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  • Question 1 - The steps of cardiac cycle in sequence are: ...

    Incorrect

    • The steps of cardiac cycle in sequence are:

      Your Answer: Isovolumetric relaxation, isovolumetric contraction, ejection, passive ventricular filling, active ventricular filling

      Correct Answer: Isovolumic contraction, ejection, isovolumic relaxation, passive ventricular filling, active ventricular filling.

      Explanation:

      The cardiac cycle refers to a complete heartbeat from its generation to the beginning of the next beat, and so includes the diastole, the systole, and the intervening pause.1st stage: diastole, or passive filling is when the semilunar valves (the pulmonary valve and the aortic valve) close, the atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the whole heart is relaxed. 2nd stage: atrial systole, is when the atrium contracts, and blood flows from atrium to the ventricle (active filling).3rd stage: isovolumic contraction is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. 4th stage: ventricular ejection, is when the ventricles are contracting and emptying, and the semilunar valves are open. 5th stage: isovolumic relaxation time, pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      62.2
      Seconds

  • Question 2 - The chemosensitive area in the medulla responds to: ...

    Incorrect

    • The chemosensitive area in the medulla responds to:

      Your Answer: Low oxygen and high carbon dioxide

      Correct Answer: High hydrogen and high carbon dioxide

      Explanation:

      The chemosensitive area in the medulla responds mainly to high pH levels and carbon dioxide levels. Baroreceptors in the carotid and aortic body respond mainly to oxygen and carbon dioxide partial pressure in blood.

    • This question is part of the following fields:

      • Medicine
      • Respiratory
      51.7
      Seconds

  • Question 3 - A son has brought his 72-year-old mother to clinic. He is concerned about...

    Incorrect

    • A son has brought his 72-year-old mother to clinic. He is concerned about her short-term memory problems for the past 10 months. He has to remind her to take her medications and she has had two incidents of falling over in the last 10 months. Which of the following assists in the diagnosis of above condition?

      Your Answer: Loss of control of bladder

      Correct Answer: Progressive loss of function

      Explanation:

      The clinical presentation is dementia. To differentiate Alzheimer disease and vascular dementia, the progressive loss of function is important. Progressive loss of function is usually associated with vascular dementia and rest of the responses are associated with Alzheimer disease.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      64.3
      Seconds

  • Question 4 - Xanthines such as caffeine and theophylline are positively inotropic due to: ...

    Incorrect

    • Xanthines such as caffeine and theophylline are positively inotropic due to:

      Your Answer: Circulating catecholamines

      Correct Answer: Inhibition of cAMP breakdown

      Explanation:

      Xanthines exert their positive inotropic effect by inhibiting the breakdown of the cAMP resulting in stronger and sustained contractions.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      64.3
      Seconds

  • Question 5 - Physiological effects of T3 on the heart include all the following except: ...

    Incorrect

    • Physiological effects of T3 on the heart include all the following except:

      Your Answer: Increased number of β1-adrenergic receptors

      Correct Answer: Increased expression of β-myosin heavy chain gene

      Explanation:

      Tri-iodothyronine, also known as T3, is a hormone which can affect almost every system in the human body. In the heart, it increases the number of β1-adrenergic receptors, enhances the response to circulating catecholamines, increases the proportion of α-myosin heavy chains in the atria, and increases the expression of serca pump gene.

    • This question is part of the following fields:

      • Endocrinology
      • Medicine
      85.2
      Seconds

  • Question 6 - Regarding taste threshold and intensity discrimination: ...

    Correct

    • Regarding taste threshold and intensity discrimination:

      Your Answer: 30% change in concentration of substance tasted is necessary before an intensity difference can be detected

      Explanation:

      The ability of humans to differentiate differences in intensity of taste is poor. A 30% change in the concentration of the substance being tasted is required before an intensity difference is perceived.

    • This question is part of the following fields:

      • Medicine
      • Neurology
      6.7
      Seconds

  • Question 7 - Which of the following results in the resting membrane potential of a myocyte?...

