-
Question 1
Correct
-
A 70-year-old patient diagnosed with Cushing's syndrome, has a history of weight gain, hypertension, and easy bruising.Which of the following statements about Cushing's syndrome is NOTÂ true?Â
Your Answer: Menorrhagia is a common feature
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids.Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome.Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep. The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.Insulin resistance causes hyperglycaemia, which is a frequent symptom. Insulin resistance can produce acanthosis nigricans in the axilla and around the neck, as well as other skin abnormalities.In contrast to menorrhagia, elevated testosterone levels are more likely to produce amenorrhoea or oligomenorrhoea. Infertility in women of reproductive age can also be caused by high androgen levels.A dexamethasone suppression test or a 24-hour urine free cortisol collection can both be used to establish the existence of Cushing’s syndrome.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 2
Incorrect
-
Regarding beta-thalassaemia, which of the following statements is CORRECT:
Your Answer: The anaemia of beta-thalassaemia major is usually apparent from birth.
Correct Answer: Beta-thalassaemia trait is associated with a raised HbA2.
Explanation:Beta-thalassaemia major is caused by a complete or almost complete failure of β-globin chain synthesis, severe imbalance of α:β-chains with deposition of α-chains in erythroblasts, ineffective erythropoiesis and extramedullary haemopoiesis. The severe anaemia becomes apparent at 3 – 6 months when the switch from γ-chain to β-chain synthesis normally occurs. Beta-thalassaemia minor is a variable syndrome, milder than thalassaemia major, with later onset and characterised by moderate hypochromic microcytic anaemia with raised haemoglobin A2. Beta-thalassaemia trait is characterised by mild hypochromic, microcytic anaemia with raised red cell count and raised haemoglobin A2.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 3
Incorrect
-
A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that she has a full, plethoric aspect to her face, as well as significant supraclavicular fat pads, when you examine her. She has previously been diagnosed with Cushing's syndrome.Which of the following biochemical profiles best supports this diagnosis?
Your Answer: Hyperkalaemic metabolic alkalosis
Correct Answer: Hypokalaemic metabolic alkalosis
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.A typical biochemical profile can help establish a diagnosis of Cushing’s syndrome. The following are the primary characteristics:HypokalaemiaAlkalosis metabolique
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 4
Correct
-
Which of the following is the correct sequential order of the phases of healing:
Your Answer: Haemostasis, inflammation, proliferation, remodelling
Explanation:Acute wound healing has four main stages: haemostasis, inflammation, proliferation and remodelling.
-
This question is part of the following fields:
- Pathology
- Wound Healing
-
-
Question 5
Correct
-
Regarding probability distribution, which of the following statements is CORRECT:
Your Answer: In a negative skew, the mass of distribution is concentrated on the right.
Explanation:Distribution of data is usually unimodal (one peak) but may be bimodal (two peaks) or uniform (no peaks, each value equally likely). The normal distribution is a symmetrical bell-shaped curve. The mean, median, and mode of a normal distribution are equal. In a positive skew, the right tail is longer and the mass of distribution is concentrated on the left; mean > median > mode. In a negative skew, the left tail is longer and the mass of distribution is concentrated on the right; mean < median < mode.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 6
Incorrect
-
Which of the following increases the tendency for oedema to occur?
Your Answer: Venodilation
Correct Answer: Increased venous pressure
Explanation:When more fluid is filtered out of the capillaries than can be returned to the circulation by the lymphatics, oedema occurs. Changes that increase capillary hydrostatic pressure or decrease plasma oncotic pressure will increase filtration. Arteriolar constriction reduces hydrostatic capillary pressure and transiently increase absorption of fluid. Dehydration increases plasma protein concentration and therefore increases plasma oncotic pressure and absorption. Capillary hydrostatic pressure and filtration are increased when there is increased venous pressure.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 7
Incorrect
-
A 77 year old lady presents to ED with her left leg shortened and externally rotated following slipping and falling on a wet bathroom floor. There is an intracapsular fracture of the neck of femur seen on imaging studies. She is at risk of avascular necrosis of the head of femur. This is caused by lack of blood supply from which of these arteries?
