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Question 1
Correct
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A 25 year old woman who is a known diabetic is brought to the ED with diabetic ketoacidosis. She promptly received an insulin infusion. Which of the following are expected to increase upon infusion of insulin?
Your Answer: Blood pH
Explanation:Ketoacidosis is characterized by hyperglycaemia, glycosuria, hyperkalaemia, and metabolic acidosis with respiratory compensation. An insulin infusion would be able to address these by lowering blood glucose through increased insulin-mediated cellular uptake, lowering urine glucose concentration as cellular glucose uptake is increased, decreasing K+ in her blood by shifting it into cells, and increasing blood ph by addressing the metabolic acidosis. The metabolic acidosis is addressed by the reduction of ketoacids production thereby returning her blood ph to normal and reducing the need for compensatory hyperventilation.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 2
Correct
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A 22-year-old man comes to the emergency department with a human bite injury to his hand received from a punch during a fight 3 hours earlier outside a bar. On closer inspection, you discover bite marks on his first and second knuckles. Which of the following is the best treatment option for this patient:
Your Answer: Oral co-amoxiclav for 7 days
Explanation:Even if there is no evidence of infection, prophylactic antibiotics should be administered for all human bite wounds that are less than 72 hours old. The first-line therapy is 7 days of co-amoxiclav. In penicillin-allergic people, metronidazole + doxycycline is an option. Streptococcus spp., Staphylococcus aureus, Haemophilus spp., Eikenella corrodens, Bacteroides spp., and other anaerobes are the most prevalent organisms found in human bites.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 3
Correct
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If a lesion is observed in Broca's area, which function is expected to become affected?
Your Answer: Formation of words
Explanation:The primary functions of the Broca area are both language production and comprehension. While the exact role in the production is still unclear, many believe that it directly impacts the motor movements to allow for speech. Although originally thought to only aid in speech production, lesions in the area can rarely be related to impairments in the comprehension of language. Different regions of the Broca area specialize in various aspects of comprehension. The anterior portion helps with semantics, or word meaning, while the posterior is associated with phonology, or how words sound. The Broca area is also necessary for language repetition, gesture production, sentence grammar and fluidity, and the interpretation of others’ actions.Broca’s aphasia is a non-fluent aphasia in which the output of spontaneous speech is markedly diminished and there is a loss of normal grammatical structure. Specifically, small linking words, conjunctions, such as and, or, and but, and the use of prepositions are lost. Patients may exhibit interjectional speech where there is a long latency, and the words that are expressed are produced as if under pressure. The ability to repeat phrases is also impaired in patients with Broca’s aphasia. Despite these impairments, the words that are produced are often intelligible and contextually correct. In pure Broca’s aphasia, comprehension is intact.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 4
Correct
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A new chemotherapy drug is being tested. The intervention reduces the risk of death from 10 in 1000 to 5 in 1000. What is the number needed to treat to prevent one death:
Your Answer: 200
Explanation:Absolute risk reduction (ARR) of treatment = risk of death in control group – risk of death in treatment groupARR = (10/1000) – (5/1000) = 5/1000 = 0.005Number needed to treat (NNT) = 1/ARR = 1/0.005 = 200Therefore 200 people would need to be treated to prevent one extra death.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 5
Incorrect
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Which one of the listed cells are typically found in a granuloma?
Your Answer: Langerhan’s cells
Correct Answer: Epithelioid cells
Explanation:Typically, granuloma has Langhan’s cells (large multinucleated cells ) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.Antigen presenting monocytic cells found in the skin are known as Langerhan’s cells.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 6
Correct
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Regarding the partial pressure of gases, which of the following statements is INCORRECT:
Your Answer: At high altitude, the oxygen fraction is reduced.
Explanation:At altitude, the oxygen fraction is unaltered but the barometric pressure and thus partial pressure of oxygen is reduced.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 7
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 8
Correct
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For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:
Your Answer: Synchronised DC shock
Explanation:If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 9
Incorrect
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Normal human immunoglobulin is mostly used to protect against which of the following infectious diseases?
Your Answer: Hepatitis A and hepatitis B
Correct Answer: Measles and hepatitis A
Explanation:Immune globulin IM is indicated for prophylaxis following exposureto hepatitis A, to prevent or modify measles (rubeola) in a susceptible person exposed fewer than 6 days previously,for susceptible household contacts of measles patients,particularly contacts <1 year and pregnant women without evidence of immunity, and to modify rubella in exposed pregnant women who will not consider a therapeutic abortion.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 10
Correct
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Your consultant requests that you do a lumbar puncture on a patient who is suspected of having meningitis. This patient, a 15-year-old female, presented to the emergency department with a fever, headache, and neck stiffness. Where should you aspirate a sample of CSF?
Your Answer: Subarachnoid space
Explanation:A lumbar puncture, also known as a spinal tap, is a procedure that involves inserting a needle into the lower back’s lumbar region. A needle is inserted into the space between the arachnoid mater and the pia mater, also known as the subarachnoid space, to remove a sample of cerebrospinal fluid.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 11
Correct
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A 68-year-old man is being treated with digoxin for atrial fibrillation. When serum digoxin levels are above the therapeutic range, he is at highest risk for developing digoxin toxicity if he also develops which of the following?
Your Answer: Hypokalaemia
Explanation:Predisposing factors for digoxin toxicity include hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia There should also be care taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Hyponatremia can result in the development of other pathological disturbances, but it does not make digoxin toxicity worse.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Correct
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The correct statement regarding the parasympathetic nervous system is which of the following?
Your Answer: Parasympathetic preganglionic neurones run in cranial nerves III, VII, IX and X.