    Correct

    • Which of the following results in the resting membrane potential of a myocyte?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      14.1
      Seconds

  • Question 8 - Within the hypothalamus, the dopamine-secreting neurones of the intrahypothalamic system have their cell...

    Correct

    • Within the hypothalamus, the dopamine-secreting neurones of the intrahypothalamic system have their cell bodies in which nuclei?

      Your Answer: Arcuate

      Explanation:

      Arcuate nucleus dopaminergic neurons consist of a single group of neurons that project to the median eminence where they release dopamine into the hypophyseal portal circulation to inhibit pituitary prolactin secretion.

    • This question is part of the following fields:

      • Endocrinology
      • Medicine
      188
      Seconds

  • Question 9 - What effect does osmotic diuresis have on net Na+ excretion? ...

    Incorrect

    • What effect does osmotic diuresis have on net Na+ excretion?

      Your Answer: Markedly decreased Na+ excretion

      Correct Answer: Markedly increased Na+ excretion 

      Explanation:

      Osmotic diuresis is the increase of urination rate caused by the presence of certain substances in the small tubes of the kidneys. The excretion occurs when substances such as glucose enter the kidney tubules and cannot be reabsorbed (due to a pathological state or the normal nature of the substance). The substances cause an increase in the osmotic pressure within the tubule, causing retention of water within the lumen, and thus reduces the reabsorption of water, increasing urine output (i.e. diuresis). Sodium, chloride, potassium are markedly excreted in osmotic diuresis.

    • This question is part of the following fields:

      • Medicine
      • Renal
      47.5
      Seconds

  • Question 10 - Regarding transportation of iron in the body, the process in which iron is...

    Incorrect

    • Regarding transportation of iron in the body, the process in which iron is transported from the enterocyte into the blood occurs using which transporter protein:

      Your Answer: Transferrin

      Correct Answer: Ferroportin

      Explanation:

      Divalent metal transporter 1 (DMT1) transport several divalent metals including iron across the enterocyte’s cell membrane into the cell. The cell can then release it into the body via the only known iron exporter in mammals, ferroportin.

    • This question is part of the following fields:

      • Haematology
      • Medicine
      47.5
      Seconds

  • Question 11 - Which two ducts form the ampulla of Vater? ...

    Incorrect

    • Which two ducts form the ampulla of Vater?

      Your Answer: The pancreatic duct of Wirsung and the duct of Santorini

      Correct Answer: The common bile duct and the pancreatic duct of Wirsung

      Explanation:

      The ampulla of Vater, also known as the hepatopancreatic ampulla or the hepatopancreatic duct, is formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla.

    • This question is part of the following fields:

      • Gastrointestinal
      • Medicine
      130.8
      Seconds

  • Question 12 - A 22 year old nulliparous female presents with shortness of breath. She has...

    Incorrect

    • A 22 year old nulliparous female presents with shortness of breath. She has a history of recurrent deep vein thrombosis. Complete blood count and clotting screen reveals the following results:Hb: 12.4 g/dl Plt: 137 WBC: 7.5*109/l PT: 14 secs APTT: 46 secs Which of the following would be the most likely diagnosis?

      Your Answer: Activated protein C resistance

      Correct Answer: Antiphospholipid syndrome

      Explanation:

      The combination of APTT and low platelets with recurrent DVTs make antiphospholipid syndrome the most likely diagnosis.

    • This question is part of the following fields:

      • Connective Tissue
      • Medicine
      53.5
      Seconds

  • Question 13 - Which one of the following is able to move across cell membranes by...

    Incorrect

    • Which one of the following is able to move across cell membranes by passive diffusion?

      Your Answer: Na+

      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.

    • This question is part of the following fields:

      • Cell Biology
      • Medicine
      179.1
      Seconds

  • Question 14 - Microtubule subunits include: ...

    Incorrect

    • Microtubule subunits include:

      Your Answer: Alpha tubulin only

      Correct Answer: Alpha and beta tubulin

      Explanation:

      Microtubules are long, hollow cylinders made up of polymerised α- and β-tubulin dimers.

    • This question is part of the following fields:

      • Cell Biology
      • Medicine
      13.7
      Seconds

  • Question 15 - Which of the following is responsible for transporting both glucose and fructose into...