Your Answer: Obturator artery
Correct Answer: Medial circumflex artery
Explanation:The primary blood supply to the head of the femur is from branches of the medial femoral circumflex artery. The superior and inferior gluteal arteries supply the hip joint but not the head of femur.The lateral circumflex artery anastomoses with the medial femoral circumflex artery and assists in supplying the head of femur. The obturator artery is an important source of blood supply in children up to about 8 years. It gives rise to the artery of the head of femur which runs in the ligamentum teres and is insufficient to supply the head of femur in adults.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 8
Correct
-
In patients who are not at risk of hypercapnic respiratory failure but are requiring oxygen, the oxygen saturations should be maintained at which of the following?
Your Answer: 94 - 98%
Explanation:Oxygen saturation should be 94 – 98% in most acutely ill patients with a normal or low arterial carbon dioxide (PaCO2). In some clinical situations, however, like cardiac arrest and carbon monoxide poisoning, it is more appropriate to aim for the highest possible oxygen saturation until the patient is stable.
-
This question is part of the following fields:
- Pharmacology
- Respiratory
-
-
Question 9
Correct
-
A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.Which drug is NOT likely to cause cholestatic jaundice out of the following?
Your Answer: Isoniazid
Explanation:Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.The drugs that cause cholestatic jaundice are the following:1. Nitrofurantoin2. Erythromycin3. Cephalosporins4. Verapamil5. NSAIDs6. ACE inhibitors7. Tricyclic antidepressants8. Phenytoin9. Azathioprine10. Carbamazepine11. Oral contraceptive pills12. Diazepam13. Ketoconazole14. Tamoxifen
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 10
Incorrect
-
A 71-year-old woman is treated with co-amoxiclav for a chest infection but she returns 1 week later. Her chest infection has resolved but she developed a profuse, offensive smelling diarrhoea and abdominal cramps. You suspect Clostridium difficile associated diarrhoea (CDAD).ONE of these statements is true concerning this diagnosis.
Your Answer: A positive stool culture for Clostridium difficile is the most specific test for this diagnosis
Correct Answer: The gold standard for the diagnosis of Clostridium difficile colitis is cytotoxin assay
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.Alcohol hand gel is not effective against Clostridium Difficile spores. Hand washing with soap and water is very essential for healthcare workers who come in contact with it.Currently, the gold standard for the diagnosis of Clostridium difficile colitis is cytotoxin assay. Stool culture to detect Clostridium difficile is not specific for pathogenic strains, is expensive and therefore not specific for a diagnosis of CDAD
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 11
Correct
-
Regarding Legionella species which of the following statements is CORRECT:
Your Answer: They are Gram-negative organisms.
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.The clinical features of the pneumonic form of Legionnaires’ disease include:Mild flu-like prodrome for 1-3 daysCough (usually non-productive and occurs in approximately 90%)Pleuritic chest painHaemoptysisHeadacheNausea, vomiting and diarrhoeaAnorexiaLegionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 12
Correct
-
Which of the following best describes the order in which blood passes through the nephron?Â
Your Answer: Afferent arteriole→Glomerular capillary→Efferent arteriole→Peritubular capillary→Vasa recta
Explanation:The nephron’s blood flow is as follows:Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa recta – Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa rectaThe kidney is the only vascular network in the body with two capillary beds. With arterioles supplying and draining the glomerular capillaries, higher hydrostatic pressures at the glomerulus are maintained, allowing for better filtration. A second capillary network at the tubules enables for secretion and absorption in the tubules, as well as concentrating urine.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 13
Correct
-
Gallstones are commonly found lodged in which of the following parts of the gallbladder?
Your Answer: Neck
Explanation:There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 14
Incorrect
-
Epigastric pain and haematemesis present in a 67-year-old man. In the emergency room, he is stabilised and referred to the on-call medical team. He has been scheduled for an endoscopy in the morning due to a suspected peptic ulcer. Before transferring him to the ward, you consider giving him a proton pump inhibitor (PPI).Which of the following doses and routes are the best?
Your Answer: Omeprazole 80 mg intravenously
Correct Answer: A PPI should not be prescribed
Explanation:PPIs should not be used prior to endoscopic therapy when an early endoscopic examination is performed within 24 hours of admission, according to current recommendations.High-dose PPI therapy reduces the risk of rebleeding and surgery after endoscopic treatment of severe peptic ulcer bleeding. Both oral and intravenous PPIs produce similar results, and there is no discernible benefit to using the intravenous formulation in patients who can tolerate oral medication.
