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Question 1
Incorrect
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A dermatological examination on a patient presenting with a lump shows a solid, well circumscribed, lump measuring 0.8 cm in diameter.Which one of these best describes the lump you have found on examination?
Your Answer: Macule
Correct Answer: Nodule
Explanation: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 vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter. 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 papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.A plaque is a palpable skin lesion that is elevated and measures >1cm in diameter
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 2
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 3
Correct
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Question 4
Correct
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Which of the following immunoglobulins is most important for mast cell degranulation:
Your Answer: IgE
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 5
Correct
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Liquefactive necrosis is most commonly seen in which of the following conditions:
Your Answer: Ischaemic stroke
Explanation:Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 6
Correct
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Which of the following is NOT a notifiable disease:
Your Answer: HIV
Explanation:HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.HIV is not a notifiable disease.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 7
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 8
Correct
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A patient is diagnosed with a Klebsiella infection.Which SINGLE statement regarding Klebsiella infections is true?
Your Answer: Klebsiella spp are an important cause of ventilator-associated pneumonia
Explanation:Klebsiellais a genus of non-motile,Gram-negative, rod-shaped bacteriawith a prominent polysaccharide-based capsule. They are routinely found in the nose, mouth and gastrointestinal tract as normal flora, however, they can also behave as opportunistic pathogens.Infections with Klebsiella spp. areusually nosocomial. They are an important cause of ventilator-associated pneumonia (VAP), urinary tract infection, wound infection and bacteraemia. Outbreaks of infections with Klebsiellaspp. in high-dependency units have been described and are associated with septicaemia and high mortality rates. Length of hospital stay and performance of invasive procedures are risk factors forKlebsiellainfections.Primary pneumonia withKlebsiella pneumoniaeis a rare,severe, community-acquired infection associated with a poor outcome.Klebsiella rhinoscleromatis causes a progressive granulomatous infection of the nasal passages and surrounding mucous membranes. This infection is mainly seen in the tropics.Klebsiella ozanae is a recognised cause of chronic bronchiectasis.Klebsiella organisms are resistant to multiple antibiotics including penicillins. This is thought to be a plasmid-mediated property. Agents with high intrinsic activity againstKlebsiellapneumoniaeshould be selected for severely ill patients. Examples of such agents include third-generation cephalosporins (e.g cefotaxime), carbapenems (e.g. imipenem), aminoglycosides (e.g. gentamicin), and quinolones (e.g. ciprofloxacin). These agents may be used as monotherapy or combination therapy. Aztreonam may be used in patients who are allergic to beta-lactam antibiotics.Species with ESBLs (Extended spectrum beta-lactamase) are resistant to penicillins and also cephalosporins such as cefotaxime and ceftriaxone.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 9
Correct
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A range of one standard deviation above and below the mean includes what approximate percentage of the sample values:
Your Answer: 0.68
Explanation:A range of one SD above and below the mean (+/- 1 SD) includes 68.2% of the sample values.A range of two SD above and below the mean (+/- 2 SD) includes 95.4% of the sample values.A range of three SD above and below the mean (+/- 3 SD) includes 99.7% of the sample values.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 10
Incorrect
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Question 11
Correct
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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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Incorrect
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A patient is referred for lung function tests on account of a history of breathlessness and cough.Which statement about lung volumes is correct?
Your Answer: The residual volume is the volume of air in the lungs at the end of a deep inspiration
Correct Answer: The tidal volume is the volume of air drawn in and out of the lungs during normal breathing
Explanation:The tidal volume(TV) is the amount of air that moves in and out of the lungs with each respiratory cycle. In a healthy male, the usual volume is 0.5 L (,7 ml/kg body mass).The vital capacity(VC) is the maximum amount of air that can be exhaled following maximal inspiration. The usual volume in a healthy male is 4.5 L.The residual volume(RV) is the amount of air remaining in the lungs after maximum expiration. The usual volume in a healthy male is 1.0 L.The inspiratory reserve volume(IRV) is the maximum amount of air that can be breathed in forcibly after normal inspiration. The usual volume in a healthy male is 3.0 L.The expiratory reserve volume(ERV) is the volume of air that can be breathed out forcibly after normal expiration. The usual volume in a healthy male is 1.0 L.Total lung capacity(TLC) is the volume of air the lungs can accommodate. TLC = RV+VC. The usual volume in a healthy male is 5.5 L.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 13
Correct
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A 44-year-old man with an acute episode of gout presents to you and you discuss treatment plan with him.Which one of these statements concerning the treatment of acute gout is true?
