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Question 1
Incorrect
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Which cervical interspace is most likely injured if a patient presents with difficulty of shoulder abduction and elbow flexion, pain in the right shoulder and lateral arm, and decreased sensation over the deltoid and lateral arm?
Your Answer: C6-C7
Correct Answer: C4-C5
Explanation:In the setting of cervical radiculopathy, because the nerve root of a spinal nerve is compressed or otherwise impaired, the pain and symptomatology can spread far from the neck and radiates to arm, neck, chest, upper back and/or shoulders. Often muscle weakness and impaired deep tendon reflexes are noted along the course of the spinal nerve.Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging especially in cases of trauma. If there is nerve impingement, the affected side will be reduced relative to the unaffected side. Reduction in strength of muscles innervated by the affected nerve is also significant physical finding.For a C4-C5 injury, the following symptoms may present:Weakness in the deltoid muscle (front and side of the shoulder) and upper armShoulder painNumbness along the outside of the upper arm
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 2
Correct
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Which of the following causes the first heart sound?
Your Answer: Closing of the atrioventricular valves
Explanation:The heart sounds are as a result of the various parts of the cardiac cycle.Heart Sound – Phase of Cardiac Cycle – Mechanical Event:1st heart sound – Systole starts – there is closure of the atrioventricular (mitral & tricuspid) valves2nd heart sound – Systole ends – there is closure of the semilunar (aortic and pulmonary) valves3rd heart sound – Early diastole – this is caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase4th heart sound – Late diastole – this is caused by filling of an abnormally stiff ventricle in atrial systole
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 3
Correct
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What is the average healing time for a femoral shaft fracture under normal circumstances? Choose ONE answer.
Your Answer: 12 weeks
Explanation:The process of fracture healing occurs naturally after traumatic bone disruption and begins with haemorrhage, then progresses through Inflammatory, reparative, and remodelling stagesAverage healing times of common fractures are:Femoral shaft: 12 weeksTibia: 10 weeksPhalanges: 3 weeksMetacarpals: 4-6 weeksDistal radius: 4-6 weeksHumerus: 6-8 weeks
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 4
Correct
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What proportion of peripheral blood leukocytes are monocytes?
Your Answer: 5 - 10%
Explanation:Monocytes account for around 5 to 10% of peripheral white cells. Monocytes in peripheral blood are generally bigger than other leukocytes and feature a large central oval or indented nucleus with clumped chromatin. The abundant cytoplasm staining blue and containing numerous fine vacuoles gives the appearance of ground glass. Cytoplasmic granules are another type of granule. Monocytes evolve from the granulocyte-macrophage progenitor to become monoblasts, promonocytes, monocytes, and tissue macrophages (in increasing order of maturity). Monocytes only stay in the bone marrow for a short time before exiting to circulate in the bloodstream for 20-40 hours before becoming macrophages.
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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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Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT:
Your Answer: Infection usually requires antibiotic treatment.
Explanation:Campylobacter jejuni is the primary human pathogen, typically causing dysentery (bloody diarrhoea illness) following ingestion of contaminated meat, especially poultry. Infection is typically self-limiting and does not require antibiotic therapy. Campylobacter gastroenteritis is associated with the immune-mediated complications of Guillain-Barre syndrome, reactive arthritis and Reiter’s syndrome.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 6
Incorrect
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As a result of a cardiovascular drug she was prescribed, a 67-year-old woman develops corneal microdeposits.Which of the following drugs is the MOST LIKELY cause?
Your Answer: Digoxin
Correct Answer: Amiodarone
Explanation:Corneal microdeposits are almost universally present (over 90%) in people who have been taking amiodarone for more than six months, especially at doses above 400 mg/day. Although these deposits usually cause no symptoms, about 10% of patients report seeing a ‘bluish halo.’ This goes away once the treatment is stopped, and it rarely causes vision problems.Other effects of amiodarone on the eye are much rarer, occurring in only 1-2 percent of patients:Optic neuropathy is a condition that affects the eyes.Non-arteritic anterior ischaemic optic neuropathy (N-AION)Swelling of the optic disc
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 7
Incorrect
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Which of the following best describes an intention to treat analysis:
Your Answer: All patients are included in the analysis according to the group into which they were randomised only if they remain in the study.
Correct Answer: All patients are included in the analysis according to the group into which they were randomised even if they are withdrawn from the study.
Explanation:An intention to treat (ITT) analysis is one in which all patients are included in the analysis, classified according to the group into which they were randomised, even if they were withdrawn from the study and did not actually receive the treatment, did not comply with treatment or drop-out. Intention to treat analysis is a more reliable estimate of true treatment effectiveness by replicating what happens in the ‘real world’ (e.g. noncompliance and protocol violations commonly affect therapies).
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 8
Correct
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In relation to ketamine, which of the following statements is TRUE:
Your Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.
Explanation:Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 9
Correct
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Which of the following does NOT typically cause a neutrophil leucocytosis:
Your Answer: Glandular fever
Explanation:Causes of neutrophil leucocytosis:Bacterial infectionInflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)PregnancyAcute haemorrhage or haemolysisNeoplasms of all typesDrugs (e.g. corticosteroid therapy, lithium, tetracyclines)AspleniaMyeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)Rare inherited disorders
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 10
Correct
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Pre-oxygenation is done prior to intubation to extend the ‘safe apnoea time’.Which lung volume or capacity is the most important store of oxygen in the body?
Your Answer: Functional residual capacity
Explanation:The administration of oxygen to a patient before intubation is called pre-oxygenation and it helps extend the ‘safe apnoea time’. The Functional residual capacity (FRC) is the volume of gas that remains in the lungs after normal tidal expiration. It is the most important store of oxygen in the body. The aim of pre-oxygenation is to replace the nitrogen in the FRC with oxygen. Apnoea can be tolerated for longer periods before critical hypoxia develops if the FRC is large. Patients with reduced FRC reach critical hypoxia more rapidly.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 11
Correct
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A newborn baby is rushed to the neonatal ICU 4 hours after birth due to sudden onset severe jaundice and generalised oedema. Family history reveals that this is the second baby, while blood testing shows that the mother has an Rh-negative blood group while the baby is Rh-positive. A diagnosis of haemolytic disease of the newborn is established. Which one of the following hypersensitivity reactions have occurred in this case?
Your Answer: Type II hypersensitivity reaction
Explanation:Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 12
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 13
Correct
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A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination. The brachial pulse can be best palpated at ?
Your Answer: In the antecubital fossa, medial to the tendon of the biceps brachii
Explanation:The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Incorrect
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Regarding CSF (cerebrospinal fluid) production, approximately how much is produced per day?