-
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
-
-
Question 15
Correct
-
Question 16
Correct
-
In the Kaplan-Meier plot, which of the following labels should be applied to the X-axis?
Your Answer: Time in years
Explanation:Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death, is called as survival time and the analysis of group data as survival analysis. The graph plotted between estimated survival probabilities/estimated survival percentages (on Y axis) and time past after entry into the study (on X axis) consists of horizontal and vertical lines.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 17
Incorrect
-
A six-year-old boy presents with coryzal symptoms that have persisted for more than two weeks. He was born and raised in the Middle East. His mother claims he has been tired and has complained of various 'aches and pains.' On examination, you find splenomegaly and enlarged cervical lymph nodes. His legs and arms are covered in petechiae.In this case, what is the most likely diagnosis?
Your Answer: Aplastic anaemia
Correct Answer: Acute lymphoblastic leukaemia (ALL)
Explanation:ALL is the most common leukaemia in children, with a peak incidence between the ages of 2 and 5.ALL has a wide range of clinical symptoms, but many children present with an acute illness that resembles coryza or a viral infection. ALL also has the following features:Weakness and sluggishness all overMuscle, joint, and bone pain that isn’t specificAnaemiaPetechiae and unexplained bruisingOedemaLymphadenopathyHepatosplenomegalyThe following are typical features of a full blood count in patients with ALL:Anaemia (normocytic or macrocytic)Leukopenia affects about half of the patients (WCC 4 x 109/l).Around 25% of patients have leucocytosis (WCC > 10 x 109/l).Around 25% of patients have hyperleukocytosis (WCC > 50 x 109/l).Thrombocytopaenia
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 18
Incorrect
-
Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:
Your Answer: Boyle's law
Correct Answer: Dalton's law
Explanation:Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 19
Incorrect
-
Which of the following best describes the process of opsonisation:
Your Answer: Direct neutralisation of bacterial toxins and viruses by antibodies
Correct Answer: The coating of foreign particles with molecules which allow easier recognition of that cell by phagocytes
Explanation:An opsonin is any molecule that enhances phagocytosis by marking an antigen for an immune response, for example, immunoglobulin or complement. Opsonisation is the molecular mechanism whereby molecules, microbes, or apoptotic cells are chemically modified to have a stronger attraction to the cell surface receptors on phagocytes and natural killer cells. With the antigen coated in opsonins, binding to immune cells is greatly enhanced. Opsonisation also mediates phagocytosis via signal cascades from cell surface receptors.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 20
Incorrect
-
A 74-year-old woman with a history of ischaemic heart disease and heart failure is complaining of worsening oedema, bloating, and a loss of appetite. She has ascites and peripheral oedema on examination. Her oedema is being controlled by an oral diuretic, but it appears that this is no longer enough. You discuss her care with the on-call cardiology registrar, who believes she is very likely to have significant gut oedema that is interfering with her diuretic absorption and that she will need to change her medication.Which of the following oral diuretics is most likely to help you overcome this problem?
Your Answer: Bendroflumethiazide
Correct Answer: Bumetanide
Explanation:Bumetanide is primarily used in patients with heart failure who have failed to respond to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency. In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. As a result, when it has a better bioavailability than furosemide, it is commonly used in patients with gut oedema.When taken alone, Bendroflumethiazide is a moderately potent diuretic that is unlikely to control her oedema.Mannitol is a type of osmotic diuretic used to treat cerebral oedema and high intracranial pressure.Acetazolamide is a weak diuretic that inhibits carbonic anhydrase. It’s a rare occurrence.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 21
Correct
-
If a patient dislocated his right shoulder and has been referred to the orthopaedic outpatient department for a follow-up after a successful reduction, which of the following is the most important position for him to avoid holding his arm in until he is seen in the clinic?
