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Question 1
Correct
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A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain, and breathlessness. A bedside echocardiogram was performed and revealed a large pericardial effusion. Due to this finding, a pericardiocentesis was to be performed.Which of the following statements is considered true regarding pericardiocentesis?
Your Answer: The needle should be aimed at the midpoint of the left clavicle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 2
Correct
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A 34-year-old male is brought into the Emergency Department by the paramedics after a road traffic accident. After a quick triage, you establish that he will need to be intubated, and you ask for some ketamine to be prepared. Which one of the following options regarding this drug is true?
Your Answer: It is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties
Explanation:Ketamine is a dissociative anaesthetic with analgesic, amnesic, and hypnotic effects. It is the only anaesthetic agent which causes all three of these effects.Ketamine exerts its action by non-competitive antagonism at the NMDA (N-methyl-D-aspartate) receptor. Due to its analgesic property, Ketamine is given so that patients do not retain memories of short term procedures. Ketamine is used for the induction and maintenance of anaesthesia in general surgery and for treating burn wounds, battlefield injuries, and children who cannot tolerate other anaesthetic or analgesic agents.It can be given by both intravenous and intramuscular routes. Ketamine causes cardiac stimulation by increasing the sympathetic tone. The major side effect is increased intracranial pressure as an increase in the sympathetic tone causes vasoconstriction and an increase in the MAP.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 3
Correct
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A tumour is discovered behind the pectinate line during an examination of a 72-year-old patient with rectal bleeding. Which of the following is the lymphatic drainage of the pectinate line?
Your Answer: Superficial inguinal nodes
Explanation:The pectinate line is known as the watershed line because it divides the anal canal into two sections. Below the pectinate line, lymphatic drainage drains to the superficial inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 4
Incorrect
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Regarding fluid balance, which of the following statements is CORRECT:
Your Answer: One-third of total body fluid is intracellular.
Correct Answer: About three-quarters of extracellular fluid is interstitial.
Explanation:An ‘average’ person (70 kg male) contains about 40 litres of water in total, separated into different fluid compartments by biological semipermeable membranes; plasma cell membranes between extracellular and intracellular fluid, and capillary walls between interstitial and intravascular fluid. Around two-thirds of the total fluid (27 L) is intracellular fluid (ICF) and one-third of this (13 L) is extracellular fluid (ECF). The ECF can be further divided into intravascular fluid (3.5 L) and interstitial fluid (9.5 L). Transcellular fluid refers to any fluid that does not contribute to any of the main compartments but which are derived from them e.g. gastrointestinal secretions and cerebrospinal fluid, and has a collective volume of approximately 2 L.Osmosis is the passive movement of water across a semipermeable membrane from regions of low solute concentration to those of higher solute concentration.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 5
Correct
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Which of the following is where the rectovesical fascia is located:
Your Answer: Between the fundus of the bladder and the ampulla of the rectum
Explanation:In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Correct
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Question 7
Incorrect
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You review an 18-months-old child who seems to be having a reaction following an immunisation she took earlier in the day.Which statement concerning immunity and vaccination is true?
Your Answer: Immunity is conferred approximately 1 week after injection of immunoglobulin
Correct Answer: The strongest immunological response is seen with natural immunity
Explanation:Vaccination induces ACTIVE adaptive immunity. Actively acquired immunity involves the development of an immune response either due to vaccination or natural exposure to a pathogen and leads to long-lasting resistance to infection.Immediate protection is achieved with injection of immunoglobulin. The protection is transient lasting only a few weeks and is useful as post-exposure prophylaxis. Passively acquired immunity usually leads to short-lasting resistance to infection because it does not involve a host immune response. With inactivated bacteria, a series of primary vaccinations is usually required to induce an adequate immune response. In most cases, boosters are required to sustain adequate immunity.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 8
Incorrect
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A 72-year-old man presents with chest pain that is characteristic of angina. You administer a dose of glyceryl trinitrate (GTN), which rapidly resolved his symptoms. Unfortunately, he also develops an unpleasant side effect.Which of the following side effects is he most likely to have developed? Select ONE answer only.