Your Answer: 250 ml
Correct Answer: 500 ml
Explanation:CSF fills the ventricular system, a series of interconnected spaces within the brain, and the subarachnoid space directly surrounding the brain. The intraventricular CSF reflects the composition of the brain’s extracellular space via free exchange across the ependyma, and the brain “floats” in the subarachnoid CSF to minimize the effect of external mechanical forces. The volume of CSF within the cerebral ventricles is approximately 30 mL, and that in the subarachnoid space is about 125 mL. Because about 0.35 mL of CSF is produced each minute, CSF is turned over more than three times daily. Approximately 500 mL of CSF is produced per day, at a rate of about 25 mL per hour.CSF is a filtrate of capillary blood formed largely by the choroid plexuses, which comprise pia mater, invaginating capillaries, and ependymal cells specialized for transport. The choroid plexuses are located in the lateral, third, and fourth ventricles. The lateral ventricles are situated within the two cerebral hemispheres. They each connect with the third ventricle through one of the interventricular foramina (of Monro). The third ventricle lies in the midline between the diencephalon on the two sides. The cerebral aqueduct (of Sylvius) traverses the midbrain and connects the third ventricle with the fourth ventricle. The fourth ventricle is a space defined by the pons and medulla below and the cerebellum above. The central canal of the spinal cord continues caudally from the fourth ventricle, although in adult humans the canal is not fully patent and continues to close with age.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 15
Correct
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At which opioid receptors do opioid analgesics act primarily?
Your Answer: Mu
Explanation:Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 16
Correct
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You review a 34-year-old man with lower back pain and plan to prescribe him ibuprofen and codeine phosphate. His only past medical history of note is depression, for which he takes fluoxetine.Which of the following scenarios would prompt you to consider the co-prescription of a PPI for gastro-protection? Select ONE answer only.
Your Answer: Co-prescription of fluoxetine
Explanation:Patients at risk of gastro-intestinal ulceration (including the elderly) who need NSAID treatment should receive gastroprotective treatment. The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:Using maximum recommended dose of an NSAIDAged 65 or olderHistory of peptic ulcer or GI bleedingConcomitant use of medications that increase risk:Low dose aspirinAnticoagulantsCorticosteroidsAnti-depressants including SSRIs and SNRIsRequirements for prolonged NSAID usage:Patients with OA or RA at any ageLong-term back pain if older than 45It is suggested that if required, either omeprazole 20 mg daily or lansoprazole 15-30 mg daily should be the PPIs of choice.This patient is on 400 mg of ibuprofen TDS, but the maximum recommended dose of ibuprofen is 2.4 g daily. Co-prescription of codeine, raised BMI, and a family history of peptic ulceration would also not prompt gastro-protection.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 17
Correct
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Regarding haemophilia A, which of the following statements is INCORRECT:
Your Answer: In haemophilia both the APTT and PT are prolonged.
Explanation:Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives. The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 18
Incorrect
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During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer: The wrist flexors
Correct Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:L– lateral two lumbricalsO– Opponens pollicisA– Abductor pollicisF– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Incorrect
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An elderly man presents with bilateral lower facial swelling around the mandible and upper neck. A CT scan of his neck was performed and the results were conclusive with Ludwig's angina.Which of the following spaces is most likely affected based on the case presented?
Your Answer: Submental space
Correct Answer: Submandibular space
Explanation:Ludwig’s angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. It involves three compartments of the floor of the mouth: the sublingual, submental, and submandibular.Ludwig’s angina usually originates as a dental infection of the second or third mandibular molars. The infection begins in the subgingival pocket and spreads to the musculature of the floor of the mouth. It progresses below the mylohyoid line, indicating that it has moved to the sublingual space. As the roots of the second and third mandibular molars lie below this line, infection of these teeth will predispose to Ludwig’s angina. The infection spreads lingually rather than buccally because the lingual aspect of the tooth socket is thinner. It initially spreads to the sublingual space and progresses to the submandibular space.The disease is usually polymicrobial, involving oral flora, both aerobes, and anaerobes. The most common organisms are Staphylococcus, Streptococcus, Peptostreptococcus, Fusobacterium, Bacteroides, and Actinomyces.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 20
Correct
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A patient who shows symptoms of infection and is admitted under supervision of the medical team. The organism which caused this, is a Gram-negative bacterium, according to the culture. A penicillin therapy is suggested by the microbiologist.Which of the penicillins listed below is the most effective against Gram-negative bacteria?
Your Answer: Amoxicillin
Explanation:Amoxicillin and Ampicillin are more hydrophilic (broad-spectrum) penicillins than benzylpenicillin and phenoxymethylpenicillin. Because they may penetrate through gaps in the outer phospholipid membrane, they are effective against Gram-negative bacteria. Amoxicillin and Ampicillin are resistant to penicillinase-producing microbes.Community-acquired pneumonia, otitis media, sinusitis, oral infections, and urinary tract infections are among the most prevalent conditions for which they are prescribed. The normal adult oral dose of Amoxicillin is 500 mg three times/day, which can be increased to 1 g three times/day if necessary. Ampicillin is given to adults in doses of 0.5-1 g every 6 hours.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 21
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 22
Correct
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You review a 46-year-old woman who has recently been prescribed antibiotics for a urinary tract infection. She suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, she has been experiencing nausea, vomiting and abdominal pain.Which of the following antibiotics is she MOST LIKELY to have been prescribed for her UTI? Select ONE answer only .
Your Answer: Ciprofloxacin
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 23
Correct
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One of the following pathogens is a conditional pathogen:
Your Answer: Neisseria meningitidis
Explanation:Obligate pathogens include Mycobacterium TB, HIV, Treponema pallidum, and Neisseria gonorrhoeae. Neisseria meningitidis, on the other hand, is a conditional pathogen.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 24
Correct
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Na+ is reabsorbed via the Na+/K+/2Cl-symporter in which part of the loop of Henle?
Your Answer: Thick ascending limb
Explanation:In the thick ascending limb is the part of the loop of Henle in which there is active reabsorption of Na+and Cl- ions from the tubular fluid. This occurs via the Na+/K+/2Cl-symporter on the apical membrane. This mechanism is by:1. Na+ions are transported across the basolateral membrane by Na+pumps and the Cl-ions by diffusion. 2. K+leaks back into the tubular fluid via apical ROMK K+channels which creates a positive charge. 3. This positive charge drives the reabsorption of cations (Na+, K+, Ca2+, Mg2+) through paracellular pathways. 4. Due to the thick ascending limb being impermeable to water, the tubular fluid osmolality is reduced by ion reabsorption, the interstitial fluid osmolality is increased, and an osmotic difference is created.
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This question is part of the following fields:
- Physiology
- Renal
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Question 25
Correct
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A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.Which of these antibiotics is most likely to have been used?
Your Answer: Gentamicin
Explanation:Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear). Both side effects are dose-related and occur commonly in the elderly.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 26
Correct
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A 54-year-old woman has been visiting her GP with symptoms of tiredness, muscle weakness and headaches. She is known to be hypertensive and takes amlodipine to control this. Her blood results today show that her potassium level is low at 3.0 mmol/L, and her sodium level is slightly elevated at 146 mmol/L.Which of the following is the SINGLE most appropriate INITIAL investigation?
