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  • Question 1 - Regarding folate requirements, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding folate requirements, which of the following statements is CORRECT:

      Your Answer: Absorption of folate is primarily from the terminal ileum.

      Correct Answer: Dietary folate is found particularly in leafy green vegetables and liver.

      Explanation:

      Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
      Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      53748.6
      Seconds

  • Question 2 - A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was...

    Incorrect

    • A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was rushed to the Emergency Department due to sudden onset crushing chest pain. ECG showed an ST-elevation myocardial infarct in the left anterior descending artery territory. The patient's condition was stabilised and managed with angioplasty, but he sustained significant myocardial damage.

      Which one of the following statements best agrees with the myocardial healing process?

      Your Answer:

      Correct Answer: The left ventricle will likely hypertrophy first to maintain cardiac output

      Explanation:

      Following a myocardial infarction scar tissue formation will take place at the site of the damaged muscle. This places increased load on the rest of the myocardium causing it to hypertrophy. The left ventricle will hypertrophy first as it is pumping blood against a greater afterload as compared to the right ventricle.

      There are three types of cells in the body with regards to the cell cycle: 1. permanent
      2. labile
      3. stable cells

      Permanent cells do not re-enter the cell cycle and remain in G0. If there is a pool of stem cells the stem cells will enter the cell cycle to form more cells. Myocardial cells are a type of permanent cell and there is no pool of stem cells in the heart muscle. The anterior wall will not hypertrophy as it is formed by the right atrium and ventricle and both of these hypertrophy after the left ventricle.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 3 - A 52-year-old woman visits her local pharmacy to get medication to help with...

    Incorrect

    • A 52-year-old woman visits her local pharmacy to get medication to help with mild dyspepsia symptoms. The pharmacist on duty suggests she uses an over-the-counter antacid. She purchases an antacid that contains magnesium carbonate, which relieves her symptoms, but she unfortunately also develops a side effect.

      Out of the following, which side effect is she MOST likely to develop after using the antacid?

      Your Answer:

      Correct Answer: Diarrhoea

      Explanation:

      Magnesium carbonate is an over the counter antacid commonly used to relieve symptoms in ulcer dyspepsia and non-erosive gastro-oesophageal reflux.

      Antacids containing magnesium also tend to work as a laxative, while the antacids with aluminium may cause constipation. There is no significant increased risk of anaphylaxis, hepatotoxicity or renal impairment.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      0
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  • Question 4 - Which among the following antibacterial regimens is considered the most appropriate to prescribe...

    Incorrect

    • Which among the following antibacterial regimens is considered the most appropriate to prescribe in a patient presenting with clinical signs and symptoms consistent with a diagnosis of pelvic inflammatory disease?

      Your Answer:

      Correct Answer: Ceftriaxone plus doxycycline plus metronidazole

      Explanation:

      The endocervix is the most common site of Neisseria gonorrhoeae infection in women. Symptoms of infection, when present, include dysuria, cervical discharge, and lower abdominal pain. However, 50% of cases in women may be asymptomatic leading to complications such as pelvic inflammatory disease (PID), which may cause sterility, ectopic pregnancy, or perihepatitis.

      PID is also known as Fitz-Hugh-Curtis syndrome is defined as an inflammation of the upper genital tract due to an infection in women. The disease affects the uterus, fallopian tubes, and ovaries. It is typically an ascending infection, spreading from the lower genital tract.

      The recommended intramuscular or oral regimens for PID are as follows:

      Ceftriaxone at 500 mg IM in a single dose (for persons weighing ≥150 kg, administer 1 g of ceftriaxone); plus doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 5 - Which of the following has the most potent glucocorticoid effect: ...

    Incorrect

    • Which of the following has the most potent glucocorticoid effect:

      Your Answer:

      Correct Answer: Dexamethasone

      Explanation:

      Dexamethasone and betamethasone have the most potent glucocorticoid (anti-inflammatory) effect.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
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  • Question 6 - You review a patient with a history of Addison’s disease. He takes 100...