Explanation:The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2 molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 13
Correct
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Which of the following neurotransmitter and receptor combinations is present at the neuromuscular junction:
Your 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 the power of a study, which of the following statements is INCORRECT:
Your Answer: The power of a study is not affected by data variability.
Explanation:A study should only be undertaken if the power is at least 80%; a study power set at 80% accepts a likelihood of 1 in 5 (20%) of missing a statistically significant difference where one exists.The determinants of power are:the sample size (the power increases with sample size)the variability of the observations (the power increases as the variability decreases)the effect size of interest (the power is greater for a larger expected effect size)and the significance level, α (the power is greater if the significance level is larger); therefore the probability of a type I error increases as the probability of a type II error decreases.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 15
Correct
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A 30-year old male is brought to the emergency room after a terrible fall during a photoshoot. The patient reported falling on his right forearm. There is evident swelling and tenderness on the affected area, with notable weakness of the flexor pollicis longus muscle. Radiographic imaging showed a fracture on the midshaft of the right radius.Which of the following nerves is most likely injured in the case above?
Your Answer: The anterior interosseous nerve
Explanation:Flexor pollicis longus receives nervous supply from the anterior interosseous branch of median nerve, derived from spinal roots C7 and C8.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
Correct
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What is the direct mechanism of action of digoxin as a positive inotrope:
Your Answer: Inhibition of Na+/K+ ATPase pump
Explanation:Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 17
Correct
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Question 18
Correct
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A 47-year-old woman comes in with palpitations that have been bothering her for the past four days. Her haemodynamics are normal, but her heart rate is currently 150 beats per minute. An ECG is performed, which reveals that she is experiencing atrial flutter. The patient is examined by a cardiology registrar, who recommends starting her on verapamil to control her ventricular rate while she waits for cardioversion.In these circumstances, which of the following is a contraindication to the use of verapamil?
Your Answer: Acute porphyria
Explanation:In most cases of atrial flutter, ventricular rate control is used as a stopgap measure until sinus rhythm is restored. A beta-blocker (e.g. bisoprolol), diltiazem, or verapamil can be used to reduce the rate of contractions in the heart.Electrical cardioversion, pharmacological cardioversion, and catheter ablation can all be used to return the heart to a normal rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or it has lasted longer than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is a sudden onset of symptoms and haemodynamic compromise. For recurrent atrial flutter, catheter ablation is preferred.Verapamil is a calcium-channel blocker that is non-dihydropyridine phenylalkylamine and can be used to treat supraventricular arrhythmias. It’s a calcium channel blocker with a high negative inotropic effect that lowers cardiac output, slows the heart rate, and may impair atrioventricular conduction. At high doses, it can cause heart failure, exacerbate conduction disorders, and cause hypotension.Adults should take 240-480 mg of verapamil in 2-3 divided doses. 5-10 mg IV over 30 seconds is the corresponding intravenous (IV) dose. After an IV injection, the peak effect lasts 3-5 minutes, and the action lasts 10-20 minutes.Verapamil should not be taken with beta-blockers like atenolol or quinidine because the combination of their negatively inotropic and negatively chronotropic effects can result in severe hypotension, bradycardia, impaired atrioventricular conduction, heart failure (due to impaired cardiac contractility), and sinus arrest.The use of verapamil is contraindicated in the following situations:Acute porphyrias are a type of porphyria that occurs suddenly.Accessory conducting pathways are linked to atrial flutter or fibrillation (e.g. Wolff-Parkinson-White-syndrome)BradycardiaShock caused by the heartInsufficiency of the heart (with reduced ejection fraction)Left ventricular function has been significantly harmed in the past (even if controlled by therapy)Hypotension (blood pressure less than 90 mmHg)AV block in the second and third degreesSinusitis is a condition in which the sinuses becomeSino-atrial occlusion
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 19
Correct
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Which of the following infections is vancomycin most likely prescribed for?
Your Answer: Clostridium difficile colitis
Explanation:125 mg PO q6hr for 10 days is indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhoea
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 20
Correct
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Which of the following globin chains makes up haemoglobin A2 (HbA2)?
Your Answer: Two alpha chains and two delta chains
Explanation:Haemoglobin is a 64.4 kd tetramer consisting of two pairs of globin polypeptide chains: one pair of alpha-like chains, and one pair of non-alpha chains. The chains are designated by Greek letters, which are used to describe the particular haemoglobin (e.g., Hb A is alpha2/beta2).Two copies of the alpha-globin gene (HBA2, HBA1) are located on chromosome 16 along with the embryonic zeta genes (HBZ). There is no substitute for alpha globin in the formation of any of the normal haemoglobins (Hb) following birth (e.g., Hb A, Hb A2, and Hb F). Thus, absence any alpha globin, as seen when all 4 alpha-globin genes are inactive or deleted is incompatible with extrauterine life, except when extraordinary measures are taken. A homotetramer of only alpha-globin chains is not thought to occur, but in the absence of alpha chains, beta and gamma homotetramers (HbH and Bart’s haemoglobin, respectively) can be found, although they lack cooperativity and function poorly in oxygen transport. The single beta-globin gene (HBB) resides on chromosome 11, within a gene cluster consisting of an embryonic beta-like gene, the epsilon gene (HBE1), the duplicated and nearly identical fetal, or gamma globin genes (HBG2, HBG1), and the poorly expressed delta-globin gene (HBD). A heme group, consisting of a single molecule of protoporphyrin IX co-ordinately bound to a single ferrous (Fe2+) ion, is linked covalently at a specific site to each globin chain. If the iron is oxidized to the ferric state (Fe3+), the protein is called methaemoglobin.Alpha globin chains contain 141 amino acids (residues) while the beta-like chains contain 146 amino acids. Approximately 75 percent of haemoglobin is in the form of an alpha helix. The non helical stretches permit folding of the polypeptide upon itself. Individual residues can be assigned to one of eight helices (A-H) or to adjacent non helical stretches.Heme iron is linked covalently to a histidine at the eighth residue of the F helix (His F8), at residue 87 of the alpha chain and residue 92 of the beta chain. Residues that have charged side groups, such as lysine, arginine, and glutamic acid, lie on the surface of the molecule in contact with the surrounding water solvent. Exposure of the hydrophilic (charged) amino acids to the aqueous milieu is an important determinant of the solubility of haemoglobin within the red blood cell and of the prevention of precipitation.The haemoglobin tetramer is a globular molecule (5.0 x 5.4 x 6.4 nm) with a single axis of symmetry. The polypeptide chains are folded such that the four heme groups lie in clefts on the surface of the molecule equidistant from one another.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 21
Correct
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A 54-year-old man returns from a recently holiday on a cruise ship with a dry cough and a fever. Today he has also had several episodes of diarrhoea and has developed bilateral pleuritic chest pain. He states that he is short of breath, most notably on exertion. He had been prescribed amoxicillin by the cruise ship doctor a few days earlier but has not seen any improvement.Which of the following is the most likely causative organism? Select ONE answer only.
