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Question 1
Incorrect
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Regarding bile, which of the following statements is CORRECT:
Your Answer: Bile passes out of the gallbladder via the common hepatic duct
Correct Answer: Bile passes into the duodenum through the ampulla of Vater.
Explanation:Bile is synthesised in the liver. Bile functions to eliminate endogenous and exogenous substances from the liver, to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile is stored and concentrated in the gallbladder. Bile passes out of the gallbladder via the cystic duct. Bile passes into the duodenum through the ampulla of Vater regulated by the sphincter of Oddi.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 2
Incorrect
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A 33 year old female patient presents to emergency room with some symptoms that she thinks might be due to a drug that she has recently started. She was started on hyoscine butyl bromide for symptomatic relief of irritable bowel syndrome. The least likely expected side effect of this drug in this patient is:
Your Answer:
Correct Answer: Diarrhoea
Explanation:One of the commonest antispasmodic medications that is used is hyoscine butylbromide. It is an antimuscarinic and typical side effects of this class of drugs include:
– dilation of pupils with loss of accommodation (cycloplegia)
-photophobia resulting in blurred vision (Blind as a bat)
-dry mouth, eyes and skin (Dry as a bone),
-elevated temperature (Hot as a hare)
-skin flushing (Red as a beet)
-confusion or agitation particularly in the elderly (Mad as a hatter)
-reduced bronchial secretions
-transient bradycardia followed by tachycardia, palpitation and arrhythmias
-urinary retention and/or constipation -
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 3
Incorrect
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Question 4
Incorrect
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Which of the following is NOT a feature characteristic of intravascular haemolysis:
Your Answer:
Correct Answer: Bilirubinuria
Explanation:Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria
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This question is part of the following fields:
- Haematology
- Pathology
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Question 5
Incorrect
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Which of the following best describes the typical rash of measles:
Your Answer:
Correct Answer: The typical rash of measles is maculopapular, starting behind the ears and spreading downwards to the trunk.
Explanation:A prodromal 2 – 4 day coryzal illness (fever, cough, conjunctivitis, irritability) normally occurs associated with Koplik’s spots (small white papules found on the buccal mucosa near the first premolars), before a morbilliform maculopapular rash appears, first behind the ears and then spreading downwards to whole body.The rash peels off or fades about about 7 – 10 days. The chickenpox rash is characterised by a maculopapular rash progressing to vesicles and then crusting over. Scarlet fever is characterised by a sandpaper like rash associated with a strawberry tongue.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 6
Incorrect
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Question 7
Incorrect
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A 29-year-old female with chronic anaemia secondary to sickle cell disease is being transfused. A few minutes after starting the blood transfusion, she develops widespread itching with urticarial rash, wheezing, nausea and chest pain. Her BP reduces to 60/40 mmHg.
What is the most appropriate treatment?Your Answer:
Correct Answer: Stop the transfusion and administer adrenaline
Explanation:Anaphylaxis transfusion reaction occurs when an individual has previously been sensitized to an allergen present in the blood and, on re-exposure, releases IgE or IgG antibodies. Patients with anaphylaxis usually develop laryngospasm, bronchospasm, abdominal pain, nausea, vomiting, hypotension, shock, and loss of consciousness. The transfusion should be stopped immediately and the patient should be treated with adrenaline, oxygen, corticosteroids, and antihistamines.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 8
Incorrect
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Regarding ACE inhibitors, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Angiotensin-II receptor blockers are a useful alternative in patients who cannot tolerate ACE-inhibitors due a persistent cough.
Explanation:ACE inhibitors should be used with caution in patients of Afro-Caribbean descent who may respond less well; calcium channel blockers are first line for hypertension in these patients. ACE inhibitors have a role in the management of diabetic nephropathy. ACE inhibitors are contraindicated in pregnant women. ACE inhibitors inhibit the breakdown of bradykinin; this is the cause of the persistent dry cough. Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 9
Incorrect
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A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb.
The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.
There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers.
Which of these nerve(s) has most likely been affected?
Your Answer:
Correct Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:
Loss of sensation to the lateral palm and the lateral three and a half fingers.
Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals.
Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialis
Weakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.
Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 10
Incorrect
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Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Anti-D antibodies are usually IgG.
Explanation:Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 11
Incorrect
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A patient presents to your Emergency Department with a laceration on their buttocks requiring closure with sutures.
What stage of wound healing is the first to reach completion?Your Answer:
Correct Answer: Haemostasis
Explanation:The stages of wound healing are: haemostasis, inflammatory, proliferative and remodelling (maturation) phases in that order. The first stage in the healing process of a laceration is haemostasis. Haemostasis is the process of the wound being closed by clotting.
The inflammatory phase occurs just after and up to 48 hours after injury– Blood vessels dilate to allow white blood cells, antibodies, growth factors, enzymes and nutrients to reach the wounded area leading to the characteristic signs of inflammation seen.
Epithelialisation and angiogenesis are not phases of wound healing but occur during the proliferative phase. This ia after haemolysis and inflammation phases have occurred.
The maturation phase is the final phase and occurs when the wound has closed. It involves remodelling of collagen from type III to type I. Apoptosis remove unwanted cells, cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases. This can continues for up to 1 year after injury.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 12
Incorrect
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Which of the following antibiotics may be used for malaria prophylaxis:
Your Answer:
Correct Answer: Doxycycline
Explanation:Doxycycline may be used for malaria prophylaxis and as an adjunct to quinine in the treatment of Plasmodium falciparum malaria.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 13
Incorrect
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Following an injury sustained during a rugby match, a 16-year-old boy is brought to the Emergency Department by his mother. His forearm appears to be deformed, and you believe he has a distal radius fracture. A numerical rating scale is used to assess his pain, and the triage nurse informs you that he is in moderate pain.'
The RCEM guidance recommends which of the following analgesics for the treatment of moderate pain in a child of this age?Your Answer:
Correct Answer: Oral codeine phosphate 1 mg/kg
Explanation:According to a 2018 audit conducted by the Royal College of Emergency Medicine (RCEM), the standard of care for children presenting to EDs with fractured limbs has deteriorated, with most patients waiting longer than ever before for pain relief. More than one-tenth of the children who came in with significant pain from a limb fracture received no pain relief at all.
For all patients, including children, the Agency for Health Care Policy and Research (AHCPR) in the United States recommends using the ABCs of pain management:
A – Ask about pain regularly. Assess pain systematically.
B – Believe the patient and family in their reports of pain and what relieves it.
C – Choose pain control options appropriate for the patient, family, and setting.
D – Deliver interventions in a timely, logical, coordinated fashion.
E – Empower patients and their families. Enable patients to control their course to the greatest extent possible.The RCEM guidelines recommend assessing a child’s pain within 15 minutes of arrival. This is a fundamental requirement. For the assessment of pain in children, a variety of rating scales are available; which one is used depends on the child’s age and ability to use the scale. These are some of them:
Faces of Wong-Baker Scale for assessing pain
Scale of numerical evaluation
The behavioural scale is a scale that measures how people behave.The RCEM has provided the following visual guide:
The RCEM has established the following guidelines for when patients in severe pain should receive appropriate analgesia:
100% within 60 minutes of arrival or triage, whichever is earliest
75% within 30 minutes of arrival or triage, whichever is earliest
50% within 20 minutes of arrival or triage, whichever is earliest -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 14
Incorrect
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A 71-year-old woman presents with complaints of fatigue and worsening muscle weakness, and blood tests done shows a potassium level of 2.4 mmol/L.
Which is NOT a recognised cause of hypokalaemia?
Your Answer:
Correct Answer: Type 4 renal tubular acidosis
Explanation:A plasma potassium less than 3.5 mmol/L defines hypokalaemia.
Excessive liquorice ingestion causes hypermineralocorticoidism and leads to hypokalaemia.
Gitelman’s syndrome causes metabolic alkalosis with hypokalaemia and hypomagnesaemia. It is an inherited defect of the distal convoluted tubules.
Bartter’s syndrome causes hypokalaemic alkalosis. It is a rare inherited defect in the ascending limb of the loop of Henle.
Type 1 and 2 renal tubular acidosis both cause hypokalaemia
Type 4 renal tubular acidosis causes hyperkalaemia.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 15
Incorrect
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What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer:
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 16
Incorrect
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A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.
Which of the following statements regarding the opponens pollicis muscle is considered correct?Your Answer:
Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint
Explanation:Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.
Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.
It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Incorrect
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Regarding dynamic compression of the airways, which of the following statements is CORRECT:
Your Answer:
Correct Answer: It occurs during forced expiration.
Explanation:Dynamic compression occurs because as the expiratory muscles contract during forced expiration, all the structures within the lungs, including the airways, are compressed by the positive intrapleural pressure. Consequently the smaller airways collapse before the alveoli empty completely and some air remains within the lungs (the residual volume). Physiologically this is important as a completely deflated lung with collapsed alveoli requires significantly more energy to inflate. Dynamic compression does not occur in normal expiration because the intrapleural pressure is negative throughout the whole cycle.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 18
Incorrect
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Regarding benzodiazepines, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Diazepam is a short-acting benzodiazepine.
Explanation:Diazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration. Midazolam is a water-soluble benzodiazepine that is often used in preference to intravenous diazepam; recovery is faster than from diazepam, but may be significantly longer in the elderly, in patients with a low cardiac output, or after repeated dosing. Midazolam is associated with profound sedation when high doses are given intravenously or when it is used with certain other drugs.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 19
Incorrect
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Regarding the lung roots, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.
Explanation:Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Incorrect
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Achlorhydria is diagnosed in a 37-year-old individual who has had recurring episodes of gastroenteritis. This is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production.
Damage to stomach parietal cells will alter the secretion of which other substance?Your Answer:
Correct Answer: Intrinsic factor
Explanation:Achlorhydria is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production. The parietal cells that have been injured are unable to create the necessary amount of stomach acid. As a result, the pH of the stomach rises, food digestion suffers, and the risk of gastroenteritis rises.
The secretion of hydrochloric acid and intrinsic factor is controlled by the gastric parietal cells, which are epithelial cells in the stomach. These cells can be found in the gastric glands, the fundus lining, and the stomach body.
In response to the following three stimuli, the stomach parietal cells release hydrochloric acid:
H2 Histamine receptors are stimulated by histamine (most significant contribution)
Acetylcholine stimulates M3 Receptors via parasympathetic action.
CCK2 receptors are stimulated by Gastrin.Intrinsic factor, which is essential for vitamin B12 absorption, is also produced by stomach parietal cells.
Omeprazole is a proton pump inhibitor that is both selective and irreversible. It inhibits the H+/K+-ATPase system present on the secretory membrane of gastric parietal cells, which lowers stomach acid secretion.
Ranitidine inhibits histamine H2-receptors in a competitive manner. The reversible inhibition of H2-receptors in gastric parietal cells reduces both the volume and concentration of gastric acid. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 21
Incorrect
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The Philadelphia chromosome is a genetic abnormality associated primarily with which of the following malignancies:
Your Answer:
Correct Answer: Chronic myeloid leukaemia
Explanation:Chronic myeloid leukaemia (CML) is a clonal disorder of a pluripotent stem cell. The disease accounts for around 15% of leukaemias and may occur at any age. The diagnosis of CML is rarely difficult and is assisted by the characteristic presence of the Philadelphia (ph) chromosome. This disease occurs in either sex, most frequently between the ages of 40 and 60 years. In up to 50% of cases the diagnosis is made incidentally from a routine blood count. Leucocytosis is the main feature, with a complete spectrum of myeloid cells seen in the peripheral blood. The levels of neutrophils and myelocytes exceed those of blast cells and promyelocytes.Increased circulating basophils are a characteristic feature. Normochromic normocytic anaemia is usual. Platelet count may be increased (most frequently), normal or decreased. The clinical outlook is very good and 90% of patients can expect long-term control of disease.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 22
Incorrect
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The tetanus vaccination contains inactivated tetanus toxoid, which induces the body to produce protective antibodies. How do these antibodies protect the body from tetanus?
Your Answer:
Correct Answer: Neutralise the protein exotoxin of C. tetani
Explanation:C. Tetanospasmin, an exotoxin produced by tetani, is responsible for the neurotoxic consequences of tetanus.
The tetanus vaccination contains inactivated tetanus toxoid, which induces the body to produce protective antibodies that neutralize the tetanus toxin.
It induces active immunization against Clostridium tetani exotoxin via toxoid-induced Ab generation.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 23
Incorrect
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What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer:
Correct Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Explanation:A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 24
Incorrect
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Which of the following is NOT a typical complication associated with mumps:
Your Answer:
Correct Answer: Subacute sclerosing panencephalitis
Explanation:Complications of mumps include meningitis, post meningitis deafness, encephalitis, pancreatitis, orchitis and oophoritis. Subacute sclerosing panencephalitis is a complication typically associated with measles infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 25
Incorrect
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Which of the following describes the pulse pressure:
Your Answer:
Correct Answer: Systolic - diastolic pressure
Explanation:During systole, the pressure in the left ventricle increases and blood is ejected into the aorta. The rise in pressure stretches the elastic walls of the aorta and large arteries and drives blood flow. Systolic pressure is the maximum arterial pressure during systole. During diastole, arterial blood flow is partly maintained by elastic recoil of the walls of large arteries. The minimum pressure reached before the next systole is the diastolic pressure. The difference between the systolic and diastolic pressure is the pulse pressure.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 26
Incorrect
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Which of the following is typically a cause of a normal anion gap metabolic acidosis:
Your Answer:
Correct Answer: Diarrhoea
Explanation:FUSEDCARS can be used to remember some of the causes of a normal anion gap acidosis:
Fistula (pancreaticoduodenal)
Ureteroenteric conduit
Saline administration
Endocrine (hyperparathyroidism)
Diarrhoea
Carbonic anhydrase inhibitors (e.g. acetazolamide)
Ammonium chloride
Renal tubular acidosis
Spironolactone -
This question is part of the following fields:
- Physiology
- Renal
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Question 27
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:
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 28
Incorrect
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Question 29
Incorrect
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Question 30
Incorrect
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You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available. In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines?
Your Answer:
Correct Answer: Lidocaine
Explanation:If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
