct
-
Regarding acute myeloid leukaemia (AML), which of the following statements is CORRECT:
Your Answer: AML becomes increasingly common with age.
Explanation:Acute myeloid leukaemia (AML) is the most common form of acute leukaemia in adults and becomes increasingly common with age, with a median onset of 65 years. It forms only a minor fraction (10 – 15%) of childhood leukaemia. The clinical features of AML typically presents with clinical features secondary to leukaemic infiltration of bone marrow and extramedullary sites: Anaemia (lethargy, pallor and breathlessness)Thrombocytopaenia (petechiae, bruising, epistaxis, haemorrhage) – often profoundNeutropenia (infections)HepatosplenomegalyGingival infiltrationCentral nervous system involvement in AML is uncommon.Leukaemia cutis is the infiltration of neoplastic leukocytes in the skin. It occurs in approximately 10% of patients with AML.Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count is usually increased and blood film examination typically shows a variable number of blast cells. The bone marrow is hypercellular and typically contains many blast cells.. The prognosis for patients with AML has been improving steadily, particularly for those under 60 years of age, and approximately one-third of patients of this group can expect to achieve long-term cure. For the elderly, the situation is poor and less than 10% of those over 70 years of age achieve long-term remission.CML is commonly associated with the Philadelphia chromosome. The Philadelphia chromosome is present in only 1% of adults AML cases.Lymphadenopathy is rare in AML.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 88
Correct
-
The functional residual capacity (FRC) will be decreased in which of the following:
Your Answer: Pulmonary fibrosis
Explanation:Factors decreasing FRC:Restrictive ventilatory defects e.g. pulmonary fibrosisPosture – lying supineIncreased intra-abdominal pressure (e.g. obesity, pregnancy, ascites)Reduced muscle tone of diaphragm e.g. muscle relaxants in anaesthesia, neuromuscular disease
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 89
Correct
-
A 50-year-old woman with painful joints had some blood tests done with her GP. The test showed she had anti-double stranded DNA antibodies.Which one of these disorders is most likely to be associated with anti-double stranded DNA antibodies?
Your Answer: Systemic lupus erythematosus (SLE)
Explanation:CREST syndrome is usually associated with anti-centromere antibodies.Primary biliary cirrhosis is associated with anti-mitochondrial antibodies.Sjogren’s syndrome is associated with anti-Ro and anti-La antibodies.Polymyositis is associated with anti-Jo1 antibodies.Anti-double stranded DNA antibodies are highly characteristic of systemic lupus erythematosus (SLE). They are a group of anti-nuclear antibodies (ANA) that target double stranded DNA and are implicated in the pathogenesis of lupus nephritis.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 90
Correct
-
When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?
Your Answer: Fifth cervical and fourth thoracic nerves
Explanation:The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 91
Correct
-
A 65-year-old man comes for a visit at the clinic with complaints of abdominal pain. On inquiring about drug history, you find out that he has been taking around 8-10 paracetamol to help relieve the pain. Out of the following, which one is believed to be the main mechanism of action for paracetamol?
Your Answer: Selective inhibition of COX-3 receptors
Explanation:The FDA categorizes Paracetamol as an NSAID (nonsteroidal anti-inflammatory drug) as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord. COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.Acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, therefore, has no peripheral anti-inflammatory effects.The antipyretic actions of acetaminophen are likely attributed to direct action on heat-regulating centres in the brain, resulting in peripheral vasodilation, sweating, and loss of body heat.
-
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
-
Question 92
Correct
-
The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.Which of the following medications is most likely to be the cause of this adverse reaction?
Your Answer: Amlodipine
Explanation:Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 93
Correct
-
You are asked to review the blood results on a 56-year-old man who appears to be acutely unwell. His results show that he is neutropenic.Which ONE of the following is NOT a recognized cause of a neutropenia?
Your Answer: Hyposplenism
Explanation:Neutropenia is defined as a total neutrophil count of < 2.0 x 109/l.It can be caused by:Viral infectionsCollagen disease e.g. SLE and RAChemotherapy and radiotherapyHypersplenismMarrow infiltrationVitamin and folate deficiencyDrug reactionsDrugs that cause neutropenia include flecainide, phenytoin, carbimazole, indomethacin and co-trimoxazole.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 94
Correct
-
Intravenous glucose solutions are typically used in the treatment of all of the following situations except:
Your Answer: Hypokalaemia
Explanation:In hypokalaemia, initial potassium replacement therapy should not involve glucose infusions, as glucose may cause a further decrease in the plasma-potassium concentration. Glucose infusions are used for the other indications like diabetic ketoacidosis, hypoglycaemia, routine fluid maintenance in patients who are nil by mouth (very important in children), and in hyperkalaemia.
-
This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
-
-
Question 95
Correct
-
Arterial baroreceptors are located primarily in which of the following:
Your Answer: Carotid sinus and aortic arch
Explanation:Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 96
Correct
-
Which of the following statements is true about anterior cord syndrome?
Your Answer: There is preservation of proprioception
Explanation:Anterior cord syndrome is an incomplete cord syndrome that predominantly affects the anterior 2/3 of the spinal cord, characteristically resulting in motor paralysis below the level of the lesion as well as the loss of pain and temperature at and below the level of the lesion. The patient presentation typically includes these two findings; however, there is variability depending on the portion of the spinal cord affected. Other findings include back pain, or autonomic dysfunction such as hypotension, neurogenic bowel or bladder, and sexual dysfunction. The severity of motor dysfunction can vary, typically resulting in paraplegia or quadriplegia.Proprioception, vibratory sense, two-point discrimination, and fine touch are not affected in anterior cord syndrome. These sensations are under the control of the dorsal column of the spinal cord, which is supplied by two posterior spinal arteries running in the posterior lateral sulci.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 97
Correct
-
A 70-year-old patient diagnosed with Cushing's syndrome and has a history of weight gain, hypertension, and easy bruising.Which of these assertions about Cushing's syndrome is correct?
Your Answer: Diagnosis can be confirmed by a dexamethasone suppression test
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids.Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome. Cushing’s illness is the second most prevalent cause of Cushing’s syndrome. Cushing’s disease is distinct from Cushing’s syndrome in that it refers to a single cause of the illness, a pituitary adenoma that secretes high quantities of ACTH, which raises cortisol levels.Because cortisol enhances the vasoconstrictive impact of endogenous adrenaline, patients with Cushing’s syndrome are usually hypertensive.Hyperglycaemia (due to insulin resistance) rather than hypoglycaemia is a common symptom.Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep. The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.A dexamethasone suppression test or a 24-hour urine free cortisol collection can both be used to establish the existence of Cushing’s syndrome.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 98
Correct
-
A patient who is a known case of rheumatoid arthritis presents to the clinic as his grandson was recently diagnosed with chickenpox. His grandson spent the weekend with her, and he was in close contact with him. He takes 50 mg of prednisolone once daily and has been for the past six months. There is no history of chickenpox.Out of the following, which is TRUE regarding the next plan of action for her care?
Your Answer: She should receive prophylactic varicella-zoster Immunoglobulin (VZIG)
Explanation:Varicella-zoster immunoglobulin (VZIG) is indicated for post exposure prevention and treatment of varicella. It is recommended as prophylaxis for high-risk patients with no known immunity (i.e. no known previous chickenpox) who have had a significant exposure to varicella-zoster (considered >4 hours close contact).The high-risk groups are:1. Neonates2. Pregnant women3. The immunocompromised (e.g. cancer, immunosuppressive therapies)4. Those on high dose steroids (children on more than 2 mg/kg/day for more than 14 days, or adults on 40 mg/day for more than a week)This patient is at high risk of developing adrenal insufficiency and may need a temporary increase in her steroid dose during infection or stress. It would be inappropriate to stop or wean down her dose of prednisolone and can cause side effects.Since he is on steroids without immunity for chickenpox, he is at risk of developing severe varicella infection, with possible complications including pneumonia, hepatitis and DIC. If he develops a varicella infection, he will need to be admitted and require a specialist review and intravenous Acyclovir.