Your Answer: Legionella pneumophila
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.The clinical features of the pneumonic form of Legionnaires’ disease include:Mild flu-like prodrome for 1-3 daysCough (usually non-productive and occurs in approximately 90%)Pleuritic chest painHaemoptysisHeadacheNausea, vomiting and diarrhoeaAnorexiaLegionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 22
Correct
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Regarding bronchiolitis, which of the following statements is CORRECT:
Your 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 23
Correct
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A 29-year-old female with chronic anaemia secondary to sickle cell disease is being transfused. A few minutes after starting the blood transfusion, she develops widespread itching with urticarial rash, wheezing, nausea and chest pain. Her BP reduces to 60/40 mmHg.What is the most appropriate treatment?
Your Answer: Stop the transfusion and administer adrenaline
Explanation:Anaphylaxis transfusion reaction occurs when an individual has previously been sensitized to an allergen present in the blood and, on re-exposure, releases IgE or IgG antibodies. Patients with anaphylaxis usually develop laryngospasm, bronchospasm, abdominal pain, nausea, vomiting, hypotension, shock, and loss of consciousness. The transfusion should be stopped immediately and the patient should be treated with adrenaline, oxygen, corticosteroids, and antihistamines.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 24
Correct
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You examine a child who has been admitted to the paediatric emergency department with a flu-like illness. His parents tell you that he was born with an inborn defect of steroid metabolism and that he was treated for it with hormone replacement therapy.Which of the following is classified as a steroid hormone?
Your Answer: Aldosterone
Explanation:Hormones can be classified into three categories depending on their chemical composition: amines, peptides (and proteins), and steroids. Amines are made up of single amino acids (for example, tyrosine), peptide hormones are made up of peptides (or proteins), and steroid hormones are made up of cholesterol.The table below lists some prominent instances of each of these three hormone classes:1. Peptide hormone: Adrenocorticotropic hormone (ACTH)Prolactin VasopressinOxytocin GlucagonInsulin SomatostatinCholecystokinin 2. Amine hormone:Adrenaline (epinephrine) Noradrenaline (norepinephrine)Dopamine3. Steroid hormone:Mineralocorticoids (e.g. aldosterone)Glucocorticoids (e.g. cortisol)ProgestogensAndrogensOestrogens
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 25
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 26
Correct
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A 54-year-old woman presents with polyuria and polydipsia. She is known to suffer from bipolar disorder, which has been well controlled by the use of lithium for many years.What is the SINGLE most likely diagnosis?
Your Answer: Nephrogenic diabetes insipidus
Explanation:Diabetes insipidus is the inability to produce concentrated urine. It is characterised by the presence of excessive thirst, polyuria and polydipsia. There are two distinct types of diabetes insipidus:Cranial (central) diabetes insipidus and;Nephrogenic diabetes insipidusCranial diabetes insipidus is caused by a deficiency of vasopressin (anti-diuretic hormone). Patients with cranial diabetes insipidus can have a urine output as high as 10-15 litres per 24 hours, but adequate fluid intake allows most patients to maintain normonatraemia. 30% of cases are idiopathic, and a further 30% are secondary to head injuries. Other causes include neurosurgery, brain tumours, meningitis, granulomatous disease (e.g. sarcoidosis) and drugs, such as naloxone and phenytoin. A very rare inherited form also exists that is associated with diabetes mellitus, optic atrophy, nerve deafness and bladder atonia.Nephrogenic diabetes insipidus is caused by renal resistance to the action of vasopressin. As with cranial diabetes insipidus, urine output is markedly elevated. Serum sodium levels can be maintained by secondary polydipsia or can be elevated. Causes of nephrogenic diabetes insipidus include chronic renal disease, metabolic disorders (e.g. hypercalcaemia and hypokalaemia) and drugs, including long-term lithium usage and demeclocycline.In view of the history of long-term lithium use, in this case, nephrogenic diabetes insipidus is the most likely diagnosis.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 27
Correct
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A novel anti-tuberculosis medicine was compared to standard treatment and shown to cut the risk of death from 30 to 10 per 1000 people. How many patients would need to be treated (number need to treat (NNT)) in order to prevent ten additional tuberculosis deaths:
Your Answer: 500
Explanation:The risk of mortality in the control group (usual therapy) minus the risk of death in the treatment group equals the absolute risk reduction (ARR) of treatment.30/1000 minus 10/1000 = 20/1000 = 0.02NNT = 1/ARR = 1/0.02 = 50As a result, 50 people would need to be treated in order to prevent one additional fatality, and 500 people would need to be treated in order to avoid 10 additional deaths.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 28
Correct
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Which of the following features of cell damage tends to be reversible:
Your Answer: Swelling of endoplasmic reticulum and some mitochondria
Explanation:Features of cell damage that tend to be reversible include: swelling of endoplasmic reticulum and some mitochondrialoss of ribosomescell stress responseFeatures of cell damage that tend to be irreversible include: loss of nucleolus, no ribosomes, swelling of all mitochondria, nuclear condensation, membrane blebs and holes, lysosome rupture, fragmentation of all inner membranes, nuclear breakup
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 29
Correct
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Regarding relationships between two variables, what does a negative correlation coefficient indicate:
Your Answer: The two variables are inversely related
Explanation:A negative correlation coefficient means that the two variables are inversely related e.g. socio-economic class and mortality.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 30
Correct
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The most important nerves for inversion of the foot are:
Your Answer: Tibial and deep fibular nerve
Explanation:Inversion of the foot is achieved by the tibialis anterior which is innervated by the deep fibular nerves, and the tibialis posterior muscles which is innervated by the tibial nerve respectively.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 31
Correct
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A 24-year-old female visits her family physician to complain of painless lumps in her neck. Her physician notes several enlarged, rubbery, non-tender cervical lymph nodes on examination. He immediately refers the patient for a lymph node biopsy, the results of which show the presence of Reed-Sternberg cells. What is the diagnosis in this case based on the above scenario?