Your Answer: Arm at 90 degrees to side with palm up
Explanation:The arm should be placed in a poly-sling that should be worn for about two weeks. A physiotherapist may give gentle movements for the arm to help in reducing stiffness and in relieving the pain. It is important that the patient must avoid positions that could cause re-dislocation.The most important position to avoid is the arm being held out at 90 degrees to the side with the palm facing upwards, especially if a force is being applied.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 22
Incorrect
-
Which of the following is NOT a common side effect of diazepam:
Your Answer: Amnesia
Correct Answer: Bradycardia
Explanation:Adverse effects include:Drowsiness and lightheadednessConfusion and ataxia (especially in the elderly), amnesia, muscle weaknessHeadache, vertigo, tremor, dysarthria, hypotension, decreased libido, erectile dysfunction, gynaecomastia, urinary retentionParadoxical effects such as talkativeness, excitement, irritability, aggression, anti-social behaviour, and suicidal ideationWithdrawal symptoms, for example anxiety, depression, anorexia, impaired concentration, insomnia, abdominal cramps, palpitations, tremor, tinnitus and perceptual disturbancesTolerance and dependence (people who use benzodiazepines longer term can develop tolerance and eventual dependence)
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 23
Incorrect
-
What type of pump is the Na+/K+ATPase pump?
Your Answer: An example of secondary active transport
Correct Answer: An antiporter
Explanation:In order for primary active transport to pump ions against their electrochemical gradient, chemical energy is used in the form of ATP. This is facilitated by the Na+/K+-ATPase antiporter pump, which uses metabolic energy to move 3 Na+ions out of the cell for every 2 K+ions that come in, against their respective electrochemical gradients. As a result, the cell the maintains a high intracellular concentration of K+ions and a low concentration of Na+ions.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 24
Incorrect
-
Which of the following statements is considered correct regarding Klebsiella infections?
Your Answer: Klebsiella pneumoniae is most commonly associated with chronic bronchiectasis
Correct Answer: Klebsiella spp. are non-motile
Explanation:Klebsiella is a Gram-negative, rod-shaped, non-motile bacteria. The absence of motility distinguishes Klebsiella spp. from most other members of the family Enterobacteriaceae. K. pneumoniae is the most commonly isolated species and has the distinct feature of possessing a large polysaccharide capsule. The capsule offers the organism protection against phagocytosis and antimicrobial absorption,contributing to its virulence. Colonization of gram-negative bacilli in the respiratory tracts of hospitalized patients, particularly by K. pneumoniae, increases with the length of hospital stay. It is a frequent cause of lower respiratory tract infections among hospitalized patients and in immunocompromised hosts such as newborns,elderly patients, and seriously ill patients on respirators.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 25
Correct
-
A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb. The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers. Which of these nerve(s) has most likely been affected?
Your Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:Loss of sensation to the lateral palm and the lateral three and a half fingers.Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals. Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialisWeakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 26
Incorrect
-
A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?
Your Answer: Set up transcutaneous pacing
Correct Answer: Give atropine 500 mcg
Explanation:Atropine 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 atropine 500 mcg IV:ShockSyncopeMyocardial ischemiaInsufficiency of the heartIf this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.The ALS bradycardia algorithm also suggests the following interim measures:Transcutaneous pacingIsoprenaline infusion 5 mcg/minAdrenaline infusion 2-10 mcg/minutesAlternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate)
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 27
Incorrect
-
Digoxin exhibits its positive inotropic effect by which of the following mechanisms:
Your Answer: Inhibits the Na+/Ca2+ exchanger on the myocyte membrane
Correct Answer: Inhibits the Na+/K+ pump on the myocyte membrane
Explanation:Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump (Na+/K+ATPase) which generates the Na+gradient required for driving the export of Ca2+by Na+/Ca2+exchange; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 28
Correct
-
A 42-year-old woman presents with face swelling prominently affecting her upper lip and hands. She has previously been diagnosed with hereditary angioedema.Which of these is the most appropriate management option for this acute attack?
Your Answer: Fresh frozen plasma
Explanation:Hereditary angioedema is inherited as an autosomal dominant disorder and is caused by deficiency of C1 esterase inhibitor, a protein that forms part of the complement system.Attacks can be precipitated by stress and minor surgical procedures. Clinical features of hereditary angioedema include oedema of the skin and mucous membranes commonly affecting the face, tongue and extremities.Angioedema and anaphylaxis due to a deficiency of C1 esterase inhibitor are resistant to adrenaline, steroids and antihistamines. Treatment is with fresh frozen plasma or C1 esterase inhibitor concentrate, which contains C1 esterase inhibitor.Short-term prophylaxis for events that may precipitate angioedema attack is achieved with C1 esterase inhibitor or fresh frozen plasma infusions before the event while long-term prophylaxis can be achieved with antifibrinolytic drugs (tranexamic acid) or androgenic steroids.