Your Answer: Plasma renin and aldosterone levels
Explanation:Primary hyperaldosteronism occurs when there are excessive levels of aldosterone independent of the renin-angiotensin axis. Secondary hyperaldosteronism occurs due to high renin levels.The causes of primary hyperaldosteronism include:Adrenal adenoma (Conn’s syndrome) – the most common cause of hyperaldosteronism (,80% of all cases). These are usually unilateral and solitary and are more common in women.Adrenal hyperplasia – this accounts for ,15% of all cases. Usually, bilateral adrenal hyperplasia (BAH) but can be unilateral rarely. More common in men than women.Adrenal cancer – a rare diagnosis but essential not to missFamilial aldosteronism – a rare group of inherited conditions affecting the adrenal glandsThe causes of secondary hyperaldosteronism include:Drugs – diureticsObstructive renal artery disease – renal artery stenosis and atheromaRenal vasoconstriction – occurs in accelerated hypertensionOedematous disorders – heart failure, cirrhosis and nephrotic syndromePatients are often asymptomatic. When clinical features are present, the classically described presentation of hyperaldosteronism is with:HypertensionHypokalaemiaMetabolic alkalosisSodium levels can be normal or slightly raisedOther, less common, clinical features include:LethargyHeadachesMuscle weakness (from persistent hypokalaemia)Polyuria and polydipsiaIntermittent paraesthesiaTetany and paralysis (rare)Often the earliest sign of hyperaldosteronism is from aberrant urea and electrolytes showing hypokalaemia and mild hypernatraemia. If the patient is taking diuretics, and the diagnosis is suspected, these should be repeated after the patient has taken off diuretics.If the diagnosis is suspected, plasma renin and aldosterone levels should be checked. Low renin and high aldosterone levels (with a raised aldosterone: renin ratio) is suggestive of primary aldosteronism.If the renin: aldosterone ratio is high, then the effect of posture on renin, aldosterone and cortisol can be investigated to provide further information about the underlying cause of primary hyperaldosteronism. Levels should be measured lying at 9 am and standing at noon:If aldosterone and cortisol levels fall on standing, this is suggestive of an ACTH dependent cause, e.g. adrenal adenoma (Conn’s syndrome)If aldosterone levels rise and cortisol levels fall on standing, this is suggestive of an angiotensin-II dependent cause, e.g. BAHOther investigations that can help to distinguish between an adrenal adenoma and adrenal hyperplasia include:CT scanMRI scanSelective adrenal venous sampling
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 27
Correct
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A patient noticed ankle swelling and has passed very little urine over the past 24 hours. He also has nausea and vomiting, reduced urine output and his blood results reveal a sudden rise in his creatinine levels over the past 48 hours. You make a diagnosis of acute kidney injury (AKI).Which one of these is a prerenal cause of AKI?
Your Answer: Cardiac failure
Explanation:The causes of AKI can be divided into pre-renal, intrinsic renal and post-renal causes. Majority of AKI developing in the community is due to a pre-renal causes (90% of cases).Pre-renal causes: Haemorrhage, severe vomiting or diarrhoea, burns, cardiac failure, liver cirrhosis, nephrotic syndrome, hypotension, severe cardiac failure, NSAIDs, COX-2 inhibitors, ACE inhibitors or ARBs, Abdominal aortic aneurysm, renal artery stenosis, hepatorenal syndrome, Intrinsic (renal) causes:Eclampsia, glomerulonephritis, thrombosis, haemolytic-uraemic syndrome, acute tubular necrosis (ATN), acute interstitial nephritis, drugs ( NSAIDs), infection or autoimmune diseases, vasculitis, polyarteritis nodosa, thrombotic microangiopathy, cholesterol emboli, renal vein thrombosis, malignant hypertensionPost-renal causes: Renal stones, Blood clot, Papillary necrosis, Urethral stricture, Prostatic hypertrophy or malignancy, Bladder tumour, Radiation fibrosis, Pelvic malignancy, Retroperitoneal fibrosis
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 28
Incorrect
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An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:No. of patients who took Ticagrelor: 300No. of patients who took Ticagrelor and suffered a stroke: 30No. of patients who took Warfarin: 500No. of patients who took Warfarin and suffered a stroke: 20Compute for the risk ratio of a stroke.
Your Answer: -0.06
Correct Answer: 2.5
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 = (30/300) / (20/500)RR = 2.5Recall 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 29
Incorrect
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Which of the following statements about vitamin B12 absorption is TRUE:
Your Answer: Vitamin B12 is transported around the body mainly dissolved in plasma.
Correct Answer: On ingestion, vitamin B12 is bound to R protein which protects it from digestion in the stomach.
Explanation:The substance intrinsic factor,essential for absorption of vitamin B12 in the ileum, issecreted by the parietal cells along with the secretion ofhydrochloric acid. When the acid-producing parietalcells of the stomach are destroyed, which frequentlyoccurs in chronic gastritis, the person develops not onlyachlorhydria (lack of stomach acid secretion) but oftenalso pernicious anaemia because of failure of maturationof the red blood cells in the absence of vitamin B12 stimulation of the bone marrow.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 30
Incorrect
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Which of the following is an example of continuous data:
Your Answer: Disease staging system
Correct Answer: Height
Explanation:Continuous data is data where there is no limitation on the numerical value that the variable can take e.g. weight, height.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 31
Correct
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A patient presents with a gastrointestinal infection. Which of the following microbes attaches to gut mucosa via a specialised sucking disc:
Your Answer: Giardia lamblia
Explanation:Giardia lambliainfection occurs through the ingestion of dormant microbial cysts in contaminated water, food or via faceo-oral transmission via poor hygiene.Following ingestion of the cysts, the trophozoite emerges to an active state of feeding and motility. After the feeding stage they undergo asexual replication through longitudinal binary fission.They attach to the intestinal wall via a specialised sucking disc. The mechanism for diarrhoea in giardiasis remains unknown but could possibly be due to direct cytotoxicity.Giardial trophozoites and cysts pass through the digestive system in the faeces and are excreted. While the trophozoites may be found in the faeces, only the cysts are adapted for long-term survival outside the host.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 32
Correct
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Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?
Your Answer: Left anterior descending artery
Explanation:Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern.The following ECG leads determine the location and vessels involved in myocardial infarction:ECG Leads Location Vessel involvedV1-V2 Septal wall Left anterior descendingV3-V4 Anterior wall Left anterior descendingV5-V6 Lateral wall Left circumflex arteryII, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)I, aVL High lateral wall Left circumflex arteryV1, V4R Right ventricle Right coronary arteryV7-V9 Posterior wall Right coronary artery
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 33
Correct
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Which of the following is most likely to cause a homonymous hemianopia:
Your Answer: Posterior cerebral artery stroke
Explanation:A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 34
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 35
Incorrect
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Which of the following accurately describes the extensor pollicis brevis muscle?
