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Question 1
Correct
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Question 2
Correct
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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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 3
Correct
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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.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 4
Incorrect
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The following are all examples of type IV hypersensitivity EXCEPT for:
Your Answer: Sarcoidosis
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)
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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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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
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 6
Correct
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A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.Which of the following statements regarding the pectoralis minor muscle is considered correct?
Your Answer: It stabilises the scapula
Explanation:The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 7
Correct
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All of the following typically occurs as part of normal inspiration except:
Your Answer: Contraction of the internal intercostal muscles
Explanation:Passive inspiration is a result of contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, several movements occur. These are:1. elevation of the sternal ends of the ribs (‘pump handle’ movement), 2. elevation of the lateral shafts of the ribs (‘bucket handle’ movement) 3. depression of the diaphragm. These result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. There is an increased intrathoracic volume and decreased intrathoracic pressure and air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 8
Correct
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A 30-year-old man presents with piriformis syndrome pain, tingling, and numbness in her buttocks. He noted that the pain gets worse upon sitting down. He was seen by a physiotherapist and a diagnosis of piriformis syndrome was made.Which of the following nerves becomes irritated in piriformis syndrome?
Your Answer: Sciatic nerve
Explanation:Piriformis syndrome is a clinical condition of sciatic nerve entrapment at the level of the ischial tuberosity. While there are multiple factors potentially contributing to piriformis syndrome, the clinical presentation is fairly consistent, with patients often reporting pain in the gluteal/buttock region that may shoot, burn or ache down the back of the leg (i.e. sciatic-like pain). In addition, numbness in the buttocks and tingling sensations along the distribution of the sciatic nerve is not uncommon. The sciatic nerve runs just adjacent to the piriformis muscle, which functions as an external rotator of the hip. Hence, whenever the piriformis muscle is irritated or inflamed, it also affects the sciatic nerve, which then results in sciatica-like pain.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 9
Correct
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A 50-year-old man presents with headaches, lethargy, hypertension, and electrolyte disturbance. A diagnosis of primary hyperaldosteronism is made.Which biochemical pictures would best support this diagnosis?
Your Answer: Hypokalaemic metabolic alkalosis
Explanation:When there are excessive levels of aldosterone outside of the renin-angiotensin axis, primary hyperaldosteronism occurs. High renin levels will lead to secondary hyperaldosteronism. The classical presentation of hyperaldosteronism when symptoms are present include:HypokalaemiaMetabolic alkalosisHypertensionNormal or slightly raised sodium levels
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 10
Correct
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Regarding hepatitis A, which of the following statements is CORRECT:
Your Answer: Anti-HAV IgM antibodies are diagnostic.
Explanation:Anti-HAV IgM antibodies are diagnostic. Disease in children is more commonly asymptomatic, risk of symptomatic disease increases with age. Transmission is by the faecal-oral route. Faecal shedding has been demonstrated for 2 – 3 weeks before and about a week after, the onset of jaundice. Infection confers lifelong immunity.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 11
Incorrect
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Which of the following is NOT one of the cardinal features of acute inflammation:
Your Answer: Loss of function
Correct Answer: Discharge
Explanation:Classic signs:Rubor (redness)Calor (heat)Dolour (pain)Tumour (swelling)Functio laesa (loss of function)These classic signs are produced by a rapid vascular response and cellular events. The main function of these events is to bring elements of the immune system to the site of injury and prevent further tissue damage.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 12
Correct
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A 63 year old lady presents to ED with a persistent cough and red currant jelly sputum. She has a history of chronic alcohol abuse and has an X-ray which demonstrates a cavitating pneumonia. The most likely causative pathogen is:
Your Answer: Klebsiella pneumoniae
Explanation:One of the results of Klebsiella pneumoniae is pneumonia that is usually a very severe infection. It is characterised by thick, bloody sputum (red currant jelly sputum), and is associated with complications like lung abscess, cavitation, necrosis, empyema and pleural effusions.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 13
Incorrect
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Which of the following conditions manifests hyperkalaemia as one of its symptoms?
Your Answer: Type 1 renal tubular acidosis
Correct 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.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 14
Correct
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A patient presents with a history of renal problems, generalised weakness and palpitations. Her serum potassium levels are measured and come back at 6.2 mmol/L. An ECG is performed, and it shows some changes that are consistent with hyperkalaemia.Which of the following ECG changes is usually the earliest sign of hyperkalaemia? Select ONE answer only.
