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Question 1
Incorrect
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Identify the type of graph described below:This graph has been used to create visual representations to communicate the risks and benefits of treatments using 4 face categories.
Your Answer: Forest plot
Correct Answer: Cates plot
Explanation:Cates Plot, since 1999, has been used to create visual representations to communicate the risks and benefits of treatments. The essence of Cates Plot is the use of 4 face categories to visually indicate the following:People not affected by a treatment (green faces for those with a good outcome and red for those with a bad outcome)People for which treatment changes their category from a bad outcome to a good outcome (yellow faces)People for which treatment causes an adverse event and changes their category from a good outcome to a bad outcome (crossed out green faces)
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This question is part of the following fields:
- Evidence Based Medicine
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Question 2
Correct
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The last two segments of the nephrons are the distal convoluted tubule (DCT) and collecting duct (CD).Which cell reabsorbs sodium more in the late DCT and CD?
Your Answer: Principal cells
Explanation:The main Na+ reabsorbing cells in the late distal convoluted tubule and collecting duct are the principal cells. These make up the majority of the tubular cells. The exchange is driven by the Na.K.ATPase pumps on the basolateral membrane.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 3
Correct
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A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?
Your Answer: 500 micrograms of adrenaline intramuscularly
Explanation:Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils. If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution). In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh. Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 4
Incorrect
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Regarding bronchiolitis, which of the following statements is CORRECT:
Your Answer: It occurs most commonly from infection with parainfluenza virus.
Correct Answer: Chest x-ray may show hyperinflation and increased peribronchial markings.
Explanation:Acute bronchiolitis is caused most commonly by respiratory syncytial virus, occurring mostly in children aged 6 months to 2 years. Children with bronchiolitis are febrile and tachypnoeic with a dry cough and difficulty feeding. Examination may reveal chest hyperinflation, respiratory distress, wheezing and fine end-inspiratory crepitations. Chest x-ray may show hyperinflation and increased peribronchial markings (although CXR should only performed if there is diagnostic uncertainty or an atypical course). Treatment is usually supportive, aerosolized ribavirin is reserved for severely ill or immunocompromised patients.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
Incorrect
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Which of the following accurately describes the extensor pollicis brevis muscle?
Your Answer: Its tendon forms the medial border of the anatomical snuffbox
Correct Answer: It lies on the medial side of abductor pollicis longus
Explanation:Extensor pollicis brevis is a short and slender muscle located in the posterior compartment of the forearm, extending from the posterior surface of radius to the proximal phalanx of thumb. It is one of the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus and extensor indicis muscles.Extensor pollicis brevis is a deep extensor of the thumb that lies deep to extensor digitorum muscle. It sits directly medial to abductor pollicis longus and posterolateral to extensor pollicis longus muscle. Just above the wrist, extensor pollicis brevis obliquely crosses the tendons of extensor carpi radialis brevis and extensor carpi radialis longus muscles.Extensor pollicis brevis is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).Extensor pollicis brevis receives its blood supply by posterior interosseous artery and perforating branches from the anterior interosseous artery, which are the branches of common interosseous artery. The common interosseous artery arises immediately below the tuberosity of radius from the ulnar artery.Together with extensor pollicis longus, extensor pollicis brevis is in charge of extension of the thumb in the first metacarpophalangeal joint. It also extends the thumb in the carpometacarpal joint of the thumb. This movement is important in the anatomy of the grip, as it enables letting go of an object. As it crosses the wrist, extensor pollicis brevis also participates in the extension and abduction of this joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 6
Correct
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Regarding atracurium, which of the following statements is CORRECT:
Your Answer: Effects such as flushing, tachycardia and hypotension can occur due to significant histamine release.
Explanation:Cardiovascular effects such as flushing, tachycardia, hypotension and bronchospasm are associated with significant histamine release; histamine release can be minimised by administering slowly or in divided doses over at least 1 minute. Atracurium undergoes non-enzymatic metabolism which is independent of liver and kidney function, thus allowing its use in patients with hepatic or renal impairment. Atracurium has no sedative or analgesic effects. All non-depolarising drugs should be used with care in patients suspected to be suffering with myasthenia gravis or myasthenic syndrome, as patients with these conditions are extremely sensitive to their effects and may require a reduction in dose.
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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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Cryptococcus neoformans is primarily implicated in which of the following conditions:
Your Answer: Neurocysticercosis
Correct Answer: Chronic lymphocytic meningitis
Explanation:Cryptococcus neoformans typically causes a chronic lymphocytic meningitis in immunosuppressed patients or those with intense exposure e.g. pigeon fanciers.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 8
Correct
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Which of the following statements about propofol is TRUE:
Your Answer: Propofol has some antiemetic action.
Explanation:Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 9
Incorrect
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A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.Which of the following muscles is most likely to be involved? Select ONE answer only.