Your Answer: A common first-line treatment is Naproxen as a stat dose of 750 mg followed by 250 mg TDS
Explanation:High-dose NSAIDs are the first-line treatment for acute gout. In the absence of any contraindications, Naproxen 750 mg as a stat dose followed by 250 mg TDS is commonly used.Aspirin is contraindicated in gout. It reduces the urinary clearance of urate and also interferes with the action of uricosuric agents. Colchicine is preferred in patients with heart failure or in those who are intolerant of NSAIDs. It is as effective as NSAIDs in relieving acute attacks.Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. Where Allopurinol is not tolerated, it has a role in prophylactic treatment of gout.Allopurinol should not be started in the acute phase of gout as it increases the severity and duration of symptoms. It is used as a prophylaxis in preventing future attacks and acts by reducing serum uric acid levels.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 14
Correct
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Which of the following nerves is most important for eversion of the foot:
Your Answer: Superficial fibular nerve
Explanation:Eversion of the foot is primarily produced by the fibularis longus and fibularis brevis, both innervated by the superficial fibular nerve. The fibularis tertius, innervated by the deep fibular nerve, also assists in this action.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 15
Correct
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A patient with history of weight loss and diarrhoea was found out to have Giardia lamblia in her stool since returning from a holiday to Nepal.Which of the following statements is considered true regarding the life cycle of Giardia lamblia?
Your Answer: Trophozoites attach to the intestinal wall via a specialised sucking disc
Explanation:Cysts are resistant forms and are responsible for transmission of giardiasis. Both cysts and trophozoites can be found in the faeces (diagnostic stages). The cysts are hardy and can survive several months in cold water. Infection occurs by the ingestion of cysts in contaminated water, food, or by the faecal-oral route (hands or fomites). In the small intestine, excystation releases trophozoites (each cyst produces two trophozoites).Trophozoites multiply by longitudinal binary fission, remaining in the lumen of the proximal small bowel where they can be free or attached to the mucosa by a ventral sucking disk.Encystation occurs as the parasites transit toward the colon. The cyst is the stage found most commonly in non diarrheal faeces.Because the cysts are infectious when passed in the stool or shortly afterward, person-to-person transmission is possible. While animals are infected with Giardia, their importance as a reservoir is unclear.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 16
Incorrect
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A 30-year-old woman was involved in a road traffic accident and had a class I haemorrhage.Which physiological parameter is consistent with a diagnosis of class I haemorrhage?
Your Answer: Pulse rate of 115 bpm
Correct Answer: Increased pulse pressure
Explanation:There are 4 classes of haemorrhage. Classification is based on clinical signs and physiological parameters.In CLASS I:Blood loss (ml) is < or = 750Blood loss(% blood volume) < or = 15%Pulse rate (bpm) is 30Pulse pressure is normal or increasedSystolic BP is normalCNS/mental status patient is slightly anxious In CLASS II:Blood loss (ml) is 750 – 1500Blood loss(% blood volume) is 15 – 30%Pulse rate (bpm) is 100 – 120Respiratory rate is 20-30Urine output (ml/hr) is 20-30Pulse pressure is decreasedSystolic BP is normalCNS/mental status patient is mildly anxiousIn CLASS III:Blood loss (ml) is 1500 – 2000Blood loss(% blood volume) is 30- 40%Pulse rate (bpm) is 120 – 140Respiratory rate is 30-40Urine output (ml/hr) is 5-15Pulse pressure is decreasedSystolic BP is decreasedCNS/mental status patient is anxious, confusedIn CLASS IV:Blood loss (ml) is >2000Blood loss(% blood volume) is >40%Pulse rate (bpm) is >140Respiratory rate is >40Urine output (ml/hr) is negligiblePulse pressure is decreasedSystolic BP is decreasedCNS/mental status patient is confused, lethargic
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 17
Correct
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You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?
Your Answer: Anterior communicating artery
Explanation:One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm. A berry aneurysm is the most common type of brain aneurysm. The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 18
Incorrect
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When there is the presence of distended and engorged veins in the umbilical area, which of the following portosystemic anastomoses has most likely occurred?
