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Question 1
Incorrect
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A 40-year-old male presents to your clinic complaining of a cough with bloody sputum for the past three months. He has also had fever, night sweats, and has noticed some weight loss over the past three months.
Which ONE of the following statements regarding this disease is correct?Your Answer: A Ghon focus typically appears at the apex of a lung
Correct Answer: It can be diagnosed using the Ziehl-Neelson stain
Explanation:Tuberculosis is an infection caused by the microorganism Mycobacterium tuberculosis. TB can affect any organ system in the body, but it most commonly affects the lungs, followed by the lymph nodes.
Option Tuberculosis is spread by the faecal-oral route: It is spread by inhalation of droplet nuclei.
There are different methods to diagnose a tuberculosis infection.
1) Direct Microscopy: The organisms are visualised using Ziehl-Neelsen or Auramine staining. This is the quickest method to establish a diagnosis and start treatment.
2) Culture: M. tuberculosis can be grown on Lowenstein-Jensen or Ogawa mediums, but it can take up to 8 weeks; therefore, ZN staining is also performed to start treatment immediately.Option There are several types of vaccine currently available: The BCG vaccine is the only vaccine approved to prevent TB and is administered at birth.
Option Miliary tuberculosis refers to tuberculosis that affects the spine: Miliary tuberculosis refers to a tuberculosis infection disseminated throughout the body’s organ systems via the blood or lymphatics. Pott’s disease is extrapulmonary TB that affects the spine. It usually affects the lower thoracic and upper lumbar regions.
Option A Ghon focus typically appears at the apex of a lung: The Ghon focus is a primary sign of TB that forms in the lung of previously unaffected patients. It typically occurs in the mid or lower zones of the lung.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 2
Incorrect
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Parathyroid hormone is released by which of the following:
Your Answer: Parafollicular cells of the thyroid gland
Correct 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 3
Correct
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How is measles primarily transmitted:
Your Answer: Respiratory droplet route
Explanation:Measles belongs to the paramyxoviridae group of viruses. The incubation period is 7-18 days (average 10) and it is spread by airborne or droplet transmission. The classical presentation is of a high fever with coryzal symptoms and photophobia with conjunctivitis often being present. The rash that is associated is a widespread erythematous maculopapular rash. Koplik spots are pathognomonic for measles, and are the presence of white lesions on the buccal mucosa.
Differential diagnoses would include:
Rubella
Roseola infantum (exanthem subitom)
Scarlet fever
Kawasaki disease
Erythema infectiosum (5thdisease)
Enterovirus
Infectious mononucleosis
Diagnosis can be confirmed by the following means:
Salivary swab for measles specific IgM
Serum sample for measles specific IgM
Salivary swab for RNA detection
Possible complications include:
Otitis media
Febrile convulsions
Pneumonia
Bronchiectasis
Diarrhoea
Meningitis
Encephalitis
Immunosuppression
Subacute sclerosing panencephalitis
Death -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 4
Correct
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Dexamethasone would be most useful for which of the following conditions:
Your Answer: Raised intracranial pressure secondary to malignancy
Explanation:Dexamethasone has a very high glucocorticoid activity in conjunction with insignificant mineralocorticoid activity. This makes it particularly suitable for high-dose therapy in conditions where fluid retention would be a disadvantage such as in the management of raised intracranial pressure or cerebral oedema secondary to malignancy. Dexamethasone also has a long duration of action and this, coupled with its lack of mineralocorticoid action makes it particularly suitable for suppression of corticotropin secretion in congenital adrenal hyperplasia. In most individuals a single dose of dexamethasone at night, is sufficient to inhibit corticotropin secretion for 24 hours. This is the basis of the ‘overnight dexamethasone suppression test’ for diagnosing Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 5
Incorrect
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Which of the following statements is correct with regards to Klebsiella spp?
Your Answer: They are not usually found in normal human flora.
Correct Answer: They are typically associated with nosocomial infection.
Explanation:Klebsiella is a type of bacteria commonly found in nature. In humans, the bacteria are often present in parts of the digestive tract and respiratory flora, where they do not generally cause problems. They are anaerobic Gram-negative rods. They are usually opportunistic pathogens which cause nosocomial infections, the most common ones being pneumonia and UTI.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 6
Incorrect
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Which of the following statement is correct with regards to the female urethra?
Your Answer: The inferior aspect of the urethra is bound to the posterior surface of the vagina.
Correct Answer: The urethra opens in the vestibule that lies between the labia minora.
Explanation:The urethra in women is short (about 4 cm long), and begins at the base of the bladder. Its course runs inferiorly through the urogenital diaphragm, then into the perineum. It then opens in the vestibule which lies between the labia minora. The inferior aspect of the urethra is bound to the anterior surface of the vagina. The urethral opening is anterior to the vaginal opening in the vestibule. As the urethra passes through the pelvic floor, it is surrounded by the external urethral sphincter.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 7
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: Adenovirus
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 8
Correct
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Which of the following muscles acts as an extensor of the shoulder joint?
Your Answer: Teres major
Explanation:The glenohumeral joint possesses the capability of allowing an extreme range of motion in multiple planes.
Flexion – Defined as bringing the upper limb anterior in the sagittal plane. The usual range of motion is 180 degrees. The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.
Extension—Defined as bringing the upper limb posterior in a sagittal plane. The normal range of motion is 45 to 60 degrees. The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.
Internal rotation—Defined as rotation toward the midline along a vertical axis. The normal range of motion is 70 to 90 degrees. The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.
External rotation – Defined as rotation away from the midline along a vertical axis. The normal range of motion is 90 degrees. Primarily infraspinatus and teres minor are responsible for the motion.
Adduction – Defined as bringing the upper limb towards the midline in the coronal plane. Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.
Abduction – Defined as bringing the upper limb away from the midline in the coronal plane. The normal range of motion is 150 degrees. Due to the ability to differentiate several pathologies by the range of motion of the glenohumeral joint in this plane of motion, it is essential to understand how different muscles contribute to this action.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 9
Correct
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A patient is sent in to ED by her GP with hyponatraemia and hyperkalaemia. There is most likely to be a deficiency in which of the following hormones:
Your Answer: Aldosterone
Explanation:A deficiency of aldosterone, as seen in adrenal insufficiency, can result in hyponatraemia and hyperkalaemia.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 10
Incorrect
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Regarding acute myeloid leukaemia (AML), which of the following statements is CORRECT:
Your Answer: AML is characterised by plasma cell accumulation on the bone marrow.
Correct Answer: AML becomes increasingly common with age.
Explanation:Acute myeloid leukaemia (AML) is the most common form of acute leukaemia in adults and becomes increasingly common with age, with a median onset of 65 years. It forms only a minor fraction (10 – 15%) of childhood leukaemia. The clinical features of AML typically presents with clinical features secondary to leukaemic infiltration of bone marrow and extramedullary sites:
Anaemia (lethargy, pallor and breathlessness)
Thrombocytopaenia (petechiae, bruising, epistaxis, haemorrhage) – often profound
Neutropenia (infections)
Hepatosplenomegaly
Gingival infiltration
Central nervous system involvement in AML is uncommon.
Leukaemia cutis is the infiltration of neoplastic leukocytes in the skin. It occurs in approximately 10% of patients with AML.Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count is usually increased and blood film examination typically shows a variable number of blast cells. The bone marrow is hypercellular and typically contains many blast cells.. The prognosis for patients with AML has been improving steadily, particularly for those under 60 years of age, and approximately one-third of patients of this group can expect to achieve long-term cure. For the elderly, the situation is poor and less than 10% of those over 70 years of age achieve long-term remission.
CML is commonly associated with the Philadelphia chromosome. The Philadelphia chromosome is present in only 1% of adults AML cases.
Lymphadenopathy is rare in AML. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 11
Correct
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A patient presents to your Emergency Department with a laceration on their buttocks requiring closure with sutures.
What stage of wound healing is the first to reach completion?Your Answer: Haemostasis
Explanation:The stages of wound healing are: haemostasis, inflammatory, proliferative and remodelling (maturation) phases in that order. The first stage in the healing process of a laceration is haemostasis. Haemostasis is the process of the wound being closed by clotting.
The inflammatory phase occurs just after and up to 48 hours after injury– Blood vessels dilate to allow white blood cells, antibodies, growth factors, enzymes and nutrients to reach the wounded area leading to the characteristic signs of inflammation seen.
Epithelialisation and angiogenesis are not phases of wound healing but occur during the proliferative phase. This ia after haemolysis and inflammation phases have occurred.
The maturation phase is the final phase and occurs when the wound has closed. It involves remodelling of collagen from type III to type I. Apoptosis remove unwanted cells, cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases. This can continues for up to 1 year after injury.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 12
Incorrect
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Insulin binds to the insulin receptor (IR) on cell surfaces to exert its action. The IR is a very specific transmembrane receptor belonging to the tyrosine kinase receptor class.
One of these also activates the IR:
Your Answer: Somatostatin
Correct Answer: IGF-I
Explanation:Insulin receptor (IR), in addition to being activated by insulin, is also activated by IGF-I and IGF-II.
The IR is a dimer with two identical subunits spanning the cell membrane and are connected by a single disulphide bond. The two sub-units include: The alpha chain situated on the exterior of the cell membrane and the beta chain spanning the cell membrane in a single segment.
When insulin is detected, the alpha chains move together folding around the insulin making the beta chains move together, converting them into an active tyrosine kinase. This initiates a phosphorylation cascade increasing the expression of GLUT4 and allowing uptake of glucose by cells.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 13
Incorrect
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A 23-year-old has a known diagnosis of HIV. Blood is sent to the laboratory for tests.
AIDS be diagnosed at a CD4 counts below?Your Answer: 1000 cells/mm 3
Correct Answer: 200 cells/mm 3
Explanation:A normal CD4 count ranges from 500-1000 cells/mm3.
At CD4 count of less than 350 cells/mm3 treatment with anti-retroviral therapy should be considered.
At a CD4 count of >200 cells/mm3 AIDS is diagnosed.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 14
Incorrect
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You intend to suture a hand wound with plain 1 percent lidocaine.
In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?Your Answer: 10 mcg lidocaine hydrochloride
Correct Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 15
Correct
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A 32-year-old woman with a history of bipolar disorder exhibits lithium toxicity symptoms.
Which of the following is the MOST LIKELY feature to be present?Your Answer: Clonus
Explanation:Lithium toxicity manifests itself in the following ways:
Ataxia
Clonus
Coma
Confusion
Convulsions
Diarrhoea
Increased muscle tone
Nausea and vomiting
Nephrogenic diabetes insipidus
Renal failure
Tremor -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 16
Correct
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A 25-year-old girl just got back from a trip to Northern India. She complains of headaches and intermittent fever. The fever starts with intense chills, then feels very hot, followed by profuse sweating. She is drowsy and is running a fever of 39.0°C. On examination, there are no palpable lymph nodes or rash seen. She has hepatosplenomegaly.
Which one of the following is the most likely diagnosis?Your Answer: Malaria
Explanation:Malaria is a protozoal infection of red blood cells and the liver. It is caused by the parasite belonging to the genus Plasmodium. It is transmitted by the female mosquito Anopheles.
Several species with distinct features:
P. vivax/P. ovale
P. malariae
P. falciparumThe common symptoms of malaria are:
Paroxysms of fever – a cyclical occurrence of:
1) a cold phase – the patient experiences intense chills
2) a hot stage – the patient feels extremely hot
3) a sweating stage – the fever declines and the patient sweats profusely
– Fever recurs at regular intervals (48hrs, 72hrs): Variable by species of PlasmodiumAnaemia (RBC infection)
– Severity varies by species of Plasmodium
– Haemolytic: sometimes jaundiceSplenomegaly
Also nonspecific symptoms:
– Sweating
– fatigue
– malaise
– arthralgias
– headache
– Sometimes cough, vomiting, diarrhoea -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 17
Incorrect
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Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:
Your Answer: There is strong correlation between two variables
Correct Answer: The two variables are directly proportional
Explanation:A positive correlation coefficient means that the two variables are directly proportional e.g. height and weight in healthy growing children.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 18
Incorrect
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Regarding iron deficiency anaemia, which of the following statements is INCORRECT:
Your Answer: Blood loss due to menorrhagia is the most common cause of iron deficiency anaemia in pre-menopausal women in the UK.
Correct Answer: Dietary insufficiency is the most common cause of iron deficiency anaemia in adult men in the UK.
Explanation:Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia in adult men and postmenopausal women.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 19
Incorrect
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Which of the following accurately describes the extensor pollicis brevis muscle?
Your Answer: Its tendon forms the medial border of the anatomical snuffbox
Correct Answer: It lies on the medial side of abductor pollicis longus
Explanation:Extensor pollicis brevis is a short and slender muscle located in the posterior compartment of the forearm, extending from the posterior surface of radius to the proximal phalanx of thumb. It is one of the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus and extensor indicis muscles.
Extensor pollicis brevis is a deep extensor of the thumb that lies deep to extensor digitorum muscle. It sits directly medial to abductor pollicis longus and posterolateral to extensor pollicis longus muscle. Just above the wrist, extensor pollicis brevis obliquely crosses the tendons of extensor carpi radialis brevis and extensor carpi radialis longus muscles.
Extensor pollicis brevis is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor pollicis brevis receives its blood supply by posterior interosseous artery and perforating branches from the anterior interosseous artery, which are the branches of common interosseous artery. The common interosseous artery arises immediately below the tuberosity of radius from the ulnar artery.
Together with extensor pollicis longus, extensor pollicis brevis is in charge of extension of the thumb in the first metacarpophalangeal joint. It also extends the thumb in the carpometacarpal joint of the thumb. This movement is important in the anatomy of the grip, as it enables letting go of an object. As it crosses the wrist, extensor pollicis brevis also participates in the extension and abduction of this joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Incorrect
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Regarding apoptosis, which of the following statements is INCORRECT:
Your Answer: Apoptosis is mediated by activation of a caspase cascade.
Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.
Explanation:Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
