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Question 1
Correct
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Question 2
Incorrect
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Which of the following is NOT a typical effect of cortisol:
Your Answer: Increased glycolysis
Correct Answer: Decreased protein catabolism
Explanation:Cortisol is a steroid hormone produced in the zona fasciculata of the adrenal cortex. It is released in response to stress and low blood glucose concentrations.Cortisol acts to: raise plasma glucose by stimulating glycolysis and gluconeogenesis in the liver and inhibiting peripheral glucose uptake into storage tissues, increase protein breakdown in skeletal muscle, skin and bone to release amino acids, increase lipolysis from adipose tissues to release fatty acidsand at higher levels and mimic the actions of aldosterone on the kidney to retain Na+ and water and lose K+ ionssuppress the action of immune cells
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 3
Correct
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An 82 year old man taking warfarin as a maintenance medication comes in to your clinic because of an infection. Which antibiotic is the safest choice for this patient?
Your Answer: Cefalexin
Explanation:Alterations in the international normalized ratio (INR) brought about by the concurrent use of antibiotics and warfarin may result in either excessive clotting or excessive bleeding if they are deemed to have a high risk for interaction. As such, there should be careful consideration of the class of antibiotic to be used. Antibiotics from the following drug classes should generally be avoided as they have a high risk for interaction with warfarin, possible enhancing the anticoagulant effects of warfarin resulting in bleeding: Fluoroquinolones (e.g. ciprofloxacin, levofloxacin), Macrolides (e.g. clarithromycin, erythromycin, azithromycin), Nitroimidazoles (e.g. metronidazole), Sulphonamides (e.g. co-trimoxazole, a combination of trimethoprim and sulfamethoxazole), Trimethoprim, Tetracyclines (e.g. doxycycline). Low risk antibiotics that have low risk for interaction with warfarin includes cephalexin, from the cephalosporin class, and clindamycin which is a lincomycin.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 4
Incorrect
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Which of the following clinical features is most suggestive of a lesion of the frontal lobe:
Your Answer: Receptive dysphasia
Correct Answer: Conjugate eye deviation towards the side of the lesion
Explanation:Conjugate eye deviation towards the side of the lesion is seen in damage to the frontal eye field of the frontal lobe. Homonymous hemianopia is typically a result of damage to the occipital lobe (or of the optic radiation passing through the parietal and temporal lobes). Auditory agnosia may been seen in a lesion of the temporal lobe. Hemispatial neglect may be seen in a lesion of the parietal lobe. Receptive dysphasia is seen in damage to Wernicke’s area, in the temporal lobe.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 5
Incorrect
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A 38-year-old woman presented to the emergency room after an incident of slipping and falling onto her back and left hip. Upon physical examination, it was noted that she has pain on hip flexion, but normal hip adduction. Which of the following muscles was most likely injured in this case?
Your Answer: Gracilis
Correct Answer: Sartorius
Explanation:The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 6
Correct
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You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?
Your Answer: Lidocaine works by blocking fast voltage-gated sodium channels
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 7
Incorrect
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Which of the following data types does a pain-scoring system represent?
Your Answer: Discrete
Correct Answer: Ordinal
Explanation:Pain scoring systems are processes for assessing pain and the severity of illnesses that have been scientifically designed and tested. An example of ordinal categorical data is a pain scoring system.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 8
Correct
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A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give. From the following choices, which is considered an example of bacteriostatic antibiotic?
Your Answer: Trimethoprim
Explanation:Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:Bactericidal antibioticsBacteriostatic antibioticsVancomycinMetronidazoleFluoroquinolone, such as ciprofloxacinPenicillins, such as benzylpenicillinCephalosporin, such as ceftriaxoneCo-trimoxazoleTetracyclines, such as doxycyclineMacrolides, such as erythromycinSulphonamides, such as sulfamethoxazoleClindamycinTrimethoprimChloramphenicol
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 9
Correct
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A 50-year-old man managed by the renal team for stage 4 chronic kidney disease which appears to be deteriorating presents with a history of shortness of breath and ankle oedema. His most recent blood tests shows low calcium levels.Which of these increases the renal reabsorption of calcium?
Your Answer: Parathyroid hormone
Explanation:Parathyroid hormone (PTH), a polypeptide containing 84 amino acids, is the principal hormone that controls free calcium in the body.Its main actions are:Increases osteoclastic activity Increases plasma calcium concentrationDecreases renal phosphate reabsorptionDecreases plasma phosphate concentrationIncreases renal tubular reabsorption of calciumIncreases calcium and phosphate absorption in the small intestineIncreases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 10
Correct
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A 53 year old women presents to the emergency room with a chronic cough. The pulmonary receptors likely to be involved in causing her cough are:
Your Answer: Irritant receptors
Explanation:Throughout the airways, there are irritant receptors which are located between epithelial cells which are made of rapidly adapting afferent myelinated fibres in the vagus nerve. A cough is as a result of receptor stimulation located in the trachea, hyperpnoea is as a result of receptor stimulation in the lower airway. Stimulation may also result in reflex bronchial and laryngeal constriction. Many factors can stimulate irritant receptors. These include irritant gases, smoke and dust, airway deformation, pulmonary congestion, rapid inflation/deflation and inflammation. Deep augmented breaths or sighs seen every 5 – 20 minutes at rest are due to stimulation of these irritant receptors. This reverses the slow lung collapse that occurs in quiet breathing.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 11
Incorrect
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The tetanus vaccination contains inactivated tetanus toxoid, which induces the body to produce protective antibodies. How do these antibodies protect the body from tetanus?