-
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
-
-
Question 99
Correct
-
A 38-year-old woman is investigated for Addison's disease. She had low blood pressure, weakness, weight loss, and skin discoloration. An adrenocorticotropic hormone (ACTH) stimulation test is scheduled as part of her treatment.Which of the following statements about ACTH is correct?Â
Your Answer: It is released in response to the release of CRH
Explanation:The anterior pituitary gland produces and secretes a peptide hormone called adrenocorticotropic hormone (ACTH) (adenohypophysis). It is secreted in response to the hypothalamus’s secretion of the hormone corticotropin-releasing hormone (CRH).ACTH promotes cortisol secretion via binding to cell surface ACTH receptors in the zona fasciculata of the adrenal cortex.ACTH also promotes the production of beta-endorphin, which is a precursor to melanocyte-releasing hormone (MRH).
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 100
Correct
-
Which of the following is NOT a typical clinical feature of osteomalacia:
Your Answer: Hypercalcaemia
Explanation:Features of osteomalacia include: Bone pain (particularly bone, pelvis, ribs)Neuromuscular dysfunction (particularly in the gluteal muscles, leading to waddling gaitPseudofractures on x-ray (looser zones)Elevated alkaline phosphatase, hypocalcaemia and low phosphate due to secondary hyperparathyroidism
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 101
Incorrect
-
The most important Complement protein for antigen opsonization is:
Your Answer: C9
Correct Answer: C3b
Explanation:Phagocytosis is largely responsible for depletion of cells coated with antibodies. Cells opsonized by IgG antibodies are recognized by phagocyte Fc receptors, which are specific for the Fc portions of some IgG subclasses. In addition, when IgM or IgG antibodies are deposited on the surfaces of cells, they may activate the complement system by the classical pathway. Complement activation generates by-products, mainly C3b and C4b, which are deposited on the surfaces of the cells and recognized by phagocytes that express receptors for these proteins. The net result is phagocytosis of the opsonized cells and their destruction.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 102
Incorrect
-
A 17-year-old student presents with a headache and petechial rash. A diagnosis of meningitis was suspected, with a causative agent of Neisseria meningitidis. Which of the following statements is considered correct regarding Neisseria meningitidis?
Your Answer: It exists in the normal flora in the nasopharynx in 50% of adults
Correct Answer: The antiphagocytic polysaccharide capsule is the main determinant of its pathogenicity
Explanation:N. meningitidis is a Gram-negative cocci and can be found as a commensal as well as an invasive pathogen. It is an important etiologic agent of endemic and epidemic meningitis and meningococcaemia and rarely pneumonia, purulent arthritis, or endophthalmitis. N. meningitidis has also been recovered from urogenital and rectal sites as a result of oral-genital contact. Meningococcal carriage, usually involving nonencapsulated strains, may cause an increase in protective antibody against the pathogenic strains. Of the 12 meningococcal encapsulated serogroups, A, B, C, Y, and W-135 account for most cases of disease in the world. N. meningitidis possesses a polysaccharide capsule that is antiphagocytic and serves as an important virulence factor.It can be found on the mucosal surfaces of the nasopharynx and oropharynx in 30% of the human population. The organism is transmitted by close contact with respiratory droplet secretions from a carrier to a new host. Only a few newly colonized hosts develop meningococcal disease, with the highest incidence being found in infants and adolescents.The quadrivalent vaccine Menactra is a polysaccharide-protein conjugated vaccine with antigens to serogroups A, C, Y, and W-135. This conjugate vaccine is licensed for people 2 to 55 years old. This vaccine does not protect against meningitis caused by serogroup B because group B polysaccharide is a very poor immunogen in humans.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 103
Correct
-
A 74-year-old woman with a history of ischaemic heart disease and heart failure is complaining of worsening oedema, bloating, and a loss of appetite. She has ascites and peripheral oedema on examination. Her oedema is being controlled by an oral diuretic, but it appears that this is no longer enough. You discuss her care with the on-call cardiology registrar, who believes she is very likely to have significant gut oedema that is interfering with her diuretic absorption and that she will need to change her medication.Which of the following oral diuretics is most likely to help you overcome this problem?
Your Answer: Bumetanide
Explanation:Bumetanide is primarily used in patients with heart failure who have failed to respond to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency. In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. As a result, when it has a better bioavailability than furosemide, it is commonly used in patients with gut oedema.When taken alone, Bendroflumethiazide is a moderately potent diuretic that is unlikely to control her oedema.Mannitol is a type of osmotic diuretic used to treat cerebral oedema and high intracranial pressure.Acetazolamide is a weak diuretic that inhibits carbonic anhydrase. It’s a rare occurrence.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 104
Correct
-
Which of the following statements about vitamin B12 absorption is TRUE:
Your Answer: On ingestion, vitamin B12 is bound to R protein which protects it from digestion in the stomach.
Explanation:The substance intrinsic factor,essential for absorption of vitamin B12 in the ileum, issecreted by the parietal cells along with the secretion ofhydrochloric acid. When the acid-producing parietalcells of the stomach are destroyed, which frequentlyoccurs in chronic gastritis, the person develops not onlyachlorhydria (lack of stomach acid secretion) but oftenalso pernicious anaemia because of failure of maturationof the red blood cells in the absence of vitamin B12 stimulation of the bone marrow.
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 105
Correct
-
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: 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.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 106
Correct
-
Which of the following does NOT typically cause a neutrophil leucocytosis:
Your Answer: Glandular fever
Explanation:Causes of neutrophil leucocytosis:Bacterial infectionInflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)PregnancyAcute haemorrhage or haemolysisNeoplasms of all typesDrugs (e.g. corticosteroid therapy, lithium, tetracyclines)AspleniaMyeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)Rare inherited disorders
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 107
Correct
-
Question 108
Correct
-
A 32-year-old female is diagnosed case of bipolar disorder and is on medication. She presents to her psychiatric team with symptoms of severe depression. She is currently taking Lithium. Out of the following, which is TRUE regarding lithium?
Your Answer: It commonly causes a tremor
Explanation:Lithium is the drug of choice for bipolar disorders but is commonly associated with side effects and toxicity. Fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy with Lithium. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer. Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremors.Option The normal therapeutic range is 2.0-2.5 mmol/l: Lithium should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l. Levels should be checked one week after starting therapy and one week after every change in dosage. (Option Levels should be checked one month after starting therapy) Option It can induce hyperthyroidism: Lithium has a known effect on thyroid function. Lithium decreases the production of T4 and T3 and commonly causes hypothyroidism. More rarely, lithium causes hyperthyroidism due to thyroiditis.Option It can induce diabetes mellitus: Lithium can induce nephrogenic diabetes insipidus but not diabetes mellitus.
-
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
-
Question 109
Incorrect
-
Which of the following statements about lithium treatment is FALSE:
Your Answer: A serum-lithium concentration of 0.4 – 1 mmol/litre is therapeutic.
Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.
Explanation:Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 110
Correct
-
During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:L– lateral two lumbricalsO– Opponens pollicisA– Abductor pollicisF– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 111
Incorrect
-
Regarding probability distribution, which of the following statements is CORRECT:
Your Answer: The normal distribution is a sigmoid curve.
