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Question 1
Correct
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A tumour compresses the jugular foramen of a 50-year-old patient. Compression of several nerves in the jugular foramen will result in which of the following complications?
Your Answer: Loss of gag reflex
Explanation:The glossopharyngeal nerve, which is responsible for the afferent pathway of the gag reflex, the vagus nerve, which is responsible for the efferent pathway of the gag reflex, and the spinal accessory nerve all exit the skull through the jugular foramen. These nerves are most frequently affected if the jugular foramen is compressed. As a result, the patient’s gag reflex is impaired. The vestibulocochlear nerve is primarily responsible for hearing. The trigeminal nerve provides sensation in the face. The facial nerve innervates the muscles of face expression (including those responsible for closing the eye). Tongue motions are controlled mostly by the hypoglossal nerve.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 2
Correct
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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: 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 3
Correct
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A dermatological examination on a patient presenting with a lump shows a solid, well circumscribed, lump measuring 0.8 cm in diameter.Which one of these best describes the lump you have found on examination?
Your Answer: Nodule
Explanation:A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter. A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.A plaque is a palpable skin lesion that is elevated and measures >1cm in diameter
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 4
Correct
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Regarding ampicillin, which of the following statements is CORRECT:
Your Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.
Explanation:Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections. Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 5
Correct
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A 30-year-old woman presents with a history of fever and sore throat. On examination, there is tonsillar exudate and cervical lymphadenopathy and a diagnosis of tonsillitis is made. A course of penicillin is prescribed.What is the mechanism of action of penicillin?
Your Answer: Inhibition of cell wall synthesis
Explanation:Penicillin is bactericidal and produces its antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. This action inhibits cell wall synthesis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 6
Incorrect
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Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:
Your Answer: Give 300 mg IV amiodarone as soon as IV access has been achieved
Correct Answer: Give 300 mg IV amiodarone after 3 shocks
Explanation:After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 7
Incorrect
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Regarding cytotoxic T cells, which of the following statements is CORRECT:
Your Answer: They are CD4 receptor positive.
Correct Answer: They kill target cells by inducing cell apoptosis.
Explanation:CD8+ T-cells (Cytotoxic T cells)Recognise antigen only in association with HLA Class I molecules (found on all nucleated cells; present endogenous antigens such as those found in cells infected by viruses or intracellular bacteria.)Comprise about 25% of peripheral T-cellsResponsible for cytotoxic killing of target cells
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 8
Correct
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A 65-year-old man presents with cough and shortness of breath. His sputum is rusty in colour and is suffering from a fever. Upon examination, it was noted that he has crackles in the right upper lobe. A chest X-ray showed the presence of a right upper lobe cavitation.Among the following microorganisms, which is considered to be mostly associated with a cavitating upper lobe pneumonia?
Your Answer: Klebsiella pneumoniae
Explanation:Klebsiella pneumoniae is among the most common Gram-negative bacteria encountered by physicians worldwide and accounts for 0.5-5.0% of all cases of pneumonia. This organism can cause extensive pulmonary necrosis and frequent cavitation.It is one of the causes that could be suspected when there is cavitatory pneumonia with or without a bulging fissure sign. Often, there can be extensive lobar opacification with air bronchograms.A helpful feature which may help to distinguish from pneumococcal pneumonia is that Klebsiella pneumoniae develops cavitation in 30-50% of cases (in comparison, cavitation is rare in pneumococcal pneumonia). This occurs early and progresses quickly.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 9
Incorrect
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A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer: The palmar digital branch of the median nerve
Correct Answer: The recurrent branch of the median nerve
Explanation:Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint.
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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 is NOT an effect of benzodiazepines:
Your Answer: Analgesic effect
Explanation:Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhance inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 11
Incorrect
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Where is angiotensin I primarily converted to angiotensin II:
Your Answer: Adrenal gland
Correct Answer: Lungs
Explanation:Angiotensin I is converted to angiotensin II by the removal of two C-terminal residues by the enzyme angiotensin-converting enzyme (ACE). This primarily occurs in the lungs, although it does also occur to a lesser degree in endothelial cells and renal epithelial cells.The main actions of angiotensin II are:Vasoconstriction of vascular smooth muscle (resulting in increased blood pressure)Vasoconstriction of the efferent arteriole of the glomerulus (resulting in an increased filtration fraction and preserved glomerular filtration rate)Stimulation of aldosterone release from the zona glomerulosa of the adrenal cortexStimulation of anti-diuretic hormone (vasopressin) release from the posterior pituitaryStimulation of thirst via the hypothalamusActs on the Na+/H+ exchanger in the proximal tubule of the kidney to stimulate Na+reabsorption and H+excretion
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This question is part of the following fields:
- Physiology
- Renal
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Question 12
Correct
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Regarding codeine, which of the following statements is INCORRECT:
Your Answer: There is a reduced risk of toxicity in patients who are ultra-rapid metabolisers of codeine.
Explanation:Codeine phosphate is a weak opioid and can be used for the relief of mild to moderate pain where other painkillers such as paracetamol or ibuprofen have proved ineffective.Codeine is metabolised to morphine which is responsible for its therapeutic effects. Codeine 240 mg is approximately equivalent to 30 mg of morphine. The capacity to metabolise codeine can vary considerably between individuals; there is a marked increase in morphine toxicity in people who are ultra rapid metabolisers, and reduced therapeutic effect in poor codeine metabolisers. Codeine is contraindicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers).Codeine is also contraindicated in children under 12, and in children of any age who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea due to reports of morphine toxicity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 13
Incorrect
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A 55-year-old woman was complaining of headaches. On examination, the patient is found to have weakness on the left side of her body and her eyes are deviated towards the right hand side. These are signs of damage to which of the following areas?
Your Answer: Temporal lobe
Correct Answer: Frontal lobe
Explanation:Some potential symptoms of frontal lobe damage can include loss of movement, either partial or complete, on the opposite side of the body. In the patient’s case, it is a result of motor cortex damage on the right side since her left side of the body is affected. The conjugate eye deviation symptom towards the side of the lesion is a result of damage to the frontal eye field.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 14
Incorrect
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An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with left-sided hemiplegia of the face, tongue, and limbs and right-sided deficits in motor eye activity. A CT scan was ordered and showed a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer: Posterior cerebral artery
Correct Answer: Basilar artery
Explanation:Weber syndrome is a midbrain stroke characterized by crossed hemiplegia along with oculomotor nerve deficits and it occurs with the occlusion of the median and/or paramedian perforating branches of the basilar artery. Typical clinical findings include ipsilateral CN III palsy, ptosis, and mydriasis (such as damage to parasympathetic fibres of CN III) with contralateral hemiplegia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 15
Correct
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Which of the following statements is correct regarding the neuronal action potential?
Your Answer: Initial depolarisation occurs as a result of a Na + influx.
Explanation:The resting potential in most neurons has a value of approximately -70 mV. The threshold potential is generally around -55 mV. Initial depolarisation when there is Na+influx through ligand-gated Na+channels. Action potential is an all or nothing response. The size of the action potential is constant and so, the intensity of the stimulus is coded by the frequency of firing of a neuron. K+efflux is responsible for repolarisation.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 16
Correct
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Question 17
Correct
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C3 deficiency leads to particular susceptibility of infection with which of the following:
Your Answer: Encapsulated bacteria
Explanation:Macrophages and neutrophils have C3b receptors and they phagocytose C3b-coated cells. C3 deficiency thus leads to increased susceptibility of infection with encapsulated organisms (e.g. S. pneumoniae, H. influenzae).The early stages of the complement cascade leading to coating of the cells with C3b can occur by two different pathways:The classical pathway usually activated by IgG or IgM coating of cellsThe alternative pathway which is more rapid and activated by IgA, endotoxin and other factors
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 18
Correct
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In which of the following would you NOT typically see a neutropaenia:
Your Answer: Asplenism
Explanation:Causes of neutropaenia:Drug-induced (e.g. chemotherapy, chloramphenicol, co-trimoxazole, phenytoin, carbamazepine, carbimazole, furosemide, chloroquine, clozapine, some DMARDs)Benign (racial or familial)CyclicalImmune (e.g. SLE, Felty’s syndrome, hypersensitivity and anaphylaxis)LeukaemiaInfections (e.g. HIV, hepatitis, fulminant bacterial infection)General PancytopaeniaHypersplenism, aplastic anaemia, malignant infiltration of bone marrow, megaloblastic anaemia, chemotherapy, myelodysplasia
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 19
Correct
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Which of the following laboratory findings are suggestive of functional hyposplenism:
Your Answer: Howell-Jolly bodies
Explanation:Functional hyposplenism is characterised by the blood film findings of Howell-Jolly bodies or siderotic granules on iron staining. The most frequent cause is surgical removal of the spleen e.g. after traumatic rupture, but hyposplenism can also occur in sickle cell anaemia, gluten-induced enteropathy, amyloidosis and other conditions.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 20
Correct
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A 62-year-old woman has reduced urine output, nausea, and confusion. Renal function tests and other investigations done leads to a diagnosis of acute kidney injury (AKI).Which one of these is consistent with a diagnosis of AKI?
Your Answer: A rise in serum creatinine of 30 μmol/L within 48 hours
Explanation:AKI is diagnosed based on an acutely rising serum creatinine and/or reduction in urine output.
AKI can often be non-oliguric.
AKI is present if any one or more of the following criteria is met:
- A rise in serum creatinine of ≥26 micromol/L (≥0.3 mg/dL) within 48 hours
- A rise in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the past 7 days (in practice you can use the lowest value from the past 3 months as the baseline for the patient)
- Urine volume <0.5 ml/kg/hour for at least 6 hours.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 21
Incorrect
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Regarding the lacrimal apparatus, which of the following statements is CORRECT:
Your Answer: The nasolacrimal duct empties into the middle nasal meatus.
Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
Explanation:Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 22
Incorrect
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A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone. Which one of the following conditions will this woman NOT have?
Your Answer: Hypothyroidism
Correct Answer: Xanthopsia
Explanation:Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias. Side effects include:1. pulmonary fibrosis2. blue discolouration of the skin3. phototoxicity4. corneal deposits5. hepatic necrosis6. thyroid dysfunction7. sleep disturbances8. peripheral neuropathy. Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 23
Incorrect
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Which of the following best describes the popliteal artery's course?
Your Answer: Begins at the mid-thigh as a continuation of the femoral artery
Correct Answer: After exiting the popliteal fossa terminates at the lower border of the popliteus muscle
Explanation:The popliteal artery divides into the anterior and posterior tibial arteries at the lower border of the popliteus after exiting the popliteal fossa between the gastrocnemius and popliteus muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 24
Incorrect
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Which of the following statements is correct about the extensor digitorum muscle?
Your Answer: It is innervated by the median nerve
Correct Answer: It extends the medial four digits at the metacarpophalangeal joints
Explanation:Extensor digitorum is a long muscle located in the posterior compartment of the forearm. Together with the extensor carpi ulnaris and extensor digiti minimi, extensor carpi radialis longus and brevis as well as the brachioradialis, it belongs to the group of superficial extensors of the forearm. These muscles can be easily palpated in the lateral aspect of the posterior forearm, especially during the extension of hand when they are contracted.Extensor digitorum runs from the lateral epicondyle of humerus to the medial four phalanges of the hand. In this way, it generates the pull for the extension of the four medial fingers in their metacarpophalangeal and both interphalangeal joints. Extensor digitorum also participates in the extension of the wrist.Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).Extensor digitorum is vascularized by the branches of three different arteries: (1) posterior interosseous artery, (2) radial recurrent artery, and (3) anterior interosseous artery. Anterior and posterior interosseous arteries are the branches of the common interosseous artery that arises from the ulnar artery. The radial recurrent artery is a 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
Correct
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Question 26
Incorrect
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A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.Which of the drugs listed below is the best fit for this strategy?
Your Answer: Lidocaine
Correct Answer: Bisoprolol
Explanation:In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 27
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 28
Incorrect
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Amoxicillin is used first line for all of the following infections EXCEPT for:
Your Answer: Infective exacerbation of chronic bronchitis
Correct Answer: Cellulitis
Explanation:Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI). Flucloxacillin is used first line for acute cellulitis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 29
Incorrect
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An 11-year-old boy was brought to the emergency room due to fever and pain in the ears. Upon physical examination, it was observed that the mastoid area is erythematous and there is a presence of a boggy, tender mass. A diagnosis of acute mastoiditis was made.Which of the following parts of the temporal bone is most likely involved?
Your Answer: Tympanic part
Correct Answer: Petrous part
Explanation:Mastoiditis is the inflammation of a portion of the temporal bone referred to as the mastoid air cells. The mastoid air cells are epithelium lined bone septations that are continuous with the middle ear cavity.The temporal bone is composed of four parts: the mastoid process, the petrous pyramid, the squamous, and tympanic portions. The mastoid process and the petrous pyramid are the portions of particular interest because of the prevalence of suppurations within these parts of the temporal bone.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 30
Correct
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Which of the following immunoglobulins is most important for mast cell degranulation:
Your Answer: IgE
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response.
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This question is part of the following fields:
- Immune Responses
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