    Incorrect

    • Which of the following is responsible for transporting both glucose and fructose into the interstitium?

      Your Answer: SGLT 2

      Correct Answer: GLUT 2

      Explanation:

      Absorption of glucose involves transport from the intestinal lumen, across the epithelium and into blood. The transporter that carries glucose and galactose into the enterocyte is the sodium-dependent hexose transporter, known as SGLT1. As the name indicates, this molecule transports both glucose and sodium ions into the cell. Once absorbed into the enterocyte, glucose must be exported from the cell into blood. Sodium is rapidly shuttled out in exchange for potassium by Na+/K+ ATPase pumps on the basolateral membrane, and that process maintains the electrochemical gradient across the epithelium. Glucose, galactose and fructose are transported out of the enterocyte into the interstitium and in turn into the blood through another hexose transporter (called GLUT-2) in the basolateral membrane. These monosaccharides then diffuse down a concentration gradient into capillary blood.

    • This question is part of the following fields:

      • Gastrointestinal
      • Medicine
      21.8
      Seconds

  • Question 16 - Of the daily production of CSF, the vast majority is produced in the:...

    Incorrect

    • Of the daily production of CSF, the vast majority is produced in the:

      Your Answer: Foramen of Magendie

      Correct Answer: Choroid plexus

      Explanation:

      About 80% of CSF is produced by the choroid plexus. It is also produced by a single layer of column shaped ependymal cells.

    • This question is part of the following fields:

      • Medicine
      • Neurology
      76.3
      Seconds

  • Question 17 - Transport of Iron into enterocytes occurs via which membrane transporter? ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Medicine
      10.2
      Seconds

  • Question 18 - During quiet breathing the diaphragm’s role accounts for what percent of respiration? ...

    Correct

    • During quiet breathing the diaphragm’s role accounts for what percent of respiration?

      Your Answer: 75%

      Explanation:

      The contraction of the diaphragm accounts for approximately 75% of the air movement during normal breathing.

    • This question is part of the following fields:

      • Medicine
      • Respiratory
      12
      Seconds

  • Question 19 - The lower oesophageal sphincter is under neural control. Which of the following causes...

    Incorrect

    • The lower oesophageal sphincter is under neural control. Which of the following causes contraction of the intrinsic sphincter?

      Your Answer: Nitric oxide

      Correct Answer: Acetylcholine

      Explanation:

      The lower oesophageal sphincter (LOS) is a specific region of the oesophageal circular smooth muscle. It allows the passage of a food bolus to the stomach and prevents the reflux of gastric contents into the oesophagus. The tone of the LOS is myogenic in origin and depends on smooth muscle properties that lead to the opening of Ca2+ channels but can also be modulated by enteric motor neurons, the parasympathetic and sympathetic extrinsic nervous system and several neurohumoral substances. Nitric oxide causes LOS relaxation. Acetylcholine and tachykinins are involved in the LOS contraction.

    • This question is part of the following fields:

      • Gastrointestinal
      • Medicine
      26.5
      Seconds

  • Question 20 - During bone growth-the epiphysis are separated from the diaphysis by actively proliferating cartilage...

    Incorrect

    • During bone growth-the epiphysis are separated from the diaphysis by actively proliferating cartilage known as:

      Your Answer: Limiting plate

      Correct Answer: Epiphysial plate

      Explanation:

      The epiphysial plate, physis, or growth plate, is a hyaline cartilage plate located near the ends of long bones; it consists of growing tissue. It is found in children and teenagers; in adults, it is replaced by an epiphysial line or epiphysial closure. The epiphysial plate is divided into zones: zone of reserve, proliferation, maturation and hypertrophy, calcification, and ossification.

    • This question is part of the following fields:

      • Endocrinology
      • Medicine
      56.5
      Seconds

  • Question 21 - In a patient with prostate cancer, what is the mechanism by which goserelin...

    Correct

    • In a patient with prostate cancer, what is the mechanism by which goserelin acts?

      Your Answer: GnRH agonist

      Explanation:

      Androgen deprivation therapy (ADT) for prostate cancer:Goserelin (Zoladex) is a synthetic gonadotropin-releasing hormone (GnRH) analogue; chronic stimulation of goserelin results in suppression of LH, FSH serum levels thereby preventing a rise in testosterone.Dosage form: 3.6 mg/10.8mg implants.Adverse effects include flushing, sweating, diarrhoea, erectile dysfunction, less commonly, rash, depression, hypersensitivity, etc.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      23.1
      Seconds

  • Question 22 - During strenuous exercise the PO2 of mixed venous blood is: ...

    Incorrect

    • During strenuous exercise the PO2 of mixed venous blood is:

      Your Answer: 15 mmHg

      Correct Answer: 25 mmHg

      Explanation:

      During strenuous exercise the PO2 of mixed venous blood is less than 30 mmHg.

    • This question is part of the following fields:

      • Medicine
      • Respiratory
      31
      Seconds

  • Question 23 - What type of intercellular connection found between cardiac muscle fibers allow for the...

    Correct

    • What type of intercellular connection found between cardiac muscle fibers allow for the spread of excitation from one cell to another?

      Your Answer: Gap junctions

      Explanation:

      The cardiac muscles have gap junctions in-between the cells. They form low resistance passages, which allow ions to diffuse through every muscle fiber rapidly and result in the cardiac muscles functioning as a syncytium, without any protoplasmic bridges involved.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      66
      Seconds

  • Question 24 - A 68 year old male, previously diagnosed with osteoarthritis presents to your clinic...

    Incorrect

    • A 68 year old male, previously diagnosed with osteoarthritis presents to your clinic with acute on chronic pain in his big toe. Past history is significant for hypertension for which he takes Bendroflumethiazide 5mg daily. Examination reveals an erythematous, red hot metatarsophalangeal joint that has a knobbly appearance. X-ray shows punched out bony cysts. Which of the following would be the most appropriate long term management for this patient?

      Your Answer: Start ibuprofen

      Correct Answer: Stop Bendroflumethiazide and substitute a calcium antagonist

      Explanation:

      The most likely diagnosis is chronic tophaceous gout, which is classically associated with chronic renal impairment or long term diuretic therapy. There is tophus formation due to urate crystal deposition in and around the joint. These tophi can also form in the bones and soft tissues. Renal manifestations with uric acid include nephrolithiasis and uric acid nephropathy. Whenever there is an acute on chronic attack of gout, the inciting cause must be established and in case of diuretic use, they should be immediately replaced with another medication. Allopurinol is never started during an acute episode. it is first allowed to settle before administration of allopurinol. Although dietary restriction must be observed in people with a propensity of gout, this scenario clearly presents diuretics as the cause.

    • This question is part of the following fields:

      • Connective Tissue
      • Medicine
      5.8
      Seconds

  • Question 25 - Erythropoietin is synthesized by which cells of the nephron? ...

    Incorrect

    • Erythropoietin is synthesized by which cells of the nephron?

      Your Answer: Afferent arteriolar cells

      Correct Answer: Tubular interstitial cells

      Explanation:

      Erythropoietin is produced by interstitial fibroblasts in the kidney in close association with peritubular capillary and proximal convoluted tubule. It is also produced in perisinusoidal cells in the liver. While liver production predominates in the fetal and perinatal period, renal production is predominant during adulthood.

    • This question is part of the following fields:

      • Medicine
      • Renal
      67.8
      Seconds

  • Question 26 - Which hormone results in the production of pancreatic juice rich in enzymes but...

    Correct

    • Which hormone results in the production of pancreatic juice rich in enzymes but low in volume?

      Your Answer: Cholecystokinin

      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.

    • This question is part of the following fields:

      • Gastrointestinal
      • Medicine
      6.9
      Seconds

  • Question 27 - Which of the following statements is true of the beta- lactams: ...