Correct Answer: In a negative skew, the mass of distribution is concentrated on the right.
Explanation:Distribution of data is usually unimodal (one peak) but may be bimodal (two peaks) or uniform (no peaks, each value equally likely). The normal distribution is a symmetrical bell-shaped curve. The mean, median, and mode of a normal distribution are equal. In a positive skew, the right tail is longer and the mass of distribution is concentrated on the left; mean > median > mode. In a negative skew, the left tail is longer and the mass of distribution is concentrated on the right; mean < median < mode.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 112
Incorrect
-
The sensory innervation of the oropharynx is provided by which of the following nerves:
Your Answer: Maxillary nerve
Correct Answer: Glossopharyngeal nerve
Explanation:Each subdivision of the pharynx has a different sensory innervation:the nasopharynx is innervated by the maxillary nervethe oropharynx is innervated by the glossopharyngeal nervethe laryngopharynx is innervated by the vagus nerve.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 113
Correct
-
The tetanus vaccination contains inactivated tetanus toxoid, which induces the body to produce protective antibodies. How do these antibodies protect the body from tetanus?
Your Answer: Neutralise the protein exotoxin of C. tetani
Explanation:C. Tetanospasmin, an exotoxin produced by tetani, is responsible for the neurotoxic consequences of tetanus. The tetanus vaccination contains inactivated tetanus toxoid, which induces the body to produce protective antibodies that neutralize the tetanus toxin. It induces active immunization against Clostridium tetani exotoxin via toxoid-induced Ab generation.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 114
Incorrect
-
A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs. Which one is a nucleic acid synthesis inhibitor?
Your Answer: Gentamicin
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.The following is a summary of the many modes of action of various types of antimicrobial agents:Action Mechanisms-Â Examples:Cell wall production is inhibitedVancomycinVancomycinCephalosporinsThe function of the cell membrane is disrupted NystatinPolymyxinsAmphotericin BÂ Inhibition of protein synthesisChloramphenicolMacrolidesAminoglycosidesTetracyclinesNucleic acid synthesis inhibitionQuinolonesTrimethoprimRifampicin5-nitroimidazolesSulphonamidesAnti-metabolic activityIsoniazid
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 115
Correct
-
A 50-year-old man, known hypertensive on amlodipine has been visiting his GP with symptoms of headache, tiredness, and muscle weakness. His blood test today shows a low potassium level of 2.8 mmol/L, and a slightly raised sodium level at 147 mmol/L.What is the MOST LIKELY diagnosis?
Your Answer: Conn’s syndrome
Explanation:When there are excessive levels of aldosterone independent of the renin-angiotensin aldosterone axis, primary hyperaldosteronism occurs. Secondary hyperaldosteronism occurs due to high renin levels.Causes of primary hyperaldosteronism include:Conn’s syndromeAdrenal hyperplasiaAdrenal cancerFamilial aldosteronismCauses of secondary hyperaldosteronism include:Renal vasoconstrictionOedematous disordersDrugs – diureticsObstructive renal artery diseaseAlthough patients are usually asymptomatic, when clinical features are present, classically hyperaldosteronism presents with:HypokalaemiaSodium levels can be normal or slightly raisedHypertensionMetabolic alkalosisLess common, clinical features are:LethargyHeadachesIntermittent paraesthesiaPolyuria and polydipsiaMuscle weakness (from persistent hypokalaemia)Tetany and paralysis (rare)
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 116
Correct
-
A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration is 1246 pg/mL.Glucagon is produced in which of the following cells? Select ONE answer only.
Your Answer: Alpha-cells in the pancreas
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline. Glucagon then causes:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 117
Correct
-
From which of the following cell types are platelets derived?
Your Answer: Megakaryocytes
Explanation:Synthesis of platelets occurs in the bone marrow by fragmentation of megakaryocytes cytoplasm, derived from the common myeloid progenitor cell. The average time for differentiation of the human stem cell to the production of platelets is about 10 days. The major regulator of platelet formation is thrombopoietin and 95% of this is produced by the liver. Normal platelet count is 150 – 450 x 109/L and the normal lifespan of a platelet is about 10 days. Usually about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 118
Correct
-
All of the following statements regarding metronidazole are correct except:
Your Answer: Metronidazole reduces the anticoagulant effect of warfarin.
Explanation:The anticoagulant effect of warfarin is enhanced by metronidazole. If use of both cannot be avoided, one must consider appropriately reducing the warfarin dosage. With alcohol, metronidazole can cause a disulfiram-like reaction, with symptoms like flushing, headaches, dizziness, tachypnoea and tachycardia, nausea and vomiting. The common side effects of metronidazole include a metallic taste and gastrointestinal irritation, in particular nausea and vomiting. These side effects are more common at higher doses. This drug has high activity against anaerobic bacteria and protozoa, and is well absorbed orally. For severe infections, the intravenous route is normally reserved.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 119
Incorrect
-
A patient suffers a stab wound to the neck. The entry point of the blade is situated within the posterior triangle of the neck.Which of the following muscles is most likely to be involved? Select ONE answer only.
Your Answer: Trapezius
Correct Answer: Anterior scalene
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:Muscles: thyrohyoid, sternothyroid, sternohyoid musclesOrgans: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid glandArteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteriesVeins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veinsNerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.Contents:Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodesNerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexusOf the muscles listed in the options, only the anterior scalene is situated within the posterior triangle of the neck.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 120
Correct
-
What is the primary function of collagen in wound healing?
Your Answer: Strength and support
Explanation:Key elements of the maturation stage include collagen cross-linking, collagen remodelling, wound contraction, and repigmentation. The tensile strength of the wound is directly proportional to the amount of collagen present. Numerous types of collagen have been identified; types I and III predominate in the skin and aponeurotic layers. Initially, a triple helix (tropocollagen) is formed by three protein chains; two are identical alpha-1 protein chains, and the third is an alpha-2 protein.
-
This question is part of the following fields:
- Pathology
- Wound Healing
-
-
Question 121
Correct
-
Question 122
Correct
-
A blood transfusion is given to a 52-year-old woman. She develops chills and rigours shortly after the transfusion begins. The following are her observations: Temperature 40°C, HR 116 bpm, BP 80/48, SaO 2 97 percent on air.Which of the following treatments is the most appropriate?
Your Answer: Stop the transfusion and administer antibiotics
Explanation:Bacterial infections are common in the following situations:Platelet transfusions are associated with a higher risk of bacterial infection (as platelets are stored at room temperature)Immersion in a water bath thawed previously frozen components.Components of red blood cells that have been stored for several weeksGram-positive and Gram-negative bacteria have both been linked to transfusion-transmitted bacterial infection, but Gram-negative bacteria are linked to a higher rate of morbidity and mortality.Yersinia enterocolitica is the most common bacterial organism linked to transfusion-transmitted bacterial infection. This organism can multiply at low temperatures while also utilising iron as a nutrient. As a result, it’s well-suited to proliferating in blood banks.The following are some of the most common clinical signs and symptoms of a bacterial infection transmitted through a blood transfusion. These symptoms usually appear shortly after the transfusion begins:Fever is very high.Rigours and chillsVomiting and nauseaTachycardiaHypotensionCollapse of the circulatory systemIf a bacterial infection from a transfusion is suspected, the transfusion should be stopped right away. Blood cultures and a Gram stain should be requested, as well as broad-spectrum antibiotics. In addition, the blood pack should be returned to the blood bank for an urgent culture and Gram-stain.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 123
Correct
-
Regarding conduction of nerve impulses, which of the following statements is CORRECT:
Your Answer: The action potential in myelinated axons is propagated only at the nodes of Ranvier.