Your Answer: Sternocleidomastoid
Correct Answer: Sternohyoid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:Muscles: thyrohyoid, sternothyroid, sternohyoid musclesOrgans: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid glandArteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteriesVeins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veinsNerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.Contents:Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodesNerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 10
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 11
Incorrect
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The patient is a 61-year-old man with severe central chest pain. An acute myocardial infarction is revealed by his ECG. Clopidogrel is one of the medications he takes as part of his treatment.Clopidogrel's direct mechanism of action is which of the following?
Your Answer: Antagonsim of glycoprotein IIb/IIIa receptors
Correct Answer: Inhibition of platelet ADP receptors
Explanation:Clopidogrel, a thienopyridine derivative, prevents platelet aggregation and cross-linking by the protein fibrin by inhibiting the ADP receptor on platelet cell membranes (inhibits binding of ADP to its platelet receptor (P2Y12 ADP-receptor).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 12
Incorrect
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Regarding alteplase, which of the following statements is INCORRECT:
Your Answer: Alteplase has selectivity for activation of fibrin-bound plasminogen.
Correct Answer: Alteplase is commonly associated with hypotensive effects.
Explanation:Alteplase is a recombinant tissue-type plasminogen activator (tPA), a naturally occurring fibrin-specific enzyme that has selectivity for activation of fibrin-bound plasminogen. It has a short half-life of 3 – 4Â minutes and must be given by continuous intravenous infusion but is not associated with antigenic or hypotensive effects, and can be used in patients when recent streptococcal infections or recent use of streptokinase contraindicates the use of streptokinase.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 13
Incorrect
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Which of the following neurotransmitter and receptor combinations is present at the neuromuscular junction:
Your Answer: Acetylcholine acting at muscarinic receptors
Correct Answer: Acetylcholine acting at nicotinic receptors
Explanation:At the neuromuscular junction, acetylcholine is released from the prejunctional membrane which acts on cholinergic nicotinic receptors on the postjunctional membrane.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 14
Correct
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Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:
Your Answer: Anti-D antibodies are usually IgG.
Explanation:Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 15
Incorrect
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A 58-year-old male has cellulitis of his left leg. Because he is allergic to penicillin, you start him on erythromycin.What is erythromycin's mechanism of action?
Your Answer: Disruption of cell membrane function
Correct Answer: Inhibition of protein synthesis
Explanation:Bacteriostatic antibiotics include erythromycin and other macrolide antibiotics. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and thereby protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered to the infection site as a result.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 16
Incorrect
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In the Kaplan-Meier plot, which of the following labels should be applied to the X-axis?
Your Answer: Odds ratio
Correct 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.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 17
Incorrect
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All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:
Your Answer: Glossopharyngeal nerve
Correct Answer: Hypoglossal nerve
Explanation:All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which 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 18
Correct
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Following a bee sting, a 12-year old boy was transported to resus with symptoms and signs of an anaphylactic reaction. You decide to administer adrenaline IM stat.What is the recommended dose of intramuscular adrenaline?
Your Answer: 0.3 mL of 1:1000
Explanation:Anaphylaxis is a type I hypersensitivity reaction that is severe and life-threatening. It is marked by the fast onset of life-threatening airway and/or circulatory issues, which are generally accompanied by skin and mucosal abnormalities. When an antigen attaches to specific IgE immunoglobulins on mast cells, degranulation and the release of inflammatory mediators takes place (e.g. histamine, prostaglandins, and leukotrienes).The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.In anaphylaxis, age-related dosages of IM adrenaline are:150 mcg (0.15 mL of 1:1000) for a child under 6 years300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years 500 mcg (0.5 mL of 1:1000) for children aged 12 and above 500 mcg for adults (0.5 mL of 1:1000)
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 19
Incorrect
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A man presents to the emergency department with a hand laceration that has damaged the opponens digiti minimi muscle.All of the following statements regarding the opponens digiti minimi muscle is considered correct, except:
Your Answer: It draws the fifth metacarpal bone anteriorly and rotates it
Correct Answer: It is innervated by the superficial branch of the ulnar nerve
Explanation:Opponens digiti minimi (ODM) is an intrinsic muscle of the hand. It’s a triangular muscle that extends between the hamate bone (carpal bone) and the 5th metacarpal bone. It forms the hypothenar muscle group together with the abductor digiti minimi and flexor digiti minimi brevis, based on the medial side of the palm (hypothenar eminence). These muscles act together in moving the little finger. The opponens digiti minimi is responsible for flexion, lateral rotation and opposition of the little finger.Its origin is the hook of hamate and flexor retinaculum. It inserts into the medial border of 5th metacarpal bone. It is innervated by the deep branch of the ulnar nerve, which stems from the brachial plexus (C8, T1 spinal nerves).Its blood supply is by the deep palmar branch of ulnar artery and deep palmar arch, which is the terminal branch of the radial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Incorrect
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When a child has mumps, how long should he or she be off from school?