Your Answer: Para-umbilical veins and azygous vein
Correct Answer: Para-umbilical veins and inferior epigastric vein
Explanation:Caput medusae is a condition that consists of collateral veins radiating from the umbilicus and results from recanalization of the umbilical vein.Under normal conditions, the portal venous blood traverses the liver and drains into the inferior vena cava of the systemic venous circulation by way of the hepatic veins. This is the direct route. However, other, smaller communications exist between the portal and systemic systems, and they become important when the direct route becomes blocked. These communications are as follows:At the lower third of the oesophagus, the oesophageal branches of the left gastric vein (portal tributary) anastomose with the oesophageal veins draining the middle third of the oesophagus into the azygos veins (systemic tributary).Halfway down the anal canal, the superior rectal veins (portal tributary) draining the upper half of the anal canal anastomosis with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.The paraumbilical veins connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall (systemic tributaries). The paraumbilical veins travel in the falciform ligament and accompany the ligamentum teres.The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 19
Correct
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A 53 year old women presents to the emergency room with a chronic cough. The pulmonary receptors likely to be involved in causing her cough are:
Your Answer: Irritant receptors
Explanation:Throughout the airways, there are irritant receptors which are located between epithelial cells which are made of rapidly adapting afferent myelinated fibres in the vagus nerve. A cough is as a result of receptor stimulation located in the trachea, hyperpnoea is as a result of receptor stimulation in the lower airway. Stimulation may also result in reflex bronchial and laryngeal constriction. Many factors can stimulate irritant receptors. These include irritant gases, smoke and dust, airway deformation, pulmonary congestion, rapid inflation/deflation and inflammation. Deep augmented breaths or sighs seen every 5 – 20 minutes at rest are due to stimulation of these irritant receptors. This reverses the slow lung collapse that occurs in quiet breathing.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 20
Correct
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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.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 21
Correct
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Which of the following is a primary action of calcitonin:
Your Answer: Decreased bone resorption through inhibition of osteoclast activity
Explanation:Calcitonin is a 32 amino acid polypeptide that is primarily synthesised and released by the parafollicular cells (C-cells) of the thyroid gland in response to rising or high levels of plasma Ca2+ions. Its primary role is to reduce the plasma calcium concentration, therefore opposing the effects of parathyroid hormone.Secretion of calcitonin is stimulated by:- Increased plasma calcium concentration- Gastrin- Pentagastrin- The main actions of calcitonin are:- Inhibition of osteoclastic activity (decreasing calcium and phosphate resorption from bone)- Stimulation of osteoblastic activity- Decreases renal calcium reabsorption- Decreases renal phosphate reabsorption
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 22
Correct
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A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen on the way to hospital. What percentage of patients with anaphylactic reaction suffer a biphasic response?.
Your Answer: 20%
Explanation:About 20% of patients that suffer an anaphylactic reaction suffer a biphasic response 4-6 hours after the initial response (sometimes up to 72 hours after).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 23
Correct
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A patient presents with a lump for a dermatological examination. There is a circumscribed skin elevation measuring 0.3 cm in diameter seen on examination.Which one of these best describes the lump you have found on examination?
Your Answer: Papule
Explanation:A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter. A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless. A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter. A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus. A pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 24
Incorrect
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A 24-year-old patient is suspected to have a possible acute hepatitis B infection and is currently under investigation.Which of the following markers is considered the earliest indicator of acute infection in acute Hepatitis B?
Your Answer: IgM antibody to hepatitis B core antigen
Correct Answer: Hepatitis B surface Ag
Explanation:HBsAg is the serological hallmark of HBV infection. After an acute exposure to HBV, HBsAg appears in serum within 1 to 10 weeks. Persistence of this marker for more than 6 months implies chronic HBV infection.Anti-HBs is known as a neutralizing antibody, and confers long-term immunity. In patients with acquired immunity through vaccination, anti-HBs is the only serological marker detected in serum.HBcAg is an intracellular presence in infected hepatocyte, thus it is not identified in the serum. During acute infection, anti-HBc IgM and IgG emerges 1–2 weeks after the presence of HBsAg along with raised serum aminotransferase and symptoms. After 6 months of acute infection, anti-HBc IgM wears off. Anti-HBc IgG continues to detect in both patients with resolved HBV infection and chronic hepatitis B.Hepatitis D virus, also known as the delta hepatitis virus, is a defective ssRNA virus that requires HBV for replication. The infection can occur in one of two clinical forms, co-infection or superinfection. In a co-infection, the patient is simultaneously infected with HBV and HDV. In a superinfection, an HDV infection develops in a patient with a chronic HBV infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 25
Incorrect
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You review a 56-year-old man who has recently been prescribed antibiotics for a chest infection. He suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, he has been experiencing nausea, vomiting and abdominal pain.Which of the following antibiotics is he MOST LIKELY to have been prescribed for his chest infection? Select ONE answer only .
