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Question 1
Incorrect
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Which of the following would provide relief from nausea and vomiting?
Your Answer: Bromocriptine
Correct Answer: Cannabinoids
Explanation:Ondansetron, chlorpromazine and haloperidol are effective antiemetic agents. Corticosteroids, cannabinoids, and benzodiazepines, alone or in combination with 5-HT3 and D2 antagonists, are also useful in the treatment of vomiting produced by chemotherapy.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 2
Incorrect
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Which of the following is a method for measurement of cardiac output?
Your Answer: Swan-ganz catheterization
Correct Answer: Indicator dilution method
Explanation:There are two methods of calculating the cardiac output in humans other than doppler with echocardiography: The direct Fick’s method and the indicator dilution method. In the indicator dilution technique, a known amount of a substance such as a dye or, more commonly, a radioactive isotope is injected into an arm vein and the concentration of the indicator in serial samples of arterial blood is determined. The output of the heart is equal to the amount of indicator injected divided by its average concentration in arterial blood after a single circulation through the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 3
Incorrect
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What is the main function of vitamin E?
Your Answer: It is a cofactor in the formation of mannose containing glycoproteins
Correct Answer: It is an antioxidant
Explanation:Vitamin E has many biological functions, the antioxidant function being the best known. Other functions include enzymatic activities, gene expression, and neurological function(s).
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This question is part of the following fields:
- Haematology
- Medicine
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Question 4
Incorrect
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Transport of Iron into enterocytes occurs via which membrane transporter?
Your Answer: Ferroportin 1
Correct 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 5
Incorrect
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A 23-year-old female known with schizophrenia is being reviewed in the emergency department. Her mother claims that she has been 'staring' for the past few hours but has now developed abnormal head movements and has gone 'cross-eyed'. On examination, the patient's neck is extended and positioned to the right. Her eyes are deviated upwards and are slightly converged. Given the likely diagnosis, what is the most appropriate treatment?
Your Answer: Diazepam
Correct Answer: Procyclidine
Explanation:The most probable diagnosis in this patient is an oculogyric crisis, that is most appropriately managed with procyclidine or benztropine (antimuscarinic). An oculogyric crisis is a dystonic reaction to certain drugs or medical conditions.Features include:Restlessness, agitationInvoluntary upward deviation of the eyesCauses:PhenothiazinesHaloperidolMetoclopramidePostencephalitic Parkinson’s diseaseManagement:Intravenous antimuscarinic agents like benztropine or procyclidine, alternatively diphenhydramine or ethopropazine maybe used.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 6
Correct
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In the absence of insulin:
Your Answer: Glucose uptake by most of the brain is normal
Explanation:Although it is known that insulin levels affect glucose uptake, oxidation and storage in peripheral tissues, its role in the brain isn’t as clear. However, studies have shown that bulk brain glucose uptake isn’t affected by insulin. Glucose transport into the neurons is GLUT3 dependent, and its transport into glia and brain endothelial cells rely on GLUT1. Insulin isn’t necessary for GLUT1 or GLUT3, which explains why brain glucose uptake isn’t affected by insulin levels.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 7
Correct
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A 18-year-old female is brought to the emergency department by her boyfriend. He is concerned that she may have taken an overdose of her mom's morphine sulphate pills after being depressed about her mother, who is dying of carcinoma of the breast.Which of the following may point towards his suspicion?
Your Answer: Sweating
Explanation:Excessive sweating points towards a morphine overdose.Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.Most commonly used in pain management, morphine provides major relief to patients afflicted with pain.Among the more common adverse effects of morphine use is constipation. Other side effects include nausea, vomiting, drowsiness, and confusion. Psychological and physical dependence may occur.Other side effects include bronchospasm, angioedema, urinary retention, ureteric or biliary spasm, dry mouth, sweating, rash, facial flushing, vertigo, tachycardia, bradycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood change, hallucinations, seizures (adults and children) and miosis, headache and allergic reactions (including anaphylaxis) and decreased libido or potency.Raised intracranial pressure occurs in some patients. Muscle rigidity may occur with high doses. Elevated liver enzymes may occur due to biliary sphincter constriction. Large doses can lead to respiratory depression, circulatory failure, and coma.Treatment of opioid overdose:Initial treatment of overdose begins with supportive care.Naloxone is a pure competitive antagonist of opiate receptors and has no agonistic activity. The drug is relatively safe and can be administered intravenous, intramuscular, subcutaneous or via the endotracheal tube.Alternatively, nalmefene and naltrexone maybe considered.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 8
Incorrect
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The axons of the POST ganglionic neurons are mostly?
Your Answer: B fibers
Correct Answer: C fibers
Explanation:According to Erlanger- Grasser classification preganglionic fibers are B fibers whereas post ganglionic fibers are C fibers.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 9
Correct
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A 42 year old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?