Your Answer: No exclusion period
Correct Answer: 5 days from onset of swelling
Explanation:To avoid the spread of infection, infected patients should be isolated. Patients should avoid going to school, childcare, or job for five days after the swelling has occurred.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Incorrect
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A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.
Your Answer: The alveoli remain perfused in atelectasis
Correct Answer: Atelectasis is an example of a perfusion defect
Explanation:Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 22
Incorrect
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A 20-year-old with type I diabetes mellitus has an episode of hypoglycaemia following inadvertent administration of too much insulin.The mechanism by which insulin causes glucose to be transported into cells is?
Your Answer: Active transport
Correct Answer: Facilitated diffusion
Explanation:The only mechanism by which insulin facilitates uptake of glucose into cells is by facilitated diffusion through a family of hexose transporters.The major transporter used for glucose uptake is GLUT4. GLUT4 is made available in the plasma membrane by the action of insulin.When insulin concentrations are low, GLUT4 transporters are present in cytoplasmic vesicles, where they are cannot be used for transporting glucose.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 23
Incorrect
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Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT:
Your Answer: It is associated with the subsequent development of Reiter's syndrome.
Correct Answer: Infection usually requires antibiotic treatment.
Explanation:Campylobacter jejuni is the primary human pathogen, typically causing dysentery (bloody diarrhoea illness) following ingestion of contaminated meat, especially poultry. Infection is typically self-limiting and does not require antibiotic therapy. Campylobacter gastroenteritis is associated with the immune-mediated complications of Guillain-Barre syndrome, reactive arthritis and Reiter’s syndrome.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 24
Correct
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Which of the following leukaemias is most common in children in the UK:
Your Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. There is a secondary rise after the age of 40 years. 85% of cases are of B-cell lineage and have an equal sex incidence; there is a male predominance for the 15% of T-cell lineage.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 25
Correct
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Regarding aspirin at analgesic doses, which of the following statements is CORRECT:
Your Answer: It is contraindicated in patients with severe heart failure.
Explanation:Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 26
Incorrect
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You suspected a fungal nail infection in a 50-year-old man who presented with an itchy, scaly rash between his toes and a thicker, discoloured nail on his big toe that has been there for almost one month already. Which of the following tests is most likely to confirm your suspected diagnosis?
Your Answer: Skin swab for microscopy and culture
Correct Answer: Nail clippings for microscopy and culture
Explanation:Nail clippings for microscopy and culture are a diagnostic test for fungal infection. Because some fungi are restricted to the lower parts of the nail, clippings should be taken from the discoloured or brittle parts and cut back as far as possible from the free edge.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 27
Incorrect
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An 11-year-old girl presents with a 5-day history of persistent fever despite regular paracetamol, throbbing left ear pain, ear discharge and deafness. Her parents have observed that she is not her usual self, not eating well, and has been lethargic. On examination there is a tender swelling in the post auricular region on the left hand side.What is the most likely causative organism?
Your Answer: Staphylococcus aureus
Correct Answer: Streptococcus pneumonia
Explanation:Acute mastoiditis is a complication (rare) of acute otitis media (AOM) and the commonest causative organism is Streptococcus pneumoniae.Generally, acute mastoiditis presents with:PyrexiaRecent history of AOMMastoid swelling and erythemaOtalgiaOtorrhoea and perforation of tympanic membranePost-auricular painProtrusion of the ears
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 28
Incorrect
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Regarding hypertensive crises, which of the following statements is CORRECT:
Your Answer: Hypertensive urgency requires intravenous antihypertensive therapy.
Correct Answer: In a hypertensive emergency, blood pressure should be reduced by 20 - 25% within 2 hours.
Explanation:A hypertensive emergency is defined as severe hypertension (blood pressure ≥ 180/110 mmHg) with acute damage to the target organs. Prompt treatment with intravenous antihypertensive therapy is generally required; over the first few minutes or within 2 hours, blood pressure should be reduced by 20 – 25%. Severe hypertension without acute target organ damage is defined as hypertensive urgency.; blood pressure should be reduced gradually over 24 – 48 hours with oral antihypertensive therapy. If blood pressure is reduced too quickly in the management of hypertensive crises, there is a risk of reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, and myocardial ischaemia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 29
Incorrect
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A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.Which of the following statements about corticotropin-releasing hormone is correct?Â
Your Answer: It is secreted from the anterior pituitary
Correct Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus
Explanation:Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 30
Correct
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The following are all examples of type I hypersensitivity EXCEPT for:
Your Answer: Contact dermatitis
Explanation:Examples of type I reactions include:Allergic rhinitisAllergic conjunctivitisAllergic asthmaSystemic anaphylaxisAngioedemaUrticariaPenicillin allergy
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This question is part of the following fields:
- Immune Responses
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