Your Answer: It extends the distal phalanx of the thumb at the metacarpophalangeal joint
Correct Answer: It lies on the medial side of abductor pollicis longus
Explanation:Extensor pollicis brevis is a short and slender muscle located in the posterior compartment of the forearm, extending from the posterior surface of radius to the proximal phalanx of thumb. It is one of the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus and extensor indicis muscles.Extensor pollicis brevis is a deep extensor of the thumb that lies deep to extensor digitorum muscle. It sits directly medial to abductor pollicis longus and posterolateral to extensor pollicis longus muscle. Just above the wrist, extensor pollicis brevis obliquely crosses the tendons of extensor carpi radialis brevis and extensor carpi radialis longus muscles.Extensor pollicis brevis is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).Extensor pollicis brevis receives its blood supply by posterior interosseous artery and perforating branches from the anterior interosseous artery, which are the branches of common interosseous artery. The common interosseous artery arises immediately below the tuberosity of radius from the ulnar artery.Together with extensor pollicis longus, extensor pollicis brevis is in charge of extension of the thumb in the first metacarpophalangeal joint. It also extends the thumb in the carpometacarpal joint of the thumb. This movement is important in the anatomy of the grip, as it enables letting go of an object. As it crosses the wrist, extensor pollicis brevis also participates in the extension and abduction of this joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 36
Correct
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Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?
Your Answer: Posterior
Explanation:The periurethral portion of the prostate gland increases in size during puberty and after the age of 55 years due to the growth of non-malignant cells in the transition zone of the prostate that surrounds the urethra. Most cancers develop in the posterior lobe, and cancers in this location may be palpated during a digital rectal examination (DRE).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 37
Correct
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Which of the following statements is incorrect regarding potassium replacement?
Your Answer: Oral potassium supplements are often required for patients taking spironolactone.
Explanation:It is very seldom that potassium supplements are required with the small doses of diuretics given to treat hypertension. Potassium-sparing diuretics like spironolactone (rather than potassium supplements), are recommended for hypokalaemia prevention when diuretics are given to eliminate oedema, such as furosemide or the thiazides.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 38
Incorrect
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A newborn baby is born by vaginal delivery to a mother who has a Chlamydia infection and who is started on treatment after the delivery. The neonate subsequently develops an infection also.Which one of these is the most common neonatal manifestation of Chlamydia trachomatis infection?
Your Answer: Pneumonia
Correct Answer: Conjunctivitis
Explanation:Conjunctivitis is the most common neonatal manifestation of Chlamydia trachomatis infection. The second commonest neonatal manifestation is pneumoniaOphthalmia neonatorum refers to any conjunctivitis in the newborn period, irrespective of causative organism. Presently, chlamydia is the single most common cause, accounting for up to 40% of cases. Ophthalmia neonatorum caused by chlamydia typically presents 5 to 14 days after birth with unilateral or bilateral watery discharge that progressively becomes more copious and purulent. There is no associated risk of ulceration and perforation, and the eyes are less inflamed.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 39
Incorrect
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A 30-year old male is brought to the emergency room after a terrible fall during a photoshoot. The patient reported falling on his right forearm. There is evident swelling and tenderness on the affected area, with notable weakness of the flexor pollicis longus muscle. Radiographic imaging showed a fracture on the midshaft of the right radius.Which of the following nerves is most likely injured in the case above?
Your Answer: The median nerve
Correct Answer: The anterior interosseous nerve
Explanation:Flexor pollicis longus receives nervous supply from the anterior interosseous branch of median nerve, derived from spinal roots C7 and C8.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 40
Incorrect
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Urine flow rate = 2 ml/minUrine concentration of creatinine = 18 mg/ml Plasma concentration of creatinine = 0.25 mg/ml What is the estimated glomerular filtration rate (eGFR)?
Your Answer: 40 ml/min
Correct Answer: 144 ml/min
Explanation:GFR can be estimated by:GFR = UCr x V / PCrWhere:UCr = urine concentration of creatininePCr = plasma concentration of creatinineV = rate of urine flowIn this case GFR = (18 x 2) / 0.25 = 144 ml/minNote: Creatinine is used to estimate GFR because it is an organic base naturally produced by muscle breakdown, it is freely filtered at the glomerulus, it is not reabsorbed from the nephron, it is not produced by the kidney, it is not toxic, and it doesn’t alter GFR.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 41
Incorrect
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The second generation antihistamine, cetirizine is a less-sedating antihistamine than the older antihistamine, chlorphenamine because:
Your Answer: It has less anticholinergic effect.
Correct Answer: It is less lipid-soluble so less able to cross the blood brain barrier.
Explanation:All older antihistamines such as chlorphenamine cause sedation. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 42
Incorrect
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Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely caused by which of the following:
Your Answer: Aneurysm of the posterior communicating artery
Correct Answer: Diabetes mellitus
Explanation:Compressive causes of CN III palsy cause early pupillary dilatation because the parasympathetic fibres run peripherally in the nerve and are easily compressed. In diabetes mellitus the lesions are ischaemic rather than compressive and therefore typically affect the central fibres resulting in pupillary sparing.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 43
Correct
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Intrinsic factor is secreted by which of the following cell types in the stomach:
Your Answer: Parietal cells
Explanation:Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 44
Incorrect
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Which of the following is NOT a typical complication associated with mumps:
Your Answer: Orchitis
Correct Answer: Subacute sclerosing panencephalitis
Explanation:Complications of mumps include meningitis, post meningitis deafness, encephalitis, pancreatitis, orchitis and oophoritis. Subacute sclerosing panencephalitis is a complication typically associated with measles infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 45
Correct
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A 1-year-old male is brought to the paediatrician by his mother due to swelling of the right knee after a minor fall. On examination, the right knee is swollen, fluctuant and tender. Ultrasound-guided aspiration reveals a massive hemarthrosis. Family history shows that his older brother also has a bleeding disorder. Which one of the following conditions does the patient most likely have?
Your Answer: Haemophilia A
Explanation:A diagnosis of Haemophilia is supported in this patient by the family history and the presence of hemarthrosis-both characteristics of Haemophilia. Haemophilia A is caused by Factor VIII deficiency, leading to impaired coagulation. This disease typically presents after six months when the child starts crawling. Von Willebrand disease presents with nosebleeds and hematomas. Idiopathic thrombocytopenic purpura presents with bruises that resemble a rash. Glucose-6-phosphate dehydrogenase (G6PD) deficiency presents with haemolytic anaemia induced by specific drugs or foods. Factor V Leiden mutation causes blood clotting rather than bleeding.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 46
Correct
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Which of the following does NOT increase free ionised calcium levels:
Your Answer: Calcitonin
Explanation:Calcium homeostasis is primarily controlled by three hormones: parathyroid hormone, activated vitamin D and calcitonin.Parathyroid hormone acts on the kidneys to increase calcium reabsorption in the distal tubule by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane (and to decrease phosphate reabsorption in the proximal tubule).Activated vitamin D acts to increase calcium reabsorption in the distal tubule via activation of a basolateral Ca2+ATPase pump (and to increase phosphate reabsorption).Calcitonin acts to inhibit renal reabsorption of calcium (and phosphate).
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This question is part of the following fields:
- Physiology
- Renal
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Question 47
Incorrect
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A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago. Which ONE of the following options is FALSE with regards to this disorder?
