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Question 1
Incorrect
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The sensory innervation of the oropharynx is provided by which of the following nerves:
Your Answer: Vagus nerve
Correct Answer: Glossopharyngeal nerve
Explanation:Each subdivision of the pharynx has a different sensory innervation:the nasopharynx is innervated by the maxillary nervethe oropharynx is innervated by the glossopharyngeal nervethe laryngopharynx is innervated by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 2
Correct
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Which of the following statements is incorrect regarding potassium replacement?
Your Answer: Oral potassium supplements are often required for patients taking spironolactone.
Explanation:It is very seldom that potassium supplements are required with the small doses of diuretics given to treat hypertension. Potassium-sparing diuretics like spironolactone (rather than potassium supplements), are recommended for hypokalaemia prevention when diuretics are given to eliminate oedema, such as furosemide or the thiazides.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 3
Correct
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Regarding Escherichia coli, which of the following statements is INCORRECT:
Your Answer: It is a predominant member of the normal flora of the skin.
Explanation:Escherichia coli is a Gram-negative bacilli that is an important member of the intestinal flora. It is the most common cause of UTI in adults (about 70 – 95% of cases), followed by Staphylococcus saprophyticus (about 5 – 10% of cases), and an important cause of neonatal meningitis. E. coli O157 strain is implicated in the development of dysentery associated with haemolytic uraemic syndrome characterised by haemolytic anaemia, thrombocytopenia and acute renal failure.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 4
Incorrect
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Which of the following is most likely affected in De Quervain's tenosynovitis?
Your Answer: Abductor pollicis brevis
Correct Answer: Extensor pollicis brevis
Explanation:De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. It is a condition which involves tendon entrapment affecting the first dorsal compartment of the wrist. With this condition thickening of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis develops where the tendons pass in through the fibro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial and ulnar deviation of the wrist.
The estimated prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties. It may be seen more commonly in individuals with a history of medial or lateral epicondylitis. Bilateral involvement is often reported in new mothers or child care providers in whom spontaneous resolution typically occurs once lifting of the child is less frequent.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Correct
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A patient with a high potassium level is at risk of going into cardiac arrest. What changes in the ECG may indicate the incident of cardiac arrest in this patient?
Your Answer: Peaked T waves and broad QRS complex
Explanation:Severe hyperkalaemia can result in a heart attack or a life-threatening arrhythmia.
T waves become narrow-based, pointed, and tall if hyperkalaemia is not treated.
The QRS complex widens and eventually merges with the T wave, resulting in a classic sine-wave electrocardiogram. Ventricular fibrillation and asystole are likely to follow.
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This question is part of the following fields:
- Physiology
- Renal
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Question 6
Correct
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Which of the following causes the first heart sound?
Your Answer: Closing of the atrioventricular valves
Explanation:The heart sounds are as a result of the various parts of the cardiac cycle.
Heart Sound – Phase of Cardiac Cycle – Mechanical Event:
1st heart sound – Systole starts – there is closure of the atrioventricular (mitral & tricuspid) valves
2nd heart sound – Systole ends – there is closure of the semilunar (aortic and pulmonary) valves
3rd heart sound – Early diastole – this is caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase
4th heart sound – Late diastole – this is caused by filling of an abnormally stiff ventricle in atrial systole -
This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 7
Incorrect
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A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular medication.
What is the dosage per inhalation of a standard metered dose salbutamol inhaler?Your Answer: 200 micrograms
Correct Answer: 100 micrograms
Explanation:The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 8
Correct
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You are examining the lower limbs of a 54 year old man who presented after falling from a ladder at home. During your neurological assessment you note a weakness of hip flexion. Which of the following nerves is the most important for flexion of the thigh at the hip joint:
Your Answer: Femoral nerve
Explanation:Flexion of the thigh at the hip joint is produced by the sartorius, psoas major, iliacus and pectineus muscles, assisted by the rectus femoris muscle, all innervated by the femoral nerve (except for the psoas major, innervated by the anterior rami of L1 – 3).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 9
Incorrect
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Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.