Your Answer: Hodgkin’s lymphoma
Explanation:The presence of Reed-Sternberg cells is pathognomonic for Hodgkin’s Lymphoma, which is a disease-causing neoplastic transformation of lymphocytes. There is a bimodal age distribution with peaks in the 20s and 60s. Patients typically present with enlarged, rubbery, non-tender lymph nodes. Symptoms such as fever, night sweats and weight loss may be present. Pain after alcohol consumption is a pathognomonic sign of Hodgkin’s lymphoma, it is, however, not a ‘B’ symptom. It is rare though, only occurring in 2-3% of patients with Hodgkin’s lymphoma.The Ann Arbour clinical staging is as follows:Stage I: one involved lymph node groupStage II two involved lymph node groups on one side of the diaphragmStage III: lymph node groups involved on both sides of the diaphragmStage IV: Involvement of extra-nodal tissues, such as the liver or bone marrowDiagnosis is made by lymph node biopsy, which should be taken from a sufficiently large specimen or excisional biopsy, as opposed to a fine needle biopsy. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs. In non-Hodgkin’s lymphoma, Reed-Sternberg cells are not present. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 32
Correct
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Which of the following does NOT affect the rate of flow of a liquid through a tube:
Your Answer: Surface tension
Explanation:Flow through a tube is dependent upon:The pressure difference across the ends of the tube (P1– P2)The resistance to flow provided by the tube (R)This is Darcy’s law, which is analogous to Ohm’s law in electronics:Flow = (P1– P2) / RResistance in the tube is defined by Poiseuille’s law, which is determined by the diameter of the tube and the viscosity of the fluid. Poiseuille’s law is as follows:Resistance = (8VL) / (πR4)Where:V = The viscosity of the fluidL = The length of the tubeR = The radius of the tubeTherefore, in simple terms, resistance is directly proportional to the viscosity of the fluid and the length of the tube and inversely proportional to the radius of the tube. Of these three factors, the most important quantitatively and physiologically is vessel radius.It can be seen that small changes in the radius can have a dramatic effect on the flow of the fluid. For example, the constriction of an artery by 20% will decrease the flow by approximately 60%.Another important and frequently quoted example of this inverse relationship is that of the radius of an intravenous cannula. Doubling the diameter of a cannula increases the flow rate by 16-fold (r4). This is the reason the diameter of an intravenous cannula in resuscitation scenarios is so important.*Please note that knowledge of the detail of Poiseuille’s law is not a requirement of the RCEM Basic Sciences Curriculum.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 33
Incorrect
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Regarding the lumbar plexus, which of the following is a direct muscular branch?
Your Answer: Nerve to obturator internus
Correct Answer: Nerve to quadratus lumborum
Explanation:The lumbar plexus gives rise to several branches which supply various muscles and regions of the posterior abdominal wall and lower limb. These branches include the Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral and obturator nerves.In addition, the lumbar plexus gives off muscular branches from its roots, a branch to the lumbosacral trunk and occasionally an accessory obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 34
Correct
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After an accidental fall, a 75-year-old patient complains of neck pain and weakness in his upper limbs. Select the condition that most likely caused the neck pain and weakness of the upper limbs of the patient.
Your Answer: Central cord syndrome
Explanation:The cervical spinal cord is the section of the spinal cord that goes through the bones of the neck. It is injured incompletely in the central cord syndrome (CCS). This will result in arm weakness more than leg weakness.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 35
Incorrect
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One of the following pathogens is a conditional pathogen:
Your Answer: Treponema pallidum
Correct Answer: Neisseria meningitidis
Explanation:Obligate pathogens include Mycobacterium TB, HIV, Treponema pallidum, and Neisseria gonorrhoeae. Neisseria meningitidis, on the other hand, is a conditional pathogen.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 36
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 D-cells secrete which of the following substances?
Your Answer: Somatostatin
Explanation:Somatostatin-producing cells present in the pyloric antrum, duodenum, and pancreatic islets are known as D-cells or delta-cells. Somatostatin inhibits gastric acid secretion by acting directly on acid-producing parietal cells in the stomach via a G-protein coupled receptor. By suppressing the release of other hormones such as gastrin, secretin, and histamine, somatostatin can indirectly reduce stomach acid output, slowing the digesting process.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 37
Correct
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Regarding endothelin-1, which of the following statements is INCORRECT:
Your 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 38
Incorrect
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Regarding oral rehydration therapy, which of the following statements is INCORRECT:
Your Answer: Rehydration in hypernatraemic dehydration should occur more slowly.
