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Question 1
Incorrect
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The 'bucket handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The posterior ends of the ribs moving upwards and backwards
Correct Answer: The middles of the shafts of the ribs moving upwards and laterally
Explanation:Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.
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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 22-year-old with a history of brittle asthma is brought to the ED by her partner. She is wheezing and very short of breath and her condition is deteriorating rapidly. Following a series of nebulisations, hydrocortisone and IV magnesium sulphate, she is taken to resus and the intensive care team is called to review her. She is severely hypoxic and confused and a decision is made to intubate her.Which of these drugs is ideal as an induction agent in this patient?
Your Answer: Ketamine
Explanation:Only about 2% of asthma attacks requires intubation and most severe cases are managed with non-invasive ventilation techniques.Though life-saving in the crashing asthmatic, intubation in asthmatic patients is associated with significant morbidity and mortality and is risky. Indications for intubation in asthmatic patients include:Severe hypoxiaAltered mental stateRespiratory or cardiac arrestFailure to respond to medicationsKetamine (1-2 mg/kg) is the preferred induction agent. It has bronchodilatory properties and does not cause hypotension. Propofol poses a risk of hypotension but can also be used.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 3
Correct
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A 70-year-old patient develops bacteraemia following peripheral cannulation.Which of these bacteria is the most likely cause of the infection?
Your Answer: Staphylococcus epidermidis
Explanation:The commonest implicated organisms in hospital-acquired bacteraemia following cannulation are Staphylococcus aureus and Staphylococcus epidermidis. The risk is directly proportional to the length of time in-situ. Peripheral cannula should be replaced after 48 hours.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 4
Correct
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Which of the following best describes digoxin:
Your Answer: A positive inotrope and negative chronotrope
Explanation:Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 5
Incorrect
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All of the following statements are correct regarding penicillin antibiotics except:
Your Answer: Allergic reactions to penicillin occur in about 1 - 10% of treated patients.
Correct Answer: Penicillins are of no use in meningitis as they are unable to penetrate into the cerebrospinal fluid.
Explanation:Penicillin penetration into the cerebrospinal fluid is generally poor. However, when the meninges are inflamed, as in meningitis, penetration of penicillin is increased. Benzylpenicillin should be given before transfer to hospital if meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, once this does not delay transfer. Benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 6
Correct
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A 24-year-old male presents to the Emergency Department with a three-day history of high-grade fever, headache and rash along with neck stiffness. On examination, Kernig's sign is positive, and you note a petechial rash over the trunk and limbs. Her vital signs show tachycardia and hypotension. Based on these findings, you diagnose sepsis secondary to meningitis. Which one of the following definitions of sepsis is currently accepted?
Your Answer: Life-threatening organ dysfunction caused by a dysregulated host response to infection
Explanation:In 2016 the SOFA guideline was introduced, also called the Sepsis-related Organ Failure Assessment, to make a sepsis diagnosis easier and prevent mortality. According to this guideline, sepsis was defined as a life-threatening organ dysfunction due to a dysregulated host response to infection. Septic shock was defined as a subset of sepsis in which the circulatory and metabolic abnormalities would lead to a greater risk of mortality than sepsis alone. Patients with septic shock would be clinically identified by a need for vasopressors to maintain MAP greater than 65 mmHg and serum lactate greater than two mmol/L.
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This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 7
Correct
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Where: Capillary hydrostatic pressure is (P c) Hydrostatic pressure in the interstices is (P I )Plasma oncotic pressure is (π p) Interstitial oncotic pressure is (π i)Which of the following formulas best represents fluid flow at the capillary bed?
