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Question 1
Correct
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A 50-year-old woman under treatment for manic-depressive psychosis presents in an unconscious state after an episode of seizure on the street. Her husband who accompanied her into the ER reported that they argued about 6-7 hours ago. On examination, she is found to be hypertonic with a GCS of 8, BP: 90/60 mmHg and a pulse of 105 bpm. Blood investigations revealed a lithium level of 3.2 mmol/L. She was intubated and ventilated. Which of the following is the most appropriate immediate management in this case?
Your Answer: N saline should be started iv
Explanation:- Normal saline (N saline) should be started IV: Intravenous normal saline is recommended to enhance renal excretion of lithium. Adequate hydration is crucial because lithium is primarily excreted by the kidneys, and maintaining good urine output can help reduce lithium levels.
- Dialysis: This is considered the most effective treatment for severe lithium toxicity, especially when serum levels are significantly elevated (typically >2.5 mmol/L) and the patient presents with severe symptoms such as seizures, altered mental status, or renal impairment. Given the patient’s lithium level of 3.2 mmol/L and her critical condition, dialysis is necessary to rapidly reduce lithium levels.
The other options are less appropriate or ineffective in this context:
- Gastric lavage should be considered: This is not typically recommended for lithium poisoning because lithium is rapidly absorbed and lavage is unlikely to be effective several hours post-ingestion.
- Activated charcoal is likely to be effective: Activated charcoal does not effectively bind lithium and is not recommended for lithium poisoning.
- 5% dextrose should be started IV: While maintaining hydration is important, normal saline is preferred over dextrose solutions in this context to promote renal excretion of lithium.
- Dialysis is not normally required unless levels are above 5 mmol/L: This statement is incorrect. Dialysis is often required at lower levels, particularly in cases of severe toxicity or if the patient is symptomatic, as seen in this case.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 2
Incorrect
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Activation of the cool receptor (CMR-1), causes:
Your Answer: Activation of K+ channels
Correct Answer: Influx of Ca++ & Na+
Explanation:Cold and Menthol receptor 1 (CMR1) is a protein that in humans is encoded by TRPM8 gene. It is an ion channel which upon activation causes the influx of Na+ and Ca++ ions into the cell that leads to the depolarization and generation of an action potential.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 3
Incorrect
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Which of the following is not secreted by cells in the antrum of the stomach?
Your Answer: Somatostatin
Correct Answer: Hydrochloric acid
Explanation:Cells in the body of the stomach secrete mucus, HCl and pepsinogen. Cells in the antrum secrete pepsinogen, gastrin and mucus.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 4
Correct
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Which of the following provides the sympathetic nervous supply to the stomach?
Your Answer: Coeliac plexus
Explanation:Parasympathetic innervation to the stomach is from the vagus nerve and the sympathetic innervation is from the coeliac plexus.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 5
Correct
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Which hormone secreting cell of the human anterior pituitary gland secretes growth hormone?
Your Answer: Somatotroph
Explanation:Somatotroph cells are responsible for the production of growth hormone. Somatotrophs occupy nearly 40% of the total surface area of the anterior pituitary, and they are acidophilic in nature.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 6
Correct
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Bile contains:
Your Answer: Bile acids, phosphatidylcholine, cholesterol
Explanation:The main components of bile include bile acids or bile salts, phospholipids; mainly phosphatidylcholine, cholesterol, bilirubin, inorganic salts; potassium, sodium and bicarbonate.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 7
Correct
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Regarding bronchial innervation which of the following is correct:
Your Answer: Alpha 1 receptors increase bronchial constriction
Explanation:Stimulation of β2 receptors results in smooth muscle relaxation and bronchodilation. α1 receptors cause smooth muscle contraction in the bronchioles although minor to the β2 effects.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 8
Correct
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The choroid plexus:
Your Answer: All are true
Explanation:The choroid plexus is a vascular structure found in all cerebral ventricles. The functional unit of the choroid plexus, composed of a capillary, enveloped by a layer of differentiated ependymal epithelium. Unlike the capillaries that form the blood-brain barrier, choroid plexus capillaries are fenestrated and have no tight junctions. The endothelium, therefore, does not form a barrier to the movement of small molecules. Instead, the blood-CSF barrier at the choroid plexus is formed by the epithelial cells and the tight junctions that link them.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 9
Incorrect
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A 25-year-old female presents to the emergency department with severe breathlessness and tinnitus. She is under treatment for asthma and depression with albuterol and amitriptyline respectively.On examination, she seems agitated with a BP of 100/44, a pulse rate of 112 bpm, a respiratory rate of 30 cycles/min, and a temperature of 37.8'C.An arterial blood gas performed reveals:pH: 7.48 (7.36 – 7.44)pO2: 11.2 kPa (11.3 – 12.6 kPa)pCO2: 1.9 kPa (4.7 – 6.0 kPa)Bicarbonate: 13 mmol/l (20 – 28 mmol/L)What is the most probable diagnosis?