Correct Answer: Oral rehydration solutions should be slightly hyperosmolar.
Explanation:Oral rehydration therapy (ORT) is a fluid replacement strategy used to prevent or treat dehydration. It is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries. Oral rehydration solutions should be slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.ORT contains glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia. It also contains essential mineral salts.Current NICE guidance recommends that 50 ml/kg is given over 4 hours for the treatment of mild dehydration.Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 39
Incorrect
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A patient with a recent diagnosis of Hepatitis B would like to find out further information regarding his diagnosis and prognosis. Which among the following statements is considered true regarding Hepatitis B?
Your Answer: Less than 50% of patients that contract hepatitis B make a full recovery
Correct Answer: 60-65% of patients that contract hepatitis B show subclinical disease
Explanation:As the immune response is activated, the virus is slowly cleared from the system, and most patients become non-infectious. In adults, about 50% of infections are asymptomatic; 20% to 30% of patients exhibit clinical jaundice but have a benign resolution of the infection. Therefore, about 80% of infections do not cause serious sequelae. The risk for chronic infection is inversely proportional to age at time of infection, with approximately 90% of infants and only 3% of adults developing a chronic infection. Individuals with a chronic infection have a higher risk of liver disease, such as cirrhosis or hepatic carcinoma.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 40
Correct
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Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:
Your Answer: Dalton's law
Explanation:Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 41
Correct
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An 18-year-old student presents with a 1-week history of sore throat, low grade fever, and malaise. Upon history taking, she noted that she had a fine rash over her body a week ago that quickly fades. Further examination and observation was done and the presence of mild splenomegaly was noted. Her test shows positive for heterophile antibody test, suspecting a diagnosis of infectious mononucleosis.Which of the following characteristics is mostly associated with the diagnosis of infectious mononucleosis?
Your Answer: Atypical lymphocytes
Explanation:Epstein-Barr virus causes infectious mononucleosis which is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue and fever. It is accompanied by atypical large peripheral blood lymphocytes. These atypical lymphocytes, also known as Downey cells, are actually activated CD8 T lymphocytes, most of which are responding to EBV-infected cells.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 42
Correct
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Which of the following acts to inhibit antidiuretic hormone (ADH) release from the posterior pituitary:
Your Answer: Atrial natriuretic peptide
Explanation:ADH release is inhibited by low plasma osmolality, alcohol, caffeine, glucocorticoids and atrial natriuretic peptide (ANP).ADH release is stimulated primarily by raised plasma osmolality detected by osmoreceptors in the anterior hypothalamus. Other factors that increase ADH release include: extracellular fluid volume depletion, angiotensin II, nausea, pain, stress, exercise, emotion, hypoglycaemia.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 43
Correct
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Regarding fat digestion, which of the following statements is CORRECT:
Your Answer: Chylomicrons consist of a cholesterol and triglyceride core with a phospholipid coat studded with apolipoproteins.
Explanation:Dietary fat is chiefly composed of triglycerides. In the duodenum fat is emulsified by bile acids, a process where larger lipid droplets are broken down into much smaller droplets providing a greater surface area for enzymatic digestion. Once inside the epithelial cell, lipid is taken into the smooth endoplasmic reticulum where much of it is re esterified. Dietary and synthesised lipids are then incorporated into chylomicrons in the Golgi body, which are exocytosed from the basolateral membrane to enter lacteals. Chylomicrons consist mainly of triglyceride with small amounts of cholesterol and cholesteryl esters in the centre with a phospholipid coat studded with apolipoproteins. Fat-soluble are absorbed into enterocytes from micelles by simple diffusion together with the products of fat digestion.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 44
Correct
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The following all cause a left shift in the oxygen dissociation curve EXCEPT for:
Your Answer: Decrease in pH
Explanation:An increased affinity of haemoglobin for oxygen, shown by a left shift in the oxygen dissociation curve, is caused in the lungs by a rise in pH, a fall in PCO2,a decrease in temperature and a decrease in 2,3 -DPG. Carbon monoxide (CO) binds 240 times more strongly than O2to haemoglobin and by occupying O2-binding sites, reduces oxygen capacity. CO also increases oxygen affinity, shifting the oxygen haemoglobin curve to the left and making O2release to tissues more difficult.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 45
Correct
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A 30-year-old male farmer presents to the Emergency Department due to a wound on his right forearm sustained two days ago while working on the farm. He cleaned the wound under a tap, but there was still some dirt and debris on examination. Past medical history reveals that he never received a tetanus vaccine. After cleaning the wound and prescribing antibiotics, which ONE of the following actions should be taken to manage his tetanus risk?
Your Answer: Tetanus vaccination and 500 IU tetanus immunoglobulin
Explanation:If a patient presents with one of the following types of wounds, they are at risk of contracting tetanus and should be vaccinated immediately:1) Contaminated puncture-type wounds from gardening and farming (as they may contain tetanus spores)2) Wounds containing foreign bodies3) Open (compound) fractures4) Wounds or burns with sepsis5) Animal bites and scratches (animal saliva does not contain tetanus spores unless the animal was routing in soil or lives in an agriculture setting)Extremely high-risk tetanus-prone wounds are any of the above wounds with one of the following:1) Any wound contaminated by materials containing tetanus spores, e.g., soil, manure2) Burns or wounds with extensive devitalised tissue3) Wounds or burns with surgical intervention delayed for more than six hours even if the initial injury was not heavily contaminatedThe CDC recommends that adults who have never been vaccinated for tetanus receive a quick shot of the tetanus vaccine along with a booster dose ten years later. A tetanus-prone wound in an unvaccinated individual should also receive a high dose of tetanus immunoglobulin. The injected antibodies will prevent tetanus infection as the patient does not have any pre-existing antibodies against the disease.In this case, the patient has a high risk, contaminated wound. He should receive a high dose of tetanus immunoglobulin along with the tetanus vaccine. (The preventative dose of tetanus immunoglobulin is 250 IU in most cases unless over 24 hours have passed since the injury or the wound is heavily contaminated, then 500 IU should be given.) His physician also needs to be contacted to arrange the remainder of the course as indicated in this case.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 46
Correct
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A patient who has a nerve injury has sparing of the upper half of the orbicularis oculi muscle but not the lower half. Which branch of the facial nerve supplies the lower half of the orbicularis oculi?
