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Question 1
Correct
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Regarding skeletal muscle, which of the following best describes the Z-line:
Your Answer: A line dividing muscle fibres into sarcomeres
Explanation:Each muscle fibre is divided at regular intervals along its length into sarcomeres separated by Z-lines. The sarcomere is the functional unit of the muscle.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 2
Correct
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Eosinophils comprise what percentage of circulating white cells:
Your Answer: 1 - 3%
Explanation:Eosinophils comprise 1 – 3% of circulating white cells. Eosinophils are similar to neutrophils, except that the cytoplasmic granules are coarser and more deeply red staining, and there are rarely more than three nuclear lobes. They are less motile, but longer lived. They enter inflammatory exudates and have a special role in allergic responses, defence against parasites and removal of fibrin formed during inflammation. Thus they play a role in local immunity and tissue repair.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 3
Correct
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.
Which of these anatomic structures is the deepest structure injured in the case above?Your Answer: Transversalis fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:
Skin
Fatty layer of the superficial fascia (Camper’s fascia)
Membranous layer of the superficial fascia (Scarpa’s fascia)
Aponeurosis of the external and internal oblique muscles
Rectus abdominis muscle
Aponeurosis of the internal oblique and transversus abdominis
Fascia transversalis
Extraperitoneal fat
Parietal peritoneum -
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 4
Incorrect
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A 30-year-old woman with type 1 diabetes mellitus is brought in drowsy and confused. Her BM is 2.2 mmol/l and a dose of IM glucagon is administered.
What is the principal stimulus for the secretion of glucagon?Your Answer:
Correct Answer: Hypoglycaemia
Explanation:Glucagon, a peptide hormone, is produced and secreted by alpha cells of the islets of Langerhans, located in the endocrine portion of the pancreas.
Its main physiological role is stimulation of hepatic glucose output leading to increase in blood glucose. It is the major counter-regulatory hormone to insulin in maintaining glucose homeostasis.
The principal stimulus for the secretion of glucagon is hypoglycaemia. Hypoglycaemia then stimulates:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue leading to increased glycaemia.Secretion of glucagon is also stimulated by arginine, alanine, adrenaline, acetylcholine and cholecystokinin
Secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea production -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 5
Incorrect
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Lidocaine's antiarrhythmic mode of action is as follows:
Your Answer:
Correct Answer: Blocks inactivated Na+ channels
Explanation:Lidocaine is a class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity. However, in ischaemic areas, where anoxia causes depolarisation and arrhythmogenic activity, many Na+ channels are inactivated and therefore susceptible to lidocaine.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 6
Incorrect
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Question 7
Incorrect
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Thyroid cancer has spread to the regional lymph nodes of a patient as seen in a staging CT scan.
The lymph from the thyroid gland will drain directly to which of the following nodes?Your Answer:
Correct Answer: Deep lateral cervical lymph nodes
Explanation:Lymphatic drainage of the thyroid gland involves the lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes. The paratracheal and lower deep cervical nodes, specifically, receive lymphatic drainage from the isthmus and the inferior lateral lobes. The superior portions of the thyroid gland drain into the superior pretracheal and cervical nodes.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 8
Incorrect
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A 27 year old woman presents to ED having sustained a deep laceration to the dorsum of her ring finger whilst cooking. Her proximal interphalangeal joint is fixed in flexion and the distal interphalangeal joint is hyperextended. Which of the following structures in the digit has most likely been injured:
Your Answer:
Correct Answer: Insertion of the central slip of the extensor tendon
Explanation:Damage to the central slip of the extensor digitorum tendon would result in loss of extension at the proximal interphalangeal joint resulting in a fixed flexion deformity of this joint, and hyperextension of the distal interphalangeal joint due to a loss of balancing forces. This is called the Boutonniere deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 9
Incorrect
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Regarding the partial pressure of gases, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: At high altitude, the oxygen fraction is reduced.
Explanation:At altitude, the oxygen fraction is unaltered but the barometric pressure and thus partial pressure of oxygen is reduced.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 10
Incorrect
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Diagnosis of HIV is predominantly made through which of the following:
Your Answer:
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.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 11
Incorrect
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The risk of renal impairment in a patient on ACE inhibitor therapy is increased by concomitant treatment with which of the following drug classes:
Your Answer:
Correct Answer: NSAIDs
Explanation:Concomitant treatment with NSAIDs increases the risk of renal damage, and with potassium-sparing diuretics (or potassium-containing salt substitutes) increases the risk of hyperkalaemia. Hyperkalaemia and other side effects of ACE inhibitors are more common in the elderly and in those with impaired renal function and the dose may need to be reduced.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Incorrect
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A 16-year old boy is brought to the emergency room after suffering a traffic accident. Upon examination, there is noted ipsilateral loss of proprioception and vibration, ipsilateral motor loss, and contralateral loss of pain and temperature sensation. A spinal cord injury is given as a diagnosis.