Your Answer: Peaked T waves
Explanation:Hyperkalaemia causes a rapid reduction in resting membrane potential leading to increased cardiac depolarisation and muscle excitability. This in turn results in ECG changes which can rapidly progress to ventricular fibrillation or asystole. Very distinctive ECG changes that progressively change as the K+level increases:K+>5.5 mmol/l – peaked T waves (usually earliest sign of hyperkalaemia), repolarisation abnormalitiesK+>6.5 mmol/l – P waves widen and flatten, PR segment lengthens, P waves eventually disappearK+>7.0 mmol/l – Prolonged QRS interval and bizarre QRS morphology, conduction blocks (bundle branch blocks, fascicular blocks), sinus bradycardia or slow AF, development of a sine wave appearance (a pre-terminal rhythm)K+>9.0 mmol/l – Cardiac arrest due to asystole, VF or PEA with a bizarre, wide complex rhythm.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 15
Incorrect
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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: Parkinson disease
Correct 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.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 16
Incorrect
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Which statement regarding skeletal muscle is true?
Your Answer: Actin is the major constituent of the thick filament
Correct Answer: Myosin is the major constituent of the thick filament
Explanation:Myosin is the major constituent of the thick filament. Actin is the major constituent of the THIN filament. Thin filaments consist of actin, tropomyosin and troponin in the ratio 7:1:1.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 17
Incorrect
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A patient was diagnosed with Erb's palsy as a result of a brachial plexus injury sustained in a car accident and, as a result, suffers from left arm paralysis. The following muscles are affected by the injury, except
Your Answer: Biceps brachii
Correct Answer: Trapezius
Explanation:Damage to the C5 and C6 nerve roots causes Erb’s palsy. The spinal accessory nerve (CN XI) innervates the trapezius muscle, thus you would not expect this muscle to be impacted. The trapezius is a muscle that runs from the base of the neck across the shoulders and into the centre of the back.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 18
Incorrect
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You want to give colchicine to a patient who has acute gout. Which of the following is a contraindication to the use of colchicine?
Your Answer: Anticoagulant therapy
Correct Answer: Blood dyscrasias
Explanation:Colchicine is used to prevent or treat gout attacks (flares). It works by reducing swelling and the development of uric acid crystals, which cause pain in the affected joint(s). Colchicine should be avoided by patients who have blood dyscrasias or bone marrow disorders.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 19
Correct
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A 30-year-old man presents with diarrhoea, fever, vomiting, and abdominal cramps. A stool culture was ordered and showed growth of Salmonella spp.Among the following serotypes of Salmonella spp., which is considered to be the most common cause of salmonella gastroenteritis?
Your Answer: Serotype D
Explanation:A common cause of gastroenteritis, Salmonella enteritidis, and Salmonella typhi, which causes enteric fever, are both group D. Therefore, serotype D Salmonella species are most commonly associated with gastroenteritis.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 20
Incorrect
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A patient with profuse watery diarrhoea was found to have C. difficile cytotoxin. Which of the following complications is NOT a typical complication of pseudomembranous colitis:
Your Answer: Toxic megacolon
Correct Answer: Volvulus
Explanation:Dehydration, electrolyte imbalance, acute kidney injury secondary to diarrhoea, toxic megacolon, bowel perforation, and sepsis secondary to intestinal infection are all possible complications of pseudomembranous colitis. When the intestine twists around itself and the mesentery that supports it, an obstruction is created. This condition is known as a volvulus. Volvulus is caused by malrotation and other anatomical factors, as well as postoperative abdominal adhesions, and not by Clostridium difficile infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Correct
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Which of the following best describes the correct administration of adrenaline for a shockable rhythm in adult advanced life support?
Your Answer: Give 1 mg of adrenaline after the third shock and every 3 - 5 minutes thereafter
Explanation:The correct administration of IV adrenaline 1 mg (10 mL of 1:10,000 solution) is that it should be given after 3 shocks and 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 22
Incorrect
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The correct statement regarding the parasympathetic nervous system is which of the following?
Your Answer: Parasympathetic postganglionic neurones release acetylcholine which acts on cholinergic nicotinic receptors.
Correct 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.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 23
Correct
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The patients listed below have been diagnosed with a variety of ailments.In which of the following situations would aspirin be an effective treatment option?