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 29
Correct
-
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.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 30
Correct
-
A 32-year old male patient has been diagnosed with meningococcal meningitis and was given appropriate treatments. Because he is a family man, he fears that he might transmit the infection to the rest of his family members. The causative agent of meningococcal meningitis is spread via what mode of transmission?
Your Answer: Respiratory droplet route
Explanation:N. meningitidis, the causative agent of meningococcal meningitis, is considered both a commensal and a pathogen. It can be found in the surfaces of mucous membranes such as the nasopharynx and oropharynx. With this, it can be transmitted from a carrier to a new host via respiratory droplet secretions.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 31
Correct
-
The following structures all lie anteriorly to the oesophagus EXCEPT for the:
Your Answer: Thoracic duct
Explanation:Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 32
Correct
-
A 2nd-year medical student is solving an exam paper with questions about the immune system. She comes across a question regarding innate immunity. Innate immunity is the immunity naturally present within the body from birth. Which ONE of the following is not a part of this type of immunity?
Your Answer: Antibody production
Explanation:Innate immunity, also called non-specific immunity, refers to the components of the immune system naturally present in the body at birth. The components of innate immunity include: 1) Natural Killer Cells 2) Neutrophils 3) Macrophages 4) Mast Cells 5) Dendritic Cells 6) Basophils. Acquired or adaptive immunity is acquired in response to infection or vaccination. Although the response takes longer to develop, it is also a more long-lasting form of immunity. The components of this system include: 1) T lymphocytes 2) B lymphocytes 3) Antibodies
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 33
Incorrect
-
The following statements about cross-sectional studies are true EXCEPT?
Your Answer: They do not differentiate between cause and effect
Correct Answer: They can be used to determine the relative risk of a condition
Explanation:The UK national census is an example of a cross-sectional study.Cross-sectional studies can be used to assess the prevalence of a condition, and support or refute inferences of cause and effect.Cross-sectional studies are observations of the frequency and characteristics of a disease in a given population at one particular point in time. Cross-sectional studies do not differentiate between cause and effect and also do not establish the sequence of events.Cross-sectional studies cannot be used to calculate the relative risk of a condition.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 34
Incorrect
-
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: Trimethoprim
Correct 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
-
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 35
Correct
-
In the emergency department, a 50-year-old female appears with a lack of sensation over the front two-thirds of her tongue. Taste and salivation are both present. The patient might have damage which of her nerves?
Your Answer: Lingual nerve
Explanation:The lingual nerve, a branch of the mandibular nerve, transmits sensation to the anterior two-thirds of the tongue. The chorda tympani, a branch of the facial nerve, transmits taste to the front two-thirds of the tongue as well as secretomotor innervation to the submandibular and sublingual glands. As a result, any damage to the lingual nerve can cause changes in salivary secretion on the affected side, as well as a loss of taste in the anterior two-thirds of the tongue and temporary or permanent sensory changes in the anterior two-thirds of the tongue and the floor of the mouth.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 36
Correct
-
A 61-year-old man complains of crushing chest pain that radiates to his left arm and jaw. An ECG is taken, and the lateral leads show extensive ST depression. His blood pressure is currently 190/123 mmHg, and as part of his treatment, you intend to begin drug therapy to lower it.Which of the following is the INITIAL drug treatment for this patient's BP reduction?
Your Answer: Glyceryl trinitrate
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.In the presence of cardiac ischaemia, hypertensive emergencies require immediate treatment to prevent myocardial infarction. Similarly, if myonecrosis occurs in the presence of an existing infarction, prompt treatment is required to prevent further myonecrosis. When thrombolysis is used as the primary reperfusion therapy for acute myocardial infarction, blood pressure control is especially important.An intravenous nitrate is the drug of choice in this situation (e.g. GTN). These have a dual purpose in that they can help patients with ischaemic chest pain manage their symptoms. Because lowering blood pressure with nitrates isn’t always enough to achieve optimal results, intravenous beta-blockers are frequently used as a supplement. For this, intravenous atenolol and metoprolol are commonly used.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 37
Incorrect
-
A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer: Femoral nerve
Correct Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.Peroneus longus is innervated by the superficial peroneal nerve.Peroneus tertius is innervated by the deep peroneal nerve.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 38
Incorrect
-
A 21-year-old student presents with fever, headache, malaise, fatigue, and muscle aches after returning from a trip to India. A diagnosis of malaria was suspected.Which of the following statements is considered correct regarding malaria?
