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Question 1
Incorrect
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Cryptococcus neoformans is primarily transmitted by which of the following routes:
Your Answer: Oral-faecal route
Correct Answer: Inhalation of spores
Explanation:Cryptococcus neoformans is found in bird droppings and transmission is by inhalation of spores, thus the lung is the primary site of infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 2
Correct
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Intravenous glucose solutions are typically used in the treatment of all of the following situations except:
Your Answer: Hypokalaemia
Explanation:In hypokalaemia, initial potassium replacement therapy should not involve glucose infusions, as glucose may cause a further decrease in the plasma-potassium concentration. Glucose infusions are used for the other indications like diabetic ketoacidosis, hypoglycaemia, routine fluid maintenance in patients who are nil by mouth (very important in children), and in hyperkalaemia.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 3
Correct
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During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:L– lateral two lumbricalsO– Opponens pollicisA– Abductor pollicisF– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Correct
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A 20-year-old patient had sustained a supracondylar fracture due to falling from a skateboard. The frequency of acute nerve injuries accompanying supracondylar humeral fractures ranges from 10 to 20%. The most common complication is injury to which nerve?
Your Answer: Median nerve
Explanation:According to various studies, the frequency of acute nerve damage associated with supracondylar humeral fractures in children ranges from 10% to 20%. Median nerve injury and anterior interosseous nerve injury are the most common consequences. Damage to this nerve indicated weakening or abnormal extension of the index finger’s distal interphalangeal joint and the thumb’s interphalangeal joint. The absence of sensibility is a distinguishing attribute. A surgical neck humerus fracture may cause injury to the axillary nerve. A midshaft humerus fracture might cause injury to the radial nerve. A medial epicondylar fracture might cause injury to the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Correct
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Which of the following muscles are primarily involved in passive inspiration:
Your Answer: Diaphragm and external intercostal muscles
Explanation:Passive inspiration is produced by contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, elevation of the sternal ends of the ribs (‘pump handle’ movement), elevation of the lateral shafts of the ribs (‘bucket handle’ movement) and depression of the diaphragm result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in an increased intrathoracic volume and decreased intrathoracic pressure and thus air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 6
Correct
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Thiopental sodium is contraindicated in which of the following:
Your Answer: Acute intermittent porphyrias
Explanation:Barbiturates induce hepatic enzymes. The enzyme gamma aminolevulinic acid synthetase, which produces porphyrins, can be induced and in susceptible patients an attack of acute intermittent porphyria can occur. Thiopental is absolutely contraindicated in these patients.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 7
Incorrect
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Approximately how long is the duration of a lidocaine block (when given with adrenaline):
Your Answer: 1 hour
Correct Answer: 90 minutes
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 8
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 9
Incorrect
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A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration is 1246 pg/mL.Glucagon INHIBITS which of the following processes? Select ONE answer only.
Your Answer: The hydrolysis of triglycerides
Correct Answer: Glycolysis
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline. Glucagon then causes:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 10
Correct
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Cefotaxime (or ceftriaxone) is used first line for which of the following infections:
Your Answer: Blind treatment of suspected bacterial meningitis
Explanation:Cefotaxime (or ceftriaxone) are indicated first line in:- Blind treatment of meningitis in patients > 3 months (with amoxicillin if patient > 50 years)- Meningitis caused by meningococci- Meningitis caused by pneumococci- Meningitis caused by H. influenzae- Severe or invasive salmonellosis- Typhoid fever- Gonorrhoea- Gonococcal arthritis- Haemophilus influenzae epiglottitis
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 11
Correct
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An elderly man presents with bilateral lower facial swelling around the mandible and upper neck. A CT scan of his neck was performed and the results were conclusive with Ludwig's angina.Which of the following spaces is most likely affected based on the case presented?
Your Answer: Submandibular space
Explanation:Ludwig’s angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. It involves three compartments of the floor of the mouth: the sublingual, submental, and submandibular.Ludwig’s angina usually originates as a dental infection of the second or third mandibular molars. The infection begins in the subgingival pocket and spreads to the musculature of the floor of the mouth. It progresses below the mylohyoid line, indicating that it has moved to the sublingual space. As the roots of the second and third mandibular molars lie below this line, infection of these teeth will predispose to Ludwig’s angina. The infection spreads lingually rather than buccally because the lingual aspect of the tooth socket is thinner. It initially spreads to the sublingual space and progresses to the submandibular space.The disease is usually polymicrobial, involving oral flora, both aerobes, and anaerobes. The most common organisms are Staphylococcus, Streptococcus, Peptostreptococcus, Fusobacterium, Bacteroides, and Actinomyces.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 12
Correct
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Which of the following statements is correct regarding gentamicin?
Your Answer: Gentamicin is ineffective against anaerobic bacteria.
Explanation:Gentamicin is the aminoglycoside of choice in the UK and is a parenterally administered, broad spectrum antibiotic typically used for moderate to severe gram negative infections. However, it is inactive against anaerobes. There is poor activity against haemolytic streptococci and pneumococci. It is usually given in conjunction with a penicillin or metronidazole (or both) when used for the blind treatment of undiagnosed serious infections. Nephrotoxicity and ototoxicity are the main toxic effects due to damage to the vestibulocochlear nerve (CN VIII).It is contraindicated in myasthenia gravis and should be used with great care in renal disease as it may result in accumulation and a higher risk of toxic side effects.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 13
Correct
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Which of the following is NOT a typical effect caused by adrenaline:
Your Answer: Bronchoconstriction
Explanation:Actions of adrenaline:Cardiovascular system- Increased rate and force of cardiac contraction- Vasoconstriction of vessels in skin, mucous membranes and splanchnic bed- Vasodilation of skeletal muscle vessels- Increased cardiac output and blood pressureRespiratory system- Bronchodilation- Increased ventilation rateGastrointestinal system- Smooth muscle relaxation- Contraction of sphincters- Metabolism- Decreased insulin release- Increased glucagon release- Increased thermogenesis- Increased glycolysis- Increased lipolysisEye- Pupillary dilation
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 14
Correct
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Regarding autoregulation of local blood flow, which of the following statements is CORRECT:
Your Answer: An increase in blood flow dilutes locally produced vasodilating factors causing vasoconstriction.