Your Answer: It is the commonest human enzyme defect
Correct Answer: Acute haemolysis can be triggered by cephalosporin antibiotics
Explanation:Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.Triggers include: 1) Fava beans2) Sulphonamides3) Primaquine4) Anti-TB drugs5) Infections Most individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 48
Correct
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Which of the following drugs decreases plasma-theophylline levels:
Your Answer: Carbamazepine
Explanation:Examples of enzyme-inhibiting drugs (raise plasma theophylline level):ErythromycinClarithromycinCiprofloxacinFluconazoleVerapamilAllopurinolCimetidineExamples of enzyme-inducing drugs (lower plasma theophylline level):PrimidonePhenobarbitalCarbamazepinePhenytoinRitonavirRifampicinSt John’s Wort
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 49
Correct
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A 22-year-old with a history of brittle asthma is brought to the ED by her partner. She is wheezing and very short of breath and her condition is deteriorating rapidly. Following a series of nebulisations, hydrocortisone and IV magnesium sulphate, she is taken to resus and the intensive care team is called to review her. She is severely hypoxic and confused and a decision is made to intubate her.Which of these drugs is ideal as an induction agent in this patient?
Your Answer: Ketamine
Explanation:Only about 2% of asthma attacks requires intubation and most severe cases are managed with non-invasive ventilation techniques.Though life-saving in the crashing asthmatic, intubation in asthmatic patients is associated with significant morbidity and mortality and is risky. Indications for intubation in asthmatic patients include:Severe hypoxiaAltered mental stateRespiratory or cardiac arrestFailure to respond to medicationsKetamine (1-2 mg/kg) is the preferred induction agent. It has bronchodilatory properties and does not cause hypotension. Propofol poses a risk of hypotension but can also be used.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 50
Correct
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Regarding disseminated intravascular coagulation (DIC), which of the following statements is INCORRECT:
Your Answer: Thrombocytosis results in widespread platelet aggregation.
Explanation:DIC is characterised by a widespread inappropriate intravascular deposition of fibrin with consumption of coagulation factors and platelets. This may occur as a consequence of many disorders that release procoagulant material into the circulation or cause widespread endothelial damage or platelet aggregation. Increased activity of thrombin in the circulation overwhelms its normal rate of removal by natural anticoagulants. In addition to causing increased deposition of fibrin in the microcirculation and widespread platelet aggregation to the vessels, intravascular thrombin formation interferes with fibrin polymerisation. Intense fibrinolysis is stimulated by thrombi on vascular walls and the release of fibrin degradation products again interferes with fibrin polymerisation. The combined action of thrombin and plasmin causes depletion of fibrinogen and all coagulation factors, compounded by thrombocytopaenia caused by platelet consumption.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 51
Incorrect
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Identify the type of graph described below:A graph that consists of a vertical bar graph in which values are plotted in decreasing order of relative frequency from left to right. The independent variables on the chart are shown on the horizontal axis and the dependent variables are portrayed as the heights of bars.
Your Answer: Histogram
Correct Answer: Pareto diagram
Explanation:A pareto diagram, or pareto chart, consists of a vertical bar graph in which values are plotted in decreasing order of relative frequency from left to right. The independent variables on the chart are shown on the horizontal axis and the dependent variables are portrayed as the heights of bars.A point-to-point graph, which shows the cumulative relative frequency, may be superimposed on the bar.Because the values of the statistical variables are placed in order of relative frequency, the graph clearly reveals which factors have the greatest impact and where attention is likely to yield the greatest benefit. It is extremely useful for analysing what problems need attention first, because the taller bars on the chart clearly illustrate which variable have the greatest cumulative effect on a given system.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 52
Correct
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A blood culture was performed from a sample taken from a patient. It was noted that a Gram-negative coccus organism was grown.Among the following microorganisms, which is considered an example of a Gram-negative coccus?
Your Answer: Neisseria menigitidis
Explanation:Staphylococcus aureus = Gram-positive coccusBacillus cereus = Gram-positive bacillusCampylobacter jejuni = Gram-negative bacillusEscherichia coli = Gram-negative bacillusIn Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative. Neisseria species appear as Gram-negative diplococci because they form pairs and their adjacent ends are flattened that is why they are also described to have a coffee-bean or kidney-bean shape.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 53
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 54
Incorrect
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A patient has an elevated potassium level of 6.7 mmol/L. All of the following conditions may cause elevated potassium levels, except for which one?
Your Answer: Addison’s disease
Correct Answer: Bartter’s syndrome
Explanation:Bartter’s syndrome is an autosomal recessive renal tubular disorder characterized by hypokalaemia, hypochloraemia, metabolic alkalosis, and hyperreninemia with normal blood pressure. The underlying kidney abnormality results in excessive urinary losses of sodium, chloride, and potassium. Bartter’s syndrome does not cause an elevated potassium level, but instead causes a decrease in its concentration (hypokalaemia). The other choices are causes of hyperkalaemia or elevated potassium levels. Renal failure, Addison’s disease (adrenal insufficiency), congenital adrenal hyperplasia, renal tubular acidosis (type 4), rhabdomyolysis, burns and trauma, tumour syndrome, and acidosis are non-drug causes of hyperkalaemia. On the other hand, drugs that can cause hyperkalaemia include ACE inhibitors, angiotensin receptor blockers, NSAIDs, beta-blockers, digoxin, and suxamethonium.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 55
Incorrect
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A 29 year old patient with known inflammatory bowel disease presents to ED with surgical complications following his recent ileocaecal resection. Removal of the terminal ileum may result in the malabsorption of which of the following:
Your Answer: Folate
Correct Answer: Vitamin B12
Explanation:On ingestion, vitamin B12 is bound to R protein found in saliva and gastric secretions, which protects it from digestion in the stomach. Intrinsic factor is secreted by gastric parietal cells. Receptors for the IF-B12 complex are present in the membrane of epithelial cells of the terminal ileum, which bind the complex and allow uptake of vitamin B12 across the apical membrane by endocytosis. Vitamin B12 is then transported across the basal membrane into the portal blood where it is bound to transcobalamin II and processed by the liver. In pernicious anaemia, there are autoantibodies against gastric parietal cells and intrinsic factor, resulting in vitamin B12 deficiency anaemia.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 56
Incorrect
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What is the interquartile range of the following data set: 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70
Your Answer: 15
Correct Answer: 30
Explanation:5, 10, 15 /20, 25, 30 /35, 40, 45 /50, 60, 70Sample size (n) = 12Median = [(n+1)/2]th value = (12+1)/2 = 6.5 = halfway between 6th and 7th value = (30 +35)/2 = 32.5The lower (first) quartile = halfway between 15 and 20 = 17.5The upper (third) quartile = halfway between 45 and 50 = 47.5The interquartile range is the difference between the upper quartile and lower quartile = 47.5 – 17.5 = 30
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 57
Incorrect
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A 22-year-old student presents with a painful, red and itchy right eye. On examination, there is mild erythema of palpebral conjunctiva, and follicles are visible on eversion of the eyelid. Lid oedema is evident, and you can also see a few petechial subconjunctival haemorrhages. The eye appears watery, and there is no purulent discharge. He has recently recovered from a mild upper respiratory tract infection.Which of these is the most likely causative organism?