Explanation:An action potential is a self-propagating response, successive depolarisation moving along each segment of an unmyelinated nerve until it reaches the end. It is all-or-nothing and does not decrease in size. Conduction in myelinated fibres is much faster, up to 50 times that of the fastest unmyelinated nerve. Myelinated fibres are insulated except at areas devoid of myelin called nodes of Ranvier. The depolarisation jumps from one node of Ranvier to another by a process called saltatory conduction. Saltatory conduction not only increases the velocity of impulse transmission but also conserves energy for the axon because depolarisation only occurs at the nodes and not along the whole length of the nerve fibre. Larger diameter myelinated nerve fibres conduct nerve impulses faster than small unmyelinated nerve fibres.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 124
Incorrect
-
A 6-year-old girl is brought into the paediatric emergency room by her mother in a state of high-grade fever and extreme irritability. She is also reluctant to urinate as it is associated with lower abdominal pain and stinging. She has no history of any UTIs requiring antibiotics in the past 12 months. The urine sensitivity test report is still unavailable. A clean catch urine sample is taken for urine dipstick, which reveals the presence of blood, protein, leukocytes and nitrites. Fresh blood tests were sent, and her estimated GFR is calculated to be 40 ml/minute. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer: Cefalexin
Correct Answer: Trimethoprim
Explanation:The NICE guidelines for children and young people under 16 years lower UTIs are:1. Get a urine sample before antibiotics are taken, and do a dipstick test OR send for culture and susceptibility2. Assess and manage children under 5 with lower UTI with fever as recommended in the NICE guideline on fever in under 5s.3. Prescribe an immediate antibiotic prescription and take into account the previous urine culture and susceptibility results, previous antibiotic use, which may have led to resistant bacteria4. If urine culture and susceptibility report is sent- Review the choice of antibiotic when the results are available AND- change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possibleThe choice of antibiotics for non-pregnant young people under 16 years with lower UTI is summarised below:1. Children under 3 months:- Refer to paediatric specialist and treat with intravenous antibiotic in line with NICE guideline on fever in under 5s2. Children over 3 months: – First-choice Nitrofurantoin – if eGFR >45 ml/minuteTrimethoprim – (if low risk of resistance*)- Second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice not suitable)Nitrofurantoin – if eGFR >45 ml/minute and not used as first-choiceAmoxicillin (only if culture results available and susceptible)Cefalexin
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 125
Correct
-
Regarding penicillin antibiotics, which of the following statements is CORRECT:
Your Answer: Patients with a history of atopy are at higher risk of hypersensitivity reactions.
Explanation:Allergic reactions to penicillins occur in 1 – 10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. Patients with a history of atopic allergy are at higher risk of anaphylactic reactions to penicillins. Patients with a history of anaphylaxis, urticaria, or rash immediately after penicillin use should not receive a penicillin or other beta-lactam antibiotics; about 0.5 – 6.5 % of penicillin-sensitive patients will also be allergic to the cephalosporins. Patients with a history of a more minor rash (i.e. non-confluent, non-pruritic rash restricted to a small area of the body) or delayed reaction (rash occurring more than 72 hours after penicillin administration), may not be truly allergic and may be considered for penicillin or beta-lactam treatment in severe infection (although possibility of allergy should be borne in mind). Other beta-lactam antibiotics (including cephalosporins) can be used in these patients.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 126
Incorrect
-
A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from the steering wheel of his car after falling asleep while driving headlong into an oncoming HGV lorry. Bruising around his sternum was observed, which appears to be the central point of impact. Which of the following structures is most likely injured by the blunt force trauma?
Your Answer: Right atrium
Correct Answer: Right ventricle
Explanation:In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:Anterior (or sternocostal) – Right ventriclePosterior (or base) – Left atriumInferior (or diaphragmatic) – Left and right ventriclesRight pulmonary – Right atriumLeft pulmonary – Left ventricle
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 127
Correct
-
Hartmann's solution contains how much sodium:
Your Answer: 131 mmol/L
Explanation:Hartmann’s solution (compound sodium lactate) contains: Na+131 mmol/L, K+5 mmol/L, HCO3-29 mmol/L (as lactate), Cl-111 mmol/L, Ca2+2 mmol/L. It can be used instead of isotonic sodium chloride solution during or after surgery, or in the initial management of the injured or wounded; it may reduce the risk of hyperchloraemic acidosis.
-
This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
-
-
Question 128
Correct
-
Which of the following nerves is responsible for the symptoms of a patient with history of recurrent herpes simplex outbreaks on his face and presents with ophthalmic herpes zoster and a painful vesicle on the tip of his nose?
Your Answer: Nasociliary nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve. The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 129
Correct
-
A 55 year old man presents to ED complaining of leg weakness. Your colleague has examined the patient and suspects femoral nerve palsy. Which of the following clinical features would you LEAST expect to see on examination of this patient:
Your Answer: Weakness of hip extension
Explanation:Damage to the femoral nerve results in weakness of hip flexion and knee extension and loss of sensation over the anterior thigh and the anteromedial knee, medial leg and medial foot.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 130
Correct
-
Which of the following conditions manifests hyperkalaemia as one of its symptoms?
Your Answer: Congenital adrenal hyperplasia
Explanation:Plasma potassium greater than 5.5 mmol/L is hyperkalaemia or elevated plasma potassium level. Among the causes of hyperkalaemia include congenital adrenal hyperplasia. Congenital adrenal hyperplasia is a general term referring to autosomal recessive disorders involving a deficiency of an enzyme needed in cortisol and/or aldosterone synthesis. The level of cortisol and/or aldosterone deficiency affects the clinical manifestations of congenital adrenal hyperplasia. When it involves hypoaldosteronism, it can result in hyponatremia and hyperkalaemia. While hypercortisolism can cause hypoglycaemia.The other causes of hyperkalaemia may include renal failure, excess potassium supplementation, Addison’s disease (adrenal insufficiency), renal tubular acidosis (type 4), rhabdomyolysis, burns, trauma, Tumour lysis syndrome, acidosis, and medications such as ACE inhibitors, angiotensin receptor blockers, NSAIDs, beta-blockers, digoxin, and suxamethonium. Bartter’s syndrome is characterized by hypokalaemic alkalosis with normal to low blood pressure. Type 1 and 2 renal tubular acidosis both cause hypokalaemia. Gitelman’s syndrome is a defect of the distal convoluted tubule of the kidney. It causes metabolic alkalosis with hypokalaemia and hypomagnesemia. And excessive liquorice ingestion causes hypermineralocorticoidism and hypokalaemia as well. Thus, among the choices, only congenital adrenal hyperplasia can cause hyperkalaemia.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 131
Correct
-
A fracture on which of the following structures is associated with a posterior elbow dislocation?
Your Answer: Radial head
Explanation:Fracture dislocations of the elbow appear extremely complex, and identification of the basic injury patterns can facilitate management. The simplest pattern of elbow fracture dislocation is posterior dislocation of the elbow with fracture of the radial head. Addition of a coronoid fracture, no matter how small, to elbow dislocation and radial head fracture is called the terrible triad of the elbow.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 132
Correct
-
In the emergency department, a 50-year-old female appears with a lack of sensation over the front two-thirds of her tongue. Taste and salivation are both present. The patient might have damage which of her nerves?