Your Answer: Amoxicillin
Correct Answer: Levofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:Drugs increasing plasma concentration of theophyllineDrugs decreasing plasma concentration of theophyllineCalcium channel blockers, e.g. VerapamilCimetidineFluconazoleMacrolides, e.g. erythromycinQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitolPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 26
Correct
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When a person changes from a supine to an upright position, which of the followingcompensatory mechanismsoccurs:
Your Answer: Increased contractility
Explanation:On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 27
Correct
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An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her complaints of dizziness and nausea. Two days later, she returned to the clinic with no improvement in the symptoms. Which one of the following is the mechanism of action of prochlorperazine?
Your Answer: Dopamine receptor antagonism
Explanation:Prochlorperazine is a phenothiazine drug as it is categorized as a first-generation antipsychotic. It mainly blocks the D2 (dopamine 2) receptors in the brain. Along with dopamine, it also blocks histaminergic, cholinergic, and noradrenergic receptors.It exerts its antiemetic effect via dopamine (D2) receptor antagonist. It is used to treat nausea and vomiting of various causes, including labyrinthine disorders.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 28
Correct
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Angiotensin II acts to cause all but which one of the following effects:
Your Answer: Inhibit release of ADH from the posterior pituitary gland
Explanation:Angiotensin II acts to:Stimulate release of aldosterone from the zona glomerulosa of the adrenal cortex (which in turn acts to increase sodium reabsorption)Cause systemic vasoconstrictionCause vasoconstriction of the renal arterioles (predominant efferent effect thus intraglomerular pressure is stable or increased, thereby tending to maintain or even raise the GFR)Directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters)Stimulate synthesis and release of ADH from the hypothalamus and posterior pituitary respectivelyStimulate the sensation of thirstPotentiate sympathetic activity (positive feedback)Inhibit renin production by granular cells (negative feedback)
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This question is part of the following fields:
- Physiology
- Renal
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Question 29
Correct
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Fracture of the medial epicondyle would result to the following, except
Your Answer: Weakness of abduction of the thumb
Explanation:Thumb abduction is mediated by the abductor pollicis longus and brevis, which are innervated by the radial and median nerves, respectively.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 30
Incorrect
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You examine a 50-year-old female who has a swollen, painful right big toe. She has a history of gout, and this discomfort is identical to prior relapses, according to her. She is currently taking 200 mg of allopurinol per day and has been for the last year. This is her second round of acute gout within this time period. She has no prior medical history to speak of and does not take any other medications. She doesn't have any known drug allergies.Which of the following management options is the SINGLE MOST APPROPRIATE?Â
Your Answer: Increase the dose of allopurinol to 300 mg per day
Correct Answer: Continue with the allopurinol and commence naproxen
Explanation:Allopurinol should not be started during an acute gout episode because it can both prolong and trigger another acute attack. Allopurinol should be continued in patients who are currently taking it, and acute attacks should be treated as usual with NSAIDs or colchicine, as needed.Non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen, are the first-line treatment for acute gout attacks. Colchicine can be used in situations where NSAIDs are contraindicated, such as in patients with hypertension or those who have had a history of peptic ulcer disease. Because there is no reason for this patient to avoid NSAIDs, naproxen would be the medicine of choice from the list above.It would be reasonable to titrate up the allopurinol dose once the acute episode has subsided, targeting <6 mg/dl (<360 µmol/l) plasma urate levels .Febuxostat (Uloric) is a drug that can be used instead of allopurinol to treat persistent gout.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 31
Incorrect
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The least likely feature of anaemia is:
Your Answer: Bounding pulse
Correct Answer: Narrow pulse pressure
Explanation:Non-specific signs of anaemia include: 1. pallor of mucous membranes or nail beds (if Hb < 90 g/L), 2. tachycardia3. bounding pulse4. wide pulse pressure5. flow murmurs 6. cardiomegaly 7. signs of congestive cardiac failure (in severe cases)
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This question is part of the following fields:
- Haematology
- Pathology
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Question 32
Correct
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A 66-year-old female who is a known case of atrial fibrillation comes to the Emergency Department with the complaint of fever and vomiting for the past two days. When her medical chart is reviewed, you see that she takes Warfarin for her arrhythmia. Which ONE of the following medications cannot be prescribed to this patient?