    Correct

    • Which of the following statements is true of the beta- lactams:

      Your Answer: Co-amoxiclav is more likely to cause obstructive jaundice than amoxicillin

      Explanation:

      β-lactam antibiotics are a class of broad-spectrum antibiotics, consisting of all antibiotic agents that contain a β-lactam ring in their molecular structures. This includes penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems. Most β-lactam antibiotics work by inhibiting cell wall biosynthesis in the bacterial organism and are the most widely used group of antibiotics. Bacteria often develop resistance to β-lactam antibiotics by synthesizing a β-lactamase, an enzyme that attacks the β-lactam ring. To overcome this resistance, β-lactam antibiotics are often given with β-lactamase inhibitors such as clavulanic acid. Immunologically mediated adverse reactions to any β-lactam antibiotic may occur in up to 10% of patients receiving that agent (a small fraction of which are truly IgE-mediated allergic reactions). Rarely, cholestatic jaundice has been associated with Co-amoxiclav (amoxicillin/clavulanic acid). The reaction may occur up to several weeks after treatment has stopped, and usually takes weeks to resolve. It is more frequent in men, older people, and those who have taken long courses of treatment; the estimated overall incidence is one in 100,000 exposures.

    • This question is part of the following fields:

      • Infectious Diseases
      • Medicine
      6.8
      Seconds

  • Question 28 - An 81-year-old male presented to the emergency department following a fall at home....

    Correct

    • An 81-year-old male presented to the emergency department following a fall at home. He was diagnosed with osteoporosis about five years ago. He presently complains of significant low back pain. A lumbar spine X-ray was suggestive of a fractured lumbar vertebra. A subsequent MRI scan of the lumbosacral spine revealed a new L3 burst fracture with no evidence of cord compression. A neurosurgical consult was sought and conservative management was planned accordingly in the form of pain control, physiotherapy, and mobilization (as allowed by the pain). He also has been diagnosed with chronic renal disease (stage IV) with a creatinine clearance of 21ml/min, he was started on a Buprenorphine patch. Which of the following opioids would be safest to use for his breakthrough pain?

      Your Answer: Oxycodone

      Explanation:

      Oxycodone is a safer opioid to use in patients with moderate to end-stage renal failure.Active metabolites of morphine accumulate in renal failure which means that long-term use is contraindicated in patients with moderate/severe renal failure. These toxic metabolites can accumulate causing toxicity and risk overdose. Oxycodone is mainly metabolised in the liver and thus safer to use in patients with moderate to end-stage renal failure with dose reductions.Adverse effects:Constipation is the most common overall side effect. Others include: asthenia, dizziness, dry mouth, headache, nausea, pruritus, etc. Medications in renal failure:Drugs to be avoided in patients with renal failureAntibiotics: tetracycline, nitrofurantoinNSAIDsLithiumMetforminDrugs that require dose adjustment:Most antibiotics including penicillin, cephalosporins, vancomycin, gentamicin, streptomycinDigoxin, atenololMethotrexateSulphonylureasFurosemideOpioidsRelatively safe drugs:Antibiotics: erythromycin, rifampicinDiazepamWarfarin

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      50.9
      Seconds

  • Question 29 - All of the following are consistent with the indicator dilution method except--- ...

    Incorrect

    • All of the following are consistent with the indicator dilution method except---

      Your Answer: Thermodilution is an example

      Correct Answer: In thermodilution, the indicator used is warm saline

      Explanation:

      In thermodilution, the indicator used is cold saline.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      40.5
      Seconds

  • Question 30 - When the heart rate is increased (to pathological levels) which of the following...

    Correct

    • When the heart rate is increased (to pathological levels) which of the following is correct when comparing the duration of diastole to systole?

      Your Answer: It is shortened to a greater degree

      Explanation:

      The duration of systole is more fixed than the duration of diastole. When the heart rate increases the timing of the systole remains more or less the same however diastole decreases.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      54.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (3/6) 50%
Medicine (16/31) 52%
Respiratory (2/3) 67%
Geriatrics (0/1) 0%
Endocrinology (1/3) 33%
Neurology (2/2) 100%
Renal (1/3) 33%
Haematology (2/2) 100%
Gastrointestinal (1/4) 25%
Connective Tissue (0/2) 0%
Cell Biology (2/2) 100%
Pharmacology (1/2) 50%
Infectious Diseases (1/1) 100%
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