Your Answer: Haemophilus influenzae
Correct Answer: Adenovirus
Explanation:The most frequent cause of red eye is conjunctivitis. It is caused by inflammation of the conjunctiva which can be infective or allergic and accounts for about 35% of all eye problems presenting to general practice.Viral conjunctivitis is commonly caused by adenoviruses and it is the most common infectious conjunctivitis.The common bacterial causes of conjunctivitis are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.The clinical features of infective conjunctivitis include:Acute onset of conjunctival erythemaFeeling ‘grittiness’, ‘foreign body’ or ‘burning’ sensation in the eye.Watering and discharge which may cause transient blurring of visionFeatures of viral conjunctivitis include: watery and non-purulent eye discharge, lid oedema, follicles present on eyelid eversion, petechial subconjunctival haemorrhages and pseudomembranes may be seen on the tarsal conjunctival surfaces.This patients features are consistent with a viral aetiology, and the most likely causative organism is adenovirus,
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 58
Correct
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A pheochromocytoma is diagnosed in a 38-year-old female who has had episodes of acute sweating, palpitations, and paroxysmal hypertension.Which of the following is the MOST SUITABLE INITIAL TREATMENT?
Your Answer: Alpha-blocker
Explanation:A phaeochromocytoma is a rare functional tumour that develops in the adrenal medulla from chromaffin cells. Extra-adrenal paragangliomas (extra-adrenal pheochromocytomas) are tumours that arise in the sympathetic nervous system’s ganglia and are closely connected to extra-adrenal paragangliomas (extra-adrenal pheochromocytomas). Catecholamines are secreted by these tumours, which generate a variety of symptoms and indications associated with sympathetic nervous system hyperactivity.Hypertension is the most prevalent presenting symptom, which can be continuous or intermittent.Symptoms are usually intermittent, occurring anywhere from many times a day to occasionally. The symptoms of the condition tend to grow more severe and frequent as the disease progresses.The ultimate therapy of choice is surgical resection, and if full resection is done without metastases, hypertension is typically cured.Preoperative medical treatment is critical because it lowers the risk of hypertensive crises during surgery. This is commonly accomplished by combining non-competitive alpha-blockers (such as phenoxybenzamine) with beta-blockers. To allow for blood volume expansion, alpha-blockade should be started at least 7-10 days before surgery. Beta-blockade, which helps to regulate tachycardia and some arrhythmias, can be started after this is accomplished. Hypertensive crises can be triggered if beta-blockade is started too soon.There should also be genetic counselling, as well as a search for and management of any linked illnesses.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 59
Correct
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What is the main mechanism of action of cyclizine:
Your Answer: Histamine-H1 antagonist
Explanation:Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 60
Incorrect
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You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.Which of the following statements about dobutamine is correct?
Your Answer: Its primary activity results from stimulation of beta 2 -adrenergic receptors
Correct Answer: It may be infused via a peripheral line
Explanation:Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:Nausea and vomitingTachycardiaDysrhythmiasAnginaHypertensionHeadache
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 61
Correct
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Which of the following anatomical structures is most likely the cause of oedema and erythema of the arm in a patient who underwent modified radical mastectomy and radiotherapy?
Your Answer: Axillary lymph nodes
Explanation:Arm oedema is one of the sequelae after breast cancer surgery and radiation therapy. Arm oedema in the breast cancer patient is caused by interruption of the axillary lymphatic system by surgery or radiation therapy, which results in the accumulation of fluid in subcutaneous tissue in the arm, with decreased distensibility of tissue around the joints and increased weight of the extremity. Chronic inflammatory changes result in both subcutaneous and lymph vessel fibrosis.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 62
Correct
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After an accidental fall, a 75-year-old patient complains of neck pain and weakness in his upper limbs. Select the condition that most likely caused the neck pain and weakness of the upper limbs of the patient.
Your Answer: Central cord syndrome
Explanation:The cervical spinal cord is the section of the spinal cord that goes through the bones of the neck. It is injured incompletely in the central cord syndrome (CCS). This will result in arm weakness more than leg weakness.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 63
Correct
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Salbutamol should be used with caution in patients with which of the following:
Your Answer: Susceptibility to QT-interval prolongation
Explanation:Beta-2 agonists should be used with caution in people with: Cardiovascular disease, including arrhythmias and hypertension (beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate)Diabetes(risk of hyperglycaemia and ketoacidosis, especially with intravenous use)Hyperthyroidism(beta-2 agonists may stimulate thyroid activity)Hypokalaemia(potentially serious hypokalaemia may result from beta-2 agonist therapy; this effect may be potentiated in severe asthma by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia)Susceptibility to QT-interval prolongationConvulsive disorders
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 64
Correct
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A 23-year-old man is discovered to have an infection from Helicobacter pylori. Which of the following types of cancer is mostly associated with Helicobacter pylori infection?
Your Answer: Gastric cancer
Explanation:H. pylori is recognized as a major cause of type B gastritis, a chronic condition formerly associated primarily with stress and chemical irritants. In addition, the strong association between long-term H. pylori infection and gastric cancer has raised more questions regarding the clinical significance of this organism. There is speculation that long-term H. pylori infection resulting in chronic gastritis is an important risk factor for gastric carcinoma resulting in H. pylori being classified as a carcinogen.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 65
Correct
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Question 66
Incorrect
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A patient suffers from an injury to his hip and thigh. As a consequence of his injury, the nerve that was damaged innervates the obturator externus muscle.In which of the following nerves is the obturator externus muscle innervated by?
Your Answer: Anterior branch of the obturator nerve
Correct Answer: Posterior branch of the obturator nerve
Explanation:The obturator externus is innervated by the posterior branch of the obturator nerve, L2-L4.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 67
Correct
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Which of the following is the most likely causative organism of acute epiglottitis in a 6 year old?
Your Answer: Streptococcus pneumoniae
Explanation:Since the introduction of the HIB vaccine, most cases of acute epiglottitis are now caused by Streptococcus spp. The condition is now rare in children.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 68
Correct
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A 68-year-old patient shows Low calcium levels and is on dialysis for chronic kidney disease.What percentage of total serum calcium is in the form of free or ionised Ca 2+?
Your Answer: 50%
Explanation:Approximately half of total serum calcium is in the free or ionised Ca2+ state, 40% is attached to plasma proteins (mostly albumin), and the remaining 10% is in complexes with organic ions like citrate and phosphate. The ionized form is the only one that works.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 69
Correct
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A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone. Which one of the following conditions will this woman NOT have?
Your Answer: Xanthopsia
Explanation:Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias. Side effects include:1. pulmonary fibrosis2. blue discolouration of the skin3. phototoxicity4. corneal deposits5. hepatic necrosis6. thyroid dysfunction7. sleep disturbances8. peripheral neuropathy. Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 70
Incorrect
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Which of the following statements is not true regarding ion channels?
Your Answer: Ligand-gated ion channels are found in the cell membrane.
Correct Answer: Ion channels provide a charged, hydrophobic pore through which ions can diffuse across the lipid bilayer.