Your Answer: Lingual nerve
Explanation:The lingual nerve, a branch of the mandibular nerve, transmits sensation to the anterior two-thirds of the tongue. The chorda tympani, a branch of the facial nerve, transmits taste to the front two-thirds of the tongue as well as secretomotor innervation to the submandibular and sublingual glands. As a result, any damage to the lingual nerve can cause changes in salivary secretion on the affected side, as well as a loss of taste in the anterior two-thirds of the tongue and temporary or permanent sensory changes in the anterior two-thirds of the tongue and the floor of the mouth.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 133
Correct
-
A 29-year-old man is diagnosed with a severe case of asthma.In the treatment of acute asthma in adults, which of the following is NOT recommended?Â
Your Answer: Nebulised magnesium
Explanation:There is no evidence to support the use of nebulized magnesium sulphate in the treatment of adults at this time.In adults with acute asthma, the following medication dosages are recommended:By using an oxygen-driven nebuliser, you can get 5 milligrams of salbutamol.500 mcg ipratropium bromide in an oxygen-driven nebuliserOral prednisolone 40-50 mg100 mg hydrocortisone intravenous1.2-2 g magnesium sulphate IV over 20 minutesWhen inhaled treatment is ineffective, intravenous salbutamol (250 mcg IV slowly) may be explored (e.g. a patient receiving bag-mask ventilation).Following senior counsel, current ALS recommendations propose that IV aminophylline be explored in severe or life-threatening asthma. If utilized, a loading dose of 5 mg/kg should be administered over 20 minutes, then a 500-700 mcg/kg/hour infusion should be given. To avoid toxicity, serum theophylline levels should be kept below 20 mcg/ml.
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 134
Correct
-
The following are all examples of type I hypersensitivity EXCEPT for:
Your Answer: Contact dermatitis
Explanation:Examples of type I reactions include:Allergic rhinitisAllergic conjunctivitisAllergic asthmaSystemic anaphylaxisAngioedemaUrticariaPenicillin allergy
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 135
Correct
-
An 8-year-old boy was brought to the emergency room with complaints of a rash and fever that have been present for the past 3 days. Upon history taking and observation, it was noted that the rash started behind the ears and then spread to the face and body. The presence of coryzal symptoms, dry cough, and conjunctivitis was also observed.What is most likely the diagnosis of the case presented above?
Your Answer: Measles
Explanation:The measles virus is an enveloped virus classified in the genusMorbillivirus.Measles is highly contagious and spreads by aerosol. Initial replication takes place in the mucosal cells of the respiratory tract; measles virus then replicates in the local lymph nodes and spreads systemically. The virus circulates in the T and B cells and monocytes, until eventually the lungs, gut, bile duct, bladder, skin, and lymphatic organs are involved. After an incubation period of 7 to 10 days, there is an abrupt onset, with symptoms of sneezing, runny nose and cough, red eyes, and rapidly rising fever. About 2 to 3 days later, a maculopapular rash appears on the head and trunk. Koplik spots, lesions on the oral mucosa consisting of irregular red spots, with a bluish white speck in the centre, generally appear 2 to 3 days before the rash and are diagnostic.Measles is easily diagnosed clinically, so few requests for laboratory identification are made. The virus is fragile and must be handled carefully. The specimens of choice are from the nasopharynx and urine, but the virus can only be recovered from these sources in the early stages of infection. The virus grows on PMK cells, causing the formation of distinctive spindle-shaped or multinucleated cells.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 136
Incorrect
-
A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer: Posterior inferior cerebellar artery
Correct Answer: Basilar artery
Explanation:The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 137
Correct
-
Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms:
Your Answer: Binds to beta1-receptors and causes increased Ca2+ entry via L-type channels during the action potential
Explanation:Noradrenaline (the sympathetic neurotransmitter) is a positive inotrope; it binds to β1-adrenoceptors on the membrane and causes increased Ca2+entry via L-type channels during the AP and thus increases Ca2+release from the SR. Noradrenaline also increases Ca2+sequestration into the SR and thus more Ca2+is available for the next contraction. Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump which generates the Na+gradient required for driving the export of Ca2+; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction. Acidosis is negatively inotropic, largely because H+competes for Ca2+binding sites.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 138
Correct
-
The pathophysiology of Addison's disease is as follows:
Your Answer: Adrenocortical insufficiency
Explanation:Primary adrenal insufficiency, also known as Addison’s disease, occurs when the adrenal glands cannot produce an adequate amount of hormones despite a normal or increased corticotropin (ACTH) level.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 139
Incorrect
-
A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin. There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute. A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer: Ciprofloxacin
Correct Answer: Nitrofurantoin
Explanation:The NICE guidelines for men with lower UTIs are:1. Prescribe an antibiotic immediately, taking into account the previous urine culture and susceptibility results or avoiding antibiotics used previously that may have caused resistance 2. Obtain a midstream urine sample before starting antibiotics and send for urine culture and susceptibility – Review the choice of antibiotic when the results are available AND- change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possibleThe first choice of antibiotics for men with lower UTIs is:1. Trimethoprim200 mg PO BD for seven days2. Nitrofurantoin100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minuteIn men whose symptoms have not responded to a first-choice antibiotic, alternative diagnoses (such as acute pyelonephritis or acute prostatitis) should be considered. Second-choice antibiotics should be based on recent culture and susceptibility results.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 140
Correct
-
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.
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 141
Correct
-
Where on the body is the radial artery pulsation best palpated?
Your Answer: At the wrist just lateral to the flexor carpi radialis tendon
Explanation:The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 142
Correct
-
A 14-year-old female is brought to the Emergency Room by her mother after a fall from a tree in which she injured her elbow. An elbow fracture is suspected based on the examination findings, and she is given Entonox for analgesia as her elbow is set in a cast. Which one of the following statements regarding this drug is true?
Your Answer: It can cause inhibition of vitamin B12 synthesis
Explanation:Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor. It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour. Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 143
Correct
-
A patient who was put on low molecular weight heparin for suspected DVT and was scheduled for an ultrasound after the weekend, arrives at the emergency department with significant hematemesis. Which of the following medications can be used as a heparin reversal agent:
Your Answer: Protamine sulfate
Explanation:The management of bleeding in a patient receiving heparin depends upon the location and severity of bleeding, the underlying thromboembolic risk, and the current aPTT (for heparin) or anti-factor Xa activity (for LMW heparin). As an example, a patient with minor skin bleeding in the setting of a mechanical heart valve (high thromboembolic risk) and a therapeutic aPTT may continue heparin therapy, whereas a patient with major intracerebral bleeding in the setting of venous thromboembolism several months prior who is receiving heparin bridging perioperatively may require immediate heparin discontinuation and reversal with protamine sulphate. If haemorrhage occurs it is usually sufficient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulphate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Clinician judgment and early involvement of the appropriate consulting specialists is advised.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 144
Incorrect
-
The causative organism for an infection in a patient you are reviewing is a facultative anaerobe.Which of these is a facultative anaerobic organism?
Your Answer: Clostridium perfringens
Correct Answer: Staphylococcus aureus
Explanation:Facultative anaerobic bacteria make energy in the form of ATP by aerobic respiration in an oxygen rich environment and can switch to fermentation in an oxygen poor environment.Examples of facultative anaerobes are:Staphylococcus spp.Listeria spp.Streptococcus spp.Escherichia coliMycobacterium tuberculosis, and Pseudomonas aeruginosa are obligate aerobe. They require oxygen to growCampylobacter jejuni and Clostridium spp are obligate anaerobes.They live and grow in the absence of oxygen.
