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Question 1
Correct
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Which of the following best describes digoxin:
Your Answer: A positive inotrope and negative chronotrope
Explanation:Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 2
Correct
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Question 3
Correct
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Which of the following terms describes the proportion of individuals with a negative test result who actually do not have a disease:
Your Answer: Negative predictive value
Explanation:Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.
NPV = d/(c+d) -
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 4
Correct
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An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:
No. of post-menopausal women who took Calcium: 500
No. of post-menopausal women who took Calcium and suffered a hip fracture: 10
No. of post-menopausal women who took placebo: 500
No. of post-menopausal women who took placebo and suffered a hip fracture: 25
Compute for the absolute risk reduction of a hip fracture.Your Answer: 0.03
Explanation:Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).
ARR = ARC-ART
ARR = (25/500) – (10/500)
ARR = 0.03 -
This question is part of the following fields:
- Evidence Based Medicine
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Question 5
Correct
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Which of these cell types in the stomach releases pepsinogen?
Your Answer: Chief cells
Explanation:The gastric chief cells in the stomach wall releases pepsinogen. Pepsinogen is a proenzyme. It mixes with hydrochloric acid in the stomach and is converted to pepsin. Pepsin breaks down proteins into peptides aiding protein digestion.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 6
Correct
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If the ejection fraction increases, there will be a decrease in:
Your Answer: End-systolic volume
Explanation:An increase in ejection fraction means that a higher fraction of the end-diastolic volume is ejected in the stroke volume (e.g. because of the administration of a positive inotropic agent). When this situation occurs, the volume remaining in the ventricle after systole, the end-systolic volume, will be reduced. Cardiac output, stroke volume, and mean arterial pressure will be increased.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 7
Correct
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For the treatment of his atrial fibrillation, a 67-year-old man is about to begin taking warfarin. He also takes a number of other medications.
Which of the following medications will prevent warfarin from working?Your Answer: Phenytoin
Explanation:Many medications, including warfarin, require cytochrome P450 enzymes for their metabolism. When co-prescribing cytochrome p450 enzyme inducers and inhibitors with warfarin, it’s critical to be cautious.
Inhibitors of the cytochrome p450 enzyme inhibit the effects of warfarin, resulting in a lower INR. To remember the most commonly encountered cytochrome p450 enzyme inducers, use the mnemonic PC BRASS:
P– Phenytoin
C– Carbamazepine
B– Barbiturates
R– Rifampicin
A– Alcohol (chronic ingestion)
S– Sulphonylureas
S– Smoking -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 8
Correct
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A 26-year-old female cuts her hand on a knife while preparing dinner but the bleeding stops within a few minutes.
Which one of the following cells will be among the first to be present at the wound site to be involved in haemostasis?Your Answer: Platelets
Explanation:Platelets are the first cells to be attracted to the wound site due to the release of the Von Willebrand factor from the damaged endothelium. Platelets, in turn, release cytokines such as platelet-derived growth factor, which will attract other inflammatory cells to the wound site.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 9
Correct
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Following the administration of a drug that was started a few months earlier, a patient presents with features of peripheral neuropathy.
Which of the following drugs is most likely to cause peripheral neuropathy?
Your Answer: Isoniazid
Explanation:Isoniazid, a first-line agent for the treatment of tuberculosis, has the commonest side effect of peripheral neuropathy. It occurs in up to 20% of patients taking the drug at a dose > 6 mg/kg daily.
Isoniazid combines with pyridoxine (vitamin B6) to form hydrazone, which is excreted in the urine. This causes a deficiency of biologically active pyridoxine leading to peripheral neuropathy.
Peripheral neuropathy of isoniazid is prevented by the co-administration of pyridoxine at a dose of 10 mg for each 100 mg of isoniazid given.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 10
Correct
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Regarding inhaled corticosteroids, which of the following statements is INCORRECT:
Your Answer: Lower doses of inhaled corticosteroids may be required in smokers.
Explanation:Current and previous smoking reduces the effectiveness of inhaled corticosteroids and higher doses may be necessary.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 11
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 12
Correct
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In which of the following cases is intravenous phenytoin contraindicated?
Your Answer: Second degree heart block
Explanation:Phenytoin Contraindications include:
Hypersensitivity
Sinus bradycardia
Sinoatrial block
Second and third degree A-V block
Adams-Stokes syndrome
Concurrent use with delavirdine
History of prior acute hepatotoxicity attributable to phenytoin -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 13
Correct
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Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.
Explanation:A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 14
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Which of the following is NOT an advantage of a cohort study used to investigate the relationship between exposure to a risk factor and a future outcome:
Your Answer: Particularly suitable for rare diseases
Explanation:Advantages: ideal for studying associations between an exposure and an outcome when the exposure is uncommon, the time sequence of events can be assessed, they can provide information on a wide range of disease outcomes, the absolute and relative risk of disease can be measured directly, they can give a direct estimation of disease incidence rates
Disadvantages: costly and can take long periods of time if the outcome is delayed, subject to subject-selection and loss to follow-up bias, large sample size required for rare outcome of interest so it is not useful for rare diseases, prone to confounding -
This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 15
Correct
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A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular medication.
What is the dosage per inhalation of a standard metered dose salbutamol inhaler?Your Answer: 100 micrograms
Explanation:The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 16
Correct
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A 17-year-old student presents with a headache and petechial rash. A diagnosis of meningitis was suspected, with a causative agent of Neisseria meningitidis.
Which of the following statements is considered correct regarding Neisseria meningitidis?Your Answer: The antiphagocytic polysaccharide capsule is the main determinant of its pathogenicity
Explanation:N. meningitidis is a Gram-negative cocci and can be found as a commensal as well as an invasive pathogen. It is an important etiologic agent of endemic and epidemic meningitis and meningococcaemia and rarely pneumonia, purulent arthritis, or endophthalmitis. N. meningitidis has also been recovered from urogenital and rectal sites as a result of oral-genital contact. Meningococcal carriage, usually involving nonencapsulated strains, may cause an increase in protective antibody against the pathogenic strains. Of the 12 meningococcal encapsulated serogroups, A, B, C, Y, and W-135 account for most cases of disease in the world. N. meningitidis possesses a polysaccharide capsule that is antiphagocytic and serves as an important virulence factor.
It can be found on the mucosal surfaces of the nasopharynx and oropharynx in 30% of the human population. The organism is transmitted by close contact with respiratory droplet secretions from a carrier to a new host. Only a few newly colonized hosts develop meningococcal disease, with the highest incidence being found in infants and adolescents.
The quadrivalent vaccine Menactra is a polysaccharide-protein conjugated vaccine with antigens to serogroups A, C, Y, and W-135. This conjugate vaccine is licensed for people 2 to 55 years old. This vaccine does not protect against meningitis caused by serogroup B because group B polysaccharide is a very poor immunogen in humans.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 17
Correct
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Which of the following is NOT a notifiable disease:
Your Answer: HIV
Explanation:HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.
HIV is not a notifiable disease. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 18
Correct
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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: 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 19
Correct
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In the Emergency Department, a 35-year-old woman actively seizing is brought in. She is quickly shifted into the resuscitation room and is administered a dose of benzodiazepine. The seizure is quickly terminated.
Once the patient is stable, she tells you she is a known case of epilepsy and takes phenytoin to control it.
Which of the following is the primary mechanism of action of phenytoin?Your Answer: Sodium channel blocker
Explanation:Phenytoin is in the anticonvulsants class of drugs and is used in the management and treatment of the following:
1. epilepsy
2. generalized tonic-clonic seizures
3. complex partial seizures
4. status epilepticus.It works by inactivating the voltage-gated sodium channels responsible for increasing the action potential. It is non-specific and targets almost all voltage-gated sodium channel subtypes. More specifically, phenytoin prevents seizures by inhibiting the positive feedback loop that results in neuronal propagation of high-frequency action potentials.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 20
Correct
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Where is angiotensin I primarily converted to angiotensin II:
Your 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 cortex
Stimulation of anti-diuretic hormone (vasopressin) release from the posterior pituitary
Stimulation of thirst via the hypothalamus
Acts on the Na+/H+ exchanger in the proximal tubule of the kidney to stimulate Na+reabsorption and H+excretion -
This question is part of the following fields:
- Physiology
- Renal
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Question 21
Correct
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In the extrinsic pathway of the coagulation cascade, the tenase complex is:
Your Answer: Factor VIIa-tissue factor complex
Explanation:The extrinsic pathway for initiating the formation of prothrombin activator begins with a traumatized vascular wall or traumatized extravascular tissues that come in contact with the blood. Exposed and activated by vascular injury, with plasma factor VII. The extrinsic tenase complex, factor VIIa-tissue factor complex, activates factor X to factor Xa.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 22
Correct
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Which of the following statements is correct with regards to Hodgkin's lymphoma?
Your Answer: Most patients present with painless asymmetrical lymphadenopathy, with cervical nodes involved most commonly.
Explanation:Lymphoma is a cancer of the lymphatic system, which is part of the body’s germ-fighting network. They are a group of diseases that are caused by malignant lymphocytes. These malignant cells accumulate in lymph nodes and other lymphoid tissue, giving rise to the characteristic clinical feature of lymphadenopathy.
They can be subdivided into Hodgkin lymphoma (HL) which are characterised by the presence of Reed-Sternberg cells, and non-Hodgkin lymphoma (NHL).
Characteristics of HL include:
1. can present at any age but is rare in children and has a peak incidence in young adults,
2. almost 2:1 male predominance.
3. presents with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes.
4. cervical node involvement in 60-70% of cases,
5. axillary node involvement in 10-15%
6. inguinal node involvement in 6-12%.
7. modest splenomegaly during the course of the disease in 50% of patients
8. may occasionally have liver enlargement
9. bone marrow failure involvement is unusual in early disease.
Approximately 85% of patients are cured, but the prognosis depends on age, stage and histology.
Two well‐known but rare symptoms in HL are alcohol‐induced pain and pruritus. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 23
Correct
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Which of the following intravenous induction drugs results in the highest drop in blood pressure:
Your Answer: Propofol
Explanation:Propofol’s most frequent side effect is hypotension, which affects 17% of paediatric patients and 26% of adults. This is attributable to systemic vasodilation as well as a decrease in preload and afterload. Propofol has a little negative inotropic impact as well. The drop in blood pressure is dosage-dependent and is more noticeable in the elderly, thus this should be expected.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 24
Correct
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Which of the following is the most potent stimulus of fibrinolysis:
Your Answer: Tissue plasminogen activator
Explanation:Fibrinolysis is a normal haemostatic response to vascular injury. Plasminogen, a proenzyme in blood and tissue fluid, is converted to plasmin by activators either from the vessel wall (intrinsic activation) or from the tissues (extrinsic activation). The most important route follows the release of tissue plasminogen activator (TPA) from endothelial cells.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 25
Correct
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You are taking care of a 55-year-old male patient who is a weightlifter. He is suspected of having a direct inguinal hernia. Where would this hernia appear?
Your Answer: Medial to the inferior epigastric artery
Explanation:A direct inguinal hernia is a form of groin hernia that occurs when abdominal viscera protrude through a weakness in the posterior wall of the inguinal canal, notably through Hesselbach’s triangle, medial to the inferior epigastric veins.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 26
Correct
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Which of the following statements is correct with regards to Klebsiella spp?
Your Answer: They are typically associated with nosocomial infection.
Explanation:Klebsiella is a type of bacteria commonly found in nature. In humans, the bacteria are often present in parts of the digestive tract and respiratory flora, where they do not generally cause problems. They are anaerobic Gram-negative rods. They are usually opportunistic pathogens which cause nosocomial infections, the most common ones being pneumonia and UTI.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 27
Correct
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A 35-year-old man is feeling unwell following his return from a business trip. He is diagnosed with a vector transmitted disease.
Which of these organisms is commonly spread by vector-borne transmission?Your Answer: Borrelia burgdorferi
Explanation:Borrelia burgdorferiis, primarily spread by ticks and lice, is a zoonotic, vector-borne organism that causes Lyme disease.
Neisseria meningitidis and Bordetella pertussis are droplet borne infections (airborne particle > 5 µm)
Vibrio cholerae and Ascaris lumbricoides are spread by the faeco-oral route
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 28
Correct
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An elderly man with chronic heart and lung disease develops Legionnaires' Disease. By what route was the infection most likely to have been acquired:
Your Answer: Inhalation of aerosolised contaminated water
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.
The clinical features of the pneumonic form of Legionnaires’ disease include:
Mild flu-like prodrome for 1-3 days
Cough (usually non-productive and occurs in approximately 90%)
Pleuritic chest pain
Haemoptysis
Headache
Nausea, vomiting and diarrhoea
Anorexia
Legionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 29
Correct
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A 60-year-old man comes to your department with complaints of epigastric pain. There is a history of rheumatoid arthritis and he has been taking ibuprofen 200 mg TDS for the last 2 weeks.
The following scenarios would prompt you to consider the co-prescription of a PPI for gastroprotection with NSAIDs EXCEPT?
Your Answer: Long-term use for chronic back pain in a patient aged 30
Explanation:The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:
Aged 65 or older
– Using maximum recommended dose of an NSAID
– History of peptic ulcer or GI bleeding
– Concomitant use of: antidepressants like SSRIs and SNRIs, Corticosteroids, anticoagulants and low dose aspirin
– Long-term NSAID usage for: long-term back pain if older than 45 and patients with OA or RA at any ageThe maximum recommended dose of ibuprofen is 2.4 g daily and this patient is on 400 mg of ibuprofen TDS.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 30
Correct
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Needle thoracentesis in a patient with a tension pneumothorax is performed at which anatomical landmark?
Your Answer: 4th or 5th intercostal space mid-axillary line
Explanation:Tension pneumothorax is a fatal disease causing acute and severe compromise of patients’ ventilation and circulation, in which case immediate decompression is necessary for better prognosis [6]. A previous study has shown that the incidence of tension pneumothorax varies from 0.2% to 1.7% in patients with prehospital trauma. Several trauma guidelines recommend needle thoracostomy as a life-saving intervention, with placement in the second intercostal space at the midclavicular line (second ICS-MCL), the fourth intercostal space at the anterior axillary line (fourth ICS-AAL), or the fifth intercostal space at the midaxillary line (fifth ICS-MAL) for tension pneumothorax in a prehospital environment.
In 2018, according to newly issued the Advanced Trauma Life Support (ATLS) guidelines, the fifth ICS-MAL was suggested as the preferred place, and an 8 cm needle rather than the common 5 cm needle was proved to increase success rate of adults’ decompression.
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This question is part of the following fields:
- Anatomy
- Thorax
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SESSION STATS - PERFORMANCE PER SPECIALTY