Your Answer: Zygomatic branch
Explanation:The facial nerve divides into five terminal branches once in the parotid gland. 1. The temporal branch innervates muscles in the temple, forehead and supraorbital areas.2. The zygomatic branch innervates muscles in the infraorbital area, the lateral nasal area and the upper lip.3. The buccal branch innervates muscles in the cheek, the upper lip and the corner of the mouth. 4. The marginal mandibular branch innervates muscles of the lower lip and chin. 5. The cervical branch innervates the platysma muscle.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 47
Correct
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A 63-year-old man presents with severe abdominal pain and vomiting of blood. An endoscopy was performed and a peptic ulcer was found to have eroded into an artery nearby.Which of the following most likely describes the location of the ulcer?
Your Answer: The posterior duodenum
Explanation:The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, particularly gastric and duodenal ulcers. Duodenal ulcers are most commonly associated with bleeding compared with gastric ulcers. Posterior duodenal ulcers are considered to be the most likely to cause severe bleeding because of its proximity to the branches of the gastroduodenal artery (GDA).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 48
Correct
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Regarding thalassaemia, which of the following statements is CORRECT:
Your Answer: Screening for thalassaemia in pregnancy is offered to all pregnant women.
Explanation:Beta thalassemia is caused by mutations in one or both of the beta globin genes. Alpha thalassemia is caused by a deletion or mutation (less commonly) in one or more of the four alpha globin gene copies. β-thalassaemia is more common in the Mediterranean region while α-thalassaemia is more common in the Far East.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 49
Correct
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Regarding ciprofloxacin, which of the following statements is INCORRECT:
Your Answer: Ciprofloxacin decreases plasma concentrations of theophylline.
Explanation:Ciprofloxacin increases plasma concentrations of theophylline. There is an increased risk of convulsions when quinolones are given with NSAIDs or theophylline. There is an increased risk of tendon damage when quinolones are given with corticosteroids. Quinolones are known to increase the QT-interval and should not be taken with concomitantly with other drugs that are known to cause QT-interval prolongation. There is an increased risk of myopathy when erythromycin or clarithromycin are taken with simvastatin or atorvastatin.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 50
Correct
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All of the following statements are correct with regards to protection of the gastric mucosa except which of the following?
Your Answer: NSAIDs directly stimulate increased parietal cell acid production.
Explanation:Prostaglandin production, which usually inhibits acid secretion and increases mucus and bicarbonate secretion, is inhibited by NSAIDs.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 51
Correct
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A lesion to which part of the optic radiation will result in contralateral homonymous inferior quadrantanopia?
Your 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 52
Correct
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What is the average healing time for a femoral shaft fracture under normal circumstances? Choose ONE answer.
Your Answer: 12 weeks
Explanation:The process of fracture healing occurs naturally after traumatic bone disruption and begins with haemorrhage, then progresses through Inflammatory, reparative, and remodelling stagesAverage healing times of common fractures are:Femoral shaft: 12 weeksTibia: 10 weeksPhalanges: 3 weeksMetacarpals: 4-6 weeksDistal radius: 4-6 weeksHumerus: 6-8 weeks
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 53
Correct
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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 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 54
Correct
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Which of the following nerves is most likely associated with an anterior shoulder dislocation?
Your Answer: Axillary nerve
Explanation:In an anterior dislocation, the arm is an abducted and externally rotated position. In the externally rotated position, the posterosuperior aspect of the humeral head abuts and drives through the anteroinferior aspect of the glenoid rim. This can damage the humeral head, glenoid labrum, or both. An associated humeral head compression fracture is described as a Hill Sach’s lesion. If large enough, it can lead to locked dislocations that may require open reduction. The glenoid labrum is a fibrocartilaginous structure that rings the circumference of the glenoid fossa. Bankart lesions are injuries to the anteroinferior glenoid labrum complex and the most common capsulolabral injury. A bony Bankart lesion refers to an associated fracture of the glenoid rim. These capsulolabral lesions are risk factors for recurrent dislocation.Axillary nerve injury is identified in about 42% of acute anterior shoulder dislocations. Nerve transection is rare, and traction injuries are more common. Arterial injury has also been described. The subclavian artery becomes the axillary artery after passing the first rib. The distal portion of the axillary artery is anatomically fixed and, therefore, susceptible to injury in anterior dislocations. Ischemic injury, including pseudoaneurysm and arterial laceration, is rare but carries marked morbidity if not quickly identified.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 55
Correct
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A 16-year old boy is brought to the emergency room after suffering a traffic accident. Upon examination, there is noted ipsilateral loss of proprioception and vibration, ipsilateral motor loss, and contralateral loss of pain and temperature sensation. A spinal cord injury is given as a diagnosis.Which of the following is the most probable cause of this manifestation?