Which of the following is the most probable cause of this manifestation?Your Answer:
Correct Answer: Brown-Séquard syndrome
Explanation:Brown-Sequard Hemicord Syndrome consists of ipsilateral weakness (corticospinal tract) and loss of joint position and vibratory sense (posterior column), with contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex, are unilateral. Partial forms are more common than the fully developed syndrome.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 13
Incorrect
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Which of the following is typically a cause of a normal anion gap metabolic acidosis:
Your Answer:
Correct Answer: Diarrhoea
Explanation:FUSEDCARS can be used to remember some of the causes of a normal anion gap acidosis:
Fistula (pancreaticoduodenal)
Ureteroenteric conduit
Saline administration
Endocrine (hyperparathyroidism)
Diarrhoea
Carbonic anhydrase inhibitors (e.g. acetazolamide)
Ammonium chloride
Renal tubular acidosis
Spironolactone -
This question is part of the following fields:
- Physiology
- Renal
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Question 14
Incorrect
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Which of the following antibiotics may be used for malaria prophylaxis:
Your Answer:
Correct Answer: Doxycycline
Explanation:Doxycycline may be used for malaria prophylaxis and as an adjunct to quinine in the treatment of Plasmodium falciparum malaria.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 15
Incorrect
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The second generation antihistamine, cetirizine is a less-sedating antihistamine than the older antihistamine, chlorphenamine because:
Your Answer:
Correct Answer: It is less lipid-soluble so less able to cross the blood brain barrier.
Explanation:All older antihistamines such as chlorphenamine cause sedation. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 16
Incorrect
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Which of the following pathogens is the common cause of diarrhoea in a patient who has had a prolonged course of a broad spectrum of antibiotics?
Your Answer:
Correct Answer: Clostridium difficile
Explanation:Clostridium difficile is the most likely cause of diarrhoea after a long course of broad-spectrum antibiotic treatment.
Clostridium difficile-associated diarrhoea appeared to be linked to an increase in the usage of third-generation cephalosporins.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 17
Incorrect
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A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago.
Which ONE of the following options is FALSE with regards to this disorder?Your Answer:
Correct Answer: Acute haemolysis can be triggered by cephalosporin antibiotics
Explanation:Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.
Triggers include:
1) Fava beans
2) Sulphonamides
3) Primaquine
4) Anti-TB drugs
5) InfectionsMost individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 18
Incorrect
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Glucagon is the main catabolic hormone of the body and raises the concentration of glucose and fat in the bloodstream.
Which pancreatic islet cells secretes glucagon?Your Answer:
Correct Answer: Alpha
Explanation:Glucagon, secreted from the pancreatic islet alpha cells, is considered to be the main catabolic hormone of the body. It raises the concentration of glucose and fat in the bloodstream
There are five different pancreatic islet cells:
Alpha cells (20%) – produce glucagon
Beta cells (70%) – produce insulin and amylin
Delta cells (<10%) – produce somatostatin
Gamma cells (<5%) – produce pancreatic polypeptide
Epsilon cells (<1%) – produce ghrelin -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 19
Incorrect
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Regarding box and whisker plots, which of the following statements is true?
Your Answer:
Correct Answer: 25% of the values lie below the lower quartile
Explanation:A box and whisker plot is defined as a graphical method of displaying variation in a set of data. In most cases, a histogram analysis provides a sufficient display, but a box and whisker plot can provide additional detail while allowing multiple sets of data to be displayed in the same graph.
The procedure to develop a box and whisker plot comes from the five statistics below:
(1) Minimum value: The smallest value in the data set
(2) Second quartile: The value below which the lower 25% of the data are contained
(3) Median value: The middle number in a range of numbers
(4) Third quartile: The value above which the upper 25% of the data are contained
(5) Maximum value: The largest value in the data set
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This question is part of the following fields:
- Evidence Based Medicine
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Question 20
Incorrect
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Regarding renal clearance, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The MDRD equation uses plasma creatinine to estimate the GFR making an adjustment for age, sex and race.
Explanation:Clearance is defined as the volume of plasma that is cleared of a substance per unit time. Inulin clearance is the gold standard for measurement of GFR but creatinine clearance is typically used instead. Creatinine is freely filtered and not reabsorbed, but there is a little creatinine tubular secretion. In practice, GFR is usually estimated from the plasma creatinine using a formula e.g. the MDRD equation making an adjustment for age, sex and race.
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This question is part of the following fields:
- Physiology
- Renal
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Question 21
Incorrect
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Which of the following would you NOT expect from a deep fibular nerve palsy:
Your Answer:
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 22
Incorrect
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A 25-year-old girl just got back from a trip to Northern India. She complains of headaches and intermittent fever. The fever starts with intense chills, then feels very hot, followed by profuse sweating. She is drowsy and is running a fever of 39.0°C. On examination, there are no palpable lymph nodes or rash seen. She has hepatosplenomegaly.
Which one of the following is the most likely diagnosis?Your Answer:
Correct Answer: Malaria
Explanation:Malaria is a protozoal infection of red blood cells and the liver. It is caused by the parasite belonging to the genus Plasmodium. It is transmitted by the female mosquito Anopheles.