Your Answer: Volume / min = (P c - P i ) - (π p - π i )
Explanation:Starling’s equation for fluid filtration describes fluid flow at the capillary bed.Filtration forces (capillary hydrostatic pressure and interstitial oncotic pressure) stimulate fluid movement out of the capillary, while resorption forces promote fluid movement into the capillary (interstitial hydrostatic pressure and plasma oncotic pressure). Although the forces fluctuate along the length of the capillary bed, overall filtration is achieved.At the capillary bed, there is fluid movement.The reflection coefficient (σ), the surface area accessible (S), and the hydraulic conductance of the wall (Lp) are frequently used to account for the endothelium’s semi-permeability, yielding:Volume / min = LpS [(Pc- Pi) –  σ(Ï€p– Ï€i)]Volume /min = (Pc-Pi) – (Ï€p–πi) describes the fluid circulation at the capillaries.Where:Pc= capillary hydrostatic pressurePi= interstitial hydrostatic pressureÏ€p= plasma oncotic pressureÏ€i= interstitial oncotic pressure
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 8
Correct
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Which of the following is NOT an effect of benzodiazepines:
Your Answer: Analgesic effect
Explanation:Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhance inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.
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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 60-year-old man with insulin-controlled diabetes mellitus asks you about how his ability to drive is affected. He owns a car as well as a motorcycle.Which of the following statements about driving with diabetes under insulin control is correct?
Your Answer: He must not have had more than 2 episodes of hypoglycaemia requiring the assistance of others in the past 12 months
Correct Answer: He must monitor his blood glucose levels every 2 hours whilst driving
Explanation:The DVLA sends a detailed information sheet about their licence and driving to all drivers with diabetes mellitus. The primary danger of driving while diabetic is hypoglycaemia.The DVLA must be notified of the following diabetic patients:All of the drivers are on insulin. (Licenses are being reviewed more frequently.)Those who are at high risk of hypoglycaemia and have had more than one episode of severe hypoglycaemia in the previous year. (Severe hypoglycaemia is defined as requiring the assistance of another person to manage.)Those who are unaware of their hypoglycaemiaAnyone who has ever been in a car accident due to hypoglycaemiaAnyone with diabetic retinopathy who needs laser treatment (to both eyes or to a second eye if sight only in one eye)Patients with diabetes complications that impair their ability to drive.To drive, drivers with insulin-treated diabetes must meet the following requirements:They need to be aware of hypoglycaemia.They must not have had more than one episode of hypoglycaemia in the previous 12 months that necessitated the assistance of another person.They must check their blood glucose levels no later than 2 hours before the first journey.While driving, they must check their blood glucose levels every two hours.The visual acuity and visual field standards must be met.Any significant changes in their condition must be reported to the DVLA. Furthermore, on days when they are not driving, group 2 licence holders must test their blood glucose twice daily using a metre that can store three months’ worth of readings.In addition to this advice, the DVLA also offers the following advice to diabetic patients:When taking tablets that have the potential to cause hypoglycaemia (such as sulfonylureas and glinides), monitoring may be necessary if there has been more than one episode of severe hypoglycaemia.Drivers must show good control and be able to recognise hypoglycaemia.Verify that your vision meets the required standard.If a patient feels hypoglycaemic or has a blood glucose level of less than 4.0 mmol/L, they should not drive. Driving should not be resumed until blood glucose levels have returned to normal, which should take 45 minutes.If there are any warning signs, patients should carry rapidly absorbed sugar in their vehicle and stop, turn off the ignition, and eat it.If resuscitation is required, a card stating which medications they are taking should be carried.If hypoglycaemia causes an accident, a diabetic driver may be charged with driving under the influence of drugs.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 10
Correct
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Pre-oxygenation is done prior to intubation to extend the ‘safe apnoea time’.Which lung volume or capacity is the most important store of oxygen in the body?
Your Answer: Functional residual capacity
Explanation:The administration of oxygen to a patient before intubation is called pre-oxygenation and it helps extend the ‘safe apnoea time’. The Functional residual capacity (FRC) is the volume of gas that remains in the lungs after normal tidal expiration. It is the most important store of oxygen in the body. The aim of pre-oxygenation is to replace the nitrogen in the FRC with oxygen. Apnoea can be tolerated for longer periods before critical hypoxia develops if the FRC is large. Patients with reduced FRC reach critical hypoxia more rapidly.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 11
Correct
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A 62-year-old woman presents with cold sensitivity, tiredness, and weight gain. A series of blood tests done shows a grossly elevated TSH level and a diagnosis of hypothyroidism is made.What is the commonest cause of hypothyroidism worldwide?