Your Answer: A 36-year-old with an acute migraine (dose of 900-1000 mg)
Explanation:A study published in the Cochrane Database of Systematic Reviews in 2010 found that a single 1000-mg dose of aspirin is effective in treating acute migraine. It was discovered that 24 percent of aspirin users were pain-free after two hours, compared to 11 percent of placebo users. Because the BNF recommends a maximum dose of 900 mg for analgesia and most non-proprietary aspirin in the UK comes in a dose of 300 mg, a dose of 900 mg is frequently prescribed in the UK.Because aspirin is not recommended for children under the age of 16 due to the risk of Reye’s syndrome, it would be inappropriate to give it to the 12-year-old with the viral URTI.For uncomplicated dental pain, aspirin is an acceptable option, but not for patients who are taking warfarin. The combination of aspirin’s antiplatelet action and warfarin’s anticoagulation properties puts the patient at high risk of bleeding. Furthermore, aspirin can deplete the therapeutic levels of warfarin by displacing it from plasma proteins. It would be better to use another NSAID or analgesic.In gout, aspirin should be avoided because it reduces urate clearance in the urine and interferes with the action of uricosuric agents. Naproxen, diclofenac, and indomethacin are better options.Although aspirin is useful for inflammatory pains, the dose of aspirin required for an adequate analgesic effect in severe pain is associated with significant side effects. Naproxen would be a better first-line treatment option.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 24
Correct
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Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.What is cyclizine's main mechanism of action?
Your Answer: Antihistamine action
Explanation:Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 25
Correct
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You review a 50-year-old man that is requesting the seasonal influenza vaccination.Which of the following single clinical risk groups is NOT eligible to receive the seasonal influenza vaccination? Select ONE answer only.
Your Answer: Patients over the age of 50
Explanation:Patients with hypertension are only eligible for the seasonal influenza vaccination if they have co-existent cardiac complications.The UK national policy is that the seasonal influenza vaccine should be offered to the following groups:All those aged 65 years and olderChildren aged 2 to 15 yearsResidents of nursing and residential homes for the elderly (and other long-stay facilities)Carers of persons whose welfare may be at risk if the carer falls illAll those aged 6 months or older in a clinical risk groupThe following table outlines the clinical risk groups that are considered eligible for the vaccine:CategoryExamples of eligible groupsRespiratory diseaseCOPDInterstitial lung diseaseCystic fibrosisAsthma (requiring oral or inhaled steroids)Heart diseaseCongenital heart diseaseChronic heart failureCoronary heart disease (requiring medication and/or follow-up)Hypertension with cardiac complicationsKidney diseaseChronic kidney diseaseNephrotic syndromeRenal transplant patientsLiver diseaseLiver cirrhosisChronic hepatitisBiliary atresiaNeurological diseaseCerebrovascular accidentTransient ischaemic attackEndocrine diseaseType 1 and 2 diabetesImmunosuppressionPatients undergoing chemotherapyPatients taking immunosuppressive drug therapy (including systemic steroids)Asplenia or splenic dysfunctionHIV infectionPregnancyAll pregnant women
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 26
Incorrect
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A 65-year-old man presents with a red, hot, swollen great toe. A diagnosis of acute gout is made. His past medical history includes heart failure and type 2 diabetes mellitus.Which of the following is the most appropriate medication to use in the treatment of his gout? Select ONE answer only.
Your Answer: Naproxen
Correct Answer: Colchicine
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 27
Incorrect
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Which of these organisms is commonly spread by droplet transmission?
Your Answer: Rotavirus
Correct 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
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 28
Incorrect
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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: Vancomycin
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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 29
Incorrect
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Regarding dermatophytes, which of the following statement is CORRECT:
Your Answer: Tinea capitis is characterised by itchy red scaly patches on the trunk.
Correct Answer: Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings.