    Incorrect

    • You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.
      What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.

      Your Answer:

      Correct Answer: 25 mg

      Explanation:

      Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.
      The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:
      Corticosteroid
      Potency relative to hydrocortisone
      Prednisolone
      4 times more potent
      Triamcinolone
      5 times more potent
      Methylprednisolone
      5 times more potent
      Dexamethasone
      25 times more potent

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      0
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  • Question 7 - Regarding dermatophytes, which of the following statement is CORRECT: ...

    Incorrect

    • Regarding dermatophytes, which of the following statement is CORRECT:

      Your Answer:

      Correct Answer: Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings.

      Explanation:

      Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings depending on the site of infection. The lesions of ringworm typically have a dark outer ring with a pale centre. Tinea capitis is ringworm affecting the head and scalp. Spread is via direct skin contact. Treatment is usually topical, oral antifungals are reserved for refractory infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 8 - Infection with Campylobacter jejuni is one of the most common risk factors for...

    Incorrect

    • Infection with Campylobacter jejuni is one of the most common risk factors for which of the following conditions?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 9 - A 60-year-old man with trauma to his cervical spine suffers from damage to...

    Incorrect

    • A 60-year-old man with trauma to his cervical spine suffers from damage to the ansa cervicalis, resulting to paresis of his infrahyoid muscles.

      All of the following are considered infrahyoid muscles, except:

      Your Answer:

      Correct Answer: Mylohyoid

      Explanation:

      Infrahyoid muscles are also known as “strap muscles” which connect the hyoid, sternum, clavicle and scapula. They are located below the hyoid bone on the anterolateral surface of the thyroid gland and are involved in movements of the hyoid bone and thyroid cartilage during vocalization, swallowing and mastication. They are composed of four paired muscles, organized into two layers.

      Superficial layer consists of the sternohyoid and omohyoid
      Deep layer consists of the sternothyroid and thyrohyoid.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 10 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Incorrect

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer:

      Correct Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.

      For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 11 - Gastrin release from antral G-cells is stimulated by all but which one of...

    Incorrect

    • Gastrin release from antral G-cells is stimulated by all but which one of the following:

      Your Answer:

      Correct Answer: Secretin

      Explanation:

      Gastrin secretion is stimulated by:
      The presence of small peptides and amino acids in chyme
      Gastric distension
      Vagal stimulation directly via acetylcholine and indirectly via gastrin-releasing peptide (GRP)
      Raised gastric pH

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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      Seconds

  • Question 12 - About what percentage of filtered Na+is reabsorbed in the loop of Henle: ...

    Incorrect

    • About what percentage of filtered Na+is reabsorbed in the loop of Henle:

      Your Answer:

      Correct Answer: 25%

      Explanation:

      About 25% of filtered sodium is reabsorbed in the the loop of Henle.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 13 - A patient with a history of worsening chronic breathlessness on exertion undergoes lung...

    Incorrect

    • A patient with a history of worsening chronic breathlessness on exertion undergoes lung function testing. The results demonstrate an FEV 1 that is 58% predicted and an FEV 1 /FVC ratio less than 0.7.
      Which of the following is the most likely diagnosis? Select ONE answer only.

      Your Answer:

      Correct Answer: COPD

      Explanation:

      Obstructive lung disorders are characterised by airway obstruction. Many obstructive diseases of the lung result from narrowing of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself.
      In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to <0.7.
      Types of obstructive lung disorders include:
      Chronic obstructive pulmonary disease (COPD)
      Asthma
      Bronchiectasis

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
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  • Question 14 - On review of a patient's serum and urine osmolality test result, you note...

    Incorrect

    • On review of a patient's serum and urine osmolality test result, you note that both osmolarities are decreased. There urine osmolality does not increase with fluid ingestion.

      What is the most likely cause?

      Your Answer:

      Correct Answer: Hyponatraemia

      Explanation:

      As part of the investigation of hyponatraemia, serum osmolality is commonly requested in combination with urine osmolality to aid diagnosis.