Your Answer: Lungs
Explanation:Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common. Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases).
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 10
Correct
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Which statement about the 2nd heart sound is true?
Your Answer: It is caused by closure of the aortic and pulmonary valves.
Explanation:The second heart sound is produced due to closure of the aortic and pulmonary valves. It is a high pitched dub sound.
Normally the aortic closure sound (A2) occurs prior to the pulmonic closure sound (P2), and the interval between the two (splitting) widens on inspiration and narrows on expiration. With quiet respiration, A2 will normally precede P2 by 0.02 to 0.08 second (mean, 0.03 to 0.04 sec) with inspiration. In younger subjects inspiratory splitting averages 0.04 to 0.05 second during quiet respiration. With expiration, A2 and P2 may be superimposed and are rarely split as much as 0.04 second. If the second sound is split by greater than 0.04 second on expiration, it is usually abnormal. Therefore, the presence of audible splitting during expiration (i.e., the ability to hear two distinct sounds during expiration) is of greater significance at the bedside in identifying underlying cardiac pathology than is the absolute inspiratory increase in the A2–P2 interval.
The respiratory variation of the second heart sound can be categorized as follows: (1) normal (physiologic) splitting; (2) persistent (audible expiratory) splitting, with normal respiratory variation; (3) persistent splitting without respiratory variation (fixed splitting); and (4) reversed (paradoxical) splitting.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 11
Incorrect
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A 62 year old female complains of pain and stiffness in her shoulders. She also finds it difficult to get out of her chair. From the list of symptoms below, choose the one most likely to support the diagnosis of polymyalgia rheumatica.
Your Answer: Muscle tenderness
Correct Answer: Low grade fever
Explanation:Polymyalgia rheumatica is an inflammatory disease which usually causes stiffness and pain in the shoulder – this can also occur in the pelvic girdle muscles. Its onset can either be subacute or acute and is associated with a systemic inflammatory response. This, therefore, causes symptoms such as fever, weight loss, anorexia, and malaise. Polymyalgia rheumatica is unpredictable in its course and it is known that 30 per cent of patients also present with giant cell arteritis. The cause of this disease is unknown but studies have shown it have infectious origins. Diagnosis of polymyalgia rheumatica can be difficult and other inflammatory diseases have to be excluded first. Patients with this disease are usually over 60 years of age (it is very rarely seen in those under 50). Muscle weakness does not present, although this can be hard to assess when the patient is in pain. Low-grade fever and weight loss are typical of this disease due to chronic inflammation. As such, weight gain is very rare and peripheral joints are usually not affected (they can be affected but it is very rare). Also, muscle tenderness is not a specific symptom of the disease – it is therefore not a classical finding of polymyalgia rheumatica. Although patients usually complain of stiffness and pain, the muscles are usually not significantly tender – this is usually more associated with fibromyalgia or myositis. When investigated, a normochromic/normocytic anaemia; a raised erythrocyte sedimentation rate often over 50 mm/hr., and raised C reactive protein are usually revealed. Symptoms of giant cell arteritis should also be sought, such as headaches, visual disturbances, TIAs (transient ischemic attacks), jaw claudication, and thickened temporal arteries. The patient response to a moderate dose of steroids is useful when confirming a diagnosis of polymyalgia rheumatica. The maximum dose of prednisolone should not exceed 20mg once a day. After treatment, patients should show a 70 per cent improvement in symptoms within a month (between 3-4 weeks). Inflammatory markers should also fall back to their normal levels. Non-steroidal anti-inflammatories are of little use and are associated with morbidity. There is also little evidence for the use of steroidal-sparing agents.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 12
Incorrect
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A 68 year old male presented with swelling in the lower pole of his parotid gland. It is revealed that this has been ongoing for the past 10 years. Upon examination, the swelling is firm in consistency. From the list of options, choose the most probable diagnosis for this patient.
Your Answer: Frey’s syndrome
Correct Answer: Pleomorphic adenoma
Explanation:A pleomorphic adenoma is also called a benign mixed tumour – this is the most common tumour of the parotid gland. It also causes over a third of all submandibular tumours. This type of a tumour is slow-growing and has no symptoms, which means it has great malignant potentiality.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 13
Incorrect
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A 62 year old man arrives at the clinic with a history of cough and intermittent haemoptysis for the last 3 months. He has a 50 pack year smoking history and is currently waiting for bronchoscopy to assess a left lower lobe collapse. The patient also has a marked muscle weakness and wasting of proximal muscles of his shoulders and pelvic girdle. His wife states that lately he has been unable to eat solids. Which of the following statements would be true regarding this scenario?
