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Question 1
Incorrect
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A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.
Which of these statements about anaphylaxis is true?Your Answer: Prior exposure to the antigen is not required for it to occur
Correct Answer: The immunoglobulin-antigen complex binds to Fc receptors on the surface of mast cells.
Explanation:Anaphylaxis is an example of a type I hypersensitivity reaction.
It is IgE mediated.
It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.
Massive calcium influx into the cells leads to mast cell degranulation.
The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 2
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. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 3
Correct
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A 69-year-old woman with new-onset back pain was diagnosed with osteopenia, osteolytic lesions, and vertebral collapse after undergoing a radiographic examination. Her laboratory results revealed anaemia and hypercalcemia. These findings most likely indicate what condition?
Your Answer: Myeloma
Explanation:Bone pain, pathologic fractures, weakness, anaemia, infection, hypercalcemia, spinal cord compression, and renal failure are all signs and symptoms of multiple myeloma (MM). The patient’s condition matched the signs and symptoms of myeloma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 4
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 5
Correct
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You evaluate a 80-year-old man who has a history of persistent heart failure and discover that he has generalised oedema.
Which of the following claims regarding capillary hydrostatic pressure (P c) is false?Your Answer: P c increases along the length of the capillary, from arteriole to venule
Explanation:The capillary hydrostatic pressure (Pc) is normally between 15 and 30 millimetres of mercury. Pc Decreases along the capillary’s length, mirroring the arteriolar and venule pressures proximally and distally.
Pc is determined by the ratio of arteriolar resistance (RA) to venular resistance (RV).When the RA/RV ratio is high, the pressure drop across the capillary is modest, and Pcis is close to venule pressure.
When the ratio of RA/RV is low, the pressure drop across the capillary is considerable, and Pcis is close to arteriolar pressure.
Pcis closer to the venule pressure and thus more responsive to changes in venous pressure than arteriolar pressure when RA/RV is high.
Pcis the major force behind fluid pushing out of the capillary bed and into the interstitium.
It is also the most variable of the forces affecting fluid transport at the capillary, partly because sympathetic-mediated arteriolar vasoconstriction varies. -
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 6
Correct
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A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.
Which of the following nerves has been damaged in this case? Select ONE answer only.Your Answer: The median nerve
Explanation:Flexor carpi radialis is innervated by the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 7
Incorrect
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Regarding the management of gout, which of the following statements is CORRECT:
Your Answer: Ibuprofen is the NSAID of choice in treating acute gout.
Correct Answer: Allopurinol may cause an acute attack of gout when first started.
Explanation:Allopurinol is a treatment for the prevention of gout. The initiation of treatment may precipitate an acute attack, and should be covered with an NSAID or colchicine, continued for at least one month after the hyperuricaemia has been corrected. Colchicine is not indicated for long term prevention of gout. NSAIDs are first line for acute gout; colchicine is an alternative in whom NSAIDs are contraindicated, not tolerated or ineffective (including in people taking anticoagulants). Ibuprofen is not recommended for acute gout, given it has only weak anti-inflammatory properties; naproxen, diclofenac or indometacin are indicated instead.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 8
Incorrect
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Streptococcus pneumoniae is commonly implicated in all of the following infectious diseases EXCEPT for:
Your Answer: Meningitis
Correct Answer: Impetigo
Explanation:Impetigo is a highly contagious infection of the superficial epidermis that most commonly affects young children but can occur in any age group. In children it is the most common bacterial skin infection and it is the third most common skin disease overall, behind dermatitis and viral warts.
The commonest causative organism is Staphylococcus aureus. Streptococcus pyogenesis the second commonest and causes fewer cases, either alone or in combination withS. aureus.The streptococcal form tends to be commoner in warmer, more humid climates. (Hirschmann JV. Impetigo: etiology and therapy. Curr Clin Top Infect Dis. 2002;22:42–51.)
Impetigo is most commonly spread by direct person-to-person contact, and can spread rapidly through families and school classes. It can also, less commonly, be spread by indirect contact.
There are two main forms of impetigo:
Non-bullous impetigo – lesions usually start as tiny pustules or vesicles that evolve rapidly into honey-crusted plaques that tend to be under 2 cm in diameter. These can be itchy but are rarely painful.
Bullous impetigo – lesions have a thin roof and tend to rupture spontaneously. This type is more likely to be painful and may be associated with systemic upset. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 9
Correct
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 10
Incorrect
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Regarding Clostridium tetani, which of the following statements is CORRECT:
Your Answer: Tetanolysin impairs release of GABA at the presynaptic membrane.
Correct Answer: Metronidazole is usually the antibiotic of choice for tetanus infection.
Explanation:Clostridium tetani infection is predominantly derived from animal faeces and soil. Clostridium tetani has exotoxin-mediated effects, predominantly by tetanospasmin which inhibits the release of GABA at the presynaptic membrane throughout the central and peripheral nervous system. Metronidazole has overtaken penicillin as the antibiotic of choice for treatment of tetanus (together with surgical debridement, tetanus toxoid immunisation, and human tetanus immunoglobulin).
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 11
Correct
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What is the main mechanism of action of dopamine as an inotropic sympathomimetic:
Your Answer: Beta1-receptor agonist
Explanation:Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Incorrect
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One of these statements about cohort studies is true:
Your Answer: They are the best way to determine the prevalence of a disease
Correct Answer: They are longitudinal in nature
Explanation:A cohort study is a longitudinal, observational study. It follows a group of patients (the cohort) forward in time and monitors the effects of the aetiological factor under study upon them.
Cohort studies are usually of longer duration and are more expensive than case-control studies. They, however, provide more useful and reliable information.
Cohort studies follow a cohort of patients who don’t have a disease and evaluate the absolute and relative risk of contracting the disease after exposure to the aetiological agent.
Cross-sectional studies are the best way to determine the prevalence of a disease. while Cohort studies are better at determining the incidence of a disease.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 13
Correct
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A 59-year-old man presents to the emergency room with chest pain. The cardiology team recently discharged him. He underwent a procedure and was given several medications, including abciximab, during his stay. Which of the following statements about abciximab is correct?
Your Answer: It is a glycoprotein IIa/IIIb receptor antagonist
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.
It’s approved for use as a supplement to heparin and aspirin in high-risk patients undergoing percutaneous transluminal coronary intervention to prevent ischaemic complications. Only one dose of abciximab should be given (to avoid additional risk of thrombocytopenia).
Before using, it is recommended that baseline prothrombin time, activated clotting time, activated partial thromboplastin time, platelet count, haemoglobin, and haematocrit be measured. 12 and 24 hours after starting treatment, haemoglobin and haematocrit should be measured again, as should platelet count 2-4 hours and 24 hours after starting treatment.
When used for high-risk patients undergoing angioplasty, the EPIC trial(link is external)found that abciximab reduced the risk of death, myocardial infarction, repeat angioplasty, bypass surgery, and balloon pump insertion.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 years
Intracranial tumour
Aneurysm or arteriovenous malformation
Haemorrhagic diathesis is a type of haemorrhagic diathesis.
Vasculitis
Retinopathy caused by hypertensionThe following are some of the most common abciximab side effects:
Manifestations of bleeding
Bradycardia
Back ache
Pain in the chest
Vomiting and nausea
Pain at the puncture site
Thrombocytopenia -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 14
Incorrect
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Regarding alteplase, which of the following statements is INCORRECT:
Your Answer: Alteplase is a recombinant tissue-type plasminogen activator.
Correct Answer: Alteplase is commonly associated with hypotensive effects.
Explanation:Alteplase is a recombinant tissue-type plasminogen activator (tPA), a naturally occurring fibrin-specific enzyme that has selectivity for activation of fibrin-bound plasminogen. It has a short half-life of 3 – 4 minutes and must be given by continuous intravenous infusion but is not associated with antigenic or hypotensive effects, and can be used in patients when recent streptococcal infections or recent use of streptokinase contraindicates the use of streptokinase.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 15
Correct
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Which of the following acts to inhibit antidiuretic hormone (ADH) release from the posterior pituitary:
Your Answer: Atrial natriuretic peptide
Explanation:ADH release is inhibited by low plasma osmolality, alcohol, caffeine, glucocorticoids and atrial natriuretic peptide (ANP).
ADH release is stimulated primarily by raised plasma osmolality detected by osmoreceptors in the anterior hypothalamus. Other factors that increase ADH release include: extracellular fluid volume depletion, angiotensin II, nausea, pain, stress, exercise, emotion, hypoglycaemia.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 16
Incorrect
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Regarding the glomerular filtration barrier, which of the following statements is CORRECT:
Your Answer: Molecules with molecular weight of 100 kDa or less are filtered freely.
Correct Answer: The main factor determining whether a substance is filtered or not is molecular weight.
Explanation:Molecular weight is the main factor in determining whether a substance is filtered or not – molecules < 7 kDa in molecular weight are filtered freely e.g. glucose, amino acids, urea, ions but larger molecules are increasingly restricted up to 70 kDa, above which filtration is insignificant. Negatively charged molecules are further restricted, as they are repelled by negative charges, particularly in the basement membrane. Albumin has a molecular weight of 69 kDa and is negatively charged, thus only very small amounts are filtered (and all of the filtered albumin is reabsorbed in the proximal tubule), whereas small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. This means that ultrafiltrate is virtually protein free, but otherwise has an identical composition of that of plasma. The epithelial lining of the Bowman's capsule consists of a single layer of cells called podocytes. The glomerular capillary endothelium is perforated by pores (fenestrations) which allow plasma components with a molecular weight of < 70 kDa to pass freely.
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This question is part of the following fields:
- Physiology
- Renal
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Question 17
Incorrect
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A 34-year-old male presents to the Emergency Department with the complaint of palpitations and difficulty breathing, which started suddenly half an hour ago. His ECG shows findings of supraventricular tachycardia. You attempt vagal manoeuvres but cannot convert them back to sinus rhythm. Therefore, drug therapy is necessary to terminate the arrhythmia. Adenosine cannot be used in this patient because of a contra-indication listed in his medical record.
Which one of the conditions listed below would be a contraindication in this case?Your Answer: Lown-Ganong-Levine syndrome
Correct Answer: Asthma
Explanation:Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor.
It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour.
Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 18
Correct
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Which of these increases osteoclast activity?
Your Answer: Parathyroid hormone
Explanation:Osteoclasts are bone cell that break down bone tissue.
Parathyroid hormone increases osteoclastic activity.
1,25-dihydroxycholecalciferol increases osteoclastic activity
Calcitonin inhibits osteoclastic activity
Bisphosphonates are osteoclast inhibitors.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 19
Incorrect
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A patient is found to be anaemic. Which one of the following blood results would favour a diagnosis of anaemia of chronic disease rather than iron deficiency:
Your Answer: Low serum ferritin
Correct Answer: Low total iron binding capacity (TIBC)
Explanation:Anaemia of chronic disease is one of the most common causes of normocytic anaemia. The anaemia is usually mild (Hb > 90 g/L) and non-progressive. Anaemia of chronic disease is usually associated with low serum iron, low transferrin saturation, and a low total iron binding capacity (TIBC) with normal or raised ferritin which differentiates it from iron deficiency anaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 20
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 21
Correct
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A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer: Lithium
Explanation:In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.
Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.
If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.
If given in the 2nd and 3rd-trimesters, there is a risk of the following:
1. hypotonia
2. lethargy
3. feeding problems
4. hypothyroidism
5. goitre
6. nephrogenic diabetes insipidus in the neonate -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 22
Correct
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What is the effect of a positive inotrope on the Starling curve:
Your Answer: Shifts the curve upwards
Explanation:Contractility (inotropy) is the intrinsic ability of cardiac muscle to develop force at a given muscle length. It is determined by the intracellular [Ca2+] and can be estimated by the ejection fraction. Increases in contractility cause an increase in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume, and hence shift the Starling curve upwards. Decreases in contractility cause a decrease in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume and hence shift the Starling curve downwards.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 23
Correct
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A 66-year-old male is brought to your clinic by his wife with the complaint of increasing confusion and disorientation over the past three days, along with decreased urination. She reports that he has been complaining of increasing pain in his back and ribs over the past three months.
On examination, the patient looks anaemic, is not oriented in time, place and person and has tenderness on palpation of the lumbar spine and the 10th, 11th and 12th ribs.
Blood tests show anaemia which is normocytic, normochromic, raised urea and creatinine and hypercalcemia.
Which one of the following diagnoses is most likely in this case?Your Answer: Multiple myeloma
Explanation:Multiple myeloma is a clonal abnormality affecting plasma cells in which there is an overproduction of functionless immunoglobulins. The most common patient complaint is bone pain, especially in the back and ribs. Anaemia and renal failure are common, along with hypercalcemia. Hypercalcemia may lead to an altered mental status, as in this case.
Chronic lymphocytic leukaemia occurs due to the overproduction of lymphocytes, usually B cells. CLL may present with an asymptomatic elevation of B cells. Patients are generally more than 50 years old and present with non-specific fatigue and weight loss symptoms.
There is no history of alcohol abuse in this case. Furthermore, patients with a history of alcohol abuse may have signs of liver failure, which are not present here.
Metastatic prostate cancer would most often cause lower backache as it metastasises first to the lumbar spine via the vertebral venous plexus.
A patient with Vitamin B12 deficiency would have anaemia, megaloblastic, hypersegmented neutrophils, and signs of peripheral neuropathy.
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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 primary mechanism of action of ketamine is:
Your Answer: N-methyl-D-aspartate (NMDA)-receptor antagonist
Explanation:Ketamine is a non-competitive antagonist of the calcium-ion channel in the NMDA (N-methyl-D-aspartate) receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
Overdose may lead to panic attacks and aggressive behaviour; rarely seizures, increased ICP, and cardiac arrest
Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 25
Incorrect
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Cryptococcus neoformans is primarily implicated in which of the following conditions:
Your Answer: Neurocysticercosis
Correct Answer: Chronic lymphocytic meningitis
Explanation:Cryptococcus neoformans typically causes a chronic lymphocytic meningitis in immunosuppressed patients or those with intense exposure e.g. pigeon fanciers.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 26
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 27
Correct
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A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.
Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.Your Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.
Peroneus longus is innervated by the superficial peroneal nerve.
Peroneus tertius is innervated by the deep peroneal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 28
Incorrect
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A man working as a waiter cuts his arm on a glass while he was working. The palmaris longus muscle was damaged as a consequence of his injury.
Which of the following statements regarding the palmaris longus muscle is considered correct?Your Answer: Damage to it will cause a significant functional deficit at the wrist
Correct Answer: It receives its blood supply from the ulnar artery
Explanation:The palmaris longus is a small, fusiform-shaped muscle located on the anterior forearm of the human upper extremity. The palmaris longus muscle is commonly present but may be absent in a small percentage of the population, ranging from 2.5% to 26% of individuals, depending on the studied population.
The palmaris longus belongs to the anterior forearm flexor group in the human upper extremity. The muscle attaches proximally to the medial humeral epicondyle and distally to the palmar aponeurosis and flexor retinaculum. The blood supply to the palmaris longus muscle is via the ulnar artery, a branch of the brachial artery in the human upper extremity.
The palmaris longus muscle receives its innervation via branches of the median nerve containing nerve roots C5-T1. Median nerve injury at or above the elbow joint (including brachial plexus and nerve root injury) can lead to deficits in the palmaris longus and other forearm flexor muscles, leading to weakened elbow flexion, wrist flexion, radial deviation, finger flexion, thumb opposition, flexion, and abduction, in addition to the loss of sensory function in the distribution of the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 29
Incorrect
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Which one of the listed cells are typically found in a granuloma?
Your Answer: B lymphocytes
Correct Answer: Epithelioid cells
Explanation:Typically, a granuloma has Langhan’s cells (large multinucleated cells) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.
Antigen presenting monocytic cells are found in the skin are known as Langerhan’s cells.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 30
Incorrect
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Regarding beta-thalassaemia, which of the following statements is CORRECT:
Your Answer: Beta-thalassaemia is typically associated with a macrocytic anaemia.
Correct Answer: Beta-thalassaemia trait is associated with a raised HbA2.
Explanation:Beta-thalassaemia major is caused by a complete or almost complete failure of β-globin chain synthesis, severe imbalance of α:β-chains with deposition of α-chains in erythroblasts, ineffective erythropoiesis and extramedullary haemopoiesis. The severe anaemia becomes apparent at 3 – 6 months when the switch from γ-chain to β-chain synthesis normally occurs. Beta-thalassaemia minor is a variable syndrome, milder than thalassaemia major, with later onset and characterised by moderate hypochromic microcytic anaemia with raised haemoglobin A2. Beta-thalassaemia trait is characterised by mild hypochromic, microcytic anaemia with raised red cell count and raised haemoglobin A2.
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This question is part of the following fields:
- Haematology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