Explanation:Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings depending on the site of infection. The lesions of ringworm typically have a dark outer ring with a pale centre. Tinea capitis is ringworm affecting the head and scalp. Spread is via direct skin contact. Treatment is usually topical, oral antifungals are reserved for refractory infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 30
Incorrect
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Pancreatic acinar digestive enzyme secretion is mainly stimulated by which of the following hormones:
Your Answer: Secretin
Correct Answer: Cholecystokinin
Explanation:Exocrine pancreatic secretion is controlled by:Parasympathetic stimulation which enhances secretion of both the enzyme and aqueous componentsSympathetic stimulation which inhibits pancreatic secretionSecretin which stimulates secretion of the alkaline-rich fluid from ductal cellsCholecystokinin which stimulates secretion of the enzyme-rich fluid from acinar cellsSomatostatin which inhibits secretion from both acinar and ductal cellsGastrin which stimulates pancreatic acinar cells to secrete digestive enzymes
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 31
Correct
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Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis following exposure to a known allergen:
Your Answer: Generalised urticaria and angioedema alone
Explanation:Anaphylaxis is characterised by sudden onset and rapidly developing, life-threatening airway, breathing and circulation problems associated with skin and/or mucosal changes. Reactions can vary greatly, from hypotension alone, to reactions with predominantly asthmatic features, to cardiac/respiratory arrest. Skin or mucosal changes may be absent or subtle in up to 20% of cases but skin or mucosal changes alone are not a sign of an anaphylactic reaction.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 32
Correct
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Regarding loop diuretics, which of the following statements is INCORRECT:
Your Answer: The risk of hypokalaemia is greater with loop diuretics than with an equipotent dose of a thiazide diuretic.
Explanation:Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diuretic. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic failure, hypokalaemia caused by diuretics can precipitate encephalopathy, particularly in alcoholic cirrhosis.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 33
Incorrect
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Regarding autoregulation of local blood flow, which of the following statements is CORRECT:
Your Answer: The myogenic mechanism involves activation of smooth muscle stretch-activated Na + channels.
Correct Answer: An increase in blood flow dilutes locally produced vasodilating factors causing vasoconstriction.
Explanation:Autoregulation is the ability to maintain a constant blood flow despite variations in blood pressure (between 50 – 170 mmHg). It is particularly important in the brain, kidney and heart. There are two main methods contributing to autoregulation:The myogenic mechanism involves arterial constriction in response to stretching of the vessel wall, probably due to activation of smooth muscle stretch-activated Ca2+channels and Ca2+entry. A reduction in pressure and stretch closes these channels, causing vasodilation. The second mechanism of autoregulation is due to locally produced vasodilating factors; an increase in blood flow dilutes these factors causing vasoconstriction, whereas decreased blood flow has the opposite effect.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 34
Correct
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Since the fluid that enters the loop of Henle is isotonic, what is its estimated osmolality?
Your Answer: 300 mOsm
Explanation:The loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It is consists of three major segments, the thin descending limb, the thin ascending limb, and the thick ascending limb. The segments are differentiated based on structure, anatomic location, and function. The main action of the loop of Henle is to recover water and sodium chloride from urine. The liquid entering the loop of Henle is a solution of salt, urea, and other substances traversed along by the proximal convoluted tubule, from which most of the dissolved components are needed by the body, particularly glucose, amino acids, and sodium bicarbonate that have been reabsorbed into the blood. This fluid is isotonic. Isotonic fluids generally have an osmolality ranging from 270 to 310 mOsm/L. With the fluid that enters the loop of Henle, it is estimated to be 300 mOsm/L. However, after passing the loop, fluid entering the distal tubule is hypotonic to plasma since it has been diluted during its passage.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 35
Correct
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Which of the following clinical features is most suggestive of a lesion of the frontal lobe:
Your Answer: Conjugate eye deviation towards the side of the lesion
Explanation:Conjugate eye deviation towards the side of the lesion is seen in damage to the frontal eye field of the frontal lobe. Homonymous hemianopia is typically a result of damage to the occipital lobe (or of the optic radiation passing through the parietal and temporal lobes). Auditory agnosia may been seen in a lesion of the temporal lobe. Hemispatial neglect may be seen in a lesion of the parietal lobe. Receptive dysphasia is seen in damage to Wernicke’s area, in the temporal lobe.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 36
Correct
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A 40-year-old woman presents with a fever and headache upon returning from an overseas business trip. Upon further investigation, a diagnosis of Plasmodium falciparum malaria was made.All of the following statements is considered true regarding Plasmodium falciparum malaria, except:
Your Answer: It is commonly the result of travel in the Indian subcontinent
Explanation:The mean incubation period for P. falciparum is 12 days.WHO World Malaria Report 2019 states that an estimated 228 million cases of malaria occurred worldwide in 2018, and reports steadily decreasing the number of cases since 2010. In 2018, nineteen sub-Saharan African countries and India carried approximately 85% of the global malaria burden. The most prevalent and pathogenic malaria parasite, most commonly associated with severe illness and death, especially in the WHO African region, accounting for 99.7% malaria cases, is P. falciparum.The vector for Plasmodium spp. is a female Anopheles mosquito that inoculates sporozoites contained in her salivary glands into the puncture wound when feeding. Sporozoites enter peripheral bloodstream and are uptake by hepatocytes, where they undergo an asexual pre-erythrocytic liver-stage as liver schizonts lasting up to 2 weeks before the onset of the blood stage.Intravenous or intramuscular artesunate is the first-line treatment in all patients worldwide and should be used for at least 24 hours and until the oral medication is tolerated.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 37
Incorrect
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How is filtered K+mainly reabsorbed in the thick ascending limb of the loop of Henle:
Your Answer: Primary active transport via Na + /K + ATPase
Correct Answer: Secondary active transport via Na + /K + /2Cl - cotransporter
Explanation:Around 30% of filtered K+is reabsorbed in the thick ascending limb of the loop of Henle, primarily via the luminal Na+/K+/2Cl-cotransporter, but there is also significant paracellular reabsorption, encouraged by the positive potential in the tubular lumen.