Your Answer: Syncope
Correct Answer: Headache
Explanation:Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.The following are common or very common side effects of nitratesArrhythmiasAstheniaCerebral ischaemiaDizzinessDrowsinessFlushingHeadacheHypotensionNausea and vomitingDiarrhoea, syncope and cyanosis can occur, but these are rare side effects. Dry eyes, bradycardia and metabolic acidosis have not been reported.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 9
Correct
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What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient with suspected anaphylactic shock?
Your Answer: 500 micrograms intramuscularly
Explanation:1: 1000 Adrenaline solution dosage for children above the age of 12 and adults, including pregnant women (over 50 kg) is 0.50 mL, which is equivalent to 500 mcg of adrenaline.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 10
Correct
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The common bile duct drains into the duodenum in which of the following regions:
Your Answer: Second part of the duodenum
Explanation:As the common bile duct descends, it passes posterior to the first part of the duodenum before joining with the pancreatic duct from the pancreas, forming the hepatopancreatic ampulla (ampulla of Vater) at the major duodenal papilla, located in the second part of the duodenum. Surrounding the ampulla is the sphincter of Oddi, a collection of smooth muscle which can open to allow bile and pancreatic fluid to empty into the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 11
Correct
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A 16-year-old male with a known case of Haemophilia A is referred to your orthopaedic clinic for evaluation and aspiration of a hemarthrosis of the left knee joint. Out of the modes of inheritance listed below, which one is present in this disease?
Your Answer: X-linked recessive
Explanation:All the Haemophilia’s have an X-linked recessive inheritance pattern, so they only manifest in male patients. Diseases with a mitochondrial inheritance pattern include MELAS syndrome, Leigh syndrome, LHON and MERRF syndrome. Autosomal dominant disorders include Huntingdon disease and Marfan syndrome. X-linked dominant diseases include Fragile X syndrome. Autosomal recessive diseases include cystic fibrosis and sickle cell disease.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 12
Incorrect
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A patient presents with a rash for a dermatological examination. A flat circumscribed area of discoloured skin measuring 0.7 cm in diameter is seen on examination.What is the best description of this rash that you have found on examination?
Your Answer: Papule
Correct Answer: Macule
Explanation:A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin. A vesicle is a visible collection of clear fluid measuring less than 0.5 cm in diameter.A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter. A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.A plaque is a palpable skin lesion that is elevated and measures >1cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 13
Incorrect
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A patient has suffered a nerve injury that has caused weakness of the pectoralis minor muscle.Pectoralis minor receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer: Lateral pectoral nerve
Correct Answer: Medial pectoral nerve
Explanation:Pectoralis minor is a thin, triangular muscle that is situated in the upper chest. It is thinner and smaller than pectoralis major. It is innervated by the medial pectoral nerve.The origin of pectoralis minor is the 3rdto the 5thribs, near the costal cartilages. It inserts into the medial border and superior surface of the coracoid process of the scapula.The main action of pectoralis minor is to draw the scapula inferiorly and anteriorly against the thoracic wall. This serves to stabilise the scapula.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Correct
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Water is reabsorbed in which portion of the Henle loop:
Your 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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A 20-year-old female presents with painful wrist following a fall while skating. X-rays shows fracture of the ulna.The initial phase of bone healing is?
Your Answer: Haematoma at the fracture site
Explanation:Haemorrhage occurs into the fracture site from the ruptured vessels in the bone marrow and those supplying the periosteum immediately after fracture. This hematoma formation is the first phase of bone healing.The 4 stages of bone healing are:Haematoma at the fracture site (provides a framework for healing)Callus formationLamellar bone formationRemodelling
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 16
Correct
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Which of the following is a primary action of aldosterone:
Your Answer: Renal sodium reabsorption
Explanation:Aldosterone acts mainly at the renal distal convoluted tubule (DCT) to cause sodium retention and potassium loss. It increases the synthesis of transport mechanisms in the distal nephron including the Na+pump, Na+/H+symporter, and Na+and K+channels in principal cells, and H+ATPase in intercalated cells. Na+(and thus water) reabsorption and K+and H+secretion are thereby enhanced.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 17
Incorrect
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A 62-year-old female complains of pain in her right upper quadrant. An abdominal ultrasound is conducted, and a big gallstone is discovered. The radiologist who performs the scan speaks with you about the physiology of the gallbladder and biliary tract.During a 24-hour period, how much bile does the gallbladder produce?