Explanation:Autoregulation is the ability to maintain a constant blood flow despite variations in blood pressure (between 50 – 170 mmHg). It is particularly important in the brain, kidney and heart. There are two main methods contributing to autoregulation:The myogenic mechanism involves arterial constriction in response to stretching of the vessel wall, probably due to activation of smooth muscle stretch-activated Ca2+channels and Ca2+entry. A reduction in pressure and stretch closes these channels, causing vasodilation. The second mechanism of autoregulation is due to locally produced vasodilating factors; an increase in blood flow dilutes these factors causing vasoconstriction, whereas decreased blood flow has the opposite effect.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 15
Correct
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Regarding penicillin antibiotics, which of the following statements is CORRECT:
Your Answer: Patients with a history of atopy are at higher risk of hypersensitivity reactions.
Explanation:Allergic reactions to penicillins occur in 1 – 10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. Patients with a history of atopic allergy are at higher risk of anaphylactic reactions to penicillins. Patients with a history of anaphylaxis, urticaria, or rash immediately after penicillin use should not receive a penicillin or other beta-lactam antibiotics; about 0.5 – 6.5 % of penicillin-sensitive patients will also be allergic to the cephalosporins. Patients with a history of a more minor rash (i.e. non-confluent, non-pruritic rash restricted to a small area of the body) or delayed reaction (rash occurring more than 72 hours after penicillin administration), may not be truly allergic and may be considered for penicillin or beta-lactam treatment in severe infection (although possibility of allergy should be borne in mind). Other beta-lactam antibiotics (including cephalosporins) can be used in these patients.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 16
Correct
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Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department by ambulance. Her heart rate is 180 beats per minute, and the rhythm strip shows supraventricular tachycardia. You intend to give adenosine.Which of the following is NOT a contraindication for adenosine use?
Your Answer: History of heart transplant
Explanation:The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg. Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.The use of adenosine is contraindicated in the following situations:AsthmaCOPD (chronic obstructive pulmonary disease)Decompensated heart failure Long QT syndromeAV block in the second or third degreeSinusitis is a condition in which the sinuses become (unless pacemaker fitted)Hypotension that is severeIt has a half-life of less than 10 seconds and acts quickly within that time frame. The actions last between 10 and 20 seconds. Because of the short half-life of the drug, any side effects are usually only temporary. These are some of them:a feeling of impending doomFlushing of the faceDyspnoeaUncomfortable chestTastes metallic
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 17
Incorrect
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You see a 63-year-old man with a history of melaena and epigastric discomfort. For a few months, he's been taking aspirin.Which of the following statements about aspirin's mechanism of action is correct?
Your Answer: COX-1 inhibition is primarily responsible for its anti-inflammatory effects
Correct Answer: It inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day)
Explanation:Aspirin inhibits cyclo-oxygenase irreversibly by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2. The production of prostaglandin and thromboxane is reduced as a result. As a result, platelet activation and aggregation are reduced. A single dose of aspirin has a half-life of 7-10 days, which is the time it takes for the bone marrow to produce new platelets.Aspirin only inhibits COX-1, the enzyme that produces thromboxane A2, at low doses (75 mg per day), and thus has a primarily anti-thrombotic effect.Aspirin inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day). COX-2 is involved in the production of prostaglandins, so it has an anti-inflammatory effect at these concentrations.Aspirin, when used as an antipyretic for a viral illness in children, can cause Reye’s syndrome. Reye’s syndrome is a potentially fatal liver disease that causes encephalopathy and liver failure.The inability of aspirin to reduce platelet production of thromboxane A2, and thus platelet activation and aggregation, is known as aspirin resistance. Although the exact frequency and mechanism of aspirin resistance are unknown, it is thought to affect about 1% of users. Women are more likely than men to experience this phenomenon.According to new research, taking aspirin on a regular basis lowers the risk of colorectal cancer. It may also protect against cancers of the breast, bladder, prostate, and lungs.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 18
Incorrect
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While studying fluid homeostasis in the body, you encounter the term exudate. Exudate is a fluid that leaks out of the intravascular space due to changes in the permeability of the microcirculation secondary to inflammation. Which ONE of the following conditions would not be listed among the causes of an exudate?
Your Answer: Breast cancer
Correct Answer: Myxoedema
Explanation:An exudate is an inflammatory fluid that leaks out of the intravascular space due to increased vascular permeability and intravascular pressure. It is mostly caused by local processes and can occur in the following conditions:1) Infection (e.g. pneumonia)2) Malignancy3) Pericarditis4) Collagen vascular diseases, e.g., Rheumatoid ArthritisMyxoedema is a state of severe hypothyroidism in which deposition of mucopolysaccharides occurs in the dermis. This causes a transudative effusion, typically in the pretibial region.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 19
Correct
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A 18 year old university student develops facial swelling and dark frothy urine. Urine dipstick demonstrates haematuria and proteinuria. Approximately 3 weeks ago, he was treated with oral antibiotics for a sore throat. His condition is most likely to be secondary to infection with:
Your Answer: Streptococcus pyogenes
Explanation:Post-streptococcal glomerulonephritis is a postinfectious immune-mediated reaction secondary to infection with Streptococcus pyogenes. It typically occurs 2 weeks or more after acute/initial infection, and presents with haematuria, reduced urine output, peripheral oedema, proteinuria, and hypertension. Permanent kidney damage is rare.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 20
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 21
Correct
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Regarding iron handling, which of the following statements is CORRECT:
Your Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).
Explanation:Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 22
Correct
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A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?
Your Answer: Give atropine 500 mcg
Explanation:Atropine is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of atropine 500 mcg IV:ShockSyncopeMyocardial ischemiaInsufficiency of the heartIf this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.The ALS bradycardia algorithm also suggests the following interim measures:Transcutaneous pacingIsoprenaline infusion 5 mcg/minAdrenaline infusion 2-10 mcg/minutesAlternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate)
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 23
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: ALL is the most common malignancy of childhood.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.