Several species with distinct features:
P. vivax/P. ovale
P. malariae
P. falciparumThe common symptoms of malaria are:
Paroxysms of fever – a cyclical occurrence of:
1) a cold phase – the patient experiences intense chills
2) a hot stage – the patient feels extremely hot
3) a sweating stage – the fever declines and the patient sweats profusely
– Fever recurs at regular intervals (48hrs, 72hrs): Variable by species of PlasmodiumAnaemia (RBC infection)
– Severity varies by species of Plasmodium
– Haemolytic: sometimes jaundiceSplenomegaly
Also nonspecific symptoms:
– Sweating
– fatigue
– malaise
– arthralgias
– headache
– Sometimes cough, vomiting, diarrhoea -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 23
Incorrect
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Which statement concerning aerosol transmission is true?
Your Answer:
Correct Answer: They can be spread via ventilation systems in hospitals
Explanation:Aerosols are airborne particles less than 5 µm in size containing infective organisms.
They usually cause infection of both the upper and/or lower respiratory tract.
The organisms can remain suspended in the air for long periods and also survive outside the body.
They can be transmitted through the ventilation systems and can spread over great distances.
Some examples of organisms transmitted by the aerosol route include: Varicella zoster virus, Mycobacterium tuberculosis and measles virus
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 24
Incorrect
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A 32-year-old man is dehydrated as he presents with severe vomiting and diarrhoea. He urgently requires resuscitation with intravenous fluid administration. He is also administered metoclopramide.
Which of the following is the true mechanism of action of metoclopramide?Your Answer:
Correct Answer: Dopamine receptor antagonism
Explanation:Metoclopramide is used to treat nausea and vomiting. It works by blocking the central and peripheral D2 (dopamine 2) receptors in the medullary chemoreceptor trigger zone in the vomiting centre (area postrema). It decreases the sensitivity of the visceral sensory nerves that transmit from the GI system to the vomiting centre. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate.
At high doses, metoclopramide also blocks type-2 serotonin receptors though the effect is much weaker.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 25
Incorrect
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In a VF arrest, a 6-year-old child is brought to your Emergency Department resuscitation area. He weighs 16 kilogrammes. He's had three DC shocks, but he's still in VF and doesn't have an output.
What amiodarone dose should he get now, according to the most recent APLS guidelines?Your Answer:
Correct Answer: 80 mg
Explanation:In a shockable (Vf/pVT) paediatric cardiac arrest, amiodarone should be administered after the third and fifth shocks. The dose is 5 mg/kg (maximum 300 mg) and should be administered over a three-minute period. If at all possible, administration via a central line is recommended.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 26
Incorrect
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A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement of her blood glucose level is done and found to be grossly elevated. She is diagnosed with diabetic ketoacidosis. A fixed rate insulin infusion is given as part of her treatment.
Which of these is an action of insulin?Your Answer:
Correct Answer: Stimulates lipogenesis
Explanation:Insulin is an anabolic hormone. Its actions can be broadly divided into:
Lipid metabolism
Protein metabolism and
Carbohydrate metabolismFor lipid metabolism, insulin:
Stimulates lipogenesis
Inhibits lipolysis by lipaseFor carbohydrate metabolism, insulin:
Decreases gluconeogenesis
Stimulates glycolysis
Promotes glucose uptake in muscle and adipose tissue
Promotes glycogen storage
Increases glycogenesis
Decreases glycogenolysisProtein metabolism:
Stimulates protein synthesis
Accelerates net formation of protein
Stimulates amino acid uptake
Inhibits protein degradation
Inhibits amino acid conversion to glucose -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 27
Incorrect
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Regarding the resting membrane potential, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The resting cell membrane is more permeable to K + ions than to Na + ions.
Explanation:A membrane potential is a property of all cell membranes, but the ability to generate an action potential is only a property of excitable tissues. The resting membrane is more permeable to K+and Cl-than to other ions (and relatively impermeable to Na+); therefore the resting membrane potential is primarily determined by the K+equilibrium potential. At rest the inside of the cell is negative relative to the outside. In most neurones the resting potential has a value of approximately -70 mV.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 28
Incorrect
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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.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 29
Incorrect
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A 22-year-old woman is brought in by ambulance from her GP surgery with suspected meningitis. She has been given a dose of benzylpenicillin already.
What is the mechanism of action of benzylpenicillin? Select ONE answer only.Your Answer:
Correct Answer: Inhibition of 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.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
Mechanism of action
Examples
Inhibition of cell wall synthesis
Penicillins
Cephalosporins
Vancomycin
Disruption of cell membrane function
Polymyxins
Nystatin
Amphotericin B
Inhibition of protein synthesis
Macrolides
Aminoglycosides
Tetracyclines
Chloramphenicol
Inhibition of nucleic acid synthesis
Quinolones
Trimethoprim
5-nitroimidazoles
Rifampicin
Anti-metabolic activity
Sulfonamides
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 30
Incorrect
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Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:
Your Answer:
Correct Answer: Give 300 mg IV amiodarone after 3 shocks
Explanation:After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