Your Answer: 1200-1500 ml
Correct Answer: 400-800 ml
Explanation:The gallbladder stores and concentrates bile, which is produced by the liver. In a 24-hour period, around 400 to 800 mL of bile is generated. The breakdown of fats into fatty acids, the removal of waste materials, and cholesterol homeostasis are all crucial functions of bile.Bile is created on a constant basis, however it is only necessary after a meal has been consumed. The elimination of water and ions concentrates bile in the gallbladder, which is subsequently stored for later use. Food induces the release of the hormone cholecystokinin from the duodenum, the contraction of the gallbladder, and the relaxation of the sphincter of Oddi. The bile then enters the duodenum.Bile acids have a hydrophobic and hydrophilic area, making them amphipathic. Bile acids’ amphipathic nature allows them to perform the following crucial functions:Emulsification of lipid aggregates increases the surface area of fat and makes it easier for lipases to digest it.Lipid solubilization and transport: solubilizes lipids by creating micelles, which are lipid clumps that float in water.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 18
Correct
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When a person changes from a supine to an upright position, which of the followingcompensatory mechanismsoccurs:
Your Answer: Increased contractility
Explanation:On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 19
Correct
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In the emergency room, a 28-year-old woman complains of wobbly and slurred speech, is unable to do the heel-shin test, and has nystagmus. The following signs are most likely related to damage to which of the following areas:
Your Answer: Cerebellum
Explanation:Cerebellar injury causes delayed and disorganized motions. When walking, people with cerebellar abnormalities sway and stagger. Damage to the cerebellum can cause asynergia, the inability to judge distance and when to stop, dysmetria, the inability to perform rapid alternating movements or adiadochokinesia, movement tremors, staggering, wide-based walking or ataxic gait, a proclivity to fall, weak muscles or hypotonia, slurred speech or ataxic dysarthria, and abnormal eye movements or nystagmus.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 20
Correct
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What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will 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 21
Correct
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The sensory innervation of the oropharynx is provided by which of the following nerves:
Your Answer: Glossopharyngeal nerve
Explanation:Each subdivision of the pharynx has a different sensory innervation:the nasopharynx is innervated by the maxillary nervethe oropharynx is innervated by the glossopharyngeal nervethe laryngopharynx is innervated by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 22
Incorrect
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Regarding Clostridium perfringens, which of the following statements is CORRECT:
Your Answer: It has endotoxin-mediated effects in tissue causing severe tissue damage.
Correct Answer: It can cause exotoxin-mediated food poisoning.
Explanation:Clostridium perfringens is an obligate anaerobe and has exotoxin mediated effects. It is the most common cause of gas gangrene. C. perfringens is also implicated in food poisoning, cellulitis, enteritis necrotican (life-threatening infection involving ischaemic necrosis of the jejunum), and rarely, CNS infections such as meningitis and encephalitis.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 23
Correct
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Hepatitis A is transmitted by which of the following routes:
Your Answer: Faecal-oral route
Explanation:Hepatitis A transmission is by the faecal-oral route; the virus is excreted in bile and shed in the faeces of infected people.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 24
Correct
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At rest, saliva is produced predominantly by which of the following:
Your Answer: Submandibular gland
Explanation:At rest, most saliva is produced by the submandibular gland (65%). When stimulated by the autonomic nervous system, about 50% of saliva is produced by the parotid gland with only 30% produced by the submandibular gland.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 25
Correct
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Which family of receptors does the glucagon receptor belong?
