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Question 1
Incorrect
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Regarding relationships between two variables, what does a negative correlation coefficient indicate:
Your Answer: Correlation is poor between the two variables
Correct Answer: The two variables are inversely related
Explanation:A negative correlation coefficient means that the two variables are inversely related e.g. socio-economic class and mortality.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 2
Incorrect
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You evaluate a 80-year-old man who has a history of persistent heart failure and discover that he has generalised oedema.
Which of the following claims regarding capillary hydrostatic pressure (P c) is false?Your Answer: P c is the most variable of the four Starling factors affecting filtration at capillary beds
Correct Answer: P c increases along the length of the capillary, from arteriole to venule
Explanation:The capillary hydrostatic pressure (Pc) is normally between 15 and 30 millimetres of mercury. Pc Decreases along the capillary’s length, mirroring the arteriolar and venule pressures proximally and distally.
Pc is determined by the ratio of arteriolar resistance (RA) to venular resistance (RV).When the RA/RV ratio is high, the pressure drop across the capillary is modest, and Pcis is close to venule pressure.
When the ratio of RA/RV is low, the pressure drop across the capillary is considerable, and Pcis is close to arteriolar pressure.
Pcis closer to the venule pressure and thus more responsive to changes in venous pressure than arteriolar pressure when RA/RV is high.
Pcis the major force behind fluid pushing out of the capillary bed and into the interstitium.
It is also the most variable of the forces affecting fluid transport at the capillary, partly because sympathetic-mediated arteriolar vasoconstriction varies. -
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 3
Incorrect
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A 28-year-old patient who has been in a car accident needs to be intubated using a rapid sequence induction. As an induction agent, you intend to use etomidate.
Etomidate works by interacting with which type of receptor?Your Answer: Kainate
Correct Answer: Gamma-aminobutyric acid (GABA)
Explanation:Etomidate is a carboxylated imidazole derivative with a short half-life that is primarily used to induce anaesthesia.
It is thought to modulate fast inhibitory synaptic transmission in the central nervous system by acting on GABA type A receptors.
The dose for anaesthesia induction is 0.3 mg/kg. Etomidate takes 10-65 seconds to take effect after an intravenous injection, and it lasts 6-8 minutes. With repeated administration, the effects are non-cumulative.The relative cardiovascular stability of etomidate is noteworthy. During induction, it causes less hypotension than thiopental sodium and propofol. It’s also linked to a quick recovery without the hangover.
Etomidate is a strong steroidogenesis inhibitor. The drug inhibits the enzymes responsible for adrenal 11 beta-hydroxylase and cholesterol cleavage, resulting in a decrease in cortisol and aldosterone synthesis for up to 24 hours after administration. It should not be used to maintain anaesthesia because of the adrenocortical suppression.
Other side effects associated with etomidate use include:
Vomiting and nausea
The injection causes pain (in up to 50 percent )
Phlebitis and thrombosis of the veins
Heart block and arrhythmias
Hyperventilation
Apnoea and respiratory depression
It has the potential to cause both hypo- and hypertension.
Critically ill patients have a higher mortality rate. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 4
Incorrect
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In the United Kingdom, which of the following is the most often used intravenous aesthetic:
Your Answer: Ketamine
Correct Answer: Propofol
Explanation:In the United Kingdom, propofol is the most widely used intravenous anaesthetic. In adults and children, it can be used to induce or maintain anaesthesia, although it is not commonly used in newborns. It can also be used to sedate individuals in intensive care and for sedation during operations.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 5
Incorrect
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A patient is diagnosed with a Klebsiella pneumoniae infection.
Which SINGLE statement regarding Klebsiella pneumoniae is FALSE?Your Answer: It is routinely found in the nose, mouth and gastrointestinal tract as normal flora
Correct Answer: Species with ESBLs are sensitive to cefotaxime
Explanation:Klebsiellais a genus of non-motile,Gram-negative, rod-shaped bacteriawith a prominent polysaccharide-based capsule. They are routinely found in the nose, mouth and gastrointestinal tract as normal flora, however, they can also behave as opportunistic pathogens.
Infections with Klebsiella spp. areusually nosocomial. They are an important cause of ventilator-associated pneumonia (VAP), urinary tract infection, wound infection and bacteraemia. Outbreaks of infections with Klebsiellaspp. in high-dependency units have been described and are associated with septicaemia and high mortality rates. Length of hospital stay and performance of invasive procedures are risk factors forKlebsiellainfections.
Primary pneumonia withKlebsiella pneumoniaeis a rare,severe, community-acquired infection associated with a poor outcome.
Klebsiella rhinoscleromatis causes a progressive granulomatous infection of the nasal passages and surrounding mucous membranes. This infection is mainly seen in the tropics.
Klebsiella ozanae is a recognised cause of chronic bronchiectasis.
Klebsiella organisms are resistant to multiple antibiotics including penicillins. This is thought to be a plasmid-mediated property. Agents with high intrinsic activity againstKlebsiellapneumoniaeshould be selected for severely ill patients. Examples of such agents include third-generation cephalosporins (e.g cefotaxime), carbapenems (e.g. imipenem), aminoglycosides (e.g. gentamicin), and quinolones (e.g. ciprofloxacin). These agents may be used as monotherapy or combination therapy. Aztreonam may be used in patients who are allergic to beta-lactam antibiotics.
Species with ESBLs (Extended spectrum beta-lactamase) are resistant to penicillins and also cephalosporins such as cefotaxime and ceftriaxone
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 6
Correct
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Parathyroid hormone is released by which of the following:
Your Answer: Chief cells of the parathyroid gland
Explanation:Parathyroid hormone (PTH) is a peptide hormone synthesised by the chief cells of the parathyroid glands, located immediately behind the thyroid gland. PTH is primarily released in response to decreasing plasma [Ca2+] concentration. PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.
Parathyroid hormone (PTH) acts to increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane) and increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron. -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 7
Incorrect
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A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part in a powerlifting competition, he felt a painful snap at the front of his shoulder and chest. There is also the presence of bruising and swelling over the left side of his chest. A ruptured pectoralis major muscle was suspected upon examining the injured area.
Which of the following statements regarding the surface markings of the pectoralis major muscle is considered correct?Your Answer: The clavicular head originates from the lateral half of the clavicle
Correct Answer: It inserts into the lateral lip of the bicipital groove of the humerus
Explanation:The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.
Its origin lies anterior surface of the medial half of the clavicle, the anterior surface of the sternum, the first 7 costal cartilages, the sternal end of the sixth rib, and the aponeurosis of the external oblique of the anterior abdominal wall.
The insertion of the pectoralis major is at the lateral lip of the intertubercular sulcus of the humerus. There are 2 heads of the pectoralis major, the clavicular and the sternocostal, which reference their area of origin.
The function of the pectoralis major is 3-fold and dependent on which heads of muscles are involved:
– Flexion, adduction and medial rotation of the arm at the glenohumeral joint
– Clavicular head causes flexion of the extended arm
– Sternoclavicular head causes extension of the flexed armArterial supply of the pectoralis major, the pectoral artery, arises from the second branch of the axillary artery, the thoracoacromial trunk.
The 2 heads of the pectoralis major have different nervous supplies. The clavicular head derives its nerve supply from the lateral pectoral nerve. The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the medial pectoral nerve arises from the medial cord.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 8
Incorrect
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The following statements are not true of the extensor carpi radialis brevis muscle, except?
Your Answer: It is innervated by the posterior interosseous nerve
Correct Answer: It receives its blood supply from the radial artery
Explanation:Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.
The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.
Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.
The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).
Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).
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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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Which of the following is NOT a typical cerebellar sign:
Your Answer: Nystagmus
Correct Answer: Hypertonia
Explanation:Hypotonia means decreased muscle tone. It can be a condition on its own, called benign congenital hypotonia, or it can be indicative of another problem where there is progressive loss of muscle tone, such as muscular dystrophy or cerebral palsy. It is usually detected during infancy. Hypotonia is characteristic of cerebellar dysfunction.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 10
Incorrect
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Which of the following is the most abundant immunoglobulin in plasma:
Your Answer: IgE
Correct Answer: IgG
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 11
Incorrect
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In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer: 1 minute
Correct Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.
Prolonged seizures last 5 minutes or more.
Repeated seizures refer to 3 or more seizures in an hour. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 12
Correct
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A 45-year old man presented to the emergency room with complains of chest pain and breathlessness. Upon history taking and examination, it was discovered that he had a right-sided spontaneous pneumothorax and had a failed attempt at pleural aspiration. The pneumothorax is still considerable in size, but he remains breathless. A Seldinger chest drain was inserted but it started to drain frank blood shortly after.
Which of the following complications is most likely to have occurred?Your Answer: Intercostal artery laceration
Explanation:Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions.
Traditional anatomy teaching describes the ICA as lying in the intercostal groove, protected by the flange of the rib. This is the rationale behind the recommendation to insert needles just above the superior border of the rib. Current recommendations for chest drain insertion suggest that drains should be inserted in the ‘safe triangle’ in order to avoid the heart and the mediastinum and be above the level of the diaphragm.
The safe triangle is formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla. Imaging guidance also aids in the safety of the procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 13
Correct
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Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that can cause a catheter-related urinary tract infection (UTI)?
Your Answer: Pseudomonas aeruginosa
Explanation:Listeria monocytogenes is a gram-positive bacteria that does not produce spores.
Staphylococcus aureus is a gram-positive bacteria, while Candida albicans is a gram-positive yeast with a single bud.
Among the choices, gram-negative bacteria include only Klebsiella pneumoniae and Pseudomonas aeruginosa.
Pseudomonas aeruginosa is an oxidase-positive bacterium, while Klebsiella pneumoniae is an oxidase-negative bacterium.
P. aeruginosa can cause urinary tract infections (UTIs) and is spread through poor hygiene or contaminated medical equipment or devices, such as catheters that haven’t been fully sterilized.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 14
Incorrect
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A patient who has a nerve injury has sparing of the upper half of the orbicularis oculi muscle but not the lower half. Which branch of the facial nerve supplies the lower half of the orbicularis oculi?
Your Answer: Buccal branch
Correct Answer: Zygomatic branch
Explanation:The facial nerve divides into five terminal branches once in the parotid gland.
1. The temporal branch innervates muscles in the temple, forehead and supraorbital areas.
2. The zygomatic branch innervates muscles in the infraorbital area, the lateral nasal area and the upper lip.
3. The buccal branch innervates muscles in the cheek, the upper lip and the corner of the mouth.
4. The marginal mandibular branch innervates muscles of the lower lip and chin.
5. The cervical branch innervates the platysma muscle. -
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 15
Incorrect
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An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with left-sided hemiplegia of the face, tongue, and limbs and right-sided deficits in motor eye activity. A CT scan was ordered and showed a right-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer: Vertebral artery
Correct Answer: Basilar artery
Explanation:Weber syndrome is a midbrain stroke characterized by crossed hemiplegia along with oculomotor nerve deficits and it occurs with the occlusion of the median and/or paramedian perforating branches of the basilar artery.
Typical clinical findings include ipsilateral CN III palsy, ptosis, and mydriasis (such as damage to parasympathetic fibres of CN III) with contralateral hemiplegia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 16
Incorrect
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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: Upper and lower subscapular nerves
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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Incorrect
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Beta cells of the endocrine pancreas produce which of the following hormones:
Your Answer: Pancreatic polypeptide
Correct Answer: Insulin
Explanation:Insulin is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas. Insulin is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds. Proinsulin is synthesised as a single-chain peptide. Within storage granules, a connecting peptide (C peptide) is removed by proteases to yield insulin. Insulin release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin, but most output is driven by the rise in plasma glucose concentration that occurs after a meal. The effects of insulin are mediated by the receptor tyrosine kinase.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 18
Incorrect
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If a patient dislocated his right shoulder and has been referred to the orthopaedic outpatient department for a follow-up after a successful reduction, which of the following is the most important position for him to avoid holding his arm in until he is seen in the clinic?
Your Answer: Arm held flexed across abdomen palm down
Correct Answer: Arm at 90 degrees to side with palm up
Explanation:The arm should be placed in a poly-sling that should be worn for about two weeks. A physiotherapist may give gentle movements for the arm to help in reducing stiffness and in relieving the pain. It is important that the patient must avoid positions that could cause re-dislocation.
The most important position to avoid is the arm being held out at 90 degrees to the side with the palm facing upwards, especially if a force is being applied. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Incorrect
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You are asked to review the blood results on a 56-year-old man who appears to be acutely unwell. His results show that he is neutropenic.
Which ONE of the following is NOT a recognized cause of a neutropenia?Your Answer: Rheumatoid arthritis
Correct Answer: Hyposplenism
Explanation:Neutropenia is defined as a total neutrophil count of < 2.0 x 109/l.
It can be caused by:
Viral infections
Collagen disease e.g. SLE and RA
Chemotherapy and radiotherapy
Hypersplenism
Marrow infiltration
Vitamin and folate deficiency
Drug reactions
Drugs that cause neutropenia include flecainide, phenytoin, carbimazole, indomethacin and co-trimoxazole. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 20
Incorrect
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A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She states that she has also felt very itchy, particularly after a hot bath and that she is often dizzy and sweaty. On examination she appears plethoric and you note the presence of splenomegaly. Her blood tests today show that her haemoglobin level is 16.9 g/dl.
What is the most likely diagnosis in this case? Select ONE answer only.Your Answer: Chronic lymphocytic leukaemia
Correct Answer: Polycythaemia vera
Explanation:Polycythaemia vera (PCV), which is also referred to as polycythaemia rubra vera, is a clonal haematological malignancy in which the bone marrow produces too many red blood cells. It may also result in the overproduction of white blood cells and platelets. It is most commonly seen in the elderly and the mean age at diagnosis is 65-74 years.
Patients can be completely asymptomatic and it is often discovered as an incidental finding on a routine blood count. Approximately 1/3 of patients present with symptoms due to thrombosis, of these 3/4 have arterial thrombosis and 1/4 venous thrombosis. Features include stroke, myocardial infarction, deep vein thrombosis and pulmonary embolism.
The other clinical features of PCV include:
Plethoric appearance
Lethargy and tiredness
Splenomegaly (common)
Pruritis (in 40% – particularly after exposure to hot water)
Headaches, dizziness and sweating (in 30%)
Gouty arthritis (in 20%)
Budd-Chiari syndrome (in 5-10%)
Erythromyalgia (in <5% – burning pain and red/blue discolouration of hands and feet)
Increased incidence of peptic ulcer disease (possibly related to increased histamine release from mast cells)
The diagnosis of PCV requires two major criteria and one minor criterion, or the first major criterion and two minor criteria:
Major criteria:
HB > 18.5 g/dl in men, 16.5 g/dl in women
Elevated red cell mass > 25% above mean normal predicted value
Presence of JAK2 mutationMinor criteria:
Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic and megakaryocytic proliferation
Serum erythropoietin level below normal range
Endogenous erythroid colony formation in vitro
The main aim of treatment is to normalize the full blood count and prevent complications such as thrombosis. Venesection is the treatment of choice but hydroxyurea can also be used to help control thrombocytosis. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 21
Incorrect
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Regarding the flexor digitorum profundus muscle, which of the following is true?
Your Answer: The entire muscle is innervated by the ulnar nerve
Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve
Explanation:Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.
Flexor digitorum profundus has a dual innervation:
(1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);
(2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 22
Incorrect
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A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis.
Which of these blood vessels has most likely been occluded?
Your Answer: Superior cerebellar artery
Correct Answer: Posterior inferior cerebellar artery
Explanation:Posterior inferior cerebellar artery (PICA) occlusion is characterised by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. PICA occlusion causes infarction of the posterior inferior cerebellum, inferior cerebellar vermis and lateral medulla.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 23
Incorrect
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On his stool culture, a patient with a diarrhoeal illness grows Escherichia coli.
What SINGLE statement about Escherichia coli is true?
Your Answer: It is an obligate anaerobe
Correct Answer: Most serotypes are harmless
Explanation:Escherichia coli is a Gram-negative, non-spore forming, facultative anaerobic, rod-shaped bacterium.
Although some can cause serious food poisoning, most serotypes are harmless.