Your Answer: Brown-Séquard syndrome
Explanation:Brown-Sequard Hemicord Syndrome consists of ipsilateral weakness (corticospinal tract) and loss of joint position and vibratory sense (posterior column), with contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex, are unilateral. Partial forms are more common than the fully developed syndrome.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 56
Incorrect
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You need to give your patient antibiotics, so you call microbiology for some advice.Of the following antibacterial drugs, which of them is a protein synthesis inhibitor?
Your Answer: Rifampicin
Correct Answer: Erythromycin
Explanation:Bacteriostatic antibiotics include erythromycin and other macrolides. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and, as a result, inhibit protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered into the infection site as a result.Action Mechanisms- Examples:Cell wall production is inhibitedVancomycinVancomycinCephalosporinsThe function of the cell membrane is disrupted NystatinPolymyxinsAmphotericin B Inhibition of protein synthesisChloramphenicolMacrolidesAminoglycosidesTetracyclinesNucleic acid synthesis inhibitionQuinolonesTrimethoprimRifampicin5-nitroimidazolesSulphonamidesAnti-metabolic activityIsoniazid
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 57
Correct
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The parasympathetic supply to the rectum is from which of the following:
Your Answer: Pelvic splanchnic nerves
Explanation:Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 58
Correct
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Which of the following is the site of secretion of intrinsic factor:
Your Answer: Stomach
Explanation:Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 59
Correct
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A 21 year old student presents to the emergency room with severe acute asthma. Salbutamol and ipratropium bromide nebuliser are prescribed. The most appropriate dose of salbutamol that should be prescribed initially for this patient is which of the following?
Your Answer: 5 mg every 15 - 30 minutes
Explanation:The first line treatment for acute asthma is high-dose inhaled short-acting beta2-agonists like salbutamol or terbutaline. Oxygen use should be reserved for hypoxemic patients in order to maintain oxygen saturations of 94 – 98%. In patients with moderate to severe asthma, a pressurised metered dose inhaler with spacer device is preferred (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). For patients with life-threatening features or poorly responsive severe asthma, the oxygen-driven nebuliser route is recommended (salbutamol 5 mg at 15 – 30 minute intervals). In patients with severe acute asthma that is poorly responsive to initial bolus dose, continuous nebulisation should be considered (salbutamol at 5 – 10 mg/hour). For those in whom inhaled therapy cannot be used reliably, the intravenous route is usually reserved.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 60
Correct
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A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You plan on using propofol as the sedative agent.Propofol works as a result of action on what type of receptor? Select ONE answer only.
Your Answer: Gamma-aminobutyric acid (GABA)
Explanation:Propofol (2,6-diisopropylphenol) is a short-acting phenol derivative that is primarily used for the induction of anaesthesia.Its mechanism of action is unclear but is thought to act by potentiating the inhibitory neurotransmitters GABA and glycine, which enhances spinal inhibition during anaesthesia.The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.The main side effects of propofol are:Pain on injection (in up to 30%)HypotensionTransient apnoeaHyperventilationCoughing and hiccoughHeadacheThrombosis and phlebitis
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 61
Correct
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A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis on indwelling metal work and no known drug allergies. He has had a recent skin swab that has cultured MRSA and MRSA infection is suspected.Which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.
Your Answer: Vancomycin
Explanation:In the majority of patients the commonest causative organism for osteomyelitis isStaphylococcus aureus.Salmonella spp. are the commonest cause in patients with sickle cell disease.Other bacteria that can cause osteomyelitis include:Enterobacter spp.Group A and B streptococcusHaemophilus influenzaeThe current recommendations by NICE and the BNF on the treatment of osteomyelitis are:Flucloxacillin first-lineConsider adding fusidic acid or rifampicin for initial 2 weeksIf penicillin allergic use clindamycinIf MRSA is suspected use vancomycinSuggested duration of treatment is 6 weeks for acute infection
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 62
Incorrect
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A patient presents with a rash for dermatological examination. A large area of purplish discolouration of the skin that measures 2 cm in diameter and does not blanch when pressure is applied is seen .What is the best description of this rash that you have found on examination?
Your Answer: Purpura
Correct Answer: Ecchymoses
Explanation:Ecchymosis are discolouration of the skin or mucous membranes caused by extravasation of blood. They are usually red or purple in colour and measure greater than 1 cm in diameter and do not blanch on applying pressure. 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. Petechiae are discolouration of the skin measuring less than 3 mm in diameterPurpura are discolouration of the skin measuring between 0.3 cm and 1 cm in diameter.Erythema is redness of the skin or mucous membranes caused by hyperaemia of superficial capillaries caused by skin injury, infection or inflammation. Erythema blanches when pressure is applied whereas ecchymosis, purpura and petechiae do not.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 63
Incorrect
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Which of the following statements is correct regarding homeostasis?
Your Answer: The set point is a fixed value which homeostasis must maintain.
Correct Answer: In negative feedback mechanisms, effectors always act to move the variable in the opposite direction to the change that was originally detected.
Explanation:The vast majority of systems within the body work by negative feedback mechanisms. This negative feedback refers to the way that effectors act to move the variable in the opposite direction to the change that was originally detected. Because there is an inherent time delay between detecting a change in a variable and effecting a response, the negative feedback mechanisms cause oscillations in the variable they control. There is a narrow range of values within which a normal physiological function occurs and this is called the ‘set point’. The release of oxytocin in childbirth is an example of positive feedback.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 64
Incorrect
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You are instructed by a senior to administer Mannitol to an RTA patient with increased intracranial pressure. Mannitol is a low molecular weight compound that freely filters at the glomerulus and is not reabsorbed.Out of the following, which is a contraindication to the use of mannitol?
