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Question 1
Incorrect
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A blood test of a 7-year-old child with a 6-day history of bloody diarrhoea reveals a low platelet count, anaemia, and impaired kidney function. What bacteria is suspected of causing such a condition?
Your Answer: Streptococcus pyogenes
Correct Answer: Escherichia coli
Explanation:Escherichia coli produces shiga toxin that causes diarrhoea, hemorrhagic colitis, and haemolytic uremic syndrome. Haemolytic uremic syndrome is characterized by anaemia, thrombocytopenia, and acute renal failure. Transmission of E. coli is possible after consuming contaminated, undercooked drinks and foods. E. coli enters the body via the faecal-oral pathway.
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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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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 3
Incorrect
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One of the following pathogens is a conditional pathogen:
Your Answer: Mycobacterium tuberculosis
Correct Answer: Neisseria meningitidis
Explanation:Obligate pathogens include Mycobacterium TB, HIV, Treponema pallidum, and Neisseria gonorrhoeae. Neisseria meningitidis, on the other hand, is a conditional pathogen.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 4
Correct
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A patient in a high-dependency unit complains of severe and painful muscle cramps. His total corrected plasma calcium level is 1.90 mmol/L.What is the most likely underlying cause?
Your Answer: Rhabdomyolysis
Explanation:Hypocalcaemia occurs when there is abnormally low level of serum calcium ( >2.2 mmol/l) after correction for the serum albumin concentration.Rhabdomyolysis causes hyperphosphatemia, and this leads to a reduction in ionised calcium levels.Patients with rhabdomyolysis are commonly cared for in a high dependency care setting. Addison’s disease, hyperthyroidism, thiazide diuretics and lithium all cause hypercalcaemia.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 5
Incorrect
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Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:
Your Answer: Ca 2+ is transported out of the cell predominantly by Ca 2+ ATPase.
Correct Answer: The Treppe effect refers to an increase in contractility secondary to an increase in heart rate.
Explanation:Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). 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. When more action potentials occur per unit time, more Ca2+enters the cell during the AP plateau, more Ca2+is stored in the SR, more Ca2+is released from the SR and thus more Ca2+is left inside the cell and greater tension is produced during contraction. 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. Cardiac glycosides such as digoxin have a positive inotropic effect.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 6
Incorrect
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ACE inhibitors are indicated for all of the following EXCEPT for:
Your Answer: Diabetic nephropathy
Correct Answer: Angina
Explanation:ACE inhibitors have many uses and are generally well tolerated. They are indicated for:Heart failureHypertensionDiabetic nephropathySecondary prevention of cardiovascular events
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 7
Correct
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A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.Which of these statements concerning indications and contraindications for vaccination is TRUE?
Your Answer: Inactivated vaccines are safe in pregnancy
Explanation:All vaccines are contraindicated in individuals with: A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycinThere is no evidence that vaccinating pregnant women with inactivated vaccine or toxoids harms the woman or foetus. The current protocol is that a child with history of egg allergy can be safely vaccinated with Fluenz tetra. However, if they had a previous severe anaphylaxis to egg requiring intensive care, then Flenz tetra is contraindicated. BCG, yellow fever or oral typhoid vaccinations are not safe in HIV positive patients.The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should not be implemented.Concurrent antibiotic therapy is not a contraindication to vaccination.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 8
Incorrect
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Which of the following clinical features is NOT a typical feature of haemolytic anaemias:
Your Answer: Jaundice
Correct Answer: Angular cheilitis
Explanation:Features include: AnaemiaJaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)Pigment gallstonesSplenomegalyAnkle ulcersExpansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia majorAplastic crisis caused by parvovirus
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This question is part of the following fields:
- Haematology
- Pathology
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Question 9
Correct
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Regarding the extensor carpi ulnaris muscle, which of the following statements is true?
Your Answer: It receives its blood supply from the ulnar artery
Explanation:Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 10
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 11
Correct
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A patient has a cardiac output of 4.8 L/min and a heart rate of 80 bpm, therefore their stroke volume is:
Your Answer: 60 mL
Explanation:Cardiac output (CO) = Stroke volume (SV) x Heart rate (HR). Therefore SV = CO/HR = 4.8/80 = 0.06 L = 60 mL.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 12
Incorrect
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A 4-year old boy is taken to the emergency room after a sudden onset of coughing and wheezing. Further investigation reveals that he was drawing quietly in his room, when suddenly, he became anxious and started coughing. The parents also noted that the eraser on top of the pencil was missing.A plain radiographic chest imaging is conducted, and confirmed foreign body aspiration.Which of the following areas in the tracheobronchial tree is the most probable location of the aspirated eraser?
Your Answer: Left main bronchus
Correct Answer: Right main bronchus
Explanation:In foreign body aspiration, the foreign body is more likely to enter the right main bronchus because it is shorter, wider and more vertical than the left main bronchus. In a patient who is standing or sitting, the foreign body tends to become lodged in the posterobasal segment of the inferior lobe of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 13
Incorrect
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Antinuclear antibodies (ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus.Which ONE of these statements about ANAs is true?
Your Answer: Anti-dsDNA antibodies are found in around 15% of patients with SLE
Correct Answer: They can be of any immunoglobulin class
Explanation:Anti-nuclear antibodies(ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus. They can be of any immunoglobulin class.CREST syndrome is usually associated with anti-centromere antibodies.ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most reliable.Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.Anti-dsDNA antibodies are found in 80 – 90% of patients with SLE
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 14
Incorrect
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Regarding endothelin-1, which of the following statements is INCORRECT:
Your Answer: Endothelin-1 (ET-1) is released from the endothelium.
Correct Answer: Endothelin-1 release is inhibited by noradrenaline.
Explanation:Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 15
Correct
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Which one these is an example of a cause of an exudate?
Your Answer: Subphrenic abscess
Explanation:An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.Some common causes of exudates are: pneumonia, empyema, lung cancer, breast cancer, cancer of the pleura, SLE, rheumatoid arthritis, pericarditis, subphrenic abscess, chylothorax.Myxoedema, nephrotic syndrome, congestive cardiac failure, and liver cirrhosis all cause TRANSUDATE.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 16
Correct
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A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve injury. Which of the following will confirm the presence of an ulnar nerve injury?
Your Answer: Claw hand appearance
Explanation:An ulnar injury may result in abnormal sensations in the little finger and ring finger, usually on the palm side, weakness, and loss of coordination of the fingers. A claw like deformity of the hand and wrist is present. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve are also possible.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Correct
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A 36-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip extension, but normal hip abduction. Which of the following muscles was most likely injured in this case?
Your Answer: Gluteus maximus
Explanation:The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 18
Incorrect
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Following a decrease in extracellular volume, which of the following is a reaction to enhanced sympathetic innervation of the kidney:
Your Answer: Renal arteriole vasodilation
Correct Answer: Release of renin
Explanation:The RAS pathway begins with renin cleaving its substrate, angiotensinogen (AGT), to produce the inactive peptide, angiotensin I, which is then converted to angiotensin II by endothelial angiotensin-converting enzyme (ACE). ACE activation of angiotensin II occurs most extensively in the lung. Angiotensin II mediates vasoconstriction as well as aldosterone release from the adrenal gland, resulting in sodium retention and increased blood pressure.
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This question is part of the following fields:
- Physiology
- Renal
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Question 19
Incorrect
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You review a 50-year-old man that is requesting the seasonal influenza vaccination.Which of the following single clinical risk groups is NOT eligible to receive the seasonal influenza vaccination? Select ONE answer only.
Your Answer: Children aged 2 to 7 years
Correct Answer: Patients over the age of 50
Explanation:Patients with hypertension are only eligible for the seasonal influenza vaccination if they have co-existent cardiac complications.The UK national policy is that the seasonal influenza vaccine should be offered to the following groups:All those aged 65 years and olderChildren aged 2 to 15 yearsResidents of nursing and residential homes for the elderly (and other long-stay facilities)Carers of persons whose welfare may be at risk if the carer falls illAll those aged 6 months or older in a clinical risk groupThe following table outlines the clinical risk groups that are considered eligible for the vaccine:CategoryExamples of eligible groupsRespiratory diseaseCOPDInterstitial lung diseaseCystic fibrosisAsthma (requiring oral or inhaled steroids)Heart diseaseCongenital heart diseaseChronic heart failureCoronary heart disease (requiring medication and/or follow-up)Hypertension with cardiac complicationsKidney diseaseChronic kidney diseaseNephrotic syndromeRenal transplant patientsLiver diseaseLiver cirrhosisChronic hepatitisBiliary atresiaNeurological diseaseCerebrovascular accidentTransient ischaemic attackEndocrine diseaseType 1 and 2 diabetesImmunosuppressionPatients undergoing chemotherapyPatients taking immunosuppressive drug therapy (including systemic steroids)Asplenia or splenic dysfunctionHIV infectionPregnancyAll pregnant women
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 20
Incorrect
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You are planning on starting antibiotic therapy for a patient with a diagnosis of gonorrhoea.Which of these is the MOST appropriate antibiotic combination?
Your Answer: Benzylpenicillin and doxycycline
Correct Answer: Ceftriaxone and azithromycin
Explanation:Currently, ceftriaxone in combination with azithromycin or doxycycline is the combination of antibiotics used in the treatment of gonorrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 21
Correct
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An very unwell patient is receiving treatment in your hospital's HDU and is found to have an Escherichia coli O157 infection.Which one of these statements about Escherichia coli O157 is true?
Your Answer: Haemolytic uraemic syndrome develops in approximately 6% of patients
Explanation:Escherichia coli O157 is a serotype of Escherichia coli.The Escherichia coliO157 strain is ‘enterohaemorrhagic’ and causes severe forms of acute haemorrhagic diarrhoea. It can also cause non-haemorrhagic diarrhoea. Incubation period of Escherichia coli O157 is usually 3-4 days and bloody diarrhoea usually begins on the 3rd or 4th day of the infection.Infections with Escherichia coliO157 are more common during the warmer months than in winter.Haemolytic uraemic syndrome develops in approximately 6% of patients. It is commonly seen in children and in the elderly. Escherichia coli O157 can also cause:Haemorrhagic colitisHaemolytic uraemic syndromeThrombotic thrombocytopenic purpura but not immune thrombocytopenic purpura.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 22
Correct
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At which opioid receptors do opioid analgesics act primarily?
Your Answer: Mu
Explanation:Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 23
Incorrect
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A 42-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip adduction, but normal hip flexion. Which of the following muscles was most likely injured in this case?
Your Answer: Rectus femoris
Correct Answer: Pectineus
Explanation:The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 24
Correct
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A man presents to the emergency department with a hand laceration that has damaged the opponens digiti minimi muscle.All of the following statements regarding the opponens digiti minimi muscle is considered correct, except:
Your Answer: It is innervated by the superficial branch of the ulnar nerve
Explanation:Opponens digiti minimi (ODM) is an intrinsic muscle of the hand. It’s a triangular muscle that extends between the hamate bone (carpal bone) and the 5th metacarpal bone. It forms the hypothenar muscle group together with the abductor digiti minimi and flexor digiti minimi brevis, based on the medial side of the palm (hypothenar eminence). These muscles act together in moving the little finger. The opponens digiti minimi is responsible for flexion, lateral rotation and opposition of the little finger.Its origin is the hook of hamate and flexor retinaculum. It inserts into the medial border of 5th metacarpal bone. It is innervated by the deep branch of the ulnar nerve, which stems from the brachial plexus (C8, T1 spinal nerves).Its blood supply is by the deep palmar branch of ulnar artery and deep palmar arch, which is the terminal branch of the radial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 25
Incorrect
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Which of the following ligaments supports the head of the talus?
Your Answer: Calcaneofibular ligament
Correct Answer: Spring ligament
Explanation:The spring-ligament complex is a significant medial arch stabilizer. The two important functions of this ligament include promoting the stability of the talonavicular joint by acting as a support for the talus head and by acting as a static support to maintain the medial longitudinal arch.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 26
Incorrect
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What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer: Alpha2-receptor agonist
Correct Answer: Beta1-receptor agonist
Explanation:Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.
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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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You are teaching a group of medical students about cardiovascular examination. You are discussing heart sounds and the cardiac cycle. Which of the following stages of the cardiac cycle occurs immediately after the aortic valve closes:
Your Answer: Isovolumetric relaxation
Explanation:Immediately after the closure of the semilunar valves, the ventricles rapidly relax and ventricular pressure decreases rapidly but the AV valves remain closed as initially the ventricular pressure is still greater than atrial pressure. This is isovolumetric relaxation. Atrial pressure continues to rise because of venous return, with the v wave of the JVP waveform peaking during this phase. Rapid flow of blood from the atria into the ventricles during the ventricular filling phase causes thethird heart sound, which is normal in children but, in adults, is associated with disease such as ventricular dilation.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 28
Incorrect
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Which of the following hormones regulates Na+reabsorption in the proximal tubule:
Your Answer: Antidiuretic hormone
Correct Answer: Angiotensin II
Explanation:Angiotensin II increases Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters).
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This question is part of the following fields:
- Physiology
- Renal
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Question 29
Incorrect
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Regarding threadworms, which of the following statements is CORRECT:
Your Answer: Multiplication of worms occurs in the large bowel.
Correct Answer: First line treatment of threadworms is with mebendazole.
Explanation:First line treatment of threadworms is with mebendazole, with treatment of the whole family, and a repeat treatment after 2 weeks. Threadworms live in the large bowel, but direct multiplication of worms does not occur here. Threadworms most commonly infect children, and may be symptomatic or cause pruritus ani.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 30
Incorrect
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Regarding the refractory period, which of the following statements is INCORRECT:
Your Answer: The relative refractory period is due to a temporary hyperpolarisation.
Correct Answer: Action potentials can occur in the relative refractory period but the amplitude of the action potential is smaller.
Explanation:Following the action potential, Na+channels remain inactive for a time in a period known as the absolute refractory period where they cannot be opened by any amount of depolarisation. Following this there is a relative refractory period where the temporary hyperpolarisation (due to delayed closure of rectifier K+channels) makes the cell more difficult to depolarise and an action potential can be generated only in response to a larger than normal stimulus. The refractory period limits the frequency at which action potentials can be generated, and ensures that, once initiated, an action potential can travel only in one direction. An action potential is an all or nothing response so the amplitude of the action potential cannot be smaller.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