Your Answer: G-protein coupled receptors
Explanation:Glucagon binds to class B G-protein coupled receptors and activates adenylate cyclase, increasing cAMP intracellularly. This activates protein kinase A. Protein kinase A phosphorylates and activates important enzymes in target cells.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 26
Incorrect
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Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis following exposure to a known allergen:
Your Answer: Hypotension alone
Correct Answer: Generalised urticaria and angioedema alone
Explanation:Anaphylaxis is characterised by sudden onset and rapidly developing, life-threatening airway, breathing and circulation problems associated with skin and/or mucosal changes. Reactions can vary greatly, from hypotension alone, to reactions with predominantly asthmatic features, to cardiac/respiratory arrest. Skin or mucosal changes may be absent or subtle in up to 20% of cases but skin or mucosal changes alone are not a sign of an anaphylactic reaction.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 27
Correct
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A 30-year-old woman presents with a history of fever and sore throat. On examination, there is tonsillar exudate and cervical lymphadenopathy and a diagnosis of tonsillitis is made. A course of penicillin is prescribed.What is the mechanism of action of penicillin?
Your Answer: Inhibition of cell wall synthesis
Explanation:Penicillin is bactericidal and produces its antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. This action inhibits cell wall synthesis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 28
Correct
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You are going to prescribe a NSAID to a 50-year-old male patient for his back pain. Which of the following NSAIDs is least likely to cause gastrointestinal side effects:
Your Answer: Ibuprofen
Explanation:NSAIDs are associated with serious gastrointestinal irritation and drug-induced ulcers. Among the NSAIDs included in the choices, ibuprofen has the lowest risk. Piroxicam, ketoprofen, and ketorolac trometamol are associated with the highest risk of serious upper gastrointestinal side effects. Indomethacin, diclofenac, and naproxen are associated with an intermediate risk of serious upper gastrointestinal side effects.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 29
Incorrect
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A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was rushed to the Emergency Department due to sudden onset crushing chest pain. ECG showed an ST-elevation myocardial infarct in the left anterior descending artery territory. The patient's condition was stabilised and managed with angioplasty, but he sustained significant myocardial damage. Which one of the following statements best agrees with the myocardial healing process?
Your Answer: The right ventricle will likely hypertrophy first to maintain cardiac output
Correct Answer: The left ventricle will likely hypertrophy first to maintain cardiac output
Explanation:Following a myocardial infarction scar tissue formation will take place at the site of the damaged muscle. This places increased load on the rest of the myocardium causing it to hypertrophy. The left ventricle will hypertrophy first as it is pumping blood against a greater afterload as compared to the right ventricle. There are three types of cells in the body with regards to the cell cycle: 1. permanent2. labile3. stable cellsPermanent cells do not re-enter the cell cycle and remain in G0. If there is a pool of stem cells the stem cells will enter the cell cycle to form more cells. Myocardial cells are a type of permanent cell and there is no pool of stem cells in the heart muscle. The anterior wall will not hypertrophy as it is formed by the right atrium and ventricle and both of these hypertrophy after the left ventricle.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 30
Correct
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Which of the following is most true of the sinoatrial node:
Your Answer: Frequency of depolarisation is increased by sympathetic stimulation.
Explanation:Cardiac myocyte contraction is not dependent on an external nerve supply but instead the heart generates its own rhythm, demonstrating inherent rhythmicity. The heartbeat is initiated by spontaneous depolarisation of the sinoatrial node (SAN), a region of specialised myocytes in the right atrium close to the coronary sinus, at a rate of 100-110 beats/min. This intrinsic rhythm is primarily influenced by autonomic nerves, with vagal influences being dominant over sympathetic influences at rest. This vagal tone reduces the resting heart rate down to 60-80 beats/min. To increase heart rate, the autonomic nervous system increases sympathetic outflow to the SAN, with concurrent inhibition of vagal tone. These changes mean the pacemaker potential more rapidly reaches the threshold for action potential generation.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