-
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
-
-
Question 145
Incorrect
-
The results from the study investigating the accuracy of a new diagnostic test can be displayed in the following format. How is the negative predictive value calculated:Those with diseaseThose without diseaseTotalTest positiveaba+bTest negativecdc+dTotala+cb+dn=a+b+c+d
Your Answer: a/(a+b)
Correct Answer: d/(c+d)
Explanation:Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.NPV = d/(c+d)
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 146
Correct
-
A 34-year-old male presents to the Emergency Department with the complaint of palpitations and difficulty breathing, which started suddenly half an hour ago. His ECG shows findings of supraventricular tachycardia. You attempt vagal manoeuvres but cannot convert them back to sinus rhythm. Therefore, drug therapy is necessary to terminate the arrhythmia. Adenosine cannot be used in this patient because of a contra-indication listed in his medical record. Which one of the conditions listed below would be a contraindication in this case?
Your Answer: Asthma
Explanation:Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor. It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour. Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 147
Correct
-
A patient presents with a rash for a dermatological examination. A flat circumscribed area of discoloured skin measuring 0.7 cm in diameter is seen on examination.What is the best description of this rash that you have found on examination?
Your Answer: Macule
Explanation:A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin. A vesicle is a visible collection of clear fluid measuring less than 0.5 cm in diameter.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 plaque is a palpable skin lesion that is elevated and measures >1cm in diameter.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 148
Correct
-
Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:
Your Answer: Ca 2+ release from sarcoplasmic reticulum
Explanation:Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). APs travel down invaginations of the sarcolemma called T-tubules, which are close to, but do not touch, the terminal cisternae of the SR. During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. The amount of Ca2+released is dependent on how much is stored, and on the size of the initial Ca2+influx during the AP.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 149
Incorrect
-
A man working as a waiter cuts his arm on a glass while he was working. The palmaris longus muscle was damaged as a consequence of his injury.Which of the following statements regarding the palmaris longus muscle is considered correct?
Your Answer: Damage to it will cause a significant functional deficit at the wrist
Correct Answer: It receives its blood supply from the ulnar artery
Explanation:The palmaris longus is a small, fusiform-shaped muscle located on the anterior forearm of the human upper extremity. The palmaris longus muscle is commonly present but may be absent in a small percentage of the population, ranging from 2.5% to 26% of individuals, depending on the studied population.The palmaris longus belongs to the anterior forearm flexor group in the human upper extremity. The muscle attaches proximally to the medial humeral epicondyle and distally to the palmar aponeurosis and flexor retinaculum. The blood supply to the palmaris longus muscle is via the ulnar artery, a branch of the brachial artery in the human upper extremity.The palmaris longus muscle receives its innervation via branches of the median nerve containing nerve roots C5-T1. Median nerve injury at or above the elbow joint (including brachial plexus and nerve root injury) can lead to deficits in the palmaris longus and other forearm flexor muscles, leading to weakened elbow flexion, wrist flexion, radial deviation, finger flexion, thumb opposition, flexion, and abduction, in addition to the loss of sensory function in the distribution of the median nerve.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 150
Incorrect
-
Regarding macrolide antibiotics, which of the following statements is CORRECT:
Your Answer: Erythromycin is not commonly associated with gastrointestinal upset.
Correct Answer: Macrolides are first line for treatment of whooping cough.
Explanation:A macrolide antibiotic is recommended first line for whooping cough (if onset of cough is within the previous 21 days)Prescribe clarithromycin for infants less than 1 month of age.Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.Prescribe erythromycin for pregnant women.Macrolides interfere with bacterial protein synthesis and are mainly active against Gram-positive organisms. They have a similar antibacterial spectrum to penicillin and are thus a useful alternative in penicillin-allergic patients. Erythromycin is commonly associated with gastrointestinal upset.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 151
Correct
-
The weight distribution in a group of patients included in a study was normal. The patients averaged 80 kg in weight. 5 kg was determined to be the standard deviation. Which of the following statements most accurately describes this group of patients:
Your Answer: 68% of the patients will weigh between 75 and 85 kg.
Explanation:We can estimate the range of values that would be anticipated to include particular proportions of observations if we know the mean and standard deviation of a collection of normally distributed data: 68.2 percent of the sample results fall within a one SD range above and below the mean (+/- 1 SD), implying that 68 percent of the patients will weigh between 75 and 85 kg. Because +/- 2 SD encompasses 95.4 percent of the data, around 95 percent of the patients will weigh between 70 and 90 kg. +/- 3 SD encompasses 99.7% of the values, implying that nearly all of the patients will weigh between 65 and 95 kg.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 152
Correct
-
Digoxin is contraindicated in all of the following EXCEPT for:
Your Answer: Asthma
Explanation:Digoxin is contraindicated in:Supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndromeVentricular tachycardia or fibrillationHeart conduction problems e.g. second degree or intermittent complete heart blockHypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure but should be used with caution)
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 153
Correct
-
Which among the following antibacterial regimens is considered the most appropriate to prescribe in a patient presenting with clinical signs and symptoms consistent with a diagnosis of pelvic inflammatory disease?
Your Answer: Ceftriaxone plus doxycycline plus metronidazole
Explanation:The endocervix is the most common site of Neisseria gonorrhoeae infection in women. Symptoms of infection, when present, include dysuria, cervical discharge, and lower abdominal pain. However, 50% of cases in women may be asymptomatic leading to complications such as pelvic inflammatory disease (PID), which may cause sterility, ectopic pregnancy, or perihepatitis.PID is also known as Fitz-Hugh-Curtis syndrome is defined as an inflammation of the upper genital tract due to an infection in women. The disease affects the uterus, fallopian tubes, and ovaries. It is typically an ascending infection, spreading from the lower genital tract. The recommended intramuscular or oral regimens for PID are as follows:Ceftriaxone at 500 mg IM in a single dose (for persons weighing ≥150 kg, administer 1 g of ceftriaxone); plus doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 154
Correct
-
Parathyroid hormone is released by which of the following:
Your Answer: Chief cells of the parathyroid gland
Explanation:Parathyroid hormone (PTH) is a peptide hormone synthesised by the chief cells of the parathyroid glands, located immediately behind the thyroid gland. PTH is primarily released in response to decreasing plasma [Ca2+] concentration. PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.Parathyroid hormone (PTH) acts to increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane) and increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 155
Correct
-
Regarding apoptosis, which of the following statements is INCORRECT:
Your Answer: Apoptosis leads to cell swelling and eventual cell lysis.
Explanation:Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.
-
This question is part of the following fields:
- Inflammatory Responses
- Pathology
-
-
Question 156
Correct
-
An very unwell patient is receiving treatment in your hospital's HDU and is found to have an Escherichia coli O157 infection.Which one of these statements about Escherichia coli O157 is true?
Your Answer: Haemolytic uraemic syndrome develops in approximately 6% of patients
Explanation:Escherichia coli O157 is a serotype of Escherichia coli.The Escherichia coliO157 strain is ‘enterohaemorrhagic’ and causes severe forms of acute haemorrhagic diarrhoea. It can also cause non-haemorrhagic diarrhoea. Incubation period of Escherichia coli O157 is usually 3-4 days and bloody diarrhoea usually begins on the 3rd or 4th day of the infection.Infections with Escherichia coliO157 are more common during the warmer months than in winter.Haemolytic uraemic syndrome develops in approximately 6% of patients. It is commonly seen in children and in the elderly. Escherichia coli O157 can also cause:Haemorrhagic colitisHaemolytic uraemic syndromeThrombotic thrombocytopenic purpura but not immune thrombocytopenic purpura.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 157
Incorrect
-
A new test is being developed to diagnose chlamydia. 1000 people aged 15 – 35 years attending a GUM clinic undergo the new test and the current gold standard nucleic acid amplification test (NAAT) to confirm the diagnosis. Of the 1000 people, 250 are diagnosed with chlamydia. Of the patients diagnosed with chlamydia, 240 test positive with the new diagnostic test and of the patients not diagnosed with chlamydia, 150 test positive with the new diagnostic test. What is the negative predictive value of this test:Chlamydia YesChlamydia NoTotalPositive testa= 240b = 150390Negative testc = 10d = 600610Total2507501000
Your Answer: 0.75
Correct Answer: 0.98
Explanation:Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.Negative predictive value (NPV) = d/(c+d) = 600/610 = 0.98 = 98%This means there is a 98% chance, if the test is negative, that the patient does not have chlamydia.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 158
Correct
-
By what mechanism does Vibrio cholerae causes diarrhoea?
Your Answer: Increases Cl- secretory channels in crypt cells
Explanation:Cholera is a severe diarrheal illness caused by the Vibrio cholerae bacteria infecting the bowel. Ingesting cholera-infected food or drink is the a way to contract the disease. In the intestinal crypt cells, the toxigenic bacterium Vibrio cholera activates adenylate cyclase and raises cyclic adenosine monophosphate (cAMP). cAMP stimulates the Cl-secretory channels in crypt cells, resulting in the secretion of chloride with sodium ions and water. The toxin it produces causes the body to secrete massive amounts of water, resulting in diarrhoea and significant fluid and electrolyte loss.
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 159
Correct
-
On reviewing the ECG of a patient with a history of intermittent palpitations, you observe prolonged QT interval.Which of these can cause prolongation of the QT interval on the ECG?
Your Answer: Erythromycin
Explanation:Syncope and sudden death due to ventricular tachycardia, particularly Torsades-des-pointes is seen in prolongation of the QT interval.The causes of a prolonged QT interval include:ErythromycinAmiodaroneQuinidineMethadoneProcainamideSotalolTerfenadineTricyclic antidepressantsJervell-Lange-Nielsen syndrome (autosomal dominant)Romano Ward syndrome (autosomal recessive)HypothyroidismHypocalcaemiaHypokalaemiaHypomagnesaemiaHypothermiaRheumatic carditisMitral valve prolapseIschaemic heart disease
-
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
-
-
Question 160
Correct
-
A 42-year-old woman presents with face swelling prominently affecting her upper lip and hands. She has previously been diagnosed with hereditary angioedema.Which of these is the most appropriate management option for this acute attack?
Your Answer: Fresh frozen plasma
Explanation:Hereditary angioedema is inherited as an autosomal dominant disorder and is caused by deficiency of C1 esterase inhibitor, a protein that forms part of the complement system.Attacks can be precipitated by stress and minor surgical procedures. Clinical features of hereditary angioedema include oedema of the skin and mucous membranes commonly affecting the face, tongue and extremities.Angioedema and anaphylaxis due to a deficiency of C1 esterase inhibitor are resistant to adrenaline, steroids and antihistamines. Treatment is with fresh frozen plasma or C1 esterase inhibitor concentrate, which contains C1 esterase inhibitor.Short-term prophylaxis for events that may precipitate angioedema attack is achieved with C1 esterase inhibitor or fresh frozen plasma infusions before the event while long-term prophylaxis can be achieved with antifibrinolytic drugs (tranexamic acid) or androgenic steroids.
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 161
Correct
-
In relation to ketamine, which of the following statements is TRUE:
Your Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.
Explanation:Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma.
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 162
Correct
-
All of the following statements is considered true regarding Streptococcus pneumoniae, except:
Your Answer: It is the commonest cause of erysipelas
Explanation:Erysipelas is a rare infection of the skin and subcutaneous tissues observed frequently in elderly patients. It is characterized by an acute spreading skin lesion that is intensely erythematous with a plainly demarcated but irregular edge. It is most commonly caused by Streptococcus pyogenes or Group A Streptococcus (GAS).GAS are susceptible to penicillin, which remains the drug of choice for treatment. For patients allergic to penicillin, erythromycin can be used.S. pyogenes colonizes the throat and skin on humans, making these sites the primary sources of transmission. Infections resulting from S. pyogenes include pharyngitis, scarlet fever, skin or pyodermal infections, and other septic infections. In addition, the sequelae rheumatic fever and acute glomerulonephritis can occur as a result of infection with S. pyogenes.Agammaglobulinemia is mostly associated with S. pneumoniae.The M protein is attached to the peptidoglycan of the cell wall and extends tothe cell surface. The M protein is essential for virulence. The polysaccharide capsule is characteristic of S. pneumoniae.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 163
Correct
-
Carbamazepine is contraindicated in which of the following:
Your 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)
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 164
Correct
-
Which of the following side effects is most likely caused by erythromycin:
Your 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
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 165
Correct
-
A 28-year-old female arrives after taking an unknown chemical in excess. She is tired and her speech is slurred. The following are her observations and results: HR 118, BP 92/58, SaO2 96%HR 118, 11/15  The following are the results of his arterial blood gas (ABG):pH: 7.24 pO 2 : 9.4 kPa PCO2 : 3.3 kPa HCO 3 -: 22 mmol/l Na + : 143 mmol/l Cl – : 99 mmol/l Lactate: 5 IU/lWhich of the following statements about this patient is TRUE?
Your Answer: Her anion gap is elevated
Explanation:The interpretation of arterial blood gas (ABG) aids in the measurement of a patient’s pulmonary gas exchange and acid-base balance. The normal values on an ABG vary a little depending on the analyser, but they are roughly as follows:Variable RangepH 7.35 – 7.45PaO2 10 – 14 kPaPaCO2 4.5 – 6 kPaHCO3- 22 – 26 mmol/lBase excess -2 – 2 mmol/lThe patient’s history indicates that she has taken an overdose in this case. Because her GCS is 11/15 and she can communicate with slurred speech, she is clearly managing her own airway, there is no current justification for intubation.The following are the relevant ABG findings:Hypoxia (mild)pH has been lowered (acidaemia)PCO2 levels are low.bicarbonate in its natural stateLactate levels have increasedThe anion gap represents the concentration of all the unmeasured anions in the plasma. It is the difference between the primary measured cations and the primary measured anions in the serum. It can be calculated using the following formula:Anion gap = [Na+] – [Cl-] – [HCO3-]The reference range varies depending on the technique of measurement, but it is usually between 8 and 16 mmol/L.The following formula can be used to compute her anion gap:Anion gap = [143] – [99] – [22]Anion gap = 22As a result, it is clear that she has a metabolic acidosis with an increased anion gap.The following are some of the causes of type A and type B lactic acidosis:Type A lactic acidosisType B lactic acidosisShock (including septic shock)Left ventricular failureSevere anaemiaAsphyxiaCardiac arrestCO poisoningRespiratory failureSevere asthma and COPDRegional hypoperfusionRenal failureLiver failureSepsis (non-hypoxic sepsis)Thiamine deficiencyAlcoholic ketoacidosisDiabetic ketoacidosisCyanide poisoningMethanol poisoningBiguanide poisoning
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 166
Correct
-
Which of the following is most true of the sinoatrial node:
Your Answer: Frequency of depolarisation is increased by sympathetic stimulation.
Explanation:Cardiac myocyte contraction is not dependent on an external nerve supply but instead the heart generates its own rhythm, demonstrating inherent rhythmicity. The heartbeat is initiated by spontaneous depolarisation of the sinoatrial node (SAN), a region of specialised myocytes in the right atrium close to the coronary sinus, at a rate of 100-110 beats/min. This intrinsic rhythm is primarily influenced by autonomic nerves, with vagal influences being dominant over sympathetic influences at rest. This vagal tone reduces the resting heart rate down to 60-80 beats/min. To increase heart rate, the autonomic nervous system increases sympathetic outflow to the SAN, with concurrent inhibition of vagal tone. These changes mean the pacemaker potential more rapidly reaches the threshold for action potential generation.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 167
Incorrect
-
Which of the following statements regarding the infectivity periods of these corresponding diseases is correct?
Your Answer: Chickenpox is infectious from 2 days before the rash appears
Correct Answer: Rubella is infectious until 5 days after the rash appears
Explanation:Rubella can be contagious from 7 days before to 7 days after the rash appears.Patients with measles are contagious from 1-2 days before the onset of symptoms.A person with chickenpox is considered contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted (scabbed). The infectious period of mumps is considered from 2 days before to 5 days after parotitis onset.Hepatitis A is highly transmissible and has an average incubation period of 28 to 30 days (range 15–50 days). The maximum infectivity is during the second half of the incubation period (i.e. while asymptomatic) and most cases are considered non-infectious after the first week of jaundice.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 168
Incorrect
-
Which of the following best describes the order in which blood passes through the nephron?Â
Your Answer: Afferent arteriole→Glomerular capillary→Peritubular capillary→Efferent arteriole→Vasa recta
Correct Answer: Afferent arteriole→Glomerular capillary→Efferent arteriole→Peritubular capillary→Vasa recta
Explanation:The nephron’s blood flow is as follows:Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa recta – Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa rectaThe kidney is the only vascular network in the body with two capillary beds. With arterioles supplying and draining the glomerular capillaries, higher hydrostatic pressures at the glomerulus are maintained, allowing for better filtration. A second capillary network at the tubules enables for secretion and absorption in the tubules, as well as concentrating urine.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 169
Correct
-
A dermatological examination on a patient presenting with a lump shows a small visible skin elevation containing an accumulation of pus.Which one of these best describes the lump you have found on examination?
Your Answer: Pustule
Explanation:A pustule is a small visible skin elevation containing an accumulation of pus. A carbuncle is a collection of individual boils clustered together. A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter. A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus. A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 170
Correct
-
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
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 171
Incorrect
-
Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 12 months:
Your Answer: Pneumococcal conjugate vaccine (PCV)
Correct Answer: Polio
Explanation:At 12 months the following vaccines are given:Hib (4th dose) and Meningococcal group CPneumococcal (13 serotypes) (2nd dose)Measles, mumps and rubellaMeningococcal group B (3rd dose)
-
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
-
-
Question 172
Incorrect
-
An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:No. of post-menopausal women who took Calcium: 500No. of post-menopausal women who took Calcium and suffered a hip fracture: 10No. of post-menopausal women who took placebo: 500No. of post-menopausal women who took placebo and suffered a hip fracture: 25Compute for the absolute risk in the placebo group.
Your Answer: 0.02
Correct Answer: 0.05
Explanation:The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.AR = 25/500 = 0.05
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 173
Correct
-
A patient presents with nausea, anorexia, jaundice and right upper quadrant pain. A diagnosis of acute hepatitis B is suspected.Which of the following blood results is most suggestive of an acute hepatitis B infection? Select ONE answer only.
Your Answer: HBsAg positive, IgM anti-HBc positive
Explanation:Hepatitis B surface antigen (HBsAg) is a protein on the surface of the hepatitis B virus, that is the first serologic marker to appear in a new acute infection.It can be detected as early as 1 week and as late as 9 weeks. It can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine.Hepatitis B surface antibody (anti-HBs) indicates recovery and immunity from the hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame. It is not present following hepatitis B vaccination.IgM antibody to hepatitis B core antigen (IgM anti-HBc) indicates recent infection with hepatitis B virus (<6 months). Its presence indicates acute infection.The following table summarises the presence of hepatitis B markers according to each situation:Susceptible to infection:HBsAg = NegativeAnti-HBc = NegativeAnti-HBs = NegativeImmune due to natural infection:HBsAg = NegativeAnti-HBc = PositiveAnti-HBs = PositiveImmune due to vaccination:HBsAg = NegativeAnti-HBc = NegativeAnti-HBs = PositiveAcute infection:HBsAg = PositiveAnti-HBc = PositiveAnti-HBs = NegativeIgM anti-HBc = PositiveChronic infection:HBsAg = PositiveAnti-HBc = PositiveAnti-HBs = NegativeIgM anti-HBc = Negative
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 174
Correct
-
A patient presents with an adducted eye at rest which cannot abduct past the midline, which of the following cranial nerves is most likely to be affected:
Your Answer: Abducens nerve
Explanation:Abducens nerve palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 175
Incorrect
-
Which of the following is NOT typically associated with eosinophilia:
Your Answer: Hodgkin lymphoma
Correct Answer: Whooping cough
Explanation:An eosinophil leucocytosis is defined as an increase in blood eosinophils above 0.4 x 109/L.It is most frequently due to:Allergic diseases (e.g. bronchial asthma, hay fever, atopic dermatitis, urticaria)Parasites (e.g. hookworm, ascariasis, tapeworm, schistosomiasis)Skin diseases (e.g. psoriasis, pemphigus, urticaria, angioedema)Drug sensitivity
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 176
Correct
-
The 'bucket handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The middles of the shafts of the ribs moving upwards and laterally
Explanation:Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 177
Correct
-
You are reviewing a patient with hypocalcaemia secondary to hypoparathyroidism. Parathyroid hormone (PTH) acts to increased calcium reabsorption at which of the following sites in the nephron:
Your Answer: Distal convoluted tubule
Explanation:Parathyroid hormone (PTH) is a peptide hormone synthesised by the chief cells of the parathyroid glands, located immediately behind the thyroid gland. PTH is primarily released in response to decreasing plasma [Ca2+] concentration. PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.Parathyroid hormone (PTH) acts to increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane) and increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 178
Correct
-
A 62-year-old woman has reduced urine output, nausea, and confusion. Renal function tests and other investigations done leads to a diagnosis of acute kidney injury (AKI).Which one of these is consistent with a diagnosis of AKI?
Your Answer: A rise in serum creatinine of 30 μmol/L within 48 hours
Explanation:AKI is diagnosed based on an acutely rising serum creatinine and/or reduction in urine output.
AKI can often be non-oliguric.
AKI is present if any one or more of the following criteria is met:
- A rise in serum creatinine of ≥26 micromol/L (≥0.3 mg/dL) within 48 hours
- A rise in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the past 7 days (in practice you can use the lowest value from the past 3 months as the baseline for the patient)
- Urine volume <0.5 ml/kg/hour for at least 6 hours.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 179
Incorrect
-
You see a patient in the Emergency Department with features consistent with a diagnosis of type I diabetes mellitus.Which of these is MOST suggestive of type I diabetes mellitus?
Your Answer: Onset under the age of 20
Correct Answer: History of recent weight loss
Explanation:A history of recent weight loss is very suggestive of an absolute deficiency of insulin seen in type I diabetes mellitus.An age of onset of less than 20 years makes a diagnosis of type I diabetes mellitus more likely. However, an increasing number of obese children and young people are being diagnosed with type II diabetes.Microalbuminuria, peripheral neuropathy, and retinopathy all occur in both type I and type II diabetes mellitus. They are not more suggestive of type I DM.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 180
Correct
-
A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.Which of the following nerves has been damaged in this case? Select ONE answer only.
Your Answer: The median nerve
Explanation:Flexor carpi radialis is innervated by the median nerve.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
SESSION STATS - PERFORMANCE PER SPECIALTY