Your Answer: Ibuprofen
Explanation:Like other non-steroidal anti-inflammatory drugs, Ibuprofen cannot be given with Warfarin as it would increase the bleeding risk of this patient.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 33
Correct
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Which of the following best describes the typical rash of measles:
Your Answer: The typical rash of measles is maculopapular, starting behind the ears and spreading downwards to the trunk.
Explanation:A prodromal 2 – 4 day coryzal illness (fever, cough, conjunctivitis, irritability) normally occurs associated with Koplik’s spots (small white papules found on the buccal mucosa near the first premolars), before a morbilliform maculopapular rash appears, first behind the ears and then spreading downwards to whole body.The rash peels off or fades about about 7 – 10 days. The chickenpox rash is characterised by a maculopapular rash progressing to vesicles and then crusting over. Scarlet fever is characterised by a sandpaper like rash associated with a strawberry tongue.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 34
Correct
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Regarding flow through a tube, which of the following statements is CORRECT:
Your Answer: Polycythaemia will decrease the rate of blood flow through a vessel.
Explanation:Darcy’s law states that flow through a tube is dependent on the pressure differences across the ends of the tube (P1 – P2) and the resistance to flow provided by the tube (R). Resistance is due to frictional forces and is determined by the length of the tube (L), the radius of the tube (r) and the viscosity of the fluid flowing down that tube (V). The radius of the tube has the largest effect on resistance and therefore flow – this explains why smaller gauge cannulas with larger diameters have a faster rate of flow. Increased viscosity, as seen in polycythemia, will slow the rate of blood flow through a vessel.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 35
Correct
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A 6-year-old child presents with profuse watery diarrhoea and dehydration. Which of the following statements is considered correct regarding infective diarrhoea?
Your Answer: E.Coli can cause diarrhoea and renal failure
Explanation:E. coli may cause several different gastrointestinal syndromes. Based on virulence factors, clinical manifestation, epidemiology, and different O and H serotypes, there are five major categories of diarrheagenic E. coli, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroadherent, which includes diffusely adherent E. coli (DAEC) and enteroaggregative E. coli (EAEC). These five categories are sometimescollectively referred to as enterovirulent E. coli or diarrheagenic E. coli.Norwalk virus is part of the Caliciviridae family of viruses which are single-stranded RNA viruses and are the most common cause of infectious gastroenteritis in the US.Rotaviruses are the most common cause of viral gastroenteritisin infants and children. With the introduction in 2006 of a human-bovine rotavirus vaccine (RV5; RotaTeq, Merck), a delay in the onset of rotavirusseason was seen. RotaTeq is a series of three oral vaccines beginning at 6 to 12 weeks of age. A second vaccine, Rotarix (RV1; GlaxoSmithKline, Middlesex, England), was approved in June 2008.Cryptosporidium causes an illness characterized by abdominal cramping, watery diarrhoea, vomiting, fever, and anorexia. This organism is resistant to chlorine, so public swimming pools can be the source of an outbreak.G. lamblia has a worldwide distribution and has frequently been identified as the causative agent of outbreaks of gastroenteritis and traveller’s diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 36
Correct
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A 29-year-old female with a swollen red finger presents to your clinic and you suspect that the underlying process is of acute inflammation. You request for some bloods investigations.Which statement about histamine as a chemical mediator of the acute inflammatory response is TRUE?
Your Answer: It increases vascular permeability
Explanation:Histamine increases vascular permeability in the acute inflammatory response.Histamine causes vasodilation.It is released from Mast cells and basophils, eosinophils and platelets. Mast cells and basophils are its primary source Nitric oxide (not histamine) is a major factor in endotoxic shock
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 37
Correct
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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: 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.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 38
Correct
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Which of the following nerves provides cutaneous innervation to the posterior surface of the scrotum?