Your Answer: Iodine deficiency
Explanation:Hypothyroidism occurs when there is a deficiency of circulating thyroid hormones. It is commoner in women and is most frequently seen in the age over 60.Iodine deficiency is the commonest cause of hypothyroidism worldwide.In the UK and other developed countries, iodine deficiency is not a problem and autoimmune thyroiditis is the commonest cause.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 12
Correct
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The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian man is 152/96 mmHg (ABPM).The first-line drug treatment for this patient would be which of the following? Please only choose ONE answer.
Your Answer: Amlodipine
Explanation:An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 59-year-old Caucasian man.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 13
Incorrect
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Which of the following best describes pathogenicity:
Your Answer: The ability to cause disease in immunocompetent individuals
Correct Answer: The ability to cause disease
Explanation:Pathogenicity is the ability to cause disease.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 14
Correct
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The stomach G-cells are responsible for which of the following?Â
Your Answer: Secretion of gastrin
Explanation:G-cells are a type of cell found in the stomach’s pyloric antrum, duodenum, and pancreas. The secretion of the peptide hormone gastrin is their major function.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 15
Correct
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Regarding the human cell, which of the following cell organelles is responsible for the production of ATP:
Your Answer: Mitochondria
Explanation:Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 16
Incorrect
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In ventricular myocytes, the plateau phase of the action potential comes about through which of the following:
Your Answer: Opening of voltage-gated K + channels
Correct Answer: Opening of voltage-gated Ca 2+ channels
Explanation:After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 17
Incorrect
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Which of the following clinical features would you least expect to see in a lesion of the frontal lobe:
Your Answer: Primitive reflexes
Correct Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:Contralateral homonymous hemianopia with macular sparing results from damage to the primary visual cortex of the occipital lobe. Incontinence may occur due to damage of the cortical micturition centre in the prefrontal cortex. Primitive reflexes and inability to problem solve may occur due to damage to the prefrontal cortex. Motor weakness of the contralateral limb with UMN signs may occur due to damage of the primary motor cortex.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 18
Incorrect
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You review a 56-year-old man who has recently been prescribed antibiotics for a chest infection. He suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, he has been experiencing nausea, vomiting and abdominal pain.Which of the following antibiotics is he MOST LIKELY to have been prescribed for his chest infection? Select ONE answer only .
Your Answer: Amoxicillin
Correct Answer: Levofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:Drugs increasing plasma concentration of theophyllineDrugs decreasing plasma concentration of theophyllineCalcium channel blockers, e.g. VerapamilCimetidineFluconazoleMacrolides, e.g. erythromycinQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitolPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 19
Correct
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In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.Prolonged seizures last 5 minutes or more. Repeated seizures refer to 3 or more seizures in an hour.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 20
Incorrect
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Which of the following best describes a natural killer cell:
Your Answer: A professional antigen presenting cell that is important for normal T helper cell function.
Correct Answer: A large granular lymphocyte that kills by inducing target cell apoptosis.
Explanation:Natural killer (NK) cells are cytotoxic CD8 positive cells that lack the T-cell receptor. They are large cells with cytoplasmic granules. NK cells are designed to kill target cells that have a low level of expression of HLA class I molecules, such as may occur during viral infection or on a malignant cell. NK cells do this by displaying several receptors for HLA molecules on their surface. When HLA is expressed on the target cell these deliver an inhibitory signal into the NK cell. When HLA molecules are absent on the target cell this inhibitory signal is lost and the NK cell can then kill its target. In addition, NK cells display antibody-dependent cell-mediated cytotoxicity. In this, antibody binds to antigen on the surface of the target cell and then NK cells bind to the Fc portion of the bound antibody and kill the target cell.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 21
Incorrect
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Regarding endothelin-1, which of the following statements is INCORRECT:
Your Answer: Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide.
Correct Answer: Endothelin-1 release is inhibited by noradrenaline.
Explanation:Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.
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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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An increased anion gap metabolic acidosis is typically caused by which of the following?
Your Answer: Propylene glycol overdose
Explanation:Causes of a raised anion gap acidosis can be remember using the mnemonic MUDPILES:-Methanol-Uraemia (in renal failure)-Diabetic ketoacidosis-Propylene glycol overdose-Infection/Iron overdose/Isoniazid/Inborn errors of metabolism-Lactic acidosis-Ethylene glycol overdose-Salicylate overdose
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This question is part of the following fields:
- Physiology
- Renal
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Question 23
Correct
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Regarding hepatitis B, which of the following statements is CORRECT:
Your Answer: Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months.
Explanation:Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months. Hepatitis B has a long incubation period of about 2 – 6 months. Hepatitis B vaccine has recently been introduced to the routine childhood immunisation schedule – given at 2, 3 and 4 months. It is also given to babies born to hepatitis B infected mothers at birth, four weeks and 12 months old. Treatment of acute hepatitis is supportive. Treatment with antivirals should be considered in chronic infection as responders have a reduced risk of liver damage and liver cancer in the long term.
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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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All of the following predisposes to lithium toxicity in patients taking long-term therapy EXCEPT:
Your Answer: Hypernatraemia
Explanation:A common complication of long term lithium therapy results in most cases of lithium intoxication. It is caused by reduced excretion of the drug which can be due to several factors including deterioration of renal function, dehydration, hyponatraemia, infections, and co-administration of diuretics or NSAIDs or other drugs that may interact.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 25
Incorrect
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Which of the following statements is incorrect regarding the Na+/K+ATPase pump?
Your Answer: The Na + /K + ATPase pump uses energy derived from ATP hydrolysis.
Correct Answer: The Na + /K + ATPase pump moves 3 Na + ions into the cell for every 2 K + ions out.
Explanation:In order for primary active transport to pump ions against their electrochemical gradient, chemical energy is used in the form of ATP. The Na+/K+-ATPase antiporter pump uses metabolic energy to move 3 Na+ions out of the cell for every 2 K+ions in, against their respective electrochemical gradients. As a result, the cell the maintains a high intracellular concentration of K+ions and a low concentration of Na+ions.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 26
Correct
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A patient presents with a fever, headache and neck stiffness. A CSF sample of someone with meningococcal meningitis typically shows:
Your Answer: All of the above
Explanation:CSF analysis typically shows: cloudy turbid appearanceraised WCC – predominantly neutrophilshigh proteinlow glucose (typically < 40% of serum glucose)Gram-negative diplococci seen under microscopy
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 27
Correct
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Digoxin exhibits its positive inotropic effect by which of the following mechanisms:
Your Answer: Inhibits the Na+/K+ pump on the myocyte membrane
Explanation:Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump (Na+/K+ATPase) which generates the Na+gradient required for driving the export of Ca2+by Na+/Ca2+exchange; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 28
Incorrect
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A lesion to which part of the optic radiation will result in contralateral homonymous inferior quadrantanopia?
Your Answer: Right temporal lobe
Correct Answer: Right parietal lobe
Explanation:A visual loss in the lower left quadrant in both visual fields is an indication of an inferior homonymous. This is due to a lesion of the superior fibres of the optic radiation in the parietal lobe on the contralateral side of the visual pathway.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 29
Correct
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Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.Which of the following statements about aspirin's mechanism of action is correct?
Your Answer: Inhibition of cyclo-oxygenase
Explanation:Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 30
Incorrect
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A 53-year-old man arrives at the emergency department complaining of visual impairment in his right eye. On examination, you notice that neither his right nor left pupil constricts when you shine a light in his right eye. When you flash a light in his left eye, the pupils of both his left and right eyes constrict. Which of the following nerves is the most likely to be affected:
Your Answer: Oculomotor nerve
Correct Answer: Optic nerve
Explanation:In full optic nerve palsy, the afferent pupillary light reflex is lost. Because the afferent optic nerve does not sense light flashed in the afflicted eye, the ipsilateral direct and contralateral consensual reflexes are gone. However, the contralateral direct and ipsilateral consensual reflexes are intact because the efferent oculomotor nerve is normal.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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SESSION STATS - PERFORMANCE PER SPECIALTY
