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Question 1
Incorrect
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A 60 yr. old man with previous history of myocardial infarction and hypertension presented with severe retrosternal chest pain for the past 2 hours. During initial management he collapsed and pulseless ventricular tachycardia was detected. The external defibrillator arrived in 3 minutes. From the following answers, what is the most appropriate immediate management of this patient?
Your Answer: Continuous chest compressions should be started
Correct Answer: He should be given a precordial thump
Explanation:A precordial thumb is not routinely recommended because of its very low success rate for cardioversion of a shockable rhythm. It’s only recommended when there is a delay in getting the defibrillator.
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This question is part of the following fields:
- Cardiology
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Question 2
Incorrect
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A 56-year-old woman has a family history of haemochromatosis and is homozygous for the C282Y mutation. Her ferritin is 927 mg/L (normal range 15-150), haemoglobin 12.5 g/dL (normal range 11.5-16) and aspartate aminotransferase 87 U/L (normal range <40). Which is the best course of action?
Your Answer: Intravenous desferrioxamine
Correct Answer: Weekly venesection to drop her ferritin into the low-normal range
Explanation:Venesection should be done (essentially blood-letting) to decrease the too-high ferratin level. IV Desterrioxamine would have the opposite effect. ASA does not have to do with ferritin. You do not just watch this and recheck. And you do not want to make the patient anaemic.
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This question is part of the following fields:
- Gastroenterology
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Question 3
Incorrect
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What kind of receptor is the nitric oxide receptor?
Your Answer: MAPK/ERK receptor
Correct Answer: Guanylate cyclase receptor
Explanation:Soluble guanylyl cyclase (GC-1) is the primary receptor of nitric oxide (NO) in smooth muscle cells and maintains vascular function by inducing vasorelaxation in nearby blood vessels. GC-1 converts guanosine 5′-triphosphate (GTP) into cyclic guanosine 3′,5′-monophosphate (cGMP), which acts as a second messenger to improve blood flow.
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This question is part of the following fields:
- Clinical Sciences
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Question 4
Correct
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Which of the following is true concerning baclofen?
Your Answer: Causes hallucinations when withdrawn
Explanation:Baclofen is used to treat spastic movement symptoms such as those seen in cerebral palsy and multiple sclerosis. It is known to be associated with a withdrawal syndrome similar to alcohol withdrawal; thus, gradual withdrawal is necessary to avoid this.
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This question is part of the following fields:
- Neurology
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Question 5
Correct
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A 28-year-old woman is referred to the endocrinology clinic. She has been trying to conceive for the last 3 years without any success. Her prolactin level is 2600 mU/l (normal <360). The Endocrinologist arranges pituitary magnetic resonance imaging (MRI) that demonstrates a microprolactinoma. Which two of the following pharmacological agents may be appropriate treatment choices?
Your Answer: Carbergoline
Explanation:Cabergoline, an ergot derivative, is a long-acting dopamine agonist. It is usually better tolerated than Bromocriptine (BEC), and its efficacy profiles are somewhat superior to those of BEC. It offers the convenience of twice-a-week administration, with a usual starting dose of 0.25 mg biweekly to a maximum dose of 1 mg biweekly. Some studies have shown efficacy even with once-a-week dosing. Cabergoline appears to be more effective in lowering prolactin levels and restoring ovulation. Up to 70% of patients who do not respond to BEC respond to cabergoline.
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This question is part of the following fields:
- Endocrinology
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Question 6
Incorrect
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According to the Vaughan William's classification of antiarrhythmic agents, lidocaine is a:
Your Answer: Class IV agent
Correct Answer: Class Ib agent
Explanation:Lidocaine is an example of class IB antiarrhythmics.
The Vaughan-Williams classification of antiarrhythmics
I: Membrane stabilizing agents
IA: Quinidine, Procainamide, Disopyramide
IB: Lidocaine, Mexiletine
IC: Propafenone, Flecainide
II: β blockers – Propranolol, Esmolol
III: Agents widening AP – Amiodarone, Dronedarone, Dofetilide, Ibutilide, Sotalol
IV: Calcium channel blockers – Verapamil, Diltiazem
V: Miscellaneous – Digoxin, adenosine, magnesium -
This question is part of the following fields:
- Pharmacology
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Question 7
Correct
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A 14-day-old baby presented in NICU with the signs and symptoms of hydrocephaly, seizures and chorioretinitis. Which of the following infectious agents is most probably the cause in a case like this?
Your Answer: Cytomegalovirus (CMV)
Explanation:CMV is a common virus in the herpesvirus family that can cause serious illness in newborns when contracted congenitally from the mother during pregnancy. Congenital CMV infection can lead to various neurological manifestations, including hydrocephaly (enlargement of the fluid-filled spaces within the brain), seizures, and chorioretinitis (inflammation of the retina in the eye). These symptoms can result in significant morbidity and long-term complications for the affected infant.
Other congenital infections such as toxoplasmosis, rubella, herpes simplex virus (HSV), and syphilis can also cause similar symptoms in newborns. However, given the presentation described, CMV is the most likely infectious agent.
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This question is part of the following fields:
- Infectious Diseases
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Question 8
Correct
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A 27 year old female has been taken to A&E from a cinema after complaining of sudden severe pain in the eyes. This is followed by seeing coloured halos and vomiting. She has a history of reoccurring headaches which used to resolve themselves. She is examined and is found to have a fixed, dilated ovoid pupil. Choose the most appropriate first investigation from the list.
Your Answer: Applanation tonometry
Explanation:The darkness of the cinema room will have caused halfway dilation of the pupil. This can cause an acute attack of angle closure glaucoma. The appropriate test to diagnose this is applanation tonometry.
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This question is part of the following fields:
- Ophthalmology
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Question 9
Incorrect
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Which one of the following statements regarding nitric oxide is incorrect?
Your Answer: In sepsis increased levels of NO contribute to septic shock
Correct Answer: Promotes platelet aggregation
Explanation:Nitric oxide, known as an endothelium-derived relaxing factor (EDRF), is biosynthesized endogenously from L-arginine, oxygen, and NADPH by various nitric oxide synthase (NOS) enzymes and is a signaling molecule in many physiological and pathological processes in humans.
One of the main enzymatic targets of nitric oxide is guanylyl cyclase. The binding of nitric oxide to the haem region of the enzyme leads to activation, in the presence of iron. -
This question is part of the following fields:
- Clinical Sciences
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Question 10
Incorrect
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A 28 year old man was rushed to the hospital after experiencing sudden onset chest pain while playing football. He has never felt such pain in the past. However, one of his uncles had a similar sudden discomfort at a young age and he passed away following a heart problem. The following vitals are recorded on examination: BP: 101/74 mmHg RR: 22 breaths/min PR: 87 beats/min Physical examination reveals abnormally long fingers and on asking the man to hold the opposite wrist, the thumb and little finger overlap each other. He is not taking any medication regularly and past medical/surgical history is not significant. He admits to smoking half pack of cigarettes/day for the last 10 years but denies abusing any illicit drugs. Which of the following explanation most likely explains the disease process in this man?
Your Answer: Impaired hydroxylation of lysine and proline amino acids on collagen
Correct Answer: A defect of the glycoprotein structure which usually wraps around elastin
Explanation:Aortic dissection is defined as separation of the layers within the aortic wall. Tears in the intimal layer result in the propagation of dissection (proximally or distally) secondary to blood entering the intima-media space. This can be caused as a result of both congenital or acquired factors like chronic uncontrolled hypertension. This patient shows no sign of hypertension but his physical examination hints towards Marfan Syndrome. Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting the microfibrils and elastin in connective tissue throughout the body. MFS is associated with pathological manifestations in the cardiovascular system (e.g., mitral valve prolapse, aortic aneurysm, and dissection), the musculoskeletal system (e.g., tall stature with disproportionately long extremities, joint hypermobility), and the eyes (e.g., subluxation of the lens of the eye). Decreased collagen production occurs in ageing, hydroxylation defects are present in vitamin C deficiency, copper deficiency affecting lysyl oxidase enzyme occurs in Menke’s disease.
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This question is part of the following fields:
- Rheumatology
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