      When:
      Serum osmolality is decreased and urine osmolality is decreased with no intake of fluid, the causes are
      Hyponatraemia
      Overhydration
      Adrenocortical insufficiency
      Sodium loss (diuretic or a low-salt diet)

      Serum osmolality is normal or increased and urine osmolality is increased the causes include:
      Dehydration
      Hyperkalaemia
      Hyperglycaemia
      Hyponatremia
      Mannitol therapy
      Diabetes mellitus
      Alcohol ingestion
      Congestive heart failure
      Renal disease and uraemia

      Serum osmolality is normal or increased and urine osmolality is decreased the usual cause is diabetes insipidus

      Serum osmolality is decreased and urine osmolality is increased the usual cause is syndrome of inappropriate antidiuresis (SIAD)

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 15 - Which of the following statements is correct with regards to Hodgkin's lymphoma?
    ...

    Incorrect

    • Which of the following statements is correct with regards to Hodgkin's lymphoma?

      Your Answer:

      Correct Answer: Most patients present with painless asymmetrical lymphadenopathy, with cervical nodes involved most commonly.

      Explanation:

      Lymphoma is a cancer of the lymphatic system, which is part of the body’s germ-fighting network. They are a group of diseases that are caused by malignant lymphocytes. These malignant cells accumulate in lymph nodes and other lymphoid tissue, giving rise to the characteristic clinical feature of lymphadenopathy.
      They can be subdivided into Hodgkin lymphoma (HL) which are characterised by the presence of Reed-Sternberg cells, and non-Hodgkin lymphoma (NHL).
      Characteristics of HL include:
      1. can present at any age but is rare in children and has a peak incidence in young adults,
      2. almost 2:1 male predominance.
      3. presents with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes.
      4. cervical node involvement in 60-70% of cases,
      5. axillary node involvement in 10-15%
      6. inguinal node involvement in 6-12%.
      7. modest splenomegaly during the course of the disease in 50% of patients
      8. may occasionally have liver enlargement
      9. bone marrow failure involvement is unusual in early disease.
      Approximately 85% of patients are cured, but the prognosis depends on age, stage and histology.
      Two well‐known but rare symptoms in HL are alcohol‐induced pain and pruritus.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 16 - What is the primary function of the mitochondria? ...

    Incorrect

    • What is the primary function of the mitochondria?

      Your Answer:

      Correct Answer: The production of the cell's supply of chemical energy

      Explanation:

      The mitochondria is responsible for the production of the cell’s supply of chemical energy. It does this by using molecular oxygen, sugar and small fatty acid molecules to generate adenosine triphosphate (ATP) by a process ss known as oxidative phosphorylation. An enzyme called ATP synthase is required.

      Transcription of ribosomal RNA occurs in the nucleolus

      Production of messenger RNA occur in the nucleus

      Production of lysosome occurs in the Golgi apparatus

      The post-translational processing of newly made proteins occurs in the endoplasmic reticulum

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 17 - A 60-year-old patient had a sudden onset of palpitations and shortness of breath....

    Incorrect

    • A 60-year-old patient had a sudden onset of palpitations and shortness of breath. He had a history of poorly controlled hypertension and ischemic heart disease. His ECG also shows atrial fibrillation. Based on the patient’s condition, which pharmacologic cardioversion would be best to use?

      Your Answer:

      Correct Answer: Amiodarone

      Explanation:

      Chemical cardioversion, or pharmacologic cardioversion, is the treatment of abnormal heart rhythms using drugs.

      Flecainide and propafenone are examples of drugs used as chemical cardioverters.

      However, given the situation of the patient, these drugs are contraindicated for his ischaemic heart disease. Amiodarone is also an antiarrhythmic drug and is the best choice for this situation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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      Seconds

  • Question 18 - A 30-year-old female presented to the Emergency Department after a fall during a...

    Incorrect

    • A 30-year-old female presented to the Emergency Department after a fall during a hiking expedition caused severe pain in her left arm and wrist drop. An X-ray revealed a mid-shaft fracture of the humerus, which most likely damaged the radial nerve.