Your Answer: Acute asthma exacerbation
Correct Answer: Salicylate poisoning
Explanation:The blood gas analysis provided above is suggestive of a mixed respiratory alkalosis and metabolic acidosis characteristic of salicylate overdose.Pathophysiology:The direct stimulation of the cerebral medulla causes hyperventilation and respiratory alkalosis.As it is metabolized, it causes an uncoupling of oxidative phosphorylation in the mitochondria. Lactate levels then increase due to the increase in anaerobic metabolism. This, along with a slight contribution from the salicylate metabolites result in metabolic acidosis.Tinnitus is characteristic and salicylate ototoxicity may produce deafness. Other neurological sequelae include encephalopathy and agitation, seizures and CNS depression and coma. Cardiovascular complications include tachycardia, hypotension, and dysrhythmias (VT, VF, and asystole).
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 10
Incorrect
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Which of the following pairing is correct:
Your Answer: Herpes simplex type I and primary genital herpes
Correct Answer: Herpes simplex type I and herpes encephalitis
Explanation:Herpes simplex virus is likely the most common cause of Mollaret’s meningitis, and, in worse case scenarios, can lead to a potentially fatal case of herpes simplex encephalitis. The eighth human herpesvirus or HHV-8 causes Kaposi’s sarcoma and Herpes simplex type 2 is responsible for most primary genital herpes.
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This question is part of the following fields:
- Infectious Diseases
- Medicine
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Question 11
Correct
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In meiosis, the period of prophase 1 involves:
Your Answer: Replicated DNA condensing to form visible chromosomes
Explanation:Prophase 1 has been divided into five different stages (laptotene, zygotene, pachytene, diplotene and diakinesis). In prophase 1, chromosomes are going to condense to become visible, each chromosome will contain two chromatids that are joined at the centromere.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 12
Correct
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Question 13
Correct
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Which of the following cells release histamines when they are activated by binding of specific antigens to cell fixed IgE molecules?
Your Answer: Basophils
Explanation:Mast cells and basophils both contain granules of vasoactive histamine in their cytosol. Both of them express IgE receptors on their cell surface and upon binding with a specific antigen they release their cytokines including histamine.
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This question is part of the following fields:
- Immunology
- Medicine
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Question 14
Correct
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The following contributes to the rate of depolarization?
Your Answer: All of the options given
Explanation:Depolarization occurs due to impulses generated by the SA node. As the heart beats to the rhythm of the SA node, certain factors will effect the rate of depolarization. All the mentioned options effect the rate of depolarization.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 15
Correct
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Platelets are stored in this body organ.
Your Answer: Spleen
Explanation:Megakaryocyte and platelet production is regulated by thrombopoietin. Each megakaryocyte produces between 1,000 and 3,000 platelets during its lifetime. An average of 1011 platelets are produced daily in a healthy adult. Reserve platelets are stored in the spleen, and are released when needed by splenic contraction induced by the sympathetic nervous system.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 16
Correct
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Cholecystokinin causes the pancreas to
Your Answer: Produce pancreatic juice rich in enzymes
Explanation:Cholecystokinin (CCK) mediates digestion in the small intestine by inhibiting gastric emptying and decreasing gastric acid secretion. It stimulates the acinar cells of the pancreas to release a juice rich in pancreatic digestive enzymes, hence the old name pancreozymin. Together these enzymes catalyse the digestion of fat, protein, and carbohydrates.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 17
Correct
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An 18 year old boy, thin with a tall stature, and a high arched palate arrives at the hospital with a spontaneous pneumothorax. He is accompanied by his brother who has a similar appearance. You suspect Marfan's Syndrome. The gene encoding which of the following proteins is defective in this condition?