Which enzyme hydroxylates 25-hydroxycholecalciferol to form 1,25-dihydroxycholecalciferol?Your Answer: 1-beta-hydroxylase
Correct Answer: 1-alpha-hydroxylase
Explanation:The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.
In the presence of UVB light, 7-dehydrocholesterol is converted to cholecalciferol in the epidermal layer of the skin, resulting in 1,25-dihydroxycholecalciferol.
Cholecalciferol is then converted to 25-hydroxycholecalciferol in the endoplasmic reticulum of liver hepatocytes by 25-hydroxylase (calcifediol).
Finally, 1-alpha-hydroxylase converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol in the kidney. The key regulatory point in the formation of 1,25-dihydroxycholecalciferol is 1-alpha-hydroxylase, which is induced by parathyroid hormone or hypophosphatemia.
The following are the primary effects of 1,25-dihydroxycholecalciferol:
Calcium and phosphate absorption in the small intestine is increased.
Calcium reabsorption in the kidneys is increased.
Increases phosphate reabsorption in the kidneys.
Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)
Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback) -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 10
Correct
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In the small intestine, there is a deep gap between each villus that leads to the crypt of Lieberkühn, a tubular intestinal gland.
What is the primary function of these glands?
Your Answer: Production of an alkaline intestinal juice
Explanation:In the small intestine, there is a deep gap between each villus that leads to the crypt of Lieberkühn, a tubular intestinal gland. These glands create an alkaline intestinal juice that is a mixture of water and mucus with a pH of 7.4-7.8. Intestinal juice is released in a volume of 1-2 litres per day in response to distention of the small intestine or the irritating effects of chyme on the intestinal mucosa.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 11
Incorrect
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A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb.
The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.
There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers.
Which of these nerve(s) has most likely been affected?
Your Answer: Median and ulnar nerve
Correct Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:
Loss of sensation to the lateral palm and the lateral three and a half fingers.
Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals.
Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialis
Weakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.
Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Incorrect
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A 24-year-old student with red and painful right eye presents. Conjunctival erythema, mucopurulent discharge and lid crusting are seen on examination, and patient denies presence of itching of the eye. All his observations are normal, he has no fever and is otherwise well.
Which of these is the most likely causative organism?
Your Answer: Staphylococcus epidermidis
Correct Answer: Haemophilus influenzae
Explanation:The most frequent cause of red eye is conjunctivitis. It is caused by inflammation of the conjunctiva which can be infective or allergic and accounts for about 35% of all eye problems presenting to general practice.
Viral conjunctivitis is commonly caused by adenoviruses and it is the most common infectious conjunctivitis.
The common bacterial causes of conjunctivitis are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.
The clinical features of infective conjunctivitis include:
Acute onset of conjunctival erythema
Feeling ‘grittiness’, ‘foreign body’ or ‘burning’ sensation in the eye.
Watering and discharge which may cause transient blurring of visionThe discharge for viral conjunctivitis is less than that of bacterial conjunctivitis and usually watery.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 13
Incorrect
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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: Between the renal fascia and the paranephric fat
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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Incorrect
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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: Onset under the age of 20
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.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 15
Incorrect
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Which statement accurately describes the osmolality in the various parts of the Henle Loop?
Your Answer: The osmolality of the tubular fluid decreases as it passes through the ascending limb due to the active excretion of urea out of the tubule
Correct Answer: The osmolality of fluid in the descending loop equals that of the peritubular fluid
Explanation:The Loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It consists of three major segments, including the descending thin limb, the ascending thin limb, and the ascending thick limb. These segments are differentiated based on structure, anatomic location, and function.
The main function of the loop of Henle is to recover water and sodium chloride from urine. When fluid enters the loop of Henle, it has an osmolality of approximately 300 mOsm, and the main solute is sodium.
The thin descending limb has a high water permeability but a low ion permeability. Because it lacks solute transporters, it cannot reabsorb sodium. Aquaporin 1 (AQP1) channels are used to passively absorb water in this area. The peritubular fluid becomes increasingly concentrated as the loop descends into the medulla, causing water to osmose out of the tubule. The tubular fluid in this area now equalizes to the osmolality of the peritubular fluid, to a maximum of approximately 1200 mOsm in a long medullary loop of Henle and 600 mOsm in a short cortical loop of Henle.
The thin ascending limb is highly permeable to ions and impermeable to water. It allows the passive movement of sodium, chloride, and urea down their concentration gradients, so urea enters the tubule and sodium and chloride leave. Reabsorption occurs paracellularly due to the difference in osmolarity between the tubule and the interstitium.
The thick ascending limb is also impermeable to water but actively transports sodium, potassium, and chloride out of the tubular fluid. The osmolality of the tubular fluid is lower compared to the surrounding peritubular fluid. This area is water impermeable. This results in tubular fluid leaving the loop of Henle with an osmolality of approximately 100 mOsm, which is lower than the osmolality of the fluid entering the loop, and urea being the solute.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 16
Correct
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A patient with a stab wound to the axilla arrives to the emergency department. You notice weakness in elbow flexion and forearm supination during your assessment. Which of these nerves has been affected:
Your Answer: Musculocutaneous nerve
Explanation:The musculocutaneous nerve is relatively protected in the axilla, hence injury to it is uncommon. A stab wound in the axilla is the most prevalent source of damage. Because of the activities of the pectoralis major and deltoid, the brachioradialis, and the supinator muscles, arm flexion and forearm flexion and supination are diminished but not completely lost. Over the lateral part of the forearm, there is a lack of sensation.
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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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C3 deficiency leads to particular susceptibility of infection with which of the following:
Your Answer: Candida
Correct Answer: Encapsulated bacteria
Explanation:Macrophages and neutrophils have C3b receptors and they phagocytose C3b-coated cells. C3 deficiency thus leads to increased susceptibility of infection with encapsulated organisms (e.g. S. pneumoniae, H. influenzae).The early stages of the complement cascade leading to coating of the cells with C3b can occur by two different pathways:The classical pathway usually activated by IgG or IgM coating of cellsThe alternative pathway which is more rapid and activated by IgA, endotoxin and other factors
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 18
Correct
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Following a bee sting, a 8-year old boy was transported to resus with symptoms and signs of an anaphylactic reaction. You decide to administer adrenaline IM stat. What is the recommended dose of intramuscular adrenaline?
Your Answer: 0.3 mL of 1:1000
Explanation:Anaphylaxis is a type I hypersensitivity reaction that is severe and life-threatening. It is marked by the fast onset of life-threatening airway and/or circulatory issues, which are generally accompanied by skin and mucosal abnormalities. When an antigen attaches to specific IgE immunoglobulins on mast cells, degranulation and the release of inflammatory mediators takes place (e.g. histamine, prostaglandins, and leukotrienes).
The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.
In anaphylaxis, age-related dosages of IM adrenaline are:
150 mcg (0.15 mL of 1:1000) for a child under 6 years
300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years
500 mcg (0.5 mL of 1:1000) for children aged 12 and above
500 mcg for adults (0.5 mL of 1:1000) -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 19
Incorrect
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Regarding endothelin-1, which of the following statements is INCORRECT:
Your Answer: Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide.
Correct Answer: Endothelin-1 release is inhibited by noradrenaline.
Explanation:Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 20
Incorrect
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Question 21
Correct
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A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is diagnosed with hyperaldosteronism.
Which of these is the commonest cause of hyperaldosteronism?
Your Answer: Adrenal adenoma
Explanation:When there are excessive circulating levels of aldosterone, hyperaldosteronism occurs. There are two main types of hyperaldosteronism:
Primary hyperaldosteronism (,95% of cases)
Secondary hyperaldosteronism (,5% of cases)Primary causes of hyperaldosteronism include:
Adrenal adenoma (Conn’s syndrome)
Adrenal hyperplasia
Adrenal cancer
Familial aldosteronism
Secondary causes of hyperaldosteronism include:
Drugs
Obstructive renal artery disease
Renal vasoconstriction
Oedematous disorders syndromeAdrenal adenoma is the commonest cause of hyperaldosteronism (seen in ,80% of all cases).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 22
Correct
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From which of the following cell types are platelets derived?
Your Answer: Megakaryocytes
Explanation:Synthesis of platelets occurs in the bone marrow by fragmentation of megakaryocytes cytoplasm, derived from the common myeloid progenitor cell. The average time for differentiation of the human stem cell to the production of platelets is about 10 days. The major regulator of platelet formation is thrombopoietin and 95% of this is produced by the liver. Normal platelet count is 150 – 450 x 109/L and the normal lifespan of a platelet is about 10 days. Usually about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 23
Incorrect
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You're taking a history of a 59-year-old banker who has had heartburn in the past.
Which of the following information about antacids is correct?Your Answer: Aluminium hydroxide tends to have a laxative effect
Correct Answer: Magnesium carbonate can reduce the absorption of drugs taken at the same time
Explanation:Antacids such as aluminium hydroxide and magnesium carbonate are commonly used. They’re both water-insoluble and can reduce the absorption of drugs taken together. Allow at least 1-2 hours between taking these antacids and any other medications.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium carbonate has a laxative effect, whereas aluminium hydroxide has a constipating effect.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 24
Correct
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You examine a patient who is experiencing a worsening of his chronic heart failure. You discuss his care with the on-call cardiology registrar, who recommends switching him from furosemide to bumetanide at an equivalent dose. He's on 80 mg of furosemide once a day right now.
What is the recommended dose of bumetanide?Your Answer: 2 mg
Explanation:Bumetanide is 40 times more powerful than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide. This patient is currently taking 80 mg of furosemide and should be switched to a 2 mg bumetanide once daily.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 25
Correct
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What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Explanation:A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 26
Correct
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A 55 year old man presents to ED complaining of leg weakness. Your colleague has examined the patient and suspects femoral nerve palsy. Which of the following clinical features would you LEAST expect to see on examination of this patient:
Your Answer: Weakness of hip extension
Explanation:Damage to the femoral nerve results in weakness of hip flexion and knee extension and loss of sensation over the anterior thigh and the anteromedial knee, medial leg and medial foot.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 27
Incorrect
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Regarding T helper cells, which of the following statements is CORRECT:
Your Answer: They are CD8 receptor positive.
Correct Answer: They form the vast majority (about 75%) of the total circulating T-cell population.
Explanation:CD4+ T-cells (Helper T cells)Recognise antigen only in association with HLA class II molecules (found on antigen presenting cells (APCs) e.g. dendritic cells, B-cells; present exogenous antigens that have been phagocytosed/endocytosed into intracellular vesicles)Form most of the circulating T-cell population (about 75%)Secrete cytokines (e.g. IFN-gamma) which are required for recruitment and activation of other immune cells such as macrophages, T cytotoxic cells and NK cells and for the activation of and production of immunoglobulin from B-cells
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 28
Incorrect
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Which of the following factors decreases insulin secretion:
Your Answer: Glucagon
Correct Answer: Catecholamines
Explanation:Factors that increase insulin secretion:
↑ Blood glucose
↑ Amino acids
↑ Fatty acids
Glucagon
Secretin
AcetylcholineFactors that decrease insulin secretion:
↓ Blood glucose
Somatostatin
Catecholamines -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 29
Correct
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Antidiuretic hormone (ADH) is synthesised by which of the following:
Your Answer: Hypothalamus
Explanation:Antidiuretic hormone is synthesised in the hypothalamus and transported to the posterior pituitary within nerve fibres where it is stored in secretory granules. ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, raising cAMP levels and causing intracellular vesicles to fuse with the apical membrane. In their membrane these vesicles have water channels called aquaporins, which increase the water permeability allowing greater water reabsorption and concentration of urine. Excess levels of ADH results in syndrome of inappropriate ADH secretion (SIADH) characterised by hyponatremia with concomitant hypo-osmolality and high urine osmolality.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 30
Correct
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Which of the following is NOT a typical feature of benzodiazepine toxicity:
Your Answer: Hyperventilation
Explanation:Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