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This question is part of the following fields:
- Physiology
- Renal
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Question 38
Correct
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You examine a 79-year-old woman who has had hypertension and atrial fibrillation in the past. Her most recent blood tests show that she has severe renal impairment.Which medication adjustments should you make in this patient's case?
Your Answer: Reduce dose of digoxin
Explanation:Digoxin is excreted through the kidneys, and impaired renal function can lead to elevated digoxin levels and toxicity.The patient’s digoxin dose should be reduced in this case, and their digoxin level and electrolytes should be closely monitored.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 39
Correct
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The role of the juxtaglomerular (granular) cells of the juxtaglomerular apparatus is:
Your Answer: Production of renin
Explanation:Juxtaglomerular cells synthesise renin. These cells are specialised smooth muscle cells that are located in the walls of the afferent arterioles, and there are some in the efferent arterioles.
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This question is part of the following fields:
- Physiology
- Renal
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Question 40
Incorrect
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Which of the following muscles acts as an extensor of the shoulder joint?
Your Answer: Pectoralis major
Correct Answer: Teres major
Explanation:The glenohumeral joint possesses the capability of allowing an extreme range of motion in multiple planes.Flexion – Defined as bringing the upper limb anterior in the sagittal plane. The usual range of motion is 180 degrees. The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.Extension—Defined as bringing the upper limb posterior in a sagittal plane. The normal range of motion is 45 to 60 degrees. The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.Internal rotation—Defined as rotation toward the midline along a vertical axis. The normal range of motion is 70 to 90 degrees. The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.External rotation – Defined as rotation away from the midline along a vertical axis. The normal range of motion is 90 degrees. Primarily infraspinatus and teres minor are responsible for the motion.Adduction – Defined as bringing the upper limb towards the midline in the coronal plane. Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.Abduction – Defined as bringing the upper limb away from the midline in the coronal plane. The normal range of motion is 150 degrees. Due to the ability to differentiate several pathologies by the range of motion of the glenohumeral joint in this plane of motion, it is essential to understand how different muscles contribute to this action.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 41
Incorrect
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Regarding an avulsion fracture, a sudden contraction of which muscle may lead to fracture of the head of the fibula?
Your Answer: Semitendinosus
Correct Answer: Biceps femoris
Explanation:Avulsion fractures of the fibular head are rare and are so-called the arcuate signal. The “arcuate signal” is used to describe an avulsed bone fragment related to the insertion site of the tendon of the biceps femoris associated with the arcuate complex, which consists of the fabellofibular, popliteofibular, and arcuate ligaments. Such lesions are typically observed in direct trauma to the knee with excessive varus and internal rotation forces or indirect trauma with the same direction of the force.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 42
Correct
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A 45-year-old African American male presents to your clinic complaining of swelling of his feet for the past six months. On examination, there is periorbital and pedal oedema. A 24-hour urine collection is ordered, which shows 8 g of protein. The serum cholesterol is ten mmol/L. You order a renal biopsy to confirm the diagnosis. Which one of the following findings are you most likely to see in this patient's biopsy?
