-
Question 1
Incorrect
-
Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:
Your Answer: ITP is the most common cause of isolated thrombocytopaenia without anaemia or neutropaenia.
Correct Answer: ITP is classically associated with massive splenomegaly.
Explanation:Chronic ITP is a relatively common disorder. The highest incidence is in women aged 15 – 50 years. It is the most common cause of thrombocytopaenia without anaemia or neutropaenia. It is usually idiopathic but it may been seen in association with other conditions. Platelet autoantibodies (usually IgG) result in the premature removal of platelets from the circulation by macrophages of the reticuloendothelial system. In many causes the antibody is directed against the glycoprotein IIb/IIIa or Ib complex. The normal platelet lifespan of 10 days is reduced to a few hours. Total megakaryocyte mass and platelet turnover are increased to approximately five times normal. Despite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged. In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 2
Incorrect
-
Regarding antacids, which of the following statements is CORRECT:
Your Answer: Antacids are best taken regularly each morning for maximum symptom control.
Correct Answer: Antacids are contraindicated in hypophosphataemia.
Explanation:Antacids are contraindicated in hypophosphataemia. Liquid preparations are more effective than tablet preparations. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are best taken when symptoms occur or are expected, usually between meals and at bedtime. Antacids should preferably not be taken at the same time as other drugs since they may impair absorption.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 3
Correct
-
A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination.
The brachial pulse can be best palpated at ?Your Answer: In the antecubital fossa, medial to the tendon of the biceps brachii
Explanation:The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 4
Correct
-
Which of the following is NOT a contraindication to the use of diazepam:
Your Answer: Acute alcohol withdrawal
Explanation:Benzodiazepines are used to treat symptoms in patients with acute alcohol withdrawal syndrome.
Benzodiazepines are contraindicated in:
Respiratory depression
Marked neuromuscular respiratory weakness, such as unstable myasthenia gravis
Obstructive sleep apnoea syndrome (symptoms may be aggravated)
Severe hepatic impairment (the elimination half-life of diazepam may be prolonged; increased risk of coma)
Phobic or obsessional states, chronic psychosis or hyperkinesis (paradoxical reactions may occur). -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 5
Correct
-
Regarding Escherichia coli, which of the following statements is INCORRECT:
Your Answer: It is a predominant member of the normal flora of the skin.
Explanation:Escherichia coli is a Gram-negative bacilli that is an important member of the intestinal flora. It is the most common cause of UTI in adults (about 70 – 95% of cases), followed by Staphylococcus saprophyticus (about 5 – 10% of cases), and an important cause of neonatal meningitis. E. coli O157 strain is implicated in the development of dysentery associated with haemolytic uraemic syndrome characterised by haemolytic anaemia, thrombocytopenia and acute renal failure.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 6
Incorrect
-
A lung function test is being performed on a male patient. For this patient, which of the following volumes for functional residual capacity is considered a normal result?
Your Answer: 1.0 L
Correct Answer: 2.0 L
Explanation:The volume of air that remains in the lungs after a single breath is known as functional residual capacity (FRC). It is calculated by combining the expiratory reserve volume and residual volume. In a 70 kg, average-sized male, a normal functional residual capacity is approximately 2100 mL.
-
This question is part of the following fields:
- Physiology
- Respiratory Physiology
-
-
Question 7
Incorrect
-
A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.
Your Answer: Atelectasis impairs gas exchange
Correct Answer: Atelectasis is an example of a perfusion defect
Explanation:Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.
-
This question is part of the following fields:
- Physiology
- Respiratory Physiology
-
-
Question 8
Incorrect
-
Regarding hepatitis C, which of the following statements is INCORRECT:
Your Answer: Primary infection is often asymptomatic.
Correct Answer: Anti-HCV IgG antibodies are diagnostic of acute infection.
Explanation:Anti-HCV IgG antibodies indicate exposure to hepatitis C but this could be acute, chronic or resolved infection. If the antibody test is positive, HCV RNA should be tested for, which if positive indicates that a person has current infection with active hepatitis C.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 9
Correct
-
Molecules with a molecular weight of less than which of the following are filtered freely at the glomerular filtration barrier:
Your Answer: 7000 Da
Explanation:Molecular weight is the main factor in determining whether a substance is filtered or not – molecules < 7 kDa in molecular weight are filtered freely e.g. glucose, amino acids, urea, ions but larger molecules are increasingly restricted up to 70 kDa, above which filtration is insignificant. Negatively charged molecules are further restricted, as they are repelled by negative charges, particularly in the basement membrane. Albumin has a molecular weight of 69 kDa and is negatively charged, thus only very small amounts are filtered (and all of the filtered albumin is reabsorbed in the proximal tubule), whereas small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. This means that ultrafiltrate is virtually protein free, but otherwise has an identical composition of that of plasma. The epithelial lining of the Bowman's capsule consists of a single layer of cells called podocytes. The glomerular capillary endothelium is perforated by pores (fenestrations) which allow plasma components with a molecular weight of < 70 kDa to pass freely.
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 10
Correct
-
A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.
Which of the following statements about corticotropin-releasing hormone is correct?Your Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus
Explanation:Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.
The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.
Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 11
Incorrect
-
What is the mechanism of action of penicillin antibiotics:
Your Answer: Inhibition of bacterial protein synthesis
Correct Answer: Inhibition of bacterial cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring. -
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 12
Correct
-
Which of the following pathogens is most likely to cause an infection in a chemo patient with significant neutropenia?
Your Answer: Candida
Explanation:Chemotherapy that is too aggressive weakens your immune system, putting you at risk for a fungal and many other infection.
Neutropenia is a condition in which a person’s neutrophil count is abnormally low. Neutrophils are an infection-fighting type of white blood cell. Neutrophils fight infection by killing bacteria and fungi (yeast) that infiltrate the body.
Fungal organisms are significant pathogens in the setting of neutropenia.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 13
Incorrect
-
A 13-year-old male presents to the Emergency Department with a heavy nosebleed. His medical record shows that he was diagnosed with Haemophilia B as a child.
What is the mode of inheritance of this disease?Your Answer: Mitochondrial
Correct Answer: X-linked recessive
Explanation:Deficiency of Factor IX causes Haemophilia B, and like the other Haemophilia’s, it has an X-linked recessive pattern of inheritance, affecting males born to carrier mothers.
Haemophilia B is the second commonest form of haemophilia and is rarer than haemophilia A. Haemophilia B is similar to haemophilia A but is less severe. You can distinguish the two disorders by specific coagulation factor assays.
The incidence of Haemophilia B is one-fifth of that of haemophilia A.
In laboratory findings, you get prolonged APTT, normal PT and low factor IX for Haemophilia B.
There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 14
Incorrect
-
A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration is 1246 pg/mL.
Glucagon INHIBITS which of the following processes? Select ONE answer only.Your Answer: The hydrolysis of triglycerides
Correct Answer: Glycolysis
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 15
Incorrect
-
Regarding Hodgkin lymphoma, which of the following statements is CORRECT:
Your Answer: Most patients present with painful generalised lymphadenopathy.
Correct Answer: Some patients may complain alcohol-induced nodal pain and pruritus
Explanation:Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 16
Incorrect
-
What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer: Alpha2-receptor agonist
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.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 17
Correct
-
Aplastic crises in sickle cell anaemia is classically precipitated by which of the following infections:
Your Answer: Parvovirus B19
Explanation:A serious complication in sickle cell disease (SCD) is the aplastic crisis. This may be caused by infection with Parvovirus B-19 (B19V). This virus causes fifth disease, a normally benign childhood disorder associated with fever, malaise, and a mild rash. This virus infects RBC progenitors in bone marrow, resulting in impaired cell division for a few days.
Healthy people experience, at most, a slight drop in hematocrit, since the half-life of normal erythrocytes in the circulation is 40-60 days. In people with SCD, however, the RBC lifespan is greatly shortened (usually 10-20 days), and a very rapid drop in Hb occurs. The condition is self-limited, with bone marrow recovery occurring in 7-10 days, followed by brisk reticulocytosis. -
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 18
Incorrect
-
A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin. There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute. A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer: Nitrofurantoin
Correct Answer: Ciprofloxacin
Explanation:URINARY TRACT INFECTIONS IN ADULT MEN
Symptomatic urinary tract infections are much less common in men than in women, and all UTIs
in men are considered complicated UTIs. Men with UTIs should be evaluated for predisposing or
causative factors.Uncomplicated cystitis
- Fosfomycin, oral, 3 g as a single dose.
If fosfomycin is unavailable:
- Nitrofurantoin, oral, 100 mg 6 hourly for 5 days.
Do not use nitrofurantoin or fosfomycin if there is any suspicion of early pyelonephritis as they do
not achieve adequate renal tissue levels.
If there are any factors precluding the use of the above agents, then a beta-lactam should be used.
Options include:
Cefixime 200 mg PO 12 hourly for 7 days
OR
Cefpodoxime 100 mg PO 12 hourly for 7 daysComplicated cystitis
Adults- Ciprofloxacin 500 mg PO 12 hourly
OR - Levofloxacin 750 mg PO once daily
Empiric antibiotic therapy should be changed based upon the bacteria isolated and its
antimicrobial susceptibility.
Treat for a total of 7–14 days -
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 19
Incorrect
-
Due to a traffic accident, a male patient was unable to lift his arm, indicating an injury at the glenohumeral joint. Based on the patient’s current condition, which nerve or nerves are may likely damaged?
Your Answer: Axillary and thoracodorsal nerve
Correct Answer: Axillary and suprascapular nerve
Explanation:A suprascapular nerve injury causes numbness in the shoulder, as well as weakness in abduction and external rotation.
Damage to the axillary nerve can result in shoulder or arm muscle weakness, as well as difficulty lifting the arm. This is because the deltoid and supraspinatus muscles, which are innervated by the axillary and suprascapular nerves, are responsible for abduction of the arm at the shoulder joint.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 20
Correct
-
Which of the following study designs is considered the most appropriate to safely determine whether an association exists between a well-established, commonly used, anti-hypertensive medication and causing type II diabetes mellitus?
Your Answer: A meta-analysis
Explanation:Evidence-based medicine may be defined as the systematic, quantitative, preferentially experimental approach to obtaining and using medical information. Therefore, meta-analysis, a statistical procedure that integrates the results of several independent studies, plays a central role in evidence-based medicine.
Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 21
Incorrect
-
Question 22
Correct
-
A 15-year-old male is admitted to a rehabilitation centre with a history of multiple strokes, myopathy and learning disabilities since childhood. He is under the care of a multidisciplinary team, and his genetic testing reports show the presence of a mitochondrial disorder.
Which one of the following diseases does this patient most likely have?Your Answer: MELAS
Explanation:Mitochondrial diseases are a group of disorders caused by dysfunctional mitochondria. Most cases are maternally inherited, as we inherit our mitochondrial DNA from our mothers only, although mutations in nuclear DNA cause some cases.
Examples of Mitochondrial Diseases include:
1. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)
2. Mitochondrial epilepsy with ragged red fibres (MERRF)
3. Leber’s hereditary optic neuropathy (LHON)
4. Diabetes mellitus and deafness (DAD)
5. Neuropathy, ataxia, retinitis pigmentosa, and ptosis (NARP)
6. Leigh syndrome (subacute sclerosing encephalopathy).Red-green colour blindness and G6PD deficiency have an X-linked recessive pattern of inheritance.
Tay-Sachs Disease and spinal muscular atrophy have an autosomal recessive pattern of inheritance.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 23
Incorrect
-
A patient suffers an injury to the nerve that innervates gluteus medius.
The gluteus medius muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer: Femoral nerve
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is innervated by the superior gluteal nerve.
Gluteus medius is innervated by the superior gluteal nerve.
Gluteus maximus is innervated by the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 24
Incorrect
-
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 spores from moldy hay
Correct 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
-
-
Question 25
Correct
-
You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:
Your Answer: Erb's palsy may result in loss of sensation of the regimental badge area.
Explanation:Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 26
Incorrect
-
A 20-year-old male has an anaphylactic reaction following a wasp sting.
What type of hypersensitivity reaction is this?
Your Answer: Type V
Correct Answer: Type I
Explanation:Anaphylaxis is an example of a type I hypersensitivity reaction.
It is IgE mediated.
It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.
Massive calcium influx into the cells leads to mast cell degranulation.
The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 27
Incorrect
-
You note that the prostate of a 60-year-old patient is enlarged during the examination. You suspect BPH. Anatomically, the prostate has four main lobes. Which of the lobes is affected by benign prostatic hypertrophy?
Your Answer: Lateral lobe
Correct Answer: Median lobe
Explanation:Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is characterized by an enlarged prostate gland.
The prostate is divided into four major lobes. The median lobe is the most commonly affected by benign prostatic enlargement, resulting in urethral obstruction and urine symptoms.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 28
Incorrect
-
A 60-year-old female is referred to the Oncology clinic due to the presence of lumps in her neck. There is a non-tender enlargement of several groups of cervical lymph nodes on examination. She is sent for a lymph node biopsy. The results show the presence of lymphoma cells, but there are no Reed-Sternberg cells.
Which one is most appropriate for this case out of the following diagnoses?Your Answer: Hodgkin’s lymphoma
Correct Answer: Non-Hodgkin’s lymphoma
Explanation:Non-Hodgkin’s Lymphoma (NHL) causes neoplastic transformation of both B cell (85%) and T cell (15%) lines.
The most common presentation is with enlarged, rubbery, painless lymph nodes. The patient may also have B symptoms which consist of night sweats, weight loss and fevers. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs.
The presence of Reed-Sternberg cells characterises Hodgkin’s lymphoma. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.
The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.
The following are recognised risk factors for NHL:
Chromosomal translocations and molecular rearrangements
Epstein-Barr virus infection
Human T-cell leukaemia virus type-1 (HTLV-1)
Hepatitis C
Congenital and acquired immunodeficiency states
Autoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis -
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 29
Incorrect
-
Regarding the accessory nerve, which of the following statements is INCORRECT:
Your Answer: The nerve enters the cranial cavity through the foramen magnum.
Correct Answer: Accessory nerve palsy results in the inability to nod the head
Explanation:Accessory nerve palsy results in inability to shrug the shoulders and to rotate the head to look at the opposite side to the lesion.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 30
Incorrect
-
Which of the following movements is controlled by the pectoralis major muscle?
Your Answer: Elevation and rotation of the scapula
Correct Answer: Flexion, adduction and medial rotation of the humerus
Explanation:The pectoralis major is a muscle that runs across the top of the chest and connects to a ridge on the back of the humerus (the bone of the upper arm).
Adduction, or lowering, of the arm (opposed to the deltoideus muscle) and rotation of the arm forward around the axis of the body are two of its main functions.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 31
Incorrect
-
When treating diabetic ketoacidosis (DKA), glucose should be given together with insulin as soon as the blood glucose concentration falls below 14 mmol/L in the form of:
Your Answer: 5% glucose intravenous infusion at a rate of 250 mL/hour
Correct Answer: 10% glucose intravenous infusion at a rate of 125 mL/hour
Explanation:In addition to the sodium chloride 0.9 percent infusion, glucose 10% should be given intravenously (into a large vein with a large-gauge needle) at a rate of 125 mL/hour once blood glucose concentration falls below 14 mmol/litre.
-
This question is part of the following fields:
- Endocrine
- Pharmacology
-
-
Question 32
Incorrect
-
How does aspirin mediate its antiplatelet effect:
Your Answer: It is a GPIIb/IIIa inhibitor.
Correct Answer: It irreversibly inhibits cyclo-oxygenase
Explanation:Aspirin irreversibly inhibits cyclooxygenase and blocks the platelet production of thromboxane A2 (TXA2), thus inhibiting platelet aggregation.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 33
Incorrect
-
Diagnosis of HIV is predominantly made through which of the following:
Your Answer: Thick and thin blood films
Correct Answer: Antibody detection
Explanation:Diagnosis of HIV is predominantly made through detection of HIV antibody and p24 antigen. Viral load (viral PCR) and CD4 count are used to monitor progression of disease.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 34
Correct
-
From which of the following cell types are platelets derived?
Your Answer: Megakaryocytes
Explanation:Synthesis of platelets occurs in the bone marrow by fragmentation of megakaryocytes cytoplasm, derived from the common myeloid progenitor cell. The average time for differentiation of the human stem cell to the production of platelets is about 10 days. The major regulator of platelet formation is thrombopoietin and 95% of this is produced by the liver. Normal platelet count is 150 – 450 x 109/L and the normal lifespan of a platelet is about 10 days. Usually about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 35
Incorrect
-
A 28-year-old female arrives after taking an unknown chemical in excess. She is tired and her speech is slurred. The following are her observations and results:HR 118,BP 92/58,SaO2 96%
HR 118, 11/15 The following are the results of his arterial blood gas (ABG):
pH: 7.24pO 2 : 9.4kPa PCO2 : 3.3kPa HCO 3 -: 22 mmol/lNa + : 143 mmol/lCl – : 99 mmol/lLactate: 5 IU/l
Which of the following statements about this patient is TRUE?Your Answer: She has respiratory acidosis
Correct Answer: Her anion gap is elevated
Explanation:The interpretation of arterial blood gas (ABG) aids in the measurement of a patient’s pulmonary gas exchange and acid-base balance.
The normal values on an ABG vary a little depending on the analyser, but they are roughly as follows:
Variable
Range
pH
7.35 – 7.45
PaO2
10 – 14 kPa
PaCO2
4.5 – 6 kPa
HCO3-
22 – 26 mmol/l
Base excess
-2 – 2 mmol/lThe patient’s history indicates that she has taken an overdose in this case. Because her GCS is 11/15 and she can communicate with slurred speech, she is clearly managing her own airway, there is no current justification for intubation.
The following are the relevant ABG findings:
Hypoxia (mild)
pH has been lowered (acidaemia)
PCO2 levels are low.
bicarbonate in its natural state
Lactate levels have increasedThe anion gap represents the concentration of all the unmeasured anions in the plasma. It is the difference between the primary measured cations and the primary measured anions in the serum. It can be calculated using the following formula:
Anion gap = [Na+] – [Cl-] – [HCO3-]The reference range varies depending on the technique of measurement, but it is usually between 8 and 16 mmol/L.
The following formula can be used to compute her anion gap:
Anion gap = [143] – [99] – [22]
Anion gap = 22As a result, it is clear that she has a metabolic acidosis with an increased anion gap.
The following are some of the causes of type A and type B lactic acidosis:
Type A lactic acidosis
Type B lactic acidosis
Shock (including septic shock)
Left ventricular failure
Severe anaemia
Asphyxia
Cardiac arrest
CO poisoning
Respiratory failure
Severe asthma and COPD
Regional hypoperfusion
Renal failure
Liver failure
Sepsis (non-hypoxic sepsis)
Thiamine deficiency
Alcoholic ketoacidosis
Diabetic ketoacidosis
Cyanide poisoning
Methanol poisoning
Biguanide poisoning -
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 36
Correct
-
A young boy is carried by his friends to the Emergency Department in an unconscious state. He is quickly moved into the resuscitation room.
He was at a party with friends and has injected heroin. On examination, his GCS is 6/15, and he has bilateral pinpoint pupils and a very low respiratory rate of 6 breaths per minute.
Which of the following is the first-line treatment for this patient?Your Answer: Naloxone 0.8 mg IV
Explanation:Heroin is injected into the veins and is the most commonly abused drug. Acute intoxication with opioid overuse is the most common cause of death by drug overdose.
The clinical features of opioid overdose are:
1. Decreased respiratory rate
2. Reduced conscious level or coma
3. Decreased bowel sounds
4. Miotic (constricted) pupils
5. Cyanosis
6. Hypotension
7. Seizures
8. Non-cardiogenic pulmonary oedema (with IV heroin usage)The main cause of death secondary to opioid overdose is respiratory depression, which usually occurs within 1 hour of the overdose. Vomiting is also common, and aspiration can occur.
Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.
It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
Naloxone has a shorter duration of action (6-24 hours) than most opioids, and so close monitoring according to the respiratory rate and depth of coma with repeated injections is necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.
An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.
If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
-
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
-
Question 37
Incorrect
-
Identify the type of graph described below:
A graph that is a useful summary of a set of bivariate data (two variables), usually drawn before working out a linear correlation coefficient or fitting a regression line.Your Answer: Stem and leaf plot
Correct Answer: Scatterplot
Explanation:A scatterplot is a useful summary of a set of bivariate data (two variables), usually drawn before working out a linear correlation coefficient or fitting a regression line. It gives a good visual picture of the relationship between the two variables, and aids the interpretation of the correlation coefficient or regression model. Each unit contributes one point to the scatterplot, on which points are plotted but not joined. The resulting pattern indicates the type and strength of the relationship between the two variables.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 38
Correct
-
Fracture of the medial epicondyle would result to the following, except
Your 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.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 39
Incorrect
-
Question 40
Incorrect
-
A 40-year-old woman presents with a red, scaly, itchy rash around her navel that occurred after contact with a nickel belt buckle. A diagnosis of allergic contact dermatitis is made. Which type of hypersensitivity reaction is this?
Your Answer:
Correct Answer: Type IV hypersensitivity reaction
Explanation:A type IV hypersensitivity reaction occurred in this patient. Allergic contact dermatitis is an inflammatory skin reaction occurring in response to an external stimulus, acting either as an allergen or an irritant, caused by a type IV or delayed hypersensitivity reaction. They usually take several days to develop.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 41
Incorrect
-
Which of the following drugs decreases plasma-theophylline levels:
Your Answer:
Correct Answer: Carbamazepine
Explanation:Examples of enzyme-inhibiting drugs (raise plasma theophylline level):
Erythromycin
Clarithromycin
Ciprofloxacin
Fluconazole
Verapamil
Allopurinol
Cimetidine
Examples of enzyme-inducing drugs (lower plasma theophylline level):
Primidone
Phenobarbital
Carbamazepine
Phenytoin
Ritonavir
Rifampicin
St John’s Wort -
This question is part of the following fields:
- Pharmacology
- Respiratory
-
-
Question 42
Incorrect
-
One of the following statements about acute lymphoblastic leukaemia(ALL) is true.
Your Answer:
Correct Answer: It is classified using the FAB classification
Explanation:ALL affects children predominantly.
The CNS is commonly involved in ALL.
The Philadelphia chromosome is present in 25% of adult ALL and 5% of childhood ALL cases.
The cure rate in children is approximately 80% in children and 50% in adults.
ALL is classified into 3 groups using the French-American-British (FAB) classification:
ALL-L1: small uniform cells
ALL-L2: large varied cells
ALL-L3: large varied cells with vacuoles. -
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 43
Incorrect
-
You see a 30-year-old man who has come to the department with a very tender right elbow. On examination, the elbow is very hot and red, and appears to be acutely inflamed.
Which SINGLE statement regarding acute inflammation is FALSE?Your Answer:
Correct Answer: Reduced extravascular osmotic pressure leads to oedema
Explanation:Inflammation can be divided intoacute inflammation, which occurs over seconds, minutes, hours, and days, andchronic inflammation, which occurs over longer periods.
Acute inflammationcommences within seconds or minutes following the injury of tissues. There are numerous potential stimuli for an acute inflammatory response including infections (bacterial, viral, fungal, parasitic), tissue necrosis, foreign bodies, and Immune reactions (hypersensitivity reactions). The chief cell type of acute inflammation is the neutrophil.
There are three main processesthat occur in the acute inflammatory response:
Increased blood flow
Increased capillary permeability
Neutrophil migration
1. Increased blood flow:
Vasoactive mediators are released, such as nitric oxide, histamine, bradykinins, and prostaglandin E2. These mediators cause vasodilatation and increased blood flow to the area (causing redness and heat).
2. Increased capillary permeability:
The vasoactive mediators also cause increased capillary permeability by causing endothelial cell contraction that widens the intercellular gaps of venules. This allows an outpouring of protein-rich fluid (exudate) into the extracellular tissues that results in a reduction of intravascular osmotic pressure and an increase in extravascular/interstitial pressure. The increased interstitial osmotic pressure leads to oedema.
3. Neutrophil migration:
Neutrophils leave the vasculature through the following sequence of events:
Margination and rolling: neutrophils flow nearer the vessel wall, rather than in the axial stream, which is referred to as margination. Following margination the neutrophils begin rolling along the surface of the vascular endothelium.
Activation and adhesion: then as a result of interaction with endothelial cell adhesion molecules (CAMs) that is mediated by selectins, the neutrophils are activated and adhere to the endothelium.
Transmigration: once bound to the endothelium, neutrophils squeeze through gaps between adjacent endothelial cells into the interstitial fluid, in a process calleddiapedesis. -
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 44
Incorrect
-
Regarding benzylpenicillin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: If meningococcal disease is suspected, benzylpenicillin should be given before transfer to hospital.
Explanation:Benzylpenicillin (although inactivated by bacterial beta-lactamases) is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas gangrene, leptospirosis, and treatment of Lyme disease. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin should be given before transfer to hospital, so long as this does not delay the transfer; benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis. Although benzylpenicillin is effective in the treatment of tetanus, metronidazole is preferred. Benzylpenicillin is inactivated by gastric acid and absorption from the gastrointestinal tract is poor and therefore it must be given by injection.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 45
Incorrect
-
Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer:
Correct Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 46
Incorrect
-
Regarding haemoglobin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: In degradation of haemoglobin, the haem group is split from the haemoglobin and converted to biliverdin and ultimately to bilirubin.
Explanation:Haemoglobin is composed of four polypeptide globin chains each with its own iron containing haem molecule. Haem synthesis occurs largely in the mitochondria by a series of biochemical reactions commencing with the condensation of glycine and succinyl coenzyme A under the action of the key rate-limiting enzyme delta-aminolevulinic acid (ALA) synthase. The globin chains are synthesised by ribosomes in the cytosol. Haemoglobin synthesis only occurs in immature red blood cells.
There are three types of haemoglobin in normal adult blood: haemoglobin A, A2 and F:
– Normal adult haemoglobin (HbA) makes up about 96 – 98 % of total adult haemoglobin, and consists of two alpha (α) and two beta (β) globin chains.
– Haemoglobin A2 (HbA2), a normal variant of adult haemoglobin, makes up about 1.5 – 3.5 % of total adult haemoglobin and consists of two α and two delta (δ) globin chains.
– Foetal haemoglobin is the main Hb in the later two-thirds of foetal life and in the newborn until approximately 12 weeks of age. Foetal haemoglobin has a higher affinity for oxygen than adult haemoglobin.
Red cells are destroyed by macrophages in the liver and spleen after , 120 days. The haem group is split from the haemoglobin and converted to biliverdin and then bilirubin. The iron is conserved and recycled to plasma via transferrin or stored in macrophages as ferritin and haemosiderin. An increased rate of haemoglobin breakdown results in excess bilirubin and jaundice. -
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 47
Incorrect
-
A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.
Which of the following muscles is most likely to be involved? Select ONE answer only.Your Answer:
Correct Answer: Sternothyroid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
Contents:
Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus -
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 48
Incorrect
-
Which of the following is considered an example of an observational study?
Your Answer:
Correct Answer: Cohort study
Explanation:The two most common types of observational studies are cohort studies and case-control studies; a third type is cross-sectional studies.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 49
Incorrect
-
A 71-year-old man treated with antibiotics for a chest infection returns with a profuse, offensive smelling diarrhoea. A diagnosis of Clostridium difficile diarrhoea is made after investigations.
The action most effective at minimizing spread to other patients is?
Your Answer:
Correct Answer: Hand washing
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.
Alcohol hand gel is not effective against Clostridium Difficile spores. Hand washing with soap and water is very essential for healthcare workers who come in contact with it.
Wearing an apron and gloves, and isolation to a side room are important contact precautions. They are, however, ineffective if hand washing is neglected.
Although oral vancomycin is the first-line treatment for C. difficile associated diarrhoea, it will not limit patient to patient spread.
-
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 50
Incorrect
-
All of the following statements are considered true regarding L'Abbe plots, except:
Your Answer:
Correct Answer: Treatment group results are plotted on the horizontal axis
Explanation:A L’Abbé plot is a scatter plot with the risk in the control group on the x-axis and the risk in the experimental group on the y-axis. It can be used to evaluate heterogeneity in meta-analysis. Furthermore, this plot can aid to choose a summary measure (odds ratio, risk ratio, risk difference) that will result in more consistent results.
-
This question is part of the following fields:
- Evidence Based Medicine
-
SESSION STATS - PERFORMANCE PER SPECIALTY