Your Answer: Prevent binding of C. tetani endotoxin to monocyte receptors
Correct Answer: Neutralise the protein exotoxin of C. tetani
Explanation:C. Tetanospasmin, an exotoxin produced by tetani, is responsible for the neurotoxic consequences of tetanus. The tetanus vaccination contains inactivated tetanus toxoid, which induces the body to produce protective antibodies that neutralize the tetanus toxin. It induces active immunization against Clostridium tetani exotoxin via toxoid-induced Ab generation.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 12
Incorrect
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Which of these immunoglobulin molecules can cross the placenta?
Your Answer: IgA
Correct Answer: IgG
Explanation:An important mechanism that provides protection to the foetus is placental transfer of maternal IgG antibodies while his/her humoral response is inefficient. The only antibody class that significantly crosses the human placenta is IgG.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 13
Incorrect
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A 59-year-old man presents with a goitre, increased sweating, weight loss, and palpitations. A diagnosis of hyperthyroidism is suspected.What is the most appropriate first-line investigation?
Your Answer: Thyroid peroxidase antibodies
Correct Answer: TSH level
Explanation:A thyroid function test is used in the diagnosis of hyperthyroidism.Serum TSH should be the first-line investigation for patients with suspected hyperthyroidism as it has the highest sensitivity and specificity for hyperthyroidism. A normal TSH level almost always excludes the diagnosis, though there are rare exceptions to this.Antithyroglobulin antibodies are commonly present in Graves’ disease, but the test has a sensitivity of 98% and specificity of 99, and is not widely available.Radioactive iodine uptake scan using iodine-123 – shows low uptake in thyroiditis but high in Graves’ disease and toxic multinodular goitre. It is however, not first-line investigation in this caseThyroid ultrasound scan – is a cost-effective and safe alternative to the radioactive iodine uptake scan.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 14
Incorrect
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Water is reabsorbed in which portion of the Henle loop:
Your Answer: Thick and thin ascending limbs
Correct Answer: Thin descending limb
Explanation:The loop of Henle consists of three functionally distinct segments: the thin descending segment, the thin ascending segment, and the thick ascending segment. About 20 percent of the filtered water is reabsorbed in the loop of Henle and almost all of this occurs in the thin descending limb. Na+ and Cl-ions are actively reabsorbed from the tubular fluid in the thick ascending limb via the Na+/K+/2Cl-symporter on the apical membrane. Because the thick ascending limb is water-impermeable, ion reabsorption lowers tubular fluid osmolality while raising interstitial fluid osmolality, resulting in an osmotic difference. Water moves passively out of the thin descending limb as the interstitial fluid osmolality rises, concentrating the tubular fluid. This concentrated fluid descends in the opposite direction of fluid returning from the deep medulla still higher osmolality areas.
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This question is part of the following fields:
- Physiology
- Renal
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Question 15
Correct
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Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS) in a patient infected with HIV:
Your Answer: CD4 count < 200 cells/uL
Explanation:A diagnosis of AIDS can be made in a patient infected with HIV if the patient has a CD4 count < 200 cells/uL, or an AIDS-defining illness. Antiretroviral treatment should be considered in patients with CD4 counts < 350 cells/uL. Oral candidiasis is not an AIDS defining illness – candidiasis of the bronchi, trachea or lungs or of the oesophagus is an AIDS defining illness. A positive p24 antigen test seen in early HIV infection and does not indicate the development of AIDS.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 16
Correct
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Cystic fibrosis patients have a weakened lung surfactant system. Which of the following cell types is in charge of surfactant secretion?
Your Answer: Type II pneumocytes
Explanation:Alveolar type II cells are responsible for four primary functions: surfactant synthesis and secretion, xenobiotic metabolism, water transepithelial transport, and alveolar epithelium regeneration following lung injury.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 17
Incorrect
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Osteoclasts are a type of bone cell that are critical in the maintenance, repair and remodelling of bones.Which of the following inhibits osteoclast activity? Select ONE answer only.