Your Answer: Transplanted kidney
Correct Answer: Severe pulmonary oedema
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure. It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Mannitol has several contraindications and some of them are listed below:1. Anuria due to renal disease2. Acute intracranial bleeding (except during craniotomy)3. Severe cardiac failure4. Severe dehydration5. Severe pulmonary oedema or congestion6. Known hypersensitivity to mannitol
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 65
Incorrect
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Which of the following statements is considered correct regarding Klebsiella infections?
Your Answer: Klebsiella pneumoniae is most commonly associated with chronic bronchiectasis
Correct Answer: Klebsiella spp. are non-motile
Explanation:Klebsiella is a Gram-negative, rod-shaped, non-motile bacteria. The absence of motility distinguishes Klebsiella spp. from most other members of the family Enterobacteriaceae. K. pneumoniae is the most commonly isolated species and has the distinct feature of possessing a large polysaccharide capsule. The capsule offers the organism protection against phagocytosis and antimicrobial absorption,contributing to its virulence. Colonization of gram-negative bacilli in the respiratory tracts of hospitalized patients, particularly by K. pneumoniae, increases with the length of hospital stay. It is a frequent cause of lower respiratory tract infections among hospitalized patients and in immunocompromised hosts such as newborns,elderly patients, and seriously ill patients on respirators.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 66
Correct
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Which patient group are most commonly associated with infection with Klebsiella spp:
Your Answer: Hospitalised patients
Explanation:Klebsiella spp. are facultatively anaerobic Gram-negative rods, found in the normal intestinal and respiratory flora. These organisms are usually opportunistic pathogens that cause nosocomial infections, most commonly pneumonia and UTI.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 67
Correct
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A 7-year-old girl is admitted to the hospital with a persistently high temperature. To help her reduce her fever, you decide to give her paracetamol and ibuprofen.What are the effects of paracetamol and ibuprofen on fever?
Your Answer: Reduction in prostaglandin synthesis
Explanation:Interleukin-1, which is released by leukocytes and acts on the thermoregulatory centre of the hypothalamus, causes fever. Because prostaglandins mediate this process, antipyretics such as NSAIDs, paracetamol, and aspirin reduce prostaglandin levels by inhibiting cyclooxygenase enzymes. Malignant disease secretes interleukins, which cause the B-symptoms seen in lymphoma, for example. Bacterial toxins can also cause interleukins to be produced.Pyrexia of unknown origin (PUO) is defined as a fever of greater than 38.3 degrees Celsius that lasts for more than 2-3 weeks with no clear diagnosis despite extensive investigation.Investigation necessitates a thorough understanding of the conditions that can cause febrile illness, which may be missed during an initial investigation, as well as a thorough history, examination, and investigation centred on that list.Pyrexia of unknown origin has a wide differential diagnosis, which includes:InfectionBacterialPyogenic abscessTuberculosisInfective endocarditisBrucellosisLyme diseaseViralHIV Epstein Barr VirusCytomegalovirusParasiteToxoplasmosisMalignancy LeukaemiaLymphomaRenal cell carcinomaHepatocellular carcinomaVasculitides Still’s diseaseGranulomatosis with polyangiitis (formerly Wegener’s)Systemic lupus erythematosusGiant cell arteritisRheumatoid arthritisPolymyalgia rheumaticaMiscellaneous Drug induced fevers Familial Mediterranean feverThyrotoxicosisInflammatory bowel diseaseSarcoidosisFactitious fever Exaggerated normal circadian fluctuationThe patient might need to be admitted to the hospital for observation and further investigation. Because infection is still a possibility, blood cultures should be repeated on a regular basis, and inflammatory markers should be closely monitored. CT, PET, and MRI imaging have largely replaced diagnostic laparotomy as a diagnostic tool.
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This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 68
Incorrect
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Regarding the lacrimal apparatus, which of the following statements is CORRECT:
Your Answer: The lacrimal gland is located in the superomedial region of the orbit.
Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
Explanation:Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 69
Correct
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A 19-year-old with a longstanding history of asthma presents to the ED with worsening symptoms of cough and wheeze and a peak expiratory flow rate (PEFR) measurement is taken.Which statement concerning PEFR is true?
Your Answer: PEFR is dependent upon the patient's height
Explanation:The maximum flow rate generated during a forceful exhalation, after maximal inspiration is the peak expiratory flow rate (PEFR).PEFR is dependent upon initial lung volume. It is, therefore, dependant on patient’s age, sex and height.PEFR is dependent on voluntary effort and muscular strength of the patient.PEFR is decreased with increasing airway resistance, e.g. in asthma, and it correlates well with the forced expiratory volume in one second (FEV1) value measured in spirometry. This correlation decreases in patients with asthma as airflow decreases.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 70
Correct
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How is measles primarily transmitted:
Your Answer: Respiratory droplet route
Explanation:Measles belongs to the paramyxoviridae group of viruses. The incubation period is 7-18 days (average 10) and it is spread by airborne or droplet transmission. The classical presentation is of a high fever with coryzal symptoms and photophobia with conjunctivitis often being present. The rash that is associated is a widespread erythematous maculopapular rash. Koplik spots are pathognomonic for measles, and are the presence of white lesions on the buccal mucosa.Differential diagnoses would include:RubellaRoseola infantum (exanthem subitom)Scarlet feverKawasaki diseaseErythema infectiosum (5thdisease)EnterovirusInfectious mononucleosisDiagnosis can be confirmed by the following means:Salivary swab for measles specific IgMSerum sample for measles specific IgMSalivary swab for RNA detectionPossible complications include:Otitis mediaFebrile convulsionsPneumoniaBronchiectasisDiarrhoeaMeningitisEncephalitisImmunosuppressionSubacute sclerosing panencephalitisDeath
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This question is part of the following fields:
- Microbiology
- Pathogens
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SESSION STATS - PERFORMANCE PER SPECIALTY