Explanation:Ion channels are pore-forming protein complexes that facilitate the flow of ions across the hydrophobic core of cell membranes. They are present in the plasma membrane and membranes of intracellular organelles of all cells, and perform essential physiological functions. They provide a charged, hydrophilic pore through which ions can move across the lipid bilayer. They are selective for particular ions and their pores may be opened or closed. Because of this ability to open and close, ion channels allow the cell to have the ability to closely control the movement of ions across the membrane. Gating refers to the transition between an open and closed ion channel state, and is brought about by a conformationational change in the protein subunits that open or close the ion-permeable pore. Ion channels can be:1. voltage-gated these are regulated according to the potential difference across the cell membrane or2. ligand-gated – these are regulated by the presence of a specific signal molecule.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 71
Correct
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A 67-year-old woman complains of general malaise, nausea, and vomiting. She is perplexed and declares that everything 'looks yellow.' Her potassium level is 6.8 mmol/l, according to a blood test.Which of the drugs listed below is most likely to be the cause of her symptoms?
Your Answer: Digoxin
Explanation:Because digoxin has a narrow therapeutic index, it can cause toxicity both during long-term therapy and after an overdose. Even when the serum digoxin concentration is within the therapeutic range, it can happen.Acute digoxin toxicity usually manifests itself within 2-4 hours of an overdose, with serum levels peaking around 6 hours after ingestion and life-threatening cardiovascular complications following 8-12 hours.Chronic digoxin toxicity is most common in the elderly or those with impaired renal function, and it is often caused by a coexisting illness. The clinical signs and symptoms usually appear gradually over days to weeks.The following are characteristics of digoxin toxicity:Nausea and vomitingDiarrhoeaAbdominal painConfusionTachyarrhythmias or bradyarrhythmiasXanthopsia (yellow-green vision)Hyperkalaemia (early sign of significant toxicity)Some precipitating factors are as follows:Elderly patientsRenal failureMyocardial ischaemiaHypokalaemiaHypomagnesaemiaHypercalcaemiaHypernatraemiaAcidosisHypothyroidismSpironolactoneAmiodaroneQuinidineVerapamilDiltiazem
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 72
Correct
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Which of the following is NOT a typical clinical feature of hypoglycaemia:
Your Answer: Polyuria
Explanation:Clinical features of hypoglycaemia: Autonomic symptoms: Sweating, feeling hot, anxiety/agitation, palpitations, shaking, paraesthesia, dizzinessNeuroglycopaenic symptoms: Weakness, blurred vision, difficulty speaking, poor concentration, poor coordination, drowsiness, confusion, seizures, comaOther symptoms: Nausea, fatigue, hunger
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 73
Correct
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Regarding autoregulation of local blood flow, which of the following statements is CORRECT:
Your 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 74
Correct
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You review a patient with urinary sepsis and decide to start her on gentamicin.Which statement about gentamicin is true?
Your Answer: Ototoxicity is a dose-related effect
Explanation:Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.Gentamicin is given by injection because it is NOT absorbed orally. It is excreted in the kidneys by glomerular filtrationGentamicin is not to be used for the treatment of Neisseria meningitidis, Neisseria gonorrhoea, or Legionella pneumophila.There is a risk of patient going into shock from lipid A endotoxin release.Two of its most notable side effects are hearing loss reversible nephrotoxicity and which are both dose-related and levels should be monitored in patients.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 75
Correct
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A 68-year-old man has a very fast heartbeat' and is out of breath. He has had a heart transplant in the past. His electrocardiogram reveals supraventricular tachycardia.Which of the following is the most appropriate adenosine dose for him to receive as a first dose?
Your Answer: Adenosine 3 mg IV
Explanation:A rapid IV bolus of adenosine is given, followed by a saline flush. The standard adult dose is 6 mg, followed by 12 mg if necessary, and then another 12 mg bolus every 1-2 minutes until an effect is seen.Patients who have had a heart transplant, on the other hand, are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 76
Correct
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A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute. She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer: Fosfomycin
Explanation:The NICE guidelines for women with lower UTIs who are not pregnant are:1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time 2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibioticThe first choice of antibiotics for non-pregnant women aged 16 years and over is:1. Nitrofurantoin100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute2. Trimethoprim 200 mg PO BD for three daysThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:1. Nitrofurantoin100 mg modified-release PO BD for three days – if eGFR >45 ml/minute2. Pivmecillinam400 mg PO initial dose, then 200 mg PO TDS for three days3. Fosfomycin 3 g single sachet dose
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 77
Incorrect
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The hypothalamus produces antidiuretic hormone (ADH), also known as vasopressin, which is a peptide hormone. It is important for maintaining water and electrolyte balance, as well helping control arterial pressure.To have an effect on blood arteries, ADH binds to which of the following receptors?
Your Answer: V 3 receptor
Correct Answer: V 1 receptor
Explanation:ADH, or antidiuretic hormone, is a hormone that regulates water and electrolyte balance. It is released in response to a variety of events, the most important of which are higher plasma osmolality or lower blood pressure. ADH increases plasma volume and blood pressure via acting on the kidneys and peripheral vasculature.It causes vasoconstriction by binding to peripheral V1 Receptors on vascular smooth muscle via the IP3 signal transduction and Rho-kinase pathways. The systemic vascular resistance and arterial pressure rise as a result. High levels of ADH appear to be required for this to have a major impact on arterial pressure, such as in hypovolaemic shock.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 78
Incorrect
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You review a 37-year-old man with a history of intravenous drug abuse who admits to sharing needles in the past. He has a flu-like illness and a rash. Concerned he may be experiencing an HIV seroconversion illness, you order a test.Which of these tests is most reliably used to diagnose HIV at this stage?
Your Answer: ‘Rapid HIV test’
Correct Answer: p24 antigen test
Explanation:Serum concentrations of the p24 antigen are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection. P24 is the viral protein that makes up most of the core of the HIV.ELISA and other antibody tests, though a very sensitive way of detecting the presence of HIV, cannot be used in the early stages of the disease. This is because of the window period of 6-12 weeks before antibodies are produced. These tests will be negative during a seroconversion illness.The ‘rapid HIV test’ is an HIV antibody test. It will also be negative during the ‘window period’ since it takes time for antibodies to be produced. It is called the ‘rapid test’ as it can detect antibodies in blood or saliva much quicker than the other antibody tests and results are often back within 20 minutes.CD4 and CD8 counts are usually normal in the early stages of the HIV infection and cannot be used in this case.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 79
Correct
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You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble breathing after eating peanuts. Which of the following diagnostic tests will confirm this?
Your Answer: Mast cell tryptase
Explanation:The concentration of serum tryptase rises in anaphylaxis and anaphylactoid responses. Because tryptase is a significant component of mast cell granules, mast cell degranulation causes elevated tryptase levels in the blood. Although tryptase levels are not always high during anaphylaxis, it is considered a particular marker.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 80
Incorrect
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The functional residual capacity (FRC) will be decreased in which of the following:
Your Answer: Emphysema
Correct Answer: Pulmonary fibrosis
Explanation:Factors decreasing FRC:Restrictive ventilatory defects e.g. pulmonary fibrosisPosture – lying supineIncreased intra-abdominal pressure (e.g. obesity, pregnancy, ascites)Reduced muscle tone of diaphragm e.g. muscle relaxants in anaesthesia, neuromuscular disease
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 81
Incorrect
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Which of the following nerves has been damaged when a patient presents with a foot drop?
