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Question 1
Correct
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Which of the following drug can cause galactorrhoea?
Your Answer: Metoclopramide
Explanation:Metoclopramide causes extrapyramidal effects (especially in children and young adults), hyperprolactinaemia, and occasionally tardive dyskinesia on prolonged administration. Also reported are drowsiness, restlessness, diarrhoea, depression, neuroleptic malignant syndrome, rashes, pruritus, oedema.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 2
Correct
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If O2 makes up 21% of air, then at one atmosphere (760mmHg) it would be expected that the PO2 of inspired air should be 0,21 x 760 = 160mmHg. In the alveoli the actual measure is 149mmHg because…
Your Answer: Water is equilibrated with air
Explanation:There are several factors that determine the value of alveolar partial oxygen pressure including: the pressure of outside air, the partial pressure of inspired oxygen and carbon dioxide, the rates of total body oxygen consumption and carbon dioxide production, the rates of alveolar ventilation and perfusion. The alveolar partial pressure is lower than the atmospheric oxygen partial pressure. One reason is, as the air enters the lungs, it is humidified by the upper airway and thus the partial pressure of water vapour reduces the oxygen partial pressure as water is equilibrated with air.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 3
Correct
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Question 4
Incorrect
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Which vaso metabolite decreases coronary blood flow?
Your Answer: Lactate
Correct Answer: Endothelin
Explanation:Decreased O2, increased CO2, lactate, prostaglandins, adenine nucleotides, adenosine, H+, K+ and cyanide produce vasodilation and thus an increase in coronary blood flow.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 5
Incorrect
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Of the daily production of CSF, the vast majority is produced in the:
Your Answer: Foramen of Luschka
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.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 6
Incorrect
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A 32 year old woman presents with a painful elbow which she has been feeling for the past two weeks. Which of the following will be consistent with a diagnosis of tennis elbow?
Your Answer: Pain on pressure over the medial epicondyle
Correct Answer: Pain on wrist extension against resistance
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles and thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which will result in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 7
Correct
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Where in the gastrointestinal tract are valvulae conniventes?
Your Answer: Jejunum
Explanation:The circular folds (valves of Kerckring or valvulae conniventes) are large valvular flaps projecting into the lumen of the small intestine.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 8
Incorrect
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A 39 year old woman with a history of rheumatoid arthritis has recently been switched from methotrexate to leflunomide. Monitoring of full blood count and LFTs has been carried out. Which of the following parameters should also be monitored in this case?
Your Answer: QT interval on ECG
Correct Answer: Blood pressure
Explanation:Blood pressure should be routinely measured as leflunomide may cause hypertension and thus an increase in BP. It doesn’t cause changes in blood sugar levels, peak expiratory flow rate or haematuria.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 9
Correct
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Under normal conditions (where n represents the number of chromosome pairs), just before mitosis begins, how many chromosomes are contained in the nucleus of each somatic cell:
Your Answer: 4n
Explanation:In a normal somatic cell there are 2n chromosome but in a replicating cell just before mitosis the chromosomes duplicate but are still joined via the centrosome. Thus there are 4n chromosomes. After completion of mitosis the number goes back to 2n.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 10
Correct
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A 45-year-old male is brought to the emergency department after being found collapsed, outside a nightclub. The ER team found an empty bottle of amyl nitrate in his pocket. The patient is hypoxic with an O2 saturation of 84% and is confused. Which of the following is the best treatment for this patient?
Your Answer: Methylene blue
Explanation:The best treatment for the patient in question would be methylene blue.The most probable diagnosis in this patient is methemoglobinemia due to the ingestion of amyl nitrate.Amyl nitrate promotes the formation of methaemoglobin, which avidly conserves oxygen and leads to decreased tissue oxygen saturations. Treatment of choice includes methylene blue and vitamin C.Adverse effects:Benign side effects include green or blue discoloration of urine and patients should be forewarned. Significant side effects are based on methylene blue, itself, being an oxidizing agent and an inhibitor of monoamine oxidase A (MAO-A). As an oxidizing agent, methylene blue can actually precipitate methemoglobinemia or haemolysis in high doses or when ineffectively reduced. Methylene blue administration in a patient taking a serotonergic agents may predispose to serotonin syndrome.Note: Although methylene blue administration is controversial in the setting of G6PD-deficiency due to reduced levels of NADPH, it is not contraindicated and should be administered cautiously and judiciously.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 11
Incorrect
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Afferent A δ fibers from nociceptors terminate primarily on neurons in which lamina:
Your Answer: III, IV, V, VI
Correct Answer: I and V
Explanation:Nociceptors are receptors of pain sensation. There are 2 primary afferent/sensory pain fibers which transmit impulses from the receptor to the CNS, specifically to the dorsal horn of the spinal cord. The two fibers are A δ and C fibers. The dorsal horn of the spinal cord is the relay centre for sensory information converging from the periphery. Grey matter of the dorsal horn is subdivided in to laminae based on cytoarchitecture. C fibers terminate in lamina II the substantia gelatinosa. A δ fibers terminate primarily in lamina I but some project more deeply to terminate in lamina V.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 12
Incorrect
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Regarding cardiac contractility, catecholamines exert their inotropic effect via:
Your Answer: Β2-adrenergic receptors and gs
Correct Answer: Β1-adrenergic receptors and gs
Explanation:Catecholamines exert their inotropic effect on