Escherichia coli is transmitted via the faeco-oral route.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 24
Incorrect
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A 71-year-old woman presents with complaints of fatigue and worsening muscle weakness, and blood tests done shows a potassium level of 2.4 mmol/L.
Which is NOT a recognised cause of hypokalaemia?
Your Answer: Bartter’s syndrome
Correct Answer: Type 4 renal tubular acidosis
Explanation:A plasma potassium less than 3.5 mmol/L defines hypokalaemia.
Excessive liquorice ingestion causes hypermineralocorticoidism and leads to hypokalaemia.
Gitelman’s syndrome causes metabolic alkalosis with hypokalaemia and hypomagnesaemia. It is an inherited defect of the distal convoluted tubules.
Bartter’s syndrome causes hypokalaemic alkalosis. It is a rare inherited defect in the ascending limb of the loop of Henle.
Type 1 and 2 renal tubular acidosis both cause hypokalaemia
Type 4 renal tubular acidosis causes hyperkalaemia.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 25
Correct
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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: 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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 26
Incorrect
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Which of the following is NOT a characteristic of megaloblastic anaemia?
Your Answer: Decreased platelet count
Correct Answer: Raised reticulocyte count
Explanation:The LDH level is usually markedly increased in severe megaloblastic anaemia. Reticulocyte counts are inappropriately low, representing a lack of production of RBCs due to massive intramedullary haemolysis. These findings are characteristics of ineffective haematopoiesis that occurs in megaloblastic anaemia as well as in other disorders such as thalassemia major.
The common feature in megaloblastosis is a defect in DNA synthesis in rapidly dividing cells. To a lesser extent, RNA and protein synthesis are impaired. Unbalanced cell growth and impaired cell division occur since nuclear maturation is arrested. More mature RBC precursors are destroyed in the bone marrow prior to entering the bloodstream (intramedullary haemolysis). -
This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Incorrect
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Which of the following is where the rectovesical fascia is located:
Your Answer: Between the ampulla of the rectum and the sacrum
Correct Answer: Between the fundus of the bladder and the ampulla of the rectum
Explanation:In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 28
Correct
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Which of the following pathogens causes tetanus:
Your Answer: Clostridium tetani
Explanation:Tetanus is caused by Clostridium tetani, a bacterium. Tetanus can cause mild spasms to severe whole-body contractions, suffocation, and heart attack.
Gas gangrene and food poisoning are both caused by Clostridium perfringens.
Pseudomembranous colitis is caused by Clostridium difficile.
Urinary tract infections, respiratory infections, dermatitis, soft tissue infections, bacteraemia, bone and joint infections, gastrointestinal infections, and a variety of systemic infections are all caused by Pseudomonas aeruginosa.
Pharyngitis, skin infections, acute rheumatic fever, scarlet fever, poststreptococcal glomerulonephritis, toxic shock–like syndrome, and necrotizing fasciitis can all be caused by Streptococcus pyogenes infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 29
Incorrect
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While studying fluid homeostasis in the body, you encounter the term exudate. Exudate is a fluid that leaks out of the intravascular space due to changes in the permeability of the microcirculation secondary to inflammation.
Which ONE of the following conditions would not be listed among the causes of an exudate?Your Answer:
Correct Answer: Myxoedema
Explanation:An exudate is an inflammatory fluid that leaks out of the intravascular space due to increased vascular permeability and intravascular pressure. It is mostly caused by local processes and can occur in the following conditions:
1) Infection (e.g. pneumonia)
2) Malignancy
3) Pericarditis
4) Collagen vascular diseases, e.g., Rheumatoid ArthritisMyxoedema is a state of severe hypothyroidism in which deposition of mucopolysaccharides occurs in the dermis. This causes a transudative effusion, typically in the pretibial region.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 30
Incorrect
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Which of the following statements is correct with regards to Horner's syndrome?
Your Answer:
Correct Answer: Miosis occurs due to paralysis of the dilator pupillae muscle.
Explanation:The characteristics of Horner’s syndrome are pupil constriction, partial ptosis and anhidrosis.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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SESSION STATS - PERFORMANCE PER SPECIALTY