Your Answer: Sural nerve
Correct Answer: Common peroneal nerve
Explanation:The common peroneal nerve often referred to as the common fibular nerve, is a major nerve that innervates the lower extremity. It is one of the two major branches off the sciatic nerve and receives fibres from the posterior divisions of L4 through S2 nerve roots. The common peroneal nerve separates from the sciatic nerve in the distal posterior thigh proximal to the popliteal fossa. After branching off of the sciatic nerve, it continues down the thigh, running posteroinferior to the biceps femoris muscle, and crosses laterally to the head of the lateral gastrocnemius muscle through the posterior intermuscular septum. The nerve then curves around the fibular neck before dividing into two branches, the superficial peroneal nerve (SPN) and the deep peroneal nerve (DPN). The common peroneal nerve does not have any motor innervation before dividing; however, it provides sensory innervation to the lateral leg via the lateral sural nerve.The superficial peroneal nerve innervates the lateral compartment of the leg, and the deep peroneal nerve innervates the anterior compartment of the leg and the dorsum of the foot. These two nerves are essential in the eversion of the foot and dorsiflexion of the foot, respectively. The superficial and deep peroneal nerves provide both motor and sensory innervation.The most common presentation with common peroneal nerve injury or palsy is acute foot drop, although symptoms may be progressive and can include sensory loss or pain. Weakness in foot eversion may occur if the superficial peroneal nerve component is involved.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 82
Correct
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Bile acids are essential for the digestion and absorption of which of the following:
Your Answer: Lipids and fat-soluble vitamins
Explanation:Bile acids are synthesised from cholesterol by hepatocyte and excreted into bile. Bile acids are essential for lipid digestion and absorption. Of the bile acids excreted into the intestine, about 95% are reabsorbed into the portal circulation by active transport mechanisms in the distal ileum and recycled by the liver. Many of the bile salts are reabsorbed unaltered, some are converted by intestinal bacteria into secondary bile acids (deoxycholic acid and lithocholic acid) and then reabsorbed and a small proportion escapes reabsorption and is excreted in the faeces.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 83
Incorrect
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The stomach G-cells are responsible for which of the following?
Your Answer: Inhibition of gastric acid secretion
Correct Answer: Secretion of gastrin
Explanation:G-cells are a type of cell found in the stomach’s pyloric antrum, duodenum, and pancreas. The secretion of the peptide hormone gastrin is their major function.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 84
Correct
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A 21 year old student presents to the emergency room with severe acute asthma. Salbutamol and ipratropium bromide nebuliser are prescribed. The most appropriate dose of salbutamol that should be prescribed initially for this patient is which of the following?
Your Answer: 5 mg every 15 - 30 minutes
Explanation:The first line treatment for acute asthma is high-dose inhaled short-acting beta2-agonists like salbutamol or terbutaline. Oxygen use should be reserved for hypoxemic patients in order to maintain oxygen saturations of 94 – 98%. In patients with moderate to severe asthma, a pressurised metered dose inhaler with spacer device is preferred (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). For patients with life-threatening features or poorly responsive severe asthma, the oxygen-driven nebuliser route is recommended (salbutamol 5 mg at 15 – 30 minute intervals). In patients with severe acute asthma that is poorly responsive to initial bolus dose, continuous nebulisation should be considered (salbutamol at 5 – 10 mg/hour). For those in whom inhaled therapy cannot be used reliably, the intravenous route is usually reserved.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 85
Correct
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At which vertebral level does the spinal cord normally end in adults?
Your Answer: L1/L2
Explanation:The spinal cord starts at the foramen magnum, where it is continuous with the medulla oblongata, which is the most caudal portion of the brainstem.It then extends inferiorly through the vertebral canal. In adults, it usually ends at the level of the first or second lumbar vertebra.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 86
Incorrect
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Regarding the factor V Leiden gene mutation, which of the following best describes the clinical effect:
Your Answer: It results in deficiency of factor V.
Correct Answer: It results in increased levels of activated factor V.
Explanation:Factor V Leiden gene mutation is the most common inherited cause of an increased risk of venous thrombosis. Activated protein C normally breaks down activated factor V and so should slow the clotting reaction and prolong the APTT, but a mutation in the factor V gene makes factor V less susceptible to cleavage by activated protein C, resulting in increased levels of activated factor V.Heterozygotes for factor V Leiden are at an approximately five- to eight- fold increased risk of venous thrombosis compared to the general population (but only 10% of carriers will develop thrombosis in their lifetime). Homozygotes have a 30 – 140-fold increased risk. The incidence of factor V Leiden in patients with venous thrombosis is approximately 20 – 40%. It does not increase the risk of arterial thrombosis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 87
Incorrect
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You've been summoned to your Emergency Department resuscitation area to see a patient. You consider giving him an atropine shot because he is severely bradycardic.Which of the following statements about the use of atropine is correct?
Your Answer: It acts as an agonist to the action of acetylcholine
Correct Answer: It blocks the effects of the vagus nerve on both the SA and AV nodes
Explanation:At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.The most common cause of asystole during cardiac arrest is primary myocardial pathology, not excessive vagal tone, and there is no evidence that atropine is helpful in the treatment of asystole or PEA. As a result, it is no longer included in the ALS algorithm’s non-shockable section. Atropine is most commonly used in the peri-arrest period. It is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of 500 mcg IV:ShockSyncopeMyocardial ischaemiaHeart failureAtropine is also used for the following purposes:Topically as a cycloplegic and mydriatic to the eyesTo cut down on secretions (e.g. in anaesthesia)Organophosphate poisoning is treated withAtropine’s side effects are dose-dependent and include:Mouth is parchedVomiting and nauseaVision is hazyRetention of urineTachyarrhythmiasIt can also cause severe confusion and hallucinations in patients, especially the elderly.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 88
Correct
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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: 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 89
Incorrect
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A well recognised adverse effect of metoclopramide is which of the following?
Your Answer: Constipation
Correct Answer: Acute dystonic reaction
Explanation:Side effects of metoclopramide are commonly associated with extrapyramidal effects and hyperprolactinemia. Therefore its use must be limited to short-term use. Metoclopramide can induce acute dystonic reactions which involve facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young girls and young women, and in the very old. These symptoms usually occur shortly after starting treatment with this drug and subside within 24 hours of stopping it. Abortion of dystonic attacks can be carried out by injection of an antiparkinsonian drug like procyclidine.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 90
Correct
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A 45-year-old man had a painless superficial inguinal lymphadenopathy. It was later found to be malignant. Which of the following parts of the body is most likely the origin of this cancerous lymph node?
Your Answer: Anal canal
Explanation:A cancer of the anal canal below the pectinate line would spread to the superficial inguinal lymph nodes. Anal cancer often spreads through lymphatic drainage to the internal iliac lymph nodes in lesions above the pectinate line and to the superficial inguinal lymph nodes in lesions below the pectinate line.
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This question is part of the following fields:
- Abdomen
- Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY
