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Question 1
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 2
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 3
Incorrect
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Which of the following would you NOT expect from a deep fibular nerve palsy:
Your Answer: High-steppage gait
Correct Answer: Loss of sensation over heel
Explanation:Damage to the deep fibular nerve results in loss of dorsiflexion of the ankle, with resultant foot drop with high-stepping gait, loss of toe extension, weakness of foot inversion and loss of sensation over the webspace between the 1st and 2nd toes.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 4
Incorrect
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.
The stomach mucous neck cells secrete which of the following substances?
Your Answer: Hydrochloric acid
Correct Answer: Bicarbonate
Explanation:Foveolar cells, also known as gastric mucous-neck cells, are cells that line the stomach mucosa and are found in the necks of the gastric pits. Mucus and bicarbonate are produced by these cells, which prevent the stomach from digesting itself. At pH 4, the mucous allows the acid to penetrate the lining, while below pH 4, the acid is unable to do so. Viscous fingering is the term for this procedure.
The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:
Cell type/ Substance secreted/ Function of secretion
Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
Chief cells/ Pepsinogen/ Protein digestion
Chief cells/ Gastric lipase/ Fat digestion
G-cells/ Gastrin/ Stimulates gastric acid secretion
Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
D-cells/ Somatostatin/ Inhibits gastric acid secretion -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 5
Incorrect
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A 40-year-old man with episodes of blood in urine and flank pain that are recurrent presents for management. He has a history of hypertension that is difficult to control and recurrent urinary tract infections. Other findings are: bilateral masses in his flanks and haematuria (3+ on dipstick).
What is the most likely diagnosis?Your Answer: Renal artery stenosis
Correct Answer: Polycystic kidney disease
Explanation:Autosomal dominant polycystic kidney disease (ADPKD) presents with abdominal or loin discomfort due to the increasing size of the kidneys, acute loin pain with or without haematuria, hypertension, and male infertility. It is the most common cause of serious renal disease and the most common inherited cause of renal failure in adults.
Alport syndrome has hearing loss and eye abnormalities in addition to symptoms of kidney disease.
Renal cell carcinoma presents with additional features of unexplained weight loss, loss of appetite, fever of unknown origin and anaemia.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 6
Correct
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A 63-year-old man presents with severe abdominal pain and vomiting of blood. An endoscopy was performed and a peptic ulcer was found to have eroded into an artery nearby.
Which of the following most likely describes the location of the ulcer?Your Answer: The posterior duodenum
Explanation:The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, particularly gastric and duodenal ulcers. Duodenal ulcers are most commonly associated with bleeding compared with gastric ulcers. Posterior duodenal ulcers are considered to be the most likely to cause severe bleeding because of its proximity to the branches of the gastroduodenal artery (GDA).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 7
Incorrect
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The functional residual capacity (FRC) will be increased in which of the following:
Your Answer: Pulmonary fibrosis
Correct Answer: Emphysema
Explanation:Factors increasing FRC:
Emphysema
Air trapping in asthma
Ageing (due to loss of elastic properties)
Increasing height of patient -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 8
Incorrect
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After collapsing at home, a 62-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is rushed to resuscitation and placed on a cardiac monitor, which reveals ventricular tachycardia. An amiodarone infusion is set up.
Which of these statements about amiodarone is correct?Your Answer: It prolongs phase 1 of the cardiac action potential
Correct Answer: It is expressed in breast milk
Explanation:Antiarrhythmic drug amiodarone is used to treat both ventricular and atrial arrhythmias. It’s a class III antiarrhythmic that works by prolonging the repolarization phase of the cardiac action potential, where potassium permeability is normally high and calcium permeability is low.
Dronedarone is sometimes used instead of amiodarone in certain situations. Although amiodarone is more effective than dronedarone, dronedarone has fewer side effects.
Grapefruit juice inhibits the metabolism of amiodarone.
The plasma half-life of amiodarone is very long, ranging from 2 weeks to 5 months. The half-life is about 2 months on average.
Because amiodarone is excreted in breast milk, it should be avoided by breastfeeding mothers. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 9
Incorrect
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A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.
She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.
Out of the following, which antibiotic is most appropriate to be prescribed to this patient?Your Answer: Co-amoxiclav
Correct Answer: Fosfomycin
Explanation:The NICE guidelines for women with lower UTIs who are not pregnant are:
1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibioticThe first choice of antibiotics for non-pregnant women aged 16 years and over is:
1. Nitrofurantoin
100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
2. Trimethoprim
200 mg PO BD for three daysThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
1. Nitrofurantoin
100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
2. Pivmecillinam
400 mg PO initial dose, then 200 mg PO TDS for three days
3. Fosfomycin 3 g single sachet dose -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 10
Incorrect
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Which of the following is NOT a typical clinical feature of osteomalacia:
Your Answer: Elevated alkaline phosphatase
Correct Answer: Hypercalcaemia
Explanation:Features of osteomalacia include:
Bone pain (particularly bone, pelvis, ribs)
Neuromuscular dysfunction (particularly in the gluteal muscles, leading to waddling gait
Pseudofractures on x-ray (looser zones)
Elevated alkaline phosphatase, hypocalcaemia and low phosphate due to secondary hyperparathyroidism -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 11
Correct
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A 37-year-old man presents with breathlessness on exertion and dry cough, fever for the past 2 days and bilateral pleuritic chest pain.
He had been diagnosed with HIV and commenced on HAART but due to side effects, his compliance has been poor over the last few months.
On examination you note scattered crackles and wheeze bilaterally, cervical and inguinal lymphadenopathy, and oral thrush. At rest his oxygen saturation is 97% but this drops to 87% on walking. There is perihilar fluffy shadowing seen on his chest X-ray.
Which of these organisms is the most likely causative organism?
Your Answer: Pneumocystis jirovecii
Explanation:All of the organisms listed above can cause pneumonia in immunocompromised individuals but the most likely cause in this patient is Pneumocystis jirovecii.
It is a leading AIDS-defining infection in HIV-infected individuals and causes opportunistic infection in immunocompromised individuals. HIV patients with a CD4 count less than 200 cells/mm3 are more prone.
The clinical features of pneumonia caused by Pneumocystis jirovecii are:
Fever, chest pain, cough (usually non-productive), exertional dyspnoea, tachypnoea, crackles and wheeze.
Desaturation on exertion is a very sensitive sign of Pneumocystis jirovecii pneumonia.Chest X-ray can show perihilar fluffy shadowing (as is seen in this case) but can also be normal.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 12
Incorrect
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A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered.
Out of the following, which parameter is MOST likely to change due to initiating insulin?Your Answer: Magnesium
Correct Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia.
Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity.
It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L
If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 13
Incorrect
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A patient presents with pain in the wrist and a tingling in the hand. On examination Tinel's test is positive and you diagnose carpal tunnel syndrome. Regarding the carpal tunnel, which of the following statements is INCORRECT:
Your Answer: The flexor retinaculum forms the roof of the carpal tunnel.
Correct Answer: The tendons of the flexor digitorum profundus, flexor digitorum superficialis and flexor pollicis longus lie within a single synovial sheath.
Explanation:Free movement of the tendons in the carpal tunnel is facilitated by synovial sheaths, which surround the tendons. All of the tendons of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) are contained within a single synovial sheath with a separate sheath enclosing the tendon of the flexor pollicis longus (FPL).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Incorrect
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All of the following statements are considered true regarding nominal variables, except:
Your Answer: They can be analyzed using the chi-squared test
Correct Answer: The central tendency of a nominal variable is given by its median
Explanation:A nominal variable is a type of variable that is used to name, label or categorize particular attributes that are being measured. It takes qualitative values representing different categories, and there is no intrinsic ordering of these categories.
A nominal variable is one of the 2 types of categorical variables and is the simplest among all the measurement variables. Some examples of nominal variables include gender, name, phone, etc.A nominal variable is qualitative, which means numbers are used here only to categorize or identify objects. They can also take quantitative values. However, these quantitative values do not have numeric properties. That is, arithmetic operations cannot be performed on them. If the variable is nominal, the mode is the only measure of central tendency to use.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 15
Correct
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You are planning on starting antibiotic therapy for a patient with a diagnosis of gonorrhoea.
Which of these is the MOST appropriate antibiotic combination?Your Answer: Ceftriaxone and azithromycin
Explanation:Currently, ceftriaxone in combination with azithromycin or doxycycline is the combination of antibiotics used in the treatment of gonorrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 16
Incorrect
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You intend to suture a hand wound with plain 1 percent lidocaine.
In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?Your Answer: 10 mcg lidocaine hydrochloride
Correct Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 17
Incorrect
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Which segment of the colon is most likely to be affected in diverticulitis?
Your Answer: Rectum
Correct Answer: Sigmoid colon
Explanation:Diverticulitis refers to inflammation and infection associated with a diverticulum and is estimated to occur in 10% to 25% of people with diverticulosis. Peridiverticular and pericolic infection results from a perforation (either macroscopic or microscopic) of a diverticulum, which leads to contamination, inflammation, and infection. The spectrum of disease ranges from mild, uncomplicated diverticulitis that can be treated in the outpatient setting, to free perforation and diffuse peritonitis that requires emergency laparotomy. Most patients present with left sided abdominal pain, with or without fever, and leucocytosis. The most common location for diverticulitis is the sigmoid colon.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 18
Correct
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Approximately how long is the duration of a lidocaine block (when given with adrenaline):
Your Answer: 90 minutes
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 19
Incorrect
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A 25 year old woman who is a known diabetic is brought to the ED with diabetic ketoacidosis. She promptly received an insulin infusion. Which of the following are expected to increase upon infusion of insulin?
Your Answer: Blood glucose concentration
Correct Answer: Blood pH
Explanation:Ketoacidosis is characterized by hyperglycaemia, glycosuria, hyperkalaemia, and metabolic acidosis with respiratory compensation. An insulin infusion would be able to address these by lowering blood glucose through increased insulin-mediated cellular uptake, lowering urine glucose concentration as cellular glucose uptake is increased, decreasing K+ in her blood by shifting it into cells, and increasing blood ph by addressing the metabolic acidosis. The metabolic acidosis is addressed by the reduction of ketoacids production thereby returning her blood ph to normal and reducing the need for compensatory hyperventilation.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 20
Incorrect
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Infection with Campylobacter jejuni is one of the most common risk factors for which of the following conditions?
Your Answer: Haemolytic uraemic syndrome
Correct Answer: Guillain-Barre syndrome
Explanation:One of the most common risk factors for GBS is infection with Campylobacter jejuni, which causes diarrhoea.
Guillain-Barré syndrome (GBS) is a rare autoimmune disorder in which the body’s immune system attacks the nerves, resulting in muscle weakness and paralysis.
Infection with Streptococcus pyogenes can cause acute glomerulonephritis and rheumatic fever.
Haemolytic uraemic syndrome is commonly linked to E. coli infection.
Following measles infection, subacute sclerosing panencephalitis develops.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Incorrect
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Which of the following is a primary action of aldosterone:
Your Answer: Afferent arteriole vasoconstriction
Correct Answer: Renal sodium reabsorption
Explanation:Aldosterone acts mainly at the renal distal convoluted tubule (DCT) to cause sodium retention and potassium loss. It increases the synthesis of transport mechanisms in the distal nephron including the Na+pump, Na+/H+symporter, and Na+and K+channels in principal cells, and H+ATPase in intercalated cells. Na+(and thus water) reabsorption and K+and H+secretion are thereby enhanced.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 22
Incorrect
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You see a 63-year-old man with a history of melaena and epigastric discomfort. For a few months, he's been taking aspirin.
Which of the following statements about aspirin's mechanism of action is correct?Your Answer: It reversibly blocks cyclo-oxygenase (COX)
Correct Answer: It inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day)
Explanation:Aspirin inhibits cyclo-oxygenase irreversibly by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2. The production of prostaglandin and thromboxane is reduced as a result. As a result, platelet activation and aggregation are reduced. A single dose of aspirin has a half-life of 7-10 days, which is the time it takes for the bone marrow to produce new platelets.
Aspirin only inhibits COX-1, the enzyme that produces thromboxane A2, at low doses (75 mg per day), and thus has a primarily anti-thrombotic effect.
Aspirin inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day). COX-2 is involved in the production of prostaglandins, so it has an anti-inflammatory effect at these concentrations.
Aspirin, when used as an antipyretic for a viral illness in children, can cause Reye’s syndrome. Reye’s syndrome is a potentially fatal liver disease that causes encephalopathy and liver failure.
The inability of aspirin to reduce platelet production of thromboxane A2, and thus platelet activation and aggregation, is known as aspirin resistance. Although the exact frequency and mechanism of aspirin resistance are unknown, it is thought to affect about 1% of users. Women are more likely than men to experience this phenomenon.
According to new research, taking aspirin on a regular basis lowers the risk of colorectal cancer. It may also protect against cancers of the breast, bladder, prostate, and lungs.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 23
Incorrect
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Action potentials are transmitted from myocyte to myocyte via which of the following:
Your Answer: Purkinje fibres
Correct Answer: Gap junctions
Explanation:Action potentials are transmitted to adjacent myocytes via gap junctions.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 24
Incorrect
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A patent has weakness of humeral flexion and extension. A CT scan reveals that he has suffered damage to the nerve that innervates pectoralis major.
Pectoralis major receives its innervation from which of the following nerves? Select ONE answer only.Your Answer: Nerve to subclavius and medial pectoral nerve
Correct Answer: Lateral and medial pectoral nerves
Explanation:Pectoralis major is a thick, fan-shaped muscle situated in the chest. It makes up the bulk of the chest musculature in the male and lies underneath the breast in the female. It overlies the thinner pectoralis minor muscle.
Superficial muscles of the chest and arm showing pectoralis major (from Gray’s Anatomy)
Pectoralis major has two heads; the clavicular head and the sternocostal head. The clavicular head originates from the anterior border and medial half of the clavicle. The sternocostal head originates from the anterior surface of the sternum, the superior six costal cartilages and the aponeurosis of the external oblique muscle. It inserts into the lateral lip of the bicipital groove of the humerus.
Pectoralis major receives dual innervation from the medial pectoral nerve and the lateral pectoral nerve.
Its main actions are as follows:
Flexes humerus (clavicular head)
Extends humerus (sternocostal head)
Adducts and medially rotates the humerus
Draws scapula anteriorly and inferiorly -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 25
Incorrect
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Discontinuous capillaries are typically found where in the body:
Your Answer: Blood-brain barrier
Correct Answer: Reticuloendothelial system
Explanation:Discontinuous capillaries, found in the reticuloendothelial system (bone marrow, liver and spleen), have large gaps between endothelial cells and are permeable to red blood cells.
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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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A 66-year-old male was admitted from the Emergency Department due to severe pain in the left forearm and hand, refractory to pain medication along with pallor and hypothermia of the affected limb. Ultrasound doppler showed an arterial embolism. Circulation was restored after vascular surgery, but there was extensive, irreversible muscle damage.
How will the muscle heal from an injury of this type?Your Answer: Callous formation
Correct Answer: Diffuse formation of fibrous tissue
Explanation:Once muscle tissue is damaged, there will be healing via diffuse formation of fibrous tissue, especially due to the widespread ischemia.
Callus formation takes place in the healing of bone, not muscle.
Organised scar formation occurs when a lacerated wound is approximated by sutures so that primary intention wound healing can occur.
Liquefaction degeneration occurs following ischemia in the brain.
Volkmann’s ischemic contracture may occur, but it is not the primary type of healing that will take place but rather the effect of the fibrous scar formation.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 27
Correct
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You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.
Which of the following statements about dobutamine is correct?Your Answer: It may be infused via a peripheral line
Explanation:Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.
Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.
It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.
At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:
Nausea and vomiting
Tachycardia
Dysrhythmias
Angina
Hypertension
Headache -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 28
Correct
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A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?
Your Answer: 500 micrograms of adrenaline intramuscularly
Explanation:Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils.
If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution).
In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh.
Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 29
Incorrect
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You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.
Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?Your Answer: It should always be used with adrenaline to lessen the risk of bleeding
Correct Answer: Lidocaine works by blocking fast voltage-gated sodium channels
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 30
Incorrect
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A patient with a diagnosis of HIV presents with a fever, sore throat, and general malaise and you are concerned the patient may have an AIDS defining illness.
Which one of these, according to the CDC definition, would mean a patient infected with HIV has AIDS?
Your Answer: Streptococcal throat infection
Correct Answer: CD4 T-cell percentage of total lymphocytes of less than 15%
Explanation:According to the CDC definition, a patient co-infected with HIV can be diagnosed with AIDS if he or she has:
A CD4 T-cell count of less than 200 cells/mm3 or;
A CD4 T-cell percentage of total lymphocytes of less than 15% or;
An AIDS defining infectionA Streptococcal throat infection is not an AIDS defining infection.
A normal CD4 count ranges from 500-1000 cells/mm3. A CD4 (not CD8) count of less than 200 cells/mm3 is AIDS defining.
The CD4 count can vary from day to day and depending upon the time that the blood test is taken. It can also be affected by the presence of other infections or illnesses. Treatment with anti-retroviral therapy should be considered at CD4 count of less than 350 cells/mm3.
Serum concentrations of the p24 antigen (the viral protein that makes up most of the core of the HIV) are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 31
Incorrect
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A 60-year-old female has a past medical history of diverticular disease. She now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, after administering this treatment, the patient develops a side-effect to the medication.
What side-effect of using hyoscine butyl bromide is she MOST likely to develop out of the following?Your Answer: Anaphylaxis
Correct Answer: Dry mouth
Explanation:Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.
It has the following side-effects:
1. Constipation
2. Dizziness
3. Drowsiness
4. Dry mouth
5. Dyspepsia
6. Flushing
7. Headache
8. Nausea and vomiting
9. Palpitations
10. Skin reactions
11. Tachycardia
12. Urinary disorders
13. Disorders of vision -
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 32
Incorrect
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Parathyroid hormone is released by which of the following:
Your Answer: Cells of the renal proximal tubule
Correct Answer: Chief cells of the parathyroid gland
Explanation:Parathyroid hormone (PTH) is a peptide hormone synthesised by the chief cells of the parathyroid glands, located immediately behind the thyroid gland. PTH is primarily released in response to decreasing plasma [Ca2+] concentration. PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.
Parathyroid hormone (PTH) acts to increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane) and increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron. -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 33
Correct
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Question 34
Correct
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While on morning rounds in the medical ward, the attending physician asks a medical student about the differences between transudates and exudates and their causes. The student explains that a transudate is an excess fluid that leaks out of an intravascular compartment due to an imbalance between oncotic and hydrostatic pressures.
Which ONE of the following conditions will he mention as the cause of a transudate?Your Answer: Meig’s syndrome
Explanation:Transudative effusions are caused due to systemic causes leading to increased hydrostatic pressure or decreased oncotic pressure. These include:
1) Meig’s Syndrome (Ovarian tumour causing ascites and pleural effusion)
2) Congestive heart failure
3) Nephrotic Syndrome
4) Myxoedema
5) Cirrhosis
6) SarcoidosisAn exudate is caused by local inflammation and results from increased vascular permeability. Causes include:
1) Rheumatoid arthritis
2) Pneumonia leading to empyema
3) Malignancies
4) Pericarditis -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 35
Incorrect
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A 72-year-old woman presents to your clinic with worsening oedema. She has ischaemic heart disease and heart failure. You decide to add a loop diuretic to her current drug regime to control the oedema. Which of the following is a contraindication to using a loop diuretic?
Your Answer: Impaired fasting glycaemia
Correct Answer: Anuria
Explanation:Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic Acid
Loop diuretics inhibit the Na-K-Cl pump in the ascending loop of Henle, resulting in salt-water excretion. This relieves congestion and reduces oedema.
The contra-indications to the use of loop diuretics are:
1. Anuria
2. Comatose and precomatose states associated with liver cirrhosis
3. Renal failure due to nephrotoxic or hepatotoxic drugs
4. Severe hypokalaemia
5. Severe hyponatremia
6. History of hypersensitivity to furosemide, bumetanide, or torsemide (or sulphonamides)The following conditions or states are not contraindications, but loop diuretics needs to be used cautiously in these conditions:
1. Diabetes (but hyperglycaemia less likely than with thiazides)
2. Gout
3. Hypotension (correct before initiation of treatment)
4. Hypovolaemia (Correct before initiation of treatment) -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 36
Incorrect
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Tiredness, night sweats, and easy bruising are symptoms of a 58-year-old woman. Splenomegaly is observed during the examination.
Which of the following diagnoses is the SINGLE MOST LIKELY?Your Answer: Non-Hodgkin lymphoma
Correct Answer: Chronic myeloid leukaemia (CML)
Explanation:CML is a myeloproliferative disorder characterised by an abnormal pluripotent haemopoietic stem cell. A cytogenetic abnormality known as the Philadelphia chromosome, which results from a reciprocal translocation between the long arms of chromosomes 9 and 22, causes more than 80% of cases of CML.
CML is a disease that develops slowly over several years. This is known as the ‘chronic stage.’ This stage is usually asymptomatic, and 90 percent of patients are diagnosed at this point, with the disease being discovered frequently as a result of a routine blood test. During this stage, the bone marrow contains less than 10% immature white cells (blasts).
When CML cells expand, symptoms typically begin to appear. The ‘accelerated stage’ is what it’s called. Approximately 10% of people are diagnosed at this point. During this stage, between 10% and 30% of blood cells in the bone marrow are blasts. During this stage, common clinical features include:
Fatigue and exhaustion
Night sweats and fever
Distension of the abdomen
Pain in the left upper quadrant (splenic infarction)
Splenomegaly (commonest examination finding)
Hepatomegaly
Bruising is simple.
Gout is a type of arthritis that affects (rapid cell turnover)
Hyperviscosity is a condition in which the viscosity of (CVA, priapism)
A small percentage of patients experience a ‘blast crisis’ (blast stage). More than 30% of the blood cells in the bone marrow are immature blast cells at this stage. Patients with severe constitutional symptoms (fever, weight loss, bone pain), infections, and bleeding diathesis typically present at this stage.In CML, laboratory findings include:
White cell count is abnormally high (often greater than 100 x 109/l).
Increased number of immature leukocytes causes a left shift.
Anaemia that is mild to moderately normochromic and normocytic.
Platelets can be low, normal, or elevated, and the Philadelphia chromosome can be found in > 80% of patients.
Serum uric acid and ALP levels are frequently elevated.
Tyrosine kinase inhibitors (TKIs), such as imatinib and dasatinib, are the current mainstay of CML treatment.
Allogenic bone marrow transplantation is now only used in cases where TKIs have failed to work. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 37
Correct
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A 1-year-old male is brought to the paediatrician by his mother due to swelling of the right knee after a minor fall. On examination, the right knee is swollen, fluctuant and tender. Ultrasound-guided aspiration reveals a massive hemarthrosis. Family history shows that his older brother also has a bleeding disorder.
Which one of the following conditions does the patient most likely have?Your Answer: Haemophilia A
Explanation:A diagnosis of Haemophilia is supported in this patient by the family history and the presence of hemarthrosis-both characteristics of Haemophilia. Haemophilia A is caused by Factor VIII deficiency, leading to impaired coagulation. This disease typically presents after six months when the child starts crawling.
Von Willebrand disease presents with nosebleeds and hematomas. Idiopathic thrombocytopenic purpura presents with bruises that resemble a rash.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency presents with haemolytic anaemia induced by specific drugs or foods.
Factor V Leiden mutation causes blood clotting rather than bleeding.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 38
Incorrect
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Which of the following best describes the popliteal artery's course?
Your Answer:
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 39
Incorrect
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Question 40
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 41
Incorrect
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A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms have been steadily deteriorating, with no intervals of remission in sight.
Which of the following aspects of nerve conduction is disrupted by multiple sclerosis?
Your Answer:
Correct Answer: Saltatory conduction
Explanation:Local currents propagate action potentials down the axons of neurons. This local current flow following depolarisation results in the depolarisation of the neighbouring axonal membrane, and when this region approaches the threshold, more action potentials are generated and so forth. Due to the refractory period, portions of the membrane that have recently depolarized will not depolarize again, resulting in the action potential only being able to go in one direction.
The square root of axonal diameter determines the velocity of the action potential; the axons with the biggest diameter have the quickest conduction velocities. When a neuron is myelinated, the speed of the action potential rises as well.
The myelin sheath is an insulating coating that surrounds certain neural axons. By increasing membrane resistance and decreasing membrane capacitance, the myelin sheath improves conduction. This enables faster electrical signal transmission via a neuron, making them more energy-efficient than non-myelinated neuronal axons.
Electrical impulses are quickly transmitted from one node to the next, causing depolarization of the membrane above the threshold and triggering another action potential, which is then transmitted to the next node. An action potential is rapidly conducted down a neuron in this manner. Saltatory conduction is the term for this.
Multiple sclerosis is an example of a clinical disorder in which the myelin sheath is affected. It is an immune-mediated disorder in which certain nerve cells in the brain and spinal cord become demyelinated. The ability of some areas of the nervous system to properly transmit action potentials is disrupted by demyelination, resulting in a variety of neurological symptoms and indications. -
This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 42
Incorrect
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A 58-year-old patient presents with sputum production and worsening exertional breathlessness. A spirometry is done and his results leads to a diagnosis of obstructive lung disease with mild airflow obstruction.
What FEV1 value would correspond with mild airflow obstruction according to the NICE guidelines?
Your Answer:
Correct Answer: FEV 1 >80%
Explanation:Airflow obstruction according to the latest NICE guidelines, is defined as:
Mild airflow obstruction = an FEV 1 of >80% in the presence of symptoms
Moderate airflow obstruction = FEV 1 of 50-79%
Severe airflow obstruction = FEV 1 of 30-49%
Very severe airflow obstruction = FEV1<30%.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 43
Incorrect
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An 18-year-old patient was brought to the ER after falling off of his skateboard. He is unable to flex the distal interphalangeal joint of his index finger. You suspect that he suffers from a supracondylar fracture. Which of the following conditions would confirm supracondylar fracture?
Your Answer:
Correct Answer: Inability to oppose the thumb
Explanation:A supracondylar fracture is a fracture that occurs through the thin section of the distal humerus above the growth plate.
A supracondylar fracture is most usually associated with median nerve injury. A medial nerve damage causes paralysis of the thenar muscles, as well as loss of thumb opposition.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 44
Incorrect
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Fracture of the medial epicondyle would result to the following, except
Your Answer:
Correct Answer: Weakness of abduction of the thumb
Explanation:Thumb abduction is mediated by the abductor pollicis longus and brevis, which are innervated by the radial and median nerves, respectively.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 45
Incorrect
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A 17-year-old male presenting in the department has a history of C3 deficiency.
C3 deficiency is associated with all of the following EXCEPT?Your Answer:
Correct Answer: Hereditary angioedema
Explanation:C1-inhibitor deficiency is the cause of hereditary angioedema not C3 deficiency,
All the other statements are correct
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 46
Incorrect
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Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:
Your Answer:
Correct Answer: Hypocalcaemia
Explanation:Common side effects of thiazide diuretics include:
Excessive diuresis, postural hypotension, dehydration, renal impairment
Acid-base and electrolyte imbalance
Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosis
Metabolic imbalance
Hyperuricaemia and gout
Impaired glucose tolerance and hyperglycaemia
Altered plasma-lipid concentrations
Mild gastrointestinal disturbances -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 47
Incorrect
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Which of these structures is the smallest and deepest component of muscle connective tissue?
Your Answer:
Correct Answer: Endomysium
Explanation:There are three types of muscle:
Skeletal muscle
Cardiac muscle
Smooth muscleIndividual muscle is enveloped in a layer of dense irregular connective tissue called the epimysium. The epimysium protects the muscles from friction against bones and other muscles.
Skeletal muscle is composed of muscle fibres, referred to as myofibers which is ensheathed by a wispy layer of areolar connective tissue called the endomysium. The endomysium is the smallest and deepest component of muscle connective tissue.
Myofibers grouped together in bundles form fascicles, or fasciculi. These are surrounded by a type of connective tissue called the perimysium.
Beneath the endomysium lies the sarcolemma, an elastic sheath with infoldings that invaginate the interior of the myofibers, particularly at the motor endplate of the neuromuscular junction.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 48
Incorrect
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Which of the following organisms can penetrate intact skin:
Your Answer:
Correct Answer: Leptospira spp.
Explanation:Leptospirosis is a bacterial disease caused byLeptospira spp. It is the most common zoonotic infection worldwide.
It is usually contracted by exposure to water contaminated with the urine of infected animals (such as rodents, cattle, and dogs). The most important reservoirs are rodents, and rats are the most common source worldwide.
The bacteria enter the body through the skin or mucous membranes. This is more likely if the skin is broken by leptospirosis is somewhat unusual in that it can enter the body through intact skin. -
This question is part of the following fields:
- Microbiology
- Principles
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Question 49
Incorrect
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An very unwell patient is receiving treatment in your hospital's HDU and is found to have an Escherichia coli O157 infection.
Which one of these statements about Escherichia coli O157 is true?Your Answer:
Correct Answer: Haemolytic uraemic syndrome develops in approximately 6% of patients
Explanation:Escherichia coli O157 is a serotype of Escherichia coli.
The Escherichia coliO157 strain is ‘enterohaemorrhagic’ and causes severe forms of acute haemorrhagic diarrhoea. It can also cause non-haemorrhagic diarrhoea.Incubation period of Escherichia coli O157 is usually 3-4 days and bloody diarrhoea usually begins on the 3rd or 4th day of the infection.
Infections with Escherichia coliO157 are more common during the warmer months than in winter.
Haemolytic uraemic syndrome develops in approximately 6% of patients. It is commonly seen in children and in the elderly.
Escherichia coli O157 can also cause:
Haemorrhagic colitis
Haemolytic uraemic syndrome
Thrombotic thrombocytopenic purpura but not immune thrombocytopenic purpura. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 50
Incorrect
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Funnel plots are typically used to display:
Your Answer:
Correct Answer: The existence of publication bias in meta-analysis
Explanation:Funnel plots are used to demonstrate the existence of publication bias in meta-analysis. Funnel plots are scatter plots of treatment effects estimated from individual studies on the x axis and some measure of study size on the y axis. Each point on the graph represents one of the studies. A symmetrical inverted funnel shape indicates an absence of publication bias. If there is publication bias, there will be asymmetry of the open wide end due to the absence of small negative results.
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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SESSION STATS - PERFORMANCE PER SPECIALTY