Your Answer: Diagnosis is normally by ELISA testing
Correct Answer: Haemoglobinuria and renal failure following treatment is suggestive of Plasmodium falciparum
Explanation:Malaria results from infection with single-celled parasites belonging to the Plasmodium genus. Five species of Plasmodium are known to cause disease in humans: P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Chloroquine remains the mainstay of treatment for uncomplicated vivax malaria.The female Anopheles mosquito serves as the biologic vector and definitive host. A complication of infection with P. falciparum is blackwater fever, a condition characterized by haemoglobinuria. Plasmodium ovale has the longest incubation period, which can be up to 40 days. Plasmodium falciparum has a shorter incubation period of 7-14 days.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 39
Incorrect
-
C3 deficiency leads to particular susceptibility of infection with which of the following:
Your Answer: Candida
Correct Answer: Encapsulated bacteria
Explanation:Macrophages and neutrophils have C3b receptors and they phagocytose C3b-coated cells. C3 deficiency thus leads to increased susceptibility of infection with encapsulated organisms (e.g. S. pneumoniae, H. influenzae).The early stages of the complement cascade leading to coating of the cells with C3b can occur by two different pathways:The classical pathway usually activated by IgG or IgM coating of cellsThe alternative pathway which is more rapid and activated by IgA, endotoxin and other factors
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 40
Incorrect
-
C5 - C9 deficiency increases susceptibility to infection with which of the following:
Your Answer: Candida
Correct Answer: Neisseria spp.
Explanation:If the complement sequence is completed, an active phospholipase (the membrane attack complex, MAC) is produced, which punches holes in the cell membrane and causes cell lysis. Because the MAC appears to be the sole means to destroy the Neisseria family of bacteria, C5 – C9 deficiency increases susceptibility to Neisseria infections.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 41
Correct
-
Which one of the listed cells are typically found in a granuloma?
Your Answer: Epithelioid cells
Explanation:Typically, granuloma has Langhan’s cells (large multinucleated cells ) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.Antigen presenting monocytic cells found in the skin are known as Langerhan’s cells.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 42
Correct
-
A patients had a left Colles' fracture, which you were able to repair. It was their second fragility fracture this year, and you'd like to provide them some tips on how to keep their bones healthy.What percentage of the calcium in the body is kept in the bones? Only ONE response is acceptable.
Your Answer: 99%
Explanation:Calcium is stored in bones for nearly all of the body’s calcium, but it is also found in some cells (most notably muscle cells) and the blood. The average adult diet comprises roughly 25 mmol of calcium per day, of which the body absorbs only about 5 mmol.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 43
Incorrect
-
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 shows X-linked recessive inheritance
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.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 44
Incorrect
-
Glomerular filtration rate can be calculated using any substance that:
Your Answer: is freely filtered and secreted by the nephron
Correct Answer: is freely filtered and neither reabsorbed nor secreted by the nephron
Explanation:Clearance of a substance can provide an accurate estimate of the glomerular filtration rate (GFR) provided that the substance is:freely filterednot reabsorbed in the nephronnot secreted in the nephronnot synthesised or metabolised by the kidney
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 45
Incorrect
-
In adults in the United Kingdom, which of the following pathogens is the most likely cause of viral infectious gastroenteritis:
Your Answer: Rhinovirus
Correct Answer: Norovirus
Explanation:Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhoea in community settings. In the United Kingdom, norovirus has become the most common cause of gastroenteritis in adults and children since the introduction of rotavirus vaccination.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 46
Correct
-
A 78-year-old male presents to the Orthopaedic clinic with lower back pain for the past month. His past medical history reveals a history of cancer. After examination, you diagnose Metastatic Spinal Cord Compression (MSCC). Which one of the following cancers is this patient most likely to have had?