Your Answer: Branch of the perineal nerve
Explanation:The following nerves provide cutaneous innervation to the scrotum, and other anatomic structures:The perineal nerve supplies the muscles in the urogenital triangle, and the skin on the posterior surface of the scrotum (or labia majora).The genital branch of the genitofemoral nerve supplies the cremaster muscle, the skin over the anterior surface of the thigh, and the anterolateral surface of the scrotum.The ilioinguinal nerve supplies the external oblique, internal oblique, transversus abdominis, skin of the upper medial aspect of thigh, the root of the penis and the anterior surface of the scrotum in the male, and the mons pubis and labia majora in the female.The posterior cutaneous nerve of the thigh, or posterior femoral cutaneous nerve, supplies the skin over the lower medial quadrant of the buttock, the inferior skin of the scrotum or labium majus, and the back of the thigh and the upper part of the leg.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 39
Correct
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Which of the following is NOT one of insulin's actions:
Your Answer: Increased gluconeogenesis
Explanation:Insulin has a number of effects on glucose metabolism, including:Inhibition of glycogenolysis and gluconeogenesisIncreased glucose transport into fat and muscleIncreased glycolysis in fat and muscleStimulation of glycogen synthesisBy inhibiting gluconeogenesis, insulin maintains the availability of amino acids as substrates for protein synthesis. Thus, insulin supports protein synthesis through direct and indirect mechanisms.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 40
Correct
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A 66-year-old male was admitted from the Emergency Department due to severe pain in the left forearm and hand, refractory to pain medication along with pallor and hypothermia of the affected limb. Ultrasound doppler showed an arterial embolism. Circulation was restored after vascular surgery, but there was extensive, irreversible muscle damage. How will the muscle heal from an injury of this type?
Your Answer: Diffuse formation of fibrous tissue
Explanation:Once muscle tissue is damaged, there will be healing via diffuse formation of fibrous tissue, especially due to the widespread ischemia. Callus formation takes place in the healing of bone, not muscle. Organised scar formation occurs when a lacerated wound is approximated by sutures so that primary intention wound healing can occur. Liquefaction degeneration occurs following ischemia in the brain. Volkmann’s ischemic contracture may occur, but it is not the primary type of healing that will take place but rather the effect of the fibrous scar formation.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 41
Incorrect
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A 57-year-old male presents to the orthopaedic clinic complaining of pain and swelling in the left knee joint. On examination, the left knee is swollen, tender and erythematous. The patient is booked for joint aspiration, and a diagnosis of pseudogout is made following the aspiration. Which types of crystals would be seen in the joint aspirate to lead to this diagnosis?
Your Answer: Negatively birefringent brick-shaped crystals
Correct Answer: Positively birefringent brick-shaped crystals
Explanation:Gout and pseudogout are both characterised by crystal deposition in the affected joints. The deposition of urate crystals causes gout, while calcium pyrophosphate crystals cause pseudogout. The crystals can be distinguished microscopically because urate crystals are negatively birefringent needle-shaped crystals, whilst calcium pyrophosphate crystals are positively birefringent brick-shaped crystals.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 42
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 43
Correct
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A 2nd-year medical student is solving an exam paper with questions about the immune system. She comes across a question regarding innate immunity. Innate immunity is the immunity naturally present within the body from birth. Which ONE of the following is not a part of this type of immunity?
Your Answer: Antibody production
Explanation:Innate immunity, also called non-specific immunity, refers to the components of the immune system naturally present in the body at birth. The components of innate immunity include: 1) Natural Killer Cells 2) Neutrophils 3) Macrophages 4) Mast Cells 5) Dendritic Cells 6) Basophils. Acquired or adaptive immunity is acquired in response to infection or vaccination. Although the response takes longer to develop, it is also a more long-lasting form of immunity. The components of this system include: 1) T lymphocytes 2) B lymphocytes 3) Antibodies
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 44
Correct
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Which of the following is considered an example of an observational study?
Your Answer: Cohort study
Explanation:The two most common types of observational studies are cohort studies and case-control studies; a third type is cross-sectional studies.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 45
Incorrect
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Which nerve innervates the brachioradialis muscle?
Your Answer: The musculocutaneous nerve
Correct Answer: The radial nerve
Explanation:Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 46
Incorrect
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What is the primary mode of action of Enoxaparin?