Your Answer: Focal segmental glomerulosclerosis
Explanation:This patient has Nephrotic Syndrome confirmed by the presence of 1. Heavy proteinuria (greater than 3-3.5 g/24 hours)2. Hypoalbuminemia (serum albumin < 25 g/L)3. Generalised oedema (often with periorbital involvement)4. Severe hyperlipidaemia (total cholesterol is often > 10 mmol/L). Focal Segmental Glomerulosclerosis will be the most likely answer as it is the most common cause of Nephrotic Syndrome in African American adults. Minimal change disease is the most common cause of nephrotic syndrome in children. Membranous glomerulonephritis is the most common cause of Nephrotic Syndrome in Caucasian adults. In IgA nephropathy, patients will complain of cola-coloured urine. Mesangiocapillary glomerulonephritis presents with features of Nephritic Syndrome.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 43
Correct
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Regarding ampicillin, which of the following statements is CORRECT:
Your Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.
Explanation:Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections. Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 44
Incorrect
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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 risk ratio of a hip fracture.
Your Answer: 0.04
Correct Answer: 0.4
Explanation:Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).RR = ART/ARCRR = (10/500) / (25/500)RR = 0.4Recall that:If RR < 1, then the intervention reduces the risk of the outcome.If RR = 1, then the treatment has no effect on the outcome.If RR > 1, then the intervention increases the risk of the outcome.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 45
Incorrect
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The QRS duration of a broad-complex tachyarrhythmia is:
Your Answer: Greater than 0.12 s
Correct Answer: Greater than or equal to 0.12 s
Explanation:It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 46
Correct
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In the extrinsic pathway of the coagulation cascade, the tenase complex is:
Your Answer: Factor VIIa-tissue factor complex
Explanation:The extrinsic pathway for initiating the formation of prothrombin activator begins with a traumatized vascular wall or traumatized extravascular tissues that come in contact with the blood. Exposed and activated by vascular injury, with plasma factor VII. The extrinsic tenase complex, factor VIIa-tissue factor complex, activates factor X to factor Xa.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 47
Incorrect
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.Which of these anatomic structures is the most superficial structure injured in the case above?
Your Answer: Transversalis fascia
Correct Answer: Camper’s fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:SkinFatty layer of the superficial fascia (Camper’s fascia)Membranous layer of the superficial fascia (Scarpa’s fascia)Aponeurosis of the external and internal oblique musclesRectus abdominis muscleAponeurosis of the internal oblique and transversus abdominisFascia transversalisExtraperitoneal fatParietal peritoneum
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 48
Correct
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Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS) in a patient infected with HIV:
Your Answer: CD4 count < 200 cells/uL
Explanation:A diagnosis of AIDS can be made in a patient infected with HIV if the patient has a CD4 count < 200 cells/uL, or an AIDS-defining illness. Antiretroviral treatment should be considered in patients with CD4 counts < 350 cells/uL. Oral candidiasis is not an AIDS defining illness – candidiasis of the bronchi, trachea or lungs or of the oesophagus is an AIDS defining illness. A positive p24 antigen test seen in early HIV infection and does not indicate the development of AIDS.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 49
Incorrect
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The percentage of patients with hepatitis B that develop chronic infection is about:
Your Answer: 20%
Correct Answer: 10%
Explanation:With hepatitis B, about 90% of people will develop lifelong immunity after clearing the infection. Chronic hepatitis develops in about 10% of patients and this may be complicated by cirrhosis or hepatocellular carcinoma. There is a very high risk of chronic infection and hepatocellular carcinoma when there is congenital infection. The risk of this in healthy adults is only about 5%.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 50
Correct
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As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction by activating which receptor?
Your Answer: Alpha1
Explanation:The rate of baroreceptor firing slows down when blood pressure falls too low. This causes an increase in sympathetic stimulation of the heart, resulting in an increase in cardiac output. It also causes vasoconstriction by activating alpha 1 receptors in smooth muscle, which causes sympathetic stimulation of peripheral vessels. Alpha2 receptors can be found in both the brain and the peripheral nervous system. They control sympathetic outflow in the brain stem. Beta1 receptors, which are found on the cell membrane of cardiac muscle cells, stimulate heart rate and myocardial contractility. The smooth muscle cell membrane contains beta2 receptors, which promote smooth muscle relaxation in the lungs causing bronchodilation, GI tract, and peripheral blood vessels.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