      Which one of the following statements best describes the healing process of peripheral nerves?

      Your Answer:

      Correct Answer: Peripheral nerve fibres regenerate at around 1mm per day

      Explanation:

      Peripheral nerves are nerves that lie outside the brain and spinal cord. Peripheral nerves readily regenerate, while central nervous system axonal injury does not spontaneously regenerate.
      If there is damage to the axons of peripheral nerves, the nerves will regenerate at a slow rate of 1 mm per day. The slow regeneration process may lead to muscle atrophy before regeneration is complete.

      Each peripheral nerve has a single cell body that supplies nutrients to the growing nerve fibre. The cell body does not undergo mitosis; only the axon is regenerated.

      Schwann cells of the peripheral nervous system provide support for this process, while the analogous oligodendrocytes of the central nervous system do not. Schwann cells themselves do not cause regeneration. Schwann cells provide myelin for myelinated fibres and surround non-myelinated fibres with their cytoplasm.

      If an axon is completely severed, as in the case of amputation, the axonal fibres regenerating from the cell body may never find their original route back to the muscle. Instead, they may form a traumatic neuroma, a painful collection of nerve fibres and myelin.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 19 - An 82 year old man has fever, left sided abdominal and back pain...

    Incorrect

    • An 82 year old man has fever, left sided abdominal and back pain and presents to the emergency room. Imaging reveals a large perinephric abscess. Which of the following most likely describes the fluid location:

      Your Answer:

      Correct Answer: Between the renal capsule and the renal fascia

      Explanation:

      The perinephric fat is immediately external to the renal capsule and completely surrounds the kidney. The renal fascia surrounds the perinephric fat and the paranephric fat is external to the renal fascia. The location of a perinephric abscess is in the perinephric fat between the renal capsule and the renal fascia.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 20 - Renal potassium excretion is promoted by all but which one of the following:...

    Incorrect

    • Renal potassium excretion is promoted by all but which one of the following:

      Your Answer:

      Correct Answer: Increased intracellular magnesium

      Explanation:

      Aldosterone: A rise in [K+] in the extracellular fluid of the adrenal cortex directly stimulates aldosterone release. Aldosterone promotes the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane, and also stimulates apical sodium and potassium channel activity, overall acting to increase sodium reabsorption and potassium secretion.
      pH changes: Potassium secretion is reduced in acute acidosis and increased in acute alkalosis. A higher pH increases the apical K+channel activity and the basolateral Na+/K+ATPase activity – both changes that promote K+secretion.
      Flow rates: Increased flow rates in the collecting duct reduce K+concentration in the lumen and therefore enhance K+secretion. Increased flow also activates BK potassium channels, and ENaC channels which promote potassium secretion and sodium reabsorption respectively.
      Sodium delivery: Decreased Na+delivery to the collecting ducts results in less Na+reabsorption and hence a reduced gradient for K+secretion.
      Magnesium: Intracellular magnesium can bind and block K+channels inhibiting K+secretion into the tubules. Therefore magnesium deficiency reduces this inhibitory effect and so allows more potassium to be secreted into tubules and can cause hypokalaemia.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 21 - A 2nd-year medical student is solving an exam paper with questions about the...

    Incorrect

    • A 2nd-year medical student is solving an exam paper with questions about the immune system. She comes across a question regarding innate immunity. Innate immunity is the immunity naturally present within the body from birth.

      Which ONE of the following is not a part of this type of immunity?

      Your Answer:

      Correct Answer: Antibody production

      Explanation:

      Innate immunity, also called non-specific immunity, refers to the components of the immune system naturally present in the body at birth.

      The components of innate immunity include:
      1) Natural Killer Cells
      2) Neutrophils
      3) Macrophages
      4) Mast Cells
      5) Dendritic Cells
      6) Basophils.

      Acquired or adaptive immunity is acquired in response to infection or vaccination. Although the response takes longer to develop, it is also a more long-lasting form of immunity.

      The components of this system include:
      1) T lymphocytes
      2) B lymphocytes
      3) Antibodies

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 22 - You see a patient in the Emergency Department with features consistent with a...

    Incorrect

    • You see a patient in the Emergency Department with features consistent with a diagnosis of type I diabetes mellitus.

      Which of these is MOST suggestive of type I diabetes mellitus?

      Your Answer:

      Correct Answer: History of recent weight loss

      Explanation:

      A history of recent weight loss is very suggestive of an absolute deficiency of insulin seen in type I diabetes mellitus.

      An age of onset of less than 20 years makes a diagnosis of type I diabetes mellitus more likely. However, an increasing number of obese children and young people are being diagnosed with type II diabetes.

      Microalbuminuria, peripheral neuropathy, and retinopathy all occur in both type I and type II diabetes mellitus. They are not more suggestive of type I DM.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 23 - Which of the following cervical nerves is likely to be affected if your...

    Incorrect

    • Which of the following cervical nerves is likely to be affected if your patient is complaining of elbow extension weakness and loss of sensation in her middle finger? She also has pain and tenderness in her cervical region, which is caused by a herniated disc, all after a whiplash-type injury in a car accident.

      Your Answer:

      Correct Answer: C7

      Explanation:

      A C7 spinal nerve controls elbow extension and some finger extension.

      Damage to this nerve can result in a burning pain in the shoulder blade or back of the arms. The ability to extend shoulders, arms, and fingers may also be affected. Dexterity may also be compromised in the hands or fingers.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 24 - Which of the following lifestyle changes is not likely to improve symptoms of...

    Incorrect

    • Which of the following lifestyle changes is not likely to improve symptoms of gastro-oesophageal reflux disease (GORD):

      Your Answer:

      Correct Answer: Lowering the head of the bed

      Explanation:

      The following approaches have some benefit in adult patients with reflux:

      Weight loss or weight management for individuals who are overweight
      Head of bed elevation is important for individuals with nocturnal or laryngeal symptoms, but its value for other situations is unclear.
      The following lifestyle approaches also are used frequently. There is some evidence that these lifestyle changes improve laboratory measures of reflux (such as lower oesophageal sphincter pressure).
      Dietary modification – A practical approach is to avoid a core group of reflux-inducing foods, including chocolate, peppermint, and alcohol, which may reduce lower oesophageal sphincter pressure. Acidic beverages, including colas with caffeine and orange juice also may exacerbate symptoms.
      Avoiding the supine position soon after eating.
      Promotion of salivation by either chewing gum or using oral lozenges. Salivation neutralizes refluxed acid, thereby increasing the rate of oesophageal acid clearance.
      Avoidance of tobacco (including passive exposure to tobacco smoke) and alcohol. Nicotine and alcohol reduce lower oesophageal sphincter pressure, and smoking also diminishes salivation.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
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  • Question 25 - One of these statements about cohort studies is true: ...

    Incorrect

    • One of these statements about cohort studies is true:

      Your Answer:

      Correct Answer: They are longitudinal in nature

      Explanation:

      A cohort study is a longitudinal, observational study. It follows a group of patients (the cohort) forward in time and monitors the effects of the aetiological factor under study upon them.

      Cohort studies are usually of longer duration and are more expensive than case-control studies. They, however, provide more useful and reliable information.

      Cohort studies follow a cohort of patients who don’t have a disease and evaluate the absolute and relative risk of contracting the disease after exposure to the aetiological agent.

      Cross-sectional studies are the best way to determine the prevalence of a disease. while Cohort studies are better at determining the incidence of a disease.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 26 - A 25-year old male is brought to the emergency room after a traffic...

    Incorrect

    • A 25-year old male is brought to the emergency room after a traffic accident. Upon examination, there was tenderness and erythema on the right acromioclavicular joint, with notable step deformity. On radiographic imaging, there is a superior elevation of the clavicle, a twice than normal coracoclavicular distance, and absence of fracture.

      Which of the following structure/s is/are likely to have ruptured?