Your Answer: Fibrillin-1
Explanation:A variety of proteins compose the structure of microfibrils, the most prominent of which are the two fibrillins. Fibrillin-1 a scaffolding protein is encoded by FBN1 on human chromosome 15q21 and fibrillin-2 is encoded by FBN2 on 5q23. Mutations in FBN1 produce Marfan syndrome, a pleiotropic autosomal dominant connective tissue disorder with prominent manifestations in the skeleton, eye and cardiovascular system. A number of conditions related to Marfan syndrome are also due to FBN1 mutations.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 18
Correct
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Which one of the following cells originates from a monocyte and resembles a macrophage?
Your Answer: Microglia
Explanation:Microglia act as the macrophages of the central nervous system, and they contribute to innate and adaptive immune responses. Studies have shown that microglial cells recognize monocyte antigens, and there are similarities between them that demonstrate that they originate from these monocytes.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 19
Correct
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What is found in the posterior cavity of the eye?
Your Answer: Vitreous humor
Explanation:The eye ball contains an anterior cavity and a posterior cavity. The anterior cavity once again is divided into the anterior chamber and posterior chamber. The anterior cavity is filled with aqueous humor whereas the posterior cavity contains vitreous humor.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 20
Correct
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Which of the following conditions has no effect on cardiac output?
Your Answer: Sleep
Explanation:Sleep has no effect on the cardiac output. Anxiety, excitement and pregnancy will increase the cardiac output. Standing from a lying position will decrease the cardiac output transiently.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 21
Correct
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Which glucose transporter is responsible for the uptake of glucose in ß cells?
Your Answer: GLUT 2
Explanation:Glucose transporter 2, also known as GLUT2 is a transmembrane carrier protein which is not insulin dependent. It is found in the liver and the pancreatic islet ß cells, where it functions as the primary glucose transporter that allows the transfer of glucose between these organs and blood.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 22
Correct
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A study is developed to look at the potential of hip protectors to reduce femoral neck fractures in elderly nursing home patients. The study included 800 patients randomly selected with an average age of 82 years of age. The data was collected over a two year period and the patients were randomly put in the standard care group or the hip protector group. From the 400 patients assigned to the hip protector group, 10 had a femoral neck fracture over the two year period. From the 400 patients assigned to the standard care group, 20 had a femoral neck fracture over the two year period. What is the correct value regarding the absolute risk reduction?
Your Answer: 0.025
Explanation:Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. In this example, the ARR is 8 per cent (20 per cent – 12 per cent = 8 per cent). This means that, if 100 children were treated, 8 would be prevented from developing bad outcomes. Another way of expressing this is the number needed to treat (NNT). If 8 children out of 100 benefit from treatment, the NNT for one child to benefit is about 13 (100 ÷ 8 = 12.5). CER = 20 / 400 = 1 / 20 = 0.05, EER = 10 / 400 = 0.025, ARR =CER – EER = 0.025
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This question is part of the following fields:
- Medicine
- Research Skills
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Question 23
Incorrect
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A 60 year old male presents with one month history of generalized headache, fever and malaise. He also complains of scalp sensitivity while combing his hair. In order to confirm the diagnosis, which of the following would be the definite test?
Your Answer: ESR
Correct Answer: Temporal artery biopsy
Explanation:Temporal arteritis is a chronic large- and medium-sized vessel vasculitis that typically involves the temporal arteries. Classical symptoms include temporal headaches, jaw claudication, amaurosis fugax. Physical exam shows scalp tenderness, palpation of the temporal area may demonstrate an absent pulse, knot-like swelling, and vision loss. Lab results reveal an increased erythematous sedimentation rate and C-reactive protein. Temporal artery biopsy confirms the diagnosis. Management approach: high-dose systemic corticosteroids should be promptly administered even before the diagnosis is established. Temporal artery biopsy confirms the diagnosis. Inability to manage this or administer glucocorticoids might lead to development of blindness.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 24
Correct
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Which one of the following is necessary to activate plasminogen to plasmin?
Your Answer: tPA
Explanation:In circulation, plasminogen adopts a closed, activation resistant conformation. Upon binding to clots, or to the cell surface, plasminogen adopts an open form that can be converted into active plasmin by a variety of enzymes, including tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), kallikrein, and factor XII (Hageman factor).