Your Answer: Parathyroid hormone
Correct Answer: Calcitonin
Explanation:Osteoclasts are a type of bone cell that breaks down bone tissue. This is a critical function in the maintenance, repair and remodelling of bones. The osteoclast disassembles and digests the composite of hydrated protein and minerals at a molecular level by secreting acid and collagenase. This process is known as bone resorption and also helps to regulate the plasma calcium concentration.Osteoclastic activity is controlled by a number of hormones:1,25-dihydroxycholecalciferol increases osteoclastic activityParathyroid hormone increases osteoclastic activityCalcitonin inhibits osteoclastic activityBisphosphonates are a class of drug that slow down and prevent bone damage. They are osteoclast inhibitors.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 18
Correct
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Surface area of the absorptive surface in the small intestine is increased by all but which of the following:
Your Answer: Teniae coli
Explanation:Factors increasing the surface area include:The small intestine is very long – about 5 m in length.The inner wall of the small intestine is covered by numerous folds of mucous membrane called plicae circulares.The lining of the small intestine is folded into many finger-like projections called villi.The surface of the villi is covered with a layer of epithelial cells which, in turn, have many small projections called microvilli that project towards the lumen of the intestine (forming the brush border).
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 19
Correct
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A 40-year-old woman presents with a red, scaly, itchy rash around her navel that occurred after contact with a nickel belt buckle. A diagnosis of allergic contact dermatitis is made. Which type of hypersensitivity reaction is this?
Your Answer: Type IV hypersensitivity reaction
Explanation:A type IV hypersensitivity reaction occurred in this patient. Allergic contact dermatitis is an inflammatory skin reaction occurring in response to an external stimulus, acting either as an allergen or an irritant, caused by a type IV or delayed hypersensitivity reaction. They usually take several days to develop.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 20
Incorrect
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Regarding Clostridium species, which of the following statements is INCORRECT:
Your Answer: They are rod-shaped.
Correct Answer: They are facultative anaerobes.
Explanation:Clostridium spp. are obligatory anaerobic spore-forming Gram-positive bacilli. Toxin production is the main pathogenicity mechanism.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Correct
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Arterial baroreceptors are located primarily in which of the following:
Your Answer: Carotid sinus and aortic arch
Explanation:Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 22
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 23
Correct
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Question 24
Incorrect
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A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke. Which of the following is considered the best diagnosis for the case presented above?
Your Answer: Lateral medullary syndrome
Correct Answer: Medial medullary syndrome
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 25
Incorrect
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Nitric oxide release from endothelium is stimulated by all of the following EXCEPT for:
Your Answer: Histamine
Correct Answer: Noradrenaline
Explanation:Nitric oxide (NO) production by the endothelium is increased by factors that elevate intracellular Ca2+, including local mediators such as bradykinin, histamine and serotonin, and some neurotransmitters (e.g. substance P). Increased flow (shear stress) also stimulates NO production and additionally activates prostacyclin synthesis. The basal production of NO continuously modulates vascular resistance; increased production of nitric oxide acts to cause vasodilation. Nitric oxide also inhibits platelet activation and thrombosis.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 26
Incorrect
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Which of the following does NOT typically cause a neutrophil leucocytosis:
Your Answer: Myeloproliferative disorders
Correct 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 27
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 28
Incorrect
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A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis on indwelling metal work and no known drug allergies. He has had a recent skin swab that has cultured MRSA and MRSA infection is suspected.Which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.
Your Answer: Co-amoxiclav
Correct Answer: Vancomycin
Explanation:In the majority of patients the commonest causative organism for osteomyelitis isStaphylococcus aureus.Salmonella spp. are the commonest cause in patients with sickle cell disease.Other bacteria that can cause osteomyelitis include:Enterobacter spp.Group A and B streptococcusHaemophilus influenzaeThe current recommendations by NICE and the BNF on the treatment of osteomyelitis are:Flucloxacillin first-lineConsider adding fusidic acid or rifampicin for initial 2 weeksIf penicillin allergic use clindamycinIf MRSA is suspected use vancomycinSuggested duration of treatment is 6 weeks for acute infection
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 29
Incorrect
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Thyroid cancer has spread to the regional lymph nodes of a patient as seen in a staging CT scan. The lymph from the thyroid gland will drain directly to which of the following nodes?
Your Answer: Submandibular lymph nodes
Correct Answer: Deep lateral cervical lymph nodes
Explanation:Lymphatic drainage of the thyroid gland involves the lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes. The paratracheal and lower deep cervical nodes, specifically, receive lymphatic drainage from the isthmus and the inferior lateral lobes. The superior portions of the thyroid gland drain into the superior pretracheal and cervical nodes.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 30
Incorrect
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When calculating the ventilation over perfusion ratio of a male patient, you should remember the ideal V/Q ratio for this patient to compare with his results. What is the approximate ventilation value for a healthy male patient?
Your Answer: 7.5 L/min
Correct Answer: 5 L/min
Explanation:The ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching ventilation and perfusion. The ideal V/Q ratio is 1. In an average healthy male, the ventilation value is approximately 5 L/min and the perfusion value is approximately 5 L/min. Any mismatch between ventilation and perfusion will be evident in the V/Q ratio. If perfusion is normal but ventilation is reduced, the V/Q ratio will be less than 1, whereas if ventilation is normal but perfusion is reduced, the V/Q ratio will be greater than 1. If the alveoli were ventilated but not perfused at all, then the V/Q ratio would be infinity.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