      Your Answer:

      Correct Answer: Acromioclavicular ligament, coracoclavicular ligament and joint capsule

      Explanation:

      Acromioclavicular joint injuries account for more than forty percent of all shoulder injuries. Mild injuries are not associated with any significant morbidity, but severe injuries can lead to significant loss of strength and function of the shoulder. Acromioclavicular injuries may be associated with a fractured clavicle, impingement syndromes, and more rarely neurovascular insults.

      The AC joint is a diarthrodial joint defined by the lateral process of the clavicle articulating with the acromion process as it projects anteriorly off the scapula. The joint is primarily stabilized by the acromioclavicular ligament, which is composed of an anterior, posterior, inferior, and superior component. Of note, the superior portion of the AC ligament is the most important component for the stability of the AC joint. Supporting structures include two coracoclavicular ligaments (trapezoid and conoid ligaments), which provide vertical stability, as well as the coracoacromial ligament.

      Patients with an AC joint injury typically present with anterosuperior shoulder pain and will describe a mechanism of injury of blunt trauma to the abducted shoulder or landing on an outstretched arm, suggestive of this type of injury. They may describe pain radiating to the neck or shoulder, which is often worse with movement or when they try to sleep on the affected shoulder. On examination, the clinician may observe swelling, bruising, or a deformity of the AC joint, depending on the degree of injury. The patient will be tender at that location. They may have a restriction in the active and passive range of motion secondary to pain. Piano key sign may be seen, with an elevation of the clavicle that rebounds after inferior compression.

      Standard X-rays are adequate to make a diagnosis of acromioclavicular joint injury and should be used to evaluate for other causes of traumatic shoulder pain.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 27 - A 29-year-old female with chronic anaemia secondary to sickle cell disease is being...

    Incorrect

    • A 29-year-old female with chronic anaemia secondary to sickle cell disease is being transfused. A few minutes after starting the blood transfusion, she develops widespread itching with urticarial rash, wheezing, nausea and chest pain. Her BP reduces to 60/40 mmHg.

      What is the most appropriate treatment?

      Your Answer:

      Correct Answer: Stop the transfusion and administer adrenaline

      Explanation:

      Anaphylaxis transfusion reaction occurs when an individual has previously been sensitized to an allergen present in the blood and, on re-exposure, releases IgE or IgG antibodies. Patients with anaphylaxis usually develop laryngospasm, bronchospasm, abdominal pain, nausea, vomiting, hypotension, shock, and loss of consciousness. The transfusion should be stopped immediately and the patient should be treated with adrenaline, oxygen, corticosteroids, and antihistamines.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 28 - Fenestrated capillaries are typically found where in the body: ...

    Incorrect

    • Fenestrated capillaries are typically found where in the body:

      Your Answer:

      Correct Answer: Renal glomeruli

      Explanation:

      Fenestrated capillaries, found in renal glomeruli, endocrine glands and intestinal villi, are more permeable than continuous capillaries with less tight junctions, and the endothelial cells are also punctured by pores which allow large amounts of fluids or metabolites to pass.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 29 - A 18 year old university student develops facial swelling and dark frothy urine. Urine...

    Incorrect

    • A 18 year old university student develops facial swelling and dark frothy urine. Urine dipstick demonstrates haematuria and proteinuria. Approximately 3 weeks ago, he was treated with oral antibiotics for a sore throat. His condition is most likely to be secondary to infection with:

      Your Answer:

      Correct Answer: Streptococcus pyogenes

      Explanation:

      Post-streptococcal glomerulonephritis is a postinfectious immune-mediated reaction secondary to infection with Streptococcus pyogenes. It typically occurs 2 weeks or more after acute/initial infection, and presents with haematuria, reduced urine output, peripheral oedema, proteinuria, and hypertension. Permanent kidney damage is rare.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 30 - Which of the following statements about lithium treatment is FALSE: ...

    Incorrect

    • Which of the following statements about lithium treatment is FALSE:

      Your Answer:

      Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.

      Explanation:

      Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.
      Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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