Your Answer: Potentiate effects of thrombin
Correct Answer: Inhibits factor Xa
Explanation:Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 47
Correct
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The following are all examples of type II hypersensitivity EXCEPT for:
Your Answer: Post-streptococcal glomerulonephritis
Explanation:Examples of type II reactions include: Incompatible blood transfusionsHaemolytic disease of the newbornAutoimmune haemolytic anaemiasGoodpasture’s syndromeRheumatic heart diseaseBullous pemphigoid
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 48
Correct
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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.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 49
Correct
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A patient is sent in by her GP with suspected ectopic pregnancy. Tubal ectopic pregnancies occur most commonly in which part of the uterine tube:
Your Answer: Ampulla
Explanation:Ectopic pregnancy most commonly occurs in the ampulla (70% of cases).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 50
Incorrect
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A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.At the moment, he is completely symptom-free. When it comes to this type of overdose, how long does it usually take for symptoms to appear?
Your Answer: 3-6 hours
Correct Answer: 1-2 hours
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.>10 tablets of verapamil (160 mg or 240 mg immediate or sustained-release capsules) or diltiazem can cause serious toxicity (180 mg, 240 mg or 360 mg immediate or sustained-release capsules)In children, 1-2 tablets of verapamil or diltiazem (immediate or sustained-release)Symptoms usually appear within 1-2 hours of ingestion with standard preparations. However, with slow-release preparations, significant toxicity may take 12-16 hours to manifest, with peak effects occurring after 24 hours.The following are the main clinical features of calcium-channel blocker overdose:Nausea and vomitingHypotensionBradycardia and first-degree heart blockMyocardial ischaemia and strokeRenal failurePulmonary oedemaHyperglycaemiaThe following are some of the most important bedside investigations to conduct:Blood glucoseECGArterial blood gasOther investigations that can be helpful includeUrea & electrolytesChest X-ray (pulmonary oedema)Echocardiography
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 51
Correct
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Which of the following does not increase renal phosphate excretion?
Your Answer: Vitamin D
Explanation:PO43-renal excretion is regulated several mechanisms. These include:-parathyroid hormone – increases excretion by inhibiting reabsorption in the proximal tubule-acidosis – increases excretion-glucocorticoids – increases excretion-calcitonin – increases excretion-activated vitamin D – decreases excretion by increasing reabsorption in the distal tubule
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This question is part of the following fields:
- Physiology
- Renal
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Question 52
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: 75% of cases occur before the age of 6 years.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. There is great variation in the chance of individual patients achieving a long-term cure based on a number of biological variables. Approximately 25% of children relapse after first-line therapy and need further treatment but overall 90% of children can expect to be cured. The cure rate in adults drops significantly to less than 5% over the age of 70 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 53
Correct
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You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:
Your Answer: Erb's palsy may result in loss of sensation of the regimental badge area.
Explanation:Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 54
Correct
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What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your Answer: 10 ml of 1 in 10,000 adrenaline solution
Explanation:Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm. IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm. For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 55
Correct
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A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.Which of the drugs listed below is the best fit for this strategy?
Your Answer: Bisoprolol
Explanation:In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 56
Incorrect
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An 11-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent petechial rash on legs and arms. The GP administered a dose of antibiotics in the prehospital setting before transferring to the Emergency Department.Which of these would the GP have administered?
Your Answer: IM benzylpenicillin 600 mg
Correct Answer: IM benzylpenicillin 1.2 g
Explanation:General Practitioners are advised to give a single injection of benzylpenicillin by intravenous or intramuscular injection before transferring the patient urgently to the ED when bacterial meningitis is suspected.The recommended doses are:Infants under 1 year: 300 mgChildren ages 1 to 9 years: 600 mgChildren aged 10 years and over: 1.2gAdults: 1.2g
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 57
Correct
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A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.Which of the following is the patient's preferred drug treatment?
Your Answer: 25% of the mean arterial pressure over the first hour
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 58
Correct
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By which of the following is mean arterial pressure (MAP) primarily determined?
Your Answer: Total peripheral resistance and cardiac output
Explanation:Mean arterial pressure (MAP) = Cardiac output (CO) x Total peripheral resistance (TPR). Cardiac output is dependent on the central venous pressure (CVP). CVP, in turn, is highly dependent on the blood volume. Any alterations of any of these variables will likely change MAP.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 59
Correct
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Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:
Your Answer: The two variables are directly proportional
Explanation:A positive correlation coefficient means that the two variables are directly proportional e.g. height and weight in healthy growing children.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 60
Incorrect
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Which of the following statements is incorrect regarding the electron transfer system?
Your Answer: The electron transfer system results in the production of water.
Correct Answer: The electron transfer system occurs in anaerobic respiration.
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 NADH2molecules 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.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