Your Answer: Prostate cancer
Explanation:Compression of the thecal sac causes metastatic Spinal Cord Compression (MSCC) due to a Metastatic tumour and its components. It can cause symptoms of limb weakness, sensory disturbances and back pain depending on the extent and level of Compression. The most common source of a tumour causing MSCC is a prostate carcinoma that metastasized to the spinal cord via the vertebral venous plexus.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 47
Incorrect
-
A 40-year-old man with reduced urine output, nausea, and confusion also has a 150% rise of creatinine from baseline over the past 7 days. A diagnosis of acute kidney injury (AKI) is made after more tests are done.His AKI stage is?
Your Answer: Stage 1
Correct Answer: Stage 2
Explanation:This patient with a 150% rise of creatinine above baseline within 7 days has stage 2 Acute kidney injury (AKI).AKI stages are as follows:Stage 1Creatinine rise of 26 micromole/L or more within 48 hours, orCreatinine rise of 50-99% from baseline within 7 days (1.5-1.99 x baseline),orUrine output <0.5 mL/kg/hour for more than 6 hoursStage 2Creatinine rise of 100-199% from baseline within 7 days (2.0-2.99 x baseline),orUrine output <0.5 mL/kg/hour for more than 12 hoursStage 3Creatinine rise of 200% or more from baseline within 7 days (3.0 or more x baseline), orCreatinine rise to 354 micromole/L or more with acute rise of 26 micromole/L or more within 48 hours or 50% or more rise within 7 days, orUrine output <0.3 mL/kg/hour for 24 hours or anuria for 12 hours
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 48
Incorrect
-
A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms have been steadily deteriorating, with no intervals of remission in sight.Which of the following aspects of nerve conduction is disrupted by multiple sclerosis?
Your Answer: Membrane resting potential
Correct Answer: Saltatory conduction
Explanation:Local currents propagate action potentials down the axons of neurons. This local current flow following depolarisation results in the depolarisation of the neighbouring axonal membrane, and when this region approaches the threshold, more action potentials are generated and so forth. Due to the refractory period, portions of the membrane that have recently depolarized will not depolarize again, resulting in the action potential only being able to go in one direction.The square root of axonal diameter determines the velocity of the action potential; the axons with the biggest diameter have the quickest conduction velocities. When a neuron is myelinated, the speed of the action potential rises as well.The myelin sheath is an insulating coating that surrounds certain neural axons. By increasing membrane resistance and decreasing membrane capacitance, the myelin sheath improves conduction. This enables faster electrical signal transmission via a neuron, making them more energy-efficient than non-myelinated neuronal axons.Electrical impulses are quickly transmitted from one node to the next, causing depolarization of the membrane above the threshold and triggering another action potential, which is then transmitted to the next node. An action potential is rapidly conducted down a neuron in this manner. Saltatory conduction is the term for this.Multiple sclerosis is an example of a clinical disorder in which the myelin sheath is affected. It is an immune-mediated disorder in which certain nerve cells in the brain and spinal cord become demyelinated. The ability of some areas of the nervous system to properly transmit action potentials is disrupted by demyelination, resulting in a variety of neurological symptoms and indications.
-
This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
-
-
Question 49
Correct
-
Fibrinoid necrosis is typically seen in which of the following:
Your Answer: Malignant hypertension
Explanation:Fibrinoid necrosis occurs in malignant hypertension where increased arterial pressure results in necrosis of smooth muscle wall. Eosinophilic and fibrinous deposits are seen.
-
This question is part of the following fields:
- Inflammatory Responses
- Pathology
-
-
Question 50
Correct
-
An ambulance transports a 37-year-old woman who is having a seizure. She is moved to resuscitation and given a benzodiazepine dose, which quickly ends the seizure. You later learn that she has epilepsy and is usually treated with carbamazepine to control her seizures.What is carbamazepine's main mechanism of action?
Your Answer: Sodium channel blocker
Explanation:Carbamazepine is primarily used to treat epilepsy, and it is effective for both focal and generalised seizures. It is not, however, effective in the treatment of absence or myoclonic seizures. It’s also commonly used to treat neuropathic pain, as well as a second-line treatment for bipolar disorder and as a supplement for acute alcohol withdrawal.Carbamazepine works as a sodium channel blocker that preferentially binds to voltage-gated sodium channels in their inactive state. This prevents an action potential from firing repeatedly and continuously.
-
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