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This question is part of the following fields:
- Haematology
- Medicine
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Question 25
Incorrect
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An 81 year old male patient was admitted after an ischaemic stroke. Physical examination reveals left hemiparesis. How would you classify this hemiparesis based on the WHO International Classification of Functioning, Disability and Health?
Your Answer: Activity limitation
Correct Answer: Impairment of body function
Explanation:Symptoms and signs are classified as ‘impairment of body function’. The types of impairment classified as ‘activity limitation’ include difficulties that a patient may have in executing certain activities. The type of impairment classified as ‘participation restriction’ are problems a patient may have in social roles. The type of impairment classified as ‘pathology’ would be the diagnosis/disease. Right total anterior circulation infarct relates to the Oxford Bamford classification for stroke.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 26
Correct
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A 31 year old female with systemic lupus erythematosus wants to know if she has any predisposing factors for the disease. Which of the following carries the greatest risk of developing SLE?
Your Answer: Monozygotic twin
Explanation:An overall concordance rate in monozygotic twins was documented to be 25% as compared to dizygotic twins with 3%. First degree relatives have a chance of around 3% of developing the disease. Caucasians show an increase frequency of HLA-B8. The Japanese lupus patients had a stronger association with HLA-DR2.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 27
Correct
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A 42-year-old female with type 1 diabetes who has undergone a renal transplant is being reviewed. She is taking azathioprine and tacrolimus for immunosuppression.Which among the following is correct regarding the given immunosuppressive agents?
Your Answer: Tacrolimus is a calcineurin inhibitor
Explanation:Tacrolimus is a calcineurin inhibitor used as an immunosuppressive agent used for prophylaxis of organ rejection post-transplant.Pharmacology: Calcineurin inhibition leads to reduced T-lymphocyte signal transduction and IL-2 expression. It has a half-life of 12 hours (average).Other off-label indications for the use of tacrolimus include Crohn disease, graft-versus-host disease (GVHD), myasthenia gravis, rheumatoid arthritis.Adverse effects of tacrolimus includes: Cardiovascular: Angina pectoris, cardiac arrhythmias, hypertensionCentral nervous system: Abnormal dreams, headaches, insomnia, tremors.Dermatologic: Acne vulgaris, alopecia, pruritis, rashEndocrine and metabolic: Decreased serum bicarbonate, decreased serum iron, new-onset diabetes mellitus after transplant (NODAT), electrolyte disturbances.Gastrointestinal: Abdominal pain, nausea, vomiting, diarrhoeaGenitourinary: Urinary tract infectionHepatic: Abnormal hepatic function testsNeuromuscular and skeletal: Arthralgia, muscle crampsOphthalmic: Blurred vision, visual disturbanceOtic: Otalgia, otitis media, tinnitusRenal: Acute renal failureOther options:Sirolimus (a macrolide) is an mTOR inhibitor that blocks the response to IL-2 and has a half-life of 12–15 hours. Azathioprine inhibits purine synthesis, an essential step in the proliferation of white cells and has a half-life of around 5 hours.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 28
Incorrect
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The process by which DNA fragments are separated by gel and transferred onto a membrane sheet is called:
Your Answer: Northern blotting
Correct Answer: Southern blotting
Explanation:A Southern blot is a method used in molecular biology for detection of a specific DNA sequence in DNA samples. Southern blotting combines transfer of electrophoresis-separated DNA fragments to a filter membrane and subsequent fragment detection by probe hybridization. The other forms of blotting involve the use of RNA and proteins.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 29
Correct
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Transport of Iron into enterocytes occurs via which membrane transporter?
Your Answer: Divalent metal transporter 1(dmt1)
Explanation:To be absorbed, dietary iron can be absorbed as part of a protein such as haem protein or iron must be in its ferrous Fe2+ form. A ferric reductase enzyme on the enterocytes’ brush border, duodenal cytochrome B (Dcytb), reduces ferric Fe3+ to Fe2+. A protein called divalent metal transporter 1 (DMT1), which can transport several divalent metals across the plasma membrane, then transports iron across the enterocyte’s cell membrane into the cell.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 30
Correct
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The actions of thrombin result directly in the release of:
Your Answer: Fibrin monomers
Explanation:Thrombin in turn acts as a serine protease that converts soluble fibrinogen into insoluble strands of fibrin, as well as catalysing many other coagulation-related reactions.
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This question is part of the following fields:
- Haematology
- Medicine
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