Your Answer: Examination of his fingers will show only clubbing
Correct Answer: He may have a photosensitive facial rash
Explanation:The patient has presented with signs of small cell lung cancer. The associated proximal muscle weakness is most probably due to dermatomyositis which occurs as a paraneoplastic syndrome associated with lung carcinoma. In most cases, the first symptom is a distinctive skin rash on the face, eyelids, chest, nail cuticle areas, knuckles, knees or elbows. The rash is patchy and usually a bluish-purple colour. Corticosteroids are helpful in the management of the cutaneous changes and muscle weakness.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 14
Incorrect
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Which enzyme deficiency can lead to ammonia intoxication?
Your Answer: Arginosuccinate synthetase
Correct Answer: Ornithine transcarbamylase
Explanation:Ornithine transcarbamylase deficiency also known as OTC deficiency is the most common urea cycle disorder in humans. Ornithine transcarbamylase, the defective enzyme in this disorder is the final enzyme in the proximal portion of the urea cycle, responsible for converting carbamoyl phosphate and ornithine into citrulline. OTC deficiency is inherited in an X-linked recessive manner, meaning males are more commonly affected than females.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 15
Correct
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Where does the pituitary gland lie?
Your Answer: In a pocket of the sphenoid bone at the base of the brain
Explanation:The pituitary lies in a small depression in the sphenoid bone, known as the sella turcica or Turkish saddle.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 16
Correct
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According to Starling's law of the heart:
Your Answer: The extent of the preload is proportional to the end-diastolic volume
Explanation:Frank starlings law describes that an increase in the venous return or the end diastolic volume will cause an increase in the stroke volume/ preload and also cardiac output. It stems from the fact that increased venous return will increase the stretch on the ventricular muscle fibers. The sarcomere will stretch a considerable length that is needed for maximum contraction and the development of tension in the muscle fiber. The greater the venous return the greater the cardiac output. This relationship is directly proportional.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 17
Incorrect
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Which of the following results in the resting membrane potential of a myocyte?
Your Answer: Activation of gated Na channels
Correct Answer: Activation of outward K+ channels
Explanation:Phase 0 is caused by the sodium current. Voltage gated sodium channels open leading to the influx of sodium into the cardiac muscle cell. Phase 1 is the rapid transient repolarization phase which is caused by the inactivation of the voltage gated sodium channels and opening of the voltage gated potassium channels along with opening of the slow calcium channels. Phase 2 which is the plateau is caused by opening of the slow calcium channels. Phase 4 is caused by closing of the slow calcium channels and opening of the potassium channels leading to efflux of potassium leading to the establishment of the resting membrane potential.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 18
Correct
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Which neurotransmitter is made from hydroxylation and decarboxylation of tryptophan?
Your Answer: Serotonin
Explanation:Serotonin is synthesized from the essential amino acid tryptophan. The rate-limiting step is the conversion of the amino acid to 5-hydroxytryptophan by tryptophan hydroxylase. This is then converted to serotonin by the aromatic L-amino acid decarboxylase.
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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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A 43 year old man with hemochromatosis presents with a painful and swollen right knee. X-ray shows extensive chondrocalcinosis but no fracture. Given the most likely diagnosis, which of the following would be present in the joint fluid aspirate?
Your Answer: Positively birefringent rhomboid-shaped crystals
Explanation:Pseudogout is a paroxysmal joint inflammation due to calcium pyrophosphate crystal deposition (calcium pyrophosphate dihydrate). Arthrocentesis should be performed, especially in acute cases. Polarized light microscopy: detection of rhomboid-shaped, positively birefringent CPPD crystals. Synovial fluid findings: 10,000-50,000 WBCs/μL with > 90% neutrophils. X-ray findings: cartilage calcification of the affected joint (chondrocalcinosis). Fibrocartilage (meniscus, annulus fibrosus of intervertebral disc) and hyaline cartilage (joint cartilage) may be affected.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 20
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 21
Correct
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Question 22
Correct
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The process where by DNA fragments are separated by size and charge is called:
Your Answer: Gel electrophoresis
Explanation:Fragments of DNA of varying length can be separated on the basis of their charge and their size by a process called gel electrophoresis. Because DNA contains negatively charged phosphate groups, it will migrate in an electric field toward the positive electrode. Shorter chains migrate more rapidly through the pores of the gel, and thus separation depends on length. DNA bands in the gel can be visualized by various techniques including staining with dyes and autoradiography.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 23
Correct
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Which dorsal (sensory) root is responsible for umbilical area sensation?