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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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The lymph drainage of the anal canal above the pectinate line is initially to the:
Your Answer: Internal iliac nodes
Explanation:Above the pectinate line, the anal canal drains to the internal iliac lymph nodes which subsequently drain to the lumbar (para-aortic) nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 25
Incorrect
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A GP is considering prescribing a non-steroidal anti-inflammatory (NSAID) for pain relief for a patient with a knee injuryWhich of these statements about NSAIDs is NOT true?
Your Answer: Most NSAIDs act as non-selective inhibitors of the enzyme cyclo-oxygenase
Correct Answer: Side effects are less commonly seen with indomethacin than naproxen
Explanation:Most NSAIDs act as non-selective inhibitors of the enzyme cyclo-oxygenase (COX). They inhibit both COX-1 and COX-2 isoenzymes. Only about 60% of patients will respond to any given NSAID.It can take 21 days of treatment for a clinically appreciable reduction in inflammation to be apparent. If no improvement is seen after 21 days, the NSAID should be changed.The use of NSAIDs in the 3rd trimester of pregnancy is associated with the following risks: delayed onset of labour, premature closure of ductus arteriosus and foetal kernicterus.Side effects are lowest in Ibuprofen and highest in indomethacin. so side effects are more commonly seen with indomethacin than naproxen.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 26
Incorrect
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What is nimodipine used predominantly in the treatment of?
Your Answer: Refractory angina
Correct Answer: Prevention and treatment of vascular spasm following subarachnoid haemorrhage
Explanation:Nimodipine is a smooth muscle relaxant that is related to nifedipine, but the effects preferentially act on cerebral arteries. It is exclusively used for the prevention and treatment of vascular spasm after an aneurysmal subarachnoid haemorrhage.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 27
Correct
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A 70-year-old woman presents with right-sided loss of pain and temperature sense on the body as well as left-sided loss of pain and temperature sense on the face. She also has complaints of vertigo, nausea, and tinnitus. Further examination of her cranial nerves suggest the presence of Horner's Syndrome. An MRI and CT scan was ordered and results showed that she is suffering from a left-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer: Posterior inferior cerebellar artery
Explanation:Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. It is the most common posterior circulation ischemic stroke syndrome. The primary pathology of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches.It is characterized by vertigo with nystagmus, nausea and vomiting, and sometimes hiccups, dysphonia, dysarthria, and dysphagia often present with ipsilateral loss of gag reflex, ipsilateral ataxia with a tendency to fall to the ipsilateral side, pain and numbness with impaired facial sensation on the face, impaired taste sensation, and impaired pain and temperature sensation in the arms and legs.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 28
Incorrect
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A 52-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.Which of the following is NOT a contraindication to abciximab (ReoPro) treatment?
Your Answer: Intracranial neoplasm
Correct Answer: Major surgery within the last 6 months
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.The use of abciximab is contraindicated in the following situations:Internal bleeding is present.Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.Stroke in the previous two yearsIntracranial tumourAneurysm or arteriovenous malformationHaemorrhagic diathesis is a type of haemorrhagic diathesis.VasculitisRetinopathy caused by hypertension
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 29
Correct
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Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism of action is best described by which of the following?
Your Answer: Nicotinic acetylcholine receptor antagonist
Explanation:Atracurium is a non-depolarizing neuromuscular blocker that is used to help with intubation and controlled ventilation by causing muscle relaxation and paralysis. At the neuromuscular junction’s post-synaptic membrane, atracurium competes with acetylcholine for nicotinic (N2) receptor binding sites. This prevents the receptors from being stimulated by acetylcholine. Muscle paralysis occurs gradually due to the competitive blockade.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 30
Incorrect
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A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?
Your Answer: ORT is hypo-osmolar
Correct Answer: ORT is sugar-free
Explanation:One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status. Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries. Some characteristics of Oral rehydration solutions are:- slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.- contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia. – also contains essential mineral saltsCurrent NICE guidance recommends that 50 ml/kg is given over 4 hours to treat 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 & Electrolytes
- Pharmacology
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Question 31
Correct
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The following are all examples of type I hypersensitivity EXCEPT for:
Your Answer: Contact dermatitis
Explanation:Examples of type I reactions include:Allergic rhinitisAllergic conjunctivitisAllergic asthmaSystemic anaphylaxisAngioedemaUrticariaPenicillin allergy
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 32
Correct
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The common bile duct drains into the duodenum in which of the following regions:
Your Answer: Second part of the duodenum
Explanation:As the common bile duct descends, it passes posterior to the first part of the duodenum before joining with the pancreatic duct from the pancreas, forming the hepatopancreatic ampulla (ampulla of Vater) at the major duodenal papilla, located in the second part of the duodenum. Surrounding the ampulla is the sphincter of Oddi, a collection of smooth muscle which can open to allow bile and pancreatic fluid to empty into the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 33
Correct
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Regarding myeloma, which of the following statements is CORRECT:
Your Answer: Myeloma is associated with marked rouleaux formation on blood film.
Explanation:98% of cases of myeloma occur over the age of 40 years with a peak incidence between 65 and 70 years. The disease is twice as common in black individuals compared to those of white or Asian origin. Laboratory findings include presence of a paraprotein in serum/urine (the paraprotein is IgG in 60% of cases, IgA in 20% and light chain only in almost all the rest) and marked Rouleaux formation on blood film. There is no cure for myeloma. The overall median survival is now 7-10 years and in younger (less than 50 years) patients it can be over 10 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 34
Correct
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Antidiuretic hormone (ADH) levels are found to be increased in a young lady with unexplained hyponatraemia.Which of the following is a result of the release of ADH?
Your Answer: Small volumes of concentrated urine
Explanation:ADH, or antidiuretic hormone, is a hormone that regulates water and electrolyte balance. It is released in response to a variety of events, the most important of which are higher plasma osmolality or lower blood pressure. ADH increases plasma volume and blood pressure via acting on the kidneys and peripheral vasculature.ADH causes extensive vasoconstriction by acting on peripheral V1 Receptors.ADH binds to B2 Receptors in the terminal distal convoluted tubule and collecting duct of the kidney, increasing transcription and aquaporin insertion in the cells that line the lumen. Aquaporins are water channels that allow water to pass through the tubule and into the interstitial fluid via osmosis, lowering urine losses.The permeability of the distal collecting duct (the section within the inner medulla) to urea is likewise increased by ADH. More urea travels out of the tubule and into the peritubular fluid, contributing to the counter current multiplier, which improves the Loop of Henle’s concentrating power.Overall, there is enhanced urea and water reabsorption in the presence of ADH, resulting in modest amounts of concentrated urine. There is minimal urea and water reabsorption in the absence of ADH, resulting in huge amounts of dilute urine.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 35
Incorrect
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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 = (π p - π i ) - (P c - P i )
Correct 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 36
Correct
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A new test is being developed to diagnose chlamydia. 1000 people aged 15 – 35 years attending a GUM clinic undergo the new test and the current gold standard nucleic acid amplification test (NAAT) to confirm the diagnosis. Of the 1000 people, 250 are diagnosed with chlamydia. Of the patients diagnosed with chlamydia, 240 test positive with the new diagnostic test and of the patients not diagnosed with chlamydia, 150 test positive with the new diagnostic test. What is the negative predictive value of this test:Chlamydia YesChlamydia NoTotalPositive testa= 240b = 150390Negative testc = 10d = 600610Total2507501000
Your Answer: 0.98
Explanation:Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.Negative predictive value (NPV) = d/(c+d) = 600/610 = 0.98 = 98%This means there is a 98% chance, if the test is negative, that the patient does not have chlamydia.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 37
Correct
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An ambulance transports a 72-year-old woman to the Emergency Department. She is confused, has been vomiting and having stomach pains. Digoxin is one of her medications.Which of the following claims about digoxin is correct?
Your Answer: Therapeutic plasma levels are between 1.0-1.5 nmol/l
Explanation:Digoxin is a cardiac glycoside that is used to treat atrial fibrillation and flutter, as well as congestive heart failure. In cardiac myocytes, it works by inhibiting the membrane Na/K ATPase. Through Na/Ca exchange, this raises intracellular sodium concentration and indirectly increases intracellular calcium availability. Increased intracellular calcium levels have both a positive inotropic and negative chronotropic effect.Digoxin therapeutic plasma levels are typically between 1.0 and 1.5 nmol/l, though higher concentrations may be required, and the value varies between laboratories. At concentrations greater than 2 nmol/l, the risk of toxicity increases dramatically.In patients with normal renal function, digoxin has a long plasma half-life of 36 to 48 hours. This can take up to 5 days in patients with impaired renal function.Hypokalaemia, rather than hyperkalaemia, has been shown to increase the risk of digoxin toxicity.In the treatment of persistent and permanent atrial fibrillation, digoxin is no longer widely used. Beta-blockers, also known as rate-limiting calcium channel blockers, are now the first-line treatment for this condition.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 38
Incorrect
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Identify the type of graph described below:This graph is a useful tool for evaluating the performance of diagnostic tests and more generally for evaluating the accuracy of a statistical model (e.g., logistic regression, linear discriminant analysis) that classifies subjects into 1 of 2 categories, diseased or non diseased. The closer the graph is to the upper left corner, which represents 100% sensitivity and 100% specificity, the more accurate the diagnostic test.
Your Answer: Kaplan-Meier plot
Correct Answer: ROC curve
Explanation:Receiver-operating characteristic (ROC) analysis was originally developed during World War II to analyse classification accuracy in differentiating signal from noise in radar detection. Recently, the methodology has been adapted to several clinical areas heavily dependent on screening and diagnostic tests, in particular, laboratory testing, epidemiology, radiology, and bioinformatics. ROC analysis is a useful tool for evaluating the performance of diagnostic tests and more generally for evaluating the accuracy of a statistical model (e.g., logistic regression, linear discriminant analysis) that classifies subjects into 1 of 2 categories, diseased or non diseased. Its function as a simple graphical tool for displaying the accuracy of a medical diagnostic test is one of the most well-known applications of ROC curve analysis.The closer the ROC curve is to the upper left corner, which has 100% sensitivity and 100% specificity, the higher the overall accuracy of the diagnostic test.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 39
Correct
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Adenosine is primarily indicated for which of the following:
Your Answer: Paroxysmal supraventricular tachycardia
Explanation:Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia including those associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 40
Incorrect
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A 28-year-old medical student ate a reheated Chinese takeaway and developed severe vomiting a few hours after.What is the SINGLE MOST likely causative organism?
Your Answer: Salmonella enteritidis
Correct Answer: Bacillus cereus
Explanation:Bacillus cereusis is the correct answer. It is a Gram-positive, rod-shaped, beta-haemolytic bacterium that causes ‘fried rice syndrome’.Hardy spores in rice can survive boiling. When left at room temperature for long periods prior to frying these spores germinate. The emetic enterotoxin-producing strains cause nausea and vomiting between 1 and 6 hours after consumption while the diarrheagenic enterotoxin-producing strains (commonly associated with ingestion of meat, vegetables and dairy products) causes abdominal pain and vomiting, which starts 8-12 hours after ingestion.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 41
Correct
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Which of the following is a contraindication to using nitrous oxide:
Your Answer: Raised intracranial pressure
Explanation:Nitrous oxide should not be utilized in patients with an air-containing confined area because it diffuses into these spaces, causing a rise in pressure. This includes circumstances like pneumothorax, intracranial air after a head injury, imprisoned air from a recent undersea dive, a recent intraocular gas injection, or intestinal blockage. Nitrous oxide increases cerebral blood flow and should be avoided in individuals who have or are at risk of having high intracranial pressure.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 42
Correct
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Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:
Your Answer: In relaxation, Ca 2+ is transported out of the cell using energy from a Na + gradient.
Explanation:During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane which pumps one Ca2+ion out in exchange for three Na+ions in, using the Na+electrochemical gradient as an energy source. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Factors that affect intracellular [Ca2+] and hence cardiac contractility are called inotropes.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 43
Correct
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A 60-year-old female presents with fatigue, easy bruising and repeated chest and skin infections for five months. She also complains about several episodes of nosebleeds over the last few days without any history of trauma. Her complete blood count shows the following results: Hb 9 g/dlTotal leukocyte count: 2.5x10^9/L, 1100 neutrophils/ųLMCV 100platelet count of 90,000/ųL. Which one of the following conditions does this patient most likely have?
Your Answer: Myelodysplastic syndrome
Explanation:Myelodysplastic syndromes are a group of clonal haematopoietic disorders which are characterised by anaemia, leukopenia and thrombocytopenia. Patients will complain of fatigue, symptoms of thrombocytopenia such as nosebleeds and easy bleeding and a history of repeated infections due to low white blood cells (especially Neutrophils). In Chronic lymphocytic leukaemia production of hematopoietic cells goes on for a longer time. Folate and B12 deficiency would result in hypersegmented neutrophils and a raised MCV. Iron deficiency anaemia would not cause neutropenia or thrombocytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 44
Correct
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If the null hypothesis is wrongly rejected when it is actually true, this is an example of:
Your Answer: A test with a type I error
Explanation:A type I error occurs when the null hypothesis is wrongly rejected when it is actually true and we conclude that there is a difference of effect when in reality there is none (a false positive result).
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 45
Correct
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Regarding box and whisker plots, which of the following statements is true?
Your Answer: 25% of the values lie below the lower quartile
Explanation:A box and whisker plot is defined as a graphical method of displaying variation in a set of data. In most cases, a histogram analysis provides a sufficient display, but a box and whisker plot can provide additional detail while allowing multiple sets of data to be displayed in the same graph.The procedure to develop a box and whisker plot comes from the five statistics below:(1) Minimum value: The smallest value in the data set(2) Second quartile: The value below which the lower 25% of the data are contained(3) Median value: The middle number in a range of numbers(4) Third quartile: The value above which the upper 25% of the data are contained(5) Maximum value: The largest value in the data set
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This question is part of the following fields:
- Evidence Based Medicine
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Question 46
Correct
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A thyroid function test is done for a 55-year-old woman with non-specific symptoms, the results are shown below:TSH = 5.2Free T4 is normalFree T3 is normalThe most likely diagnosis in this patient is?
Your Answer: Subclinical hypothyroidism
Explanation:Hypothyroidism is diagnosed using the results of thyroid function tests (TFTs). In the early stages of the disease, the earliest biochemical change noticed is a rise in thyroid-stimulating hormone (TSH) levels. Free triiodothyronine (T3) and thyroxine (T4) levels are usually normal.In primary hypothyroidism, the serum TSH level is usually greater than 10 mU/L, and free T4 levels are below the reference range.Subclinical hypothyroidism is diagnosed when the serum TSH level is above the reference range, and the free T4 levels are within the reference range. The test should, however, be repeated after 3-6 months to exclude transient causes of raised TSH.In summary, how to interpret TFTs in cases of suspected hypothyroidism is shown below:Subclinical hypothyroidismTSH is raisedFree T4 is normalFree T3 is normalPrimary hypothyroidismTSH is raisedFree T4 is loweredFree T3 is lowered or normalSecondary hypothyroidismTSH is lowered or normalFree T4 is loweredFree T3 is lowered or normal
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 47
Incorrect
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Regarding flucloxacillin, which of the following statements is CORRECT:
Your Answer: It is used first line for localised impetigo infection.
Correct Answer: It is resistant to bacterial beta-lactamases.
Explanation:Flucloxacillin is unique in that it is beta-lactamase stable and it can be used in infections caused by beta-lactamase producing staphylococci e.g. S. aureus. It is acid-stable and can therefore be given by mouth as well as by injection. It is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. The most common adverse effects of flucloxacillin include nausea, vomiting, skin rash, and diarrhoea. Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. First line treatment of animal and human bites is co-amoxiclav.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 48
Incorrect
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You examine a resuscitated patient who has been diagnosed with ventricular tachycardia. The patient's hemodynamics are normal. You intended to prescribe amiodarone to him, but you can't because he has a contraindication.In these circumstances, which of the following is a contraindication to using amiodarone?
Your Answer: Long QT syndrome
Correct Answer: Sinus node disease
Explanation:Amiodarone is an anti-arrhythmic medication that can be used to treat both ventricular and atrial arrhythmias.The use of amiodarone is contraindicated in the following situations:Conduction disturbances that are severe (unless pacemaker fitted)Sinus node disease is a condition that affects the lymph nodes in (unless pacemaker fitted)Sensitivity to iodineBlockage of the Sino-atrial heart valve (except in cardiac arrest)Bradycardia in the sinuses (except in cardiac arrest)Thyroid disorders
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 49
Incorrect
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Parasympathetic preganglionic neurons originate in which of the following locations:
Your Answer: Ventral horn of spinal cord segments - C7 - T12
Correct Answer: Brainstem and pelvic splanchnic nerves
Explanation:Parasympathetic preganglionic neurones originate in the brainstem from which they run in cranial nerves III, VII, IX and X and also from the second and third sacral segments of the spinal cord. Parasympathetic preganglionic neurones release acetylcholine into the synapse, which acts on cholinergic nicotinic receptors on the postganglionic fibre. Parasympathetic peripheral ganglia are generally found close to or within their target, whereas sympathetic peripheral ganglia are located largely in two sympathetic chains on either side of the vertebral column (paravertebral ganglia), or in diffuse prevertebral ganglia of the visceral plexuses of the abdomen and pelvis. Parasympathetic postganglionic neurones release acetylcholine, which acts on cholinergic muscarinic receptors.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 50
Incorrect
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Through which of the following anatomical structures does an indirect inguinal hernia pass?
Your Answer: Transverse abdominis
Correct Answer: External oblique
Explanation:Inguinal hernias are subdivided into direct and indirect.An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum.A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.The deep (internal) inguinal ring is located above and halfway between the pubic tubercle and the anterior superior iliac spine. This serves as the entrance to the inguinal canal. The superficial (external) inguinal ring lies immediately above and medial to the pubic tubercle. This triangular opening is a defect in the external oblique aponeurosis, and forms the exit of the inguinal canal.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 51
Correct
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Which of the following movements is controlled by the pectoralis major muscle?
Your Answer: Flexion, adduction and medial rotation of the humerus
Explanation:The pectoralis major is a muscle that runs across the top of the chest and connects to a ridge on the back of the humerus (the bone of the upper arm). Adduction, or lowering, of the arm (opposed to the deltoideus muscle) and rotation of the arm forward around the axis of the body are two of its main functions.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 52
Correct
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A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a course of antibioticsWhich of the antibiotics listed below is MOSTÂ likely to be the cause?Â
Your Answer: Ciprofloxacin
Explanation:Tendinopathy and spontaneous tendon rupture are caused by fluoroquinolones, which are an uncommon but well-known cause. Tendon problems caused by fluoroquinolones are expected to affect 15 to 20 people per 100,000. Patients over the age of 60 are most likely to develop them.It usually affects the Achilles tendon, but it has also been described in cases involving the quadriceps, peroneus brevis, extensor pollicis longus, long head of biceps brachii, and rotator cuff tendons. The exact aetiology is uncertain, although the fluoroquinolone medication is thought to obstruct collagen activity and/or cut off blood supply to the tendon.Other factors linked to tendon rupture spontaneously include:GoutTreatment with corticosteroidsHypercholesterolaemiaLong-term dialysisKidney transplantRheumatoid arthritisÂ
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 53
Correct
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Which of the following body location is the appropriate site to apply pressure when performing a carotid sinus massage?
Your Answer: Thyroid cartilage
Explanation:The common carotid artery runs through the neck and divides into internal and external carotid arteries on both sides near the upper thyroid cartilage. In emergency situations, carotid sinus massage is also used to diagnose or treat paroxysmal supraventricular tachycardia. During the procedure, to maximize access to the carotid artery, the patient is put in a supine position with the neck extended (i.e. elevating the chin away from the chest). The carotid sinus is normally positioned inferior to the angle of the jaw, near the arterial impulse, at the level of the thyroid cartilage. For 5 to 10 seconds, pressure is administered to one carotid sinus. Although pulsatile pressure applied in a vigorous circular motion may be more effective, continuous pressure is preferred since it is more reproducible. If the predicted reaction is not obtained, the operation is repeated on the opposite side after a one- to two-minute wait.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 54
Correct
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You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:
Your Answer: Erb's palsy may result in loss of sensation of the regimental badge area.
Explanation:Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.
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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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Which of the following is a contraindication for aspirin?
Your Answer: Children under 16 years
Explanation:Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 56
Incorrect
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Which of the following is the most common cause of megaloblastic anaemia:
Your Answer: Alcohol
Correct Answer: Vitamin B12 deficiency
Explanation:Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 57
Correct
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A 50-year-old man has recently been on antibiotics for a chest infection. He suffers from COPD and is currently on Seretide inhalers, salbutamol, and Phyllocontin continus. Since commencing the antibiotics, he has developed nausea, vomiting and abdominal pain.Which of the following antibiotics has he MOST LIKELY been on for his chest infection?
Your Answer: Erythromycin
Explanation:Phyllocontin continues contains aminophylline, a bronchodilator used in the management of asthma and COPD.The index patient is exhibiting symptoms of theophylline toxicity. This may have been triggered by the antibiotic he took. Macrolide antibiotics, like erythromycin and quinolone antibiotics, like ciprofloxacin and levofloxacin, increases the plasma concentration of theophyllines and can lead to toxicity.Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin. Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 58
Correct
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A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?
Your Answer: Cranial diabetes insipidus
Explanation:Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes. The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus. By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone. Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output. Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 59
Correct
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Which of the following is required for vitamin B12 absorption:
Your Answer: Intrinsic factor
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 60
Incorrect
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Identify the type of graph described below:This graph is a scatter plot of the effect estimates from individual studies against some measure of each study's size or precision.
Your Answer: Forest plot
Correct Answer: Funnel plot
Explanation:A funnel plot is a scatter plot of the effect estimates from individual studies against some measure of each study’s size or precision. The standard error of the effect estimate is often chosen as the measure of study size and plotted on the vertical axis with a reversed scale that places the larger, most powerful studies towards the top. The effect estimates from smaller studies should scatter more widely at the bottom, with the spread narrowing among larger studies. In the absence of bias and between study heterogeneity, the scatter will be due to sampling variation alone and the plot will resemble a symmetrical inverted funnel. A triangle centred on a fixed effect summary estimate and extending 1.96 standard errors either side will include about 95% of studies if no bias is present and the fixed effect assumption (that the true treatment effect is the same in each study) is valid.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 61
Incorrect
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A 60-year-old patient with a history of hypertension and chronic kidney disease (CKD) walks into the clinic to discuss her most recent blood results indicating an accelerated progression of CKD.Which of the following is the correct definition for accelerated progression of CKD?
Your Answer: A sustained decrease in GFR of 15% or more within 12 months
Correct Answer: A sustained decrease in GFR of 15 ml/minute/1.73 m 2 per year
Explanation:Chronic kidney disease (CKD) is a disorder in which kidney function gradually deteriorates over time. It’s fairly prevalent, and it typically remains unnoticed for years, with only advanced stages of the disease being recognized. There is evidence that medication can slow or stop the progression of CKD, as well as lessen or prevent consequences and the risk of cardiovascular disease (CVD).CKD is defined as kidney damage (albuminuria) and/or impaired renal function (GFR 60 ml/minute per 1.73 m2) for three months or longer, regardless of clinical diagnosis.A prolonged decline in GFR of 25% or more with a change in GFR category within 12 months, or a sustained drop in GFR of 15 ml/minute/1.73 m² per year, is considered accelerated CKD progression.End-stage renal disease (ESRD) is defined as severe irreversible kidney impairment with a GFR of less than 15 ml/minute per 1.73 m² and a GFR of less than 15 ml/minute per 1.73 m².
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 62
Incorrect
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On reviewing the ECG of a patient with a history of intermittent palpitations, you observe prolonged QT interval.Which of these can cause prolongation of the QT interval on the ECG?
Your Answer: Hyperkalaemia
Correct Answer: Erythromycin
Explanation:Syncope and sudden death due to ventricular tachycardia, particularly Torsades-des-pointes is seen in prolongation of the QT interval.The causes of a prolonged QT interval include:ErythromycinAmiodaroneQuinidineMethadoneProcainamideSotalolTerfenadineTricyclic antidepressantsJervell-Lange-Nielsen syndrome (autosomal dominant)Romano Ward syndrome (autosomal recessive)HypothyroidismHypocalcaemiaHypokalaemiaHypomagnesaemiaHypothermiaRheumatic carditisMitral valve prolapseIschaemic heart disease
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 63
Correct
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What is the mechanism of action of captopril:
Your Answer: Inhibition of the conversion of angiotensin I to angiotensin II
Explanation:Angiotensin-converting enzyme inhibitors (ACE inhibitors) e.g. captopril inhibit the conversion of angiotensin I to angiotensin II, and thus have a vasodilatory effect, lowering both arterial and venous resistance. The cardiac output increases and, because the renovascular resistance falls, there is an increase in renal blood flow. This latter effect, together with reduced aldosterone release, increases Na+ and H2O excretion, contracting the blood volume and reducing venous return to the heart.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 64
Correct
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About case-control studies, one of the following is true.
Your Answer: They are suitable to be used in the study of rare diseases
Explanation:Case-control studies are suitable when investigating a rare disease or in cases where little is known about the disease and the proposed aetiological factor, as a preliminary study. They have the ability to look at multiple risk-factors (exposures) but can only look at a single outcome.In a case-control study, two groups of patients, one with the disease and one without, are compared on the basis of a proposed causative factor that occurred in the past. They are therefore a retrospective study and useful in hypothesis generation.Cohort studies are better at identifying rare exposures. One group with an exposure is compared to a control group without that exposure.Case-control studies are usually less expensive to run and also shorter in duration compared with prospective cohort studies.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 65
Incorrect
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An 11-year-old girl presents with a 5-day history of persistent fever despite regular paracetamol, throbbing left ear pain, ear discharge and deafness. Her parents have observed that she is not her usual self, not eating well, and has been lethargic. On examination there is a tender swelling in the post auricular region on the left hand side.What is the most likely causative organism?
Your Answer: Staphylococcus aureus
Correct Answer: Streptococcus pneumonia
Explanation:Acute mastoiditis is a complication (rare) of acute otitis media (AOM) and the commonest causative organism is Streptococcus pneumoniae.Generally, acute mastoiditis presents with:PyrexiaRecent history of AOMMastoid swelling and erythemaOtalgiaOtorrhoea and perforation of tympanic membranePost-auricular painProtrusion of the ears
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 66
Correct
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Regarding macrolide antibiotics, which of the following statements is CORRECT:
Your Answer: Macrolides are first line for treatment of whooping cough.
Explanation:A macrolide antibiotic is recommended first line for whooping cough (if onset of cough is within the previous 21 days)Prescribe clarithromycin for infants less than 1 month of age.Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.Prescribe erythromycin for pregnant women.Macrolides interfere with bacterial protein synthesis and are mainly active against Gram-positive organisms. They have a similar antibacterial spectrum to penicillin and are thus a useful alternative in penicillin-allergic patients. Erythromycin is commonly associated with gastrointestinal upset.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 67
Correct
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Which of the following is an adverse effect of carbamazepine:
Your Answer: Aplastic anaemia
Explanation:Common adverse effects include nausea and vomiting, sedation, dizziness, headache, blurred vision and ataxia. These adverse effects are dose related and are most common at the start of treatment.Other adverse effects include:Allergic skin reactions (and rarely, more serious dermatological conditions)Hyponatraemia (avoid concomitant use with diuretics)Leucopenia, thrombocytopenia and other blood disorders including aplastic anaemiaHepatic impairment
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 68
Correct
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Regarding dermatophytes, which of the following statement is CORRECT:
Your Answer: Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings.
Explanation:Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings depending on the site of infection. The lesions of ringworm typically have a dark outer ring with a pale centre. Tinea capitis is ringworm affecting the head and scalp. Spread is via direct skin contact. Treatment is usually topical, oral antifungals are reserved for refractory infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 69
Correct
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Which of the following is NOT a side effect of phenytoin:
Your Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:Nausea and vomitingDrowsiness, lethargy, and loss of concentrationHeadache, dizziness, tremor, nystagmus and ataxiaGum enlargement or overgrowthCoarsening of facial features, acne and hirsutismSkin rashesBlood disorders
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 70
Correct
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Regarding Escherichia coli, which of the following statements is INCORRECT:
Your Answer: It is a predominant member of the normal flora of the skin.
Explanation:Escherichia coli is a Gram-negative bacilli that is an important member of the intestinal flora. It is the most common cause of UTI in adults (about 70 – 95% of cases), followed by Staphylococcus saprophyticus (about 5 – 10% of cases), and an important cause of neonatal meningitis. E. coli O157 strain is implicated in the development of dysentery associated with haemolytic uraemic syndrome characterised by haemolytic anaemia, thrombocytopenia and acute renal failure.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 71
Correct
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In patients requiring oxygen, who are at risk of hypercapnic respiratory failure, oxygen saturations should be maintained at:
Your Answer: 88 - 92%
Explanation:A lower target of 88 – 92% oxygen saturation is indicated for patients at risk of hypercapnic respiratory failure e.g. patients with COPD. Until blood gases can be measured, initial oxygen should be given using a controlled concentration of 28% or less, titrated towards the SpO2 of 88 – 92%. The aim is to provide the patient with enough oxygen to achieve an acceptable arterial oxygen tension without worsening carbon dioxide retention and respiratory acidosis.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 72
Correct
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Which of the following is NOT typically present in the nasopharyngeal flora:
Your Answer: Bacteroides spp.
Explanation:Bacteroides spp. are typically found in the normal flora of the lower gastrointestinal tract. Species commonly found in the flora of the nasopharynx include: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Corynebacterium spp., Moraxella spp. and Candida spp.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 73
Correct
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A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.Iliacus is innervated by which of the following nerves? Select ONE answer only.
Your Answer: Femoral nerve
Explanation:Iliacus is innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 74
Correct
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Which of the following is an action of glucagon:
Your Answer: Stimulates glycogenolysis
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline. Glucagon then causes:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 75
Correct
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Pancreatic acinar digestive enzyme secretion is mainly stimulated by which of the following hormones:
Your Answer: Cholecystokinin
Explanation:Exocrine pancreatic secretion is controlled by:Parasympathetic stimulation which enhances secretion of both the enzyme and aqueous componentsSympathetic stimulation which inhibits pancreatic secretionSecretin which stimulates secretion of the alkaline-rich fluid from ductal cellsCholecystokinin which stimulates secretion of the enzyme-rich fluid from acinar cellsSomatostatin which inhibits secretion from both acinar and ductal cellsGastrin which stimulates pancreatic acinar cells to secrete digestive enzymes
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 76
Incorrect
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A 45-year-old man, a known case of epilepsy, visits his neurologist with complaints of red, swollen gums.Which of the following medications is most likely responsible for his symptoms?
Your Answer: Lamotrigine
Correct Answer: Phenytoin
Explanation:Phenytoin is a commonly used antiepileptic drug. A well-recognized side-effect of phenytoin is gingival enlargement and occurs in about 50% of patients receiving phenytoin. It is believed that reduced folate levels may cause this, and evidence suggests that folic acid supplementation may help prevent this in patients starting phenytoin. As evidence suggests, drug-induced gingival enlargement may also improve by substituting with other anticonvulsant drugs and reinforcing a good oral hygiene regimen. Surgical excision of hyperplastic gingiva is often necessary to correct the aesthetic and functional impairment associated with this condition to manage it successfully.Phenytoin is also the only anticonvulsant therapy associated with the development of Dupuytren’s contracture.Other side effects are:1. Ataxia2. Drug-induced lupus3. Hirsutism4. Pruritic rash5. Megaloblastic anaemia6. Nystagmus
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 77
Correct
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The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.Which of the following patients has had adequate tetanus protection?
Your Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin
Explanation:25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 78
Correct
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The following statements are not true of the extensor carpi radialis brevis muscle, except?
Your Answer: It receives its blood supply from the radial artery
Explanation:Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 79
Correct
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When a child has chickenpox, how long should he or she be off from school?
Your Answer: Until all vesicles have crusted over
Explanation:To avoid the spread of infection, infected patients should be isolated. All lesions should be crusted over before children return to nursery or school, even if the standard exclusion time is 5 days.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 80
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 81
Correct
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During quiet respiration, position of the right oblique fissure can be marked by a line drawn on the thoracic wall that:
Your Answer: Begins at the spinous process of T4, crosses the fifth intercostal space laterally and follows the contour of rib 6 anteriorly.
Explanation:During quiet respiration, the approximate position of the right oblique fissure can be marked by a line on the thoracic wall that begins at the spinous process of vertebra T4, crosses the fifth intercostal space laterally and then follows the contour of rib 6 anteriorly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 82
Correct
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Question 83
Correct
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A patient with a history of worsening chronic breathlessness on exertion undergoes lung function testing. The results demonstrate an FEV 1 that is 58% predicted and an FEV 1 /FVC ratio less than 0.7.Which of the following is the most likely diagnosis? Select ONE answer only.
Your Answer: COPD
Explanation:Obstructive lung disorders are characterised by airway obstruction. Many obstructive diseases of the lung result from narrowing of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself.In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to <0.7.Types of obstructive lung disorders include:Chronic obstructive pulmonary disease (COPD)AsthmaBronchiectasis
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 84
Correct
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What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient with suspected anaphylactic shock?
Your Answer: 500 micrograms intramuscularly
Explanation:1: 1000 Adrenaline solution dosage for children above the age of 12 and adults, including pregnant women (over 50 kg) is 0.50 mL, which is equivalent to 500 mcg of adrenaline.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 85
Correct
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You see a 30-year-old man who has come to the department with a very tender right elbow. On examination, the elbow is very hot and red, and appears to be acutely inflamed.Which SINGLE statement regarding acute inflammation is FALSE?
Your Answer: Reduced extravascular osmotic pressure leads to oedema
Explanation:Inflammation can be divided intoacute inflammation, which occurs over seconds, minutes, hours, and days, andchronic inflammation, which occurs over longer periods.Acute inflammationcommences within seconds or minutes following the injury of tissues. There are numerous potential stimuli for an acute inflammatory response including infections (bacterial, viral, fungal, parasitic), tissue necrosis, foreign bodies, and Immune reactions (hypersensitivity reactions). The chief cell type of acute inflammation is the neutrophil.There are three main processesthat occur in the acute inflammatory response:Increased blood flowIncreased capillary permeabilityNeutrophil migration1. Increased blood flow:Vasoactive mediators are released, such as nitric oxide, histamine, bradykinins, and prostaglandin E2. These mediators cause vasodilatation and increased blood flow to the area (causing redness and heat).2. Increased capillary permeability:The vasoactive mediators also cause increased capillary permeability by causing endothelial cell contraction that widens the intercellular gaps of venules. This allows an outpouring of protein-rich fluid (exudate) into the extracellular tissues that results in a reduction of intravascular osmotic pressure and an increase in extravascular/interstitial pressure. The increased interstitial osmotic pressure leads to oedema.3. Neutrophil migration:Neutrophils leave the vasculature through the following sequence of events:Margination and rolling: neutrophils flow nearer the vessel wall, rather than in the axial stream, which is referred to as margination. Following margination the neutrophils begin rolling along the surface of the vascular endothelium.Activation and adhesion: then as a result of interaction with endothelial cell adhesion molecules (CAMs) that is mediated by selectins, the neutrophils are activated and adhere to the endothelium.Transmigration: once bound to the endothelium, neutrophils squeeze through gaps between adjacent endothelial cells into the interstitial fluid, in a process calleddiapedesis.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 86
Correct
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The pathophysiology of Addison's disease is as follows:
Your Answer: Adrenocortical insufficiency
Explanation:Primary adrenal insufficiency, also known as Addison’s disease, occurs when the adrenal glands cannot produce an adequate amount of hormones despite a normal or increased corticotropin (ACTH) level.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 87
Correct
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Herpes simplex virus is transmitted most commonly through which of the following routes:
Your Answer: Direct contact spread
Explanation:Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 88
Correct
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A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia. Which one of the following disorders is this patient most likely to have?
Your Answer: Paroxysmal nocturnal haemoglobinuria
Explanation:Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight. Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections. Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections. Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 89
Correct
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Question 90
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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SESSION STATS - PERFORMANCE PER SPECIALTY