Your Answer: T10
Explanation:The area of skin supplied by one nerve is called a dermatome. T10 supplies sensory neurons to the area of the umbilicus. C3 and C4 supply the neck and the shoulder, T4 supplies the dermatome at the level of the nipple, S3 supplies the inguinal region and L5 supplies the lateral aspect of the leg and the medical aspect of the dorsum of the feet plus the first 3 toes.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 24
Correct
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A 23 year old man presents with a painful right elbow and left Achilles tendon. He also gives history of dysuria, fever and conjunctivitis. Examination reveals macules and pustules on his hands. He has returned from a trip to Far East 3 weeks ago and admits to having unprotected sex. Which of the following is the most likely diagnosis?
Your Answer: Reactive arthritis
Explanation:Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. extraarticular dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum), oral ulcers. Other STDs including HIV, syphilis have different presentations. Psoriatic arthritis is not commonly associated with urethritis and conjunctivitis.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 25
Incorrect
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Which one of the following is able to move across cell membranes by passive diffusion?
Your Answer: Glucose
Correct Answer: CO2
Explanation:The cell membrane is permeable to water molecules and a few other small, uncharged, molecules like oxygen (O2) and carbon dioxide (CO2). Larger molecules like glucose or charged ions are unable to cross passively.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 26
Incorrect
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The reflex responses activated by cold are controlled by which area?
Your Answer: Anterior hypothalamus
Correct Answer: Posterior hypothalamus
Explanation:The posterior nucleus of the hypothalamus is responsible for thermoregulation and thermogenesis. Studies have shown that the neurons in the posterior hypothalamus which mediate the reflex of shivering are sensitive to temperature; damage to this nucleus produces hypothermia.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 27
Incorrect
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A 48-year-old male with a history of bipolar disorder presents with acute confusion. In-transit to hospital he had a generalized seizure which terminated spontaneously after around 30 seconds. On arrival to the emergency department, his GCS is 14/15 and he is noted to have a coarse tremor. Suspecting a diagnosis of lithium toxicity, intravenous access is obtained, a blood sample was drawn for investigations and a saline infusion is started. The blood investigations revealed:Lithium level: 4.2 mmol/lNa+: 136 mmol/lK+: 4.6 mmol/lUrea: 8.1 mmol/lCreatinine: 99 µmol/lBicarbonate: 18 mmol/lWhat is the most appropriate management for the patient?
Your Answer: Intravenous hypertonic saline
Correct Answer: Arrange haemodialysis
Explanation:The presentation of the patient is typical of chronic lithium toxicity (due to the presence of mainly neurological manifestations). Additional to the blood investigations mentioned, urine analysis, electrolyte levels, and renal function should also be performed. A low urine Anion gap and a low urine specific gravity are highly suggestive of lithium toxicity.ECG obtained in this patient is likely to show: nonspecific, diffuse ST segment depression with T wave inversion.Acute lithium toxicity presents with more GI manifestations while, the clinical features of chronic lithium toxicity are mainly neurological and can include:Coarse tremors (fine tremors are seen in therapeutic levels), hyperreflexia, acute confusion, seizures, and coma.The management of lithium toxicity is as follows:Immediate GI decontamination with gastric lavage (in case of acute intoxication)Saline Administrations: the goal of saline administration is to restore GFR, normalize urine output and enhance lithium clearance.Haemodialysis remains the mainstay treatment for lithium toxicity as lithium is readily dialyzed because of water solubility, low volume of distribution, and lack of protein binding.The Extracorporeal Treatments in Poisoning Workgroup (EXTRIP Workgroup) recommendations for dialysis (extracorporeal treatment) in lithium toxicity include:• Impaired kidney function and lithium levels > 4.0 mEq/L• Decreased consciousness, seizures, or life-threatening dysrhythmias, regardless of lithium levels• Levels are > 5.0 mEq/L, significant confusion is noted, or the expected time to reduce levels to < 1.0 mEq/L is more than 36 hoursAs post-dialysis rebound elevations in lithium levels have been documented, continuous veno-venous hemofiltration (CVVH) has been advocated.
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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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Question 29
Correct
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In Jugular vein pressure the “a” wave represents?
Your Answer: Atrial systole
Explanation:The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease. Classically three upward deflections and two downward deflections have been described: The upward deflections are the a (atrial contraction), c (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and v = venous filling.The downward deflections of the wave are the x (the atrium relaxes and the tricuspid valve moves downward) and the y descent (filling of ventricle after tricuspid opening).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 30
Incorrect
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Which of the following do not pass through the cavernous sinus?
Your Answer: CN 5
Correct Answer: CN 2
Explanation:Oculomotor nerve (N3), trochlear nerve (N4), ophthalmic and mandibular divisions of the trigeminal nerve (N5) pass along its lateral border. The abducent nerve (N6) passes through it along with the internal carotid artery.
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This question is part of the following fields:
- Medicine
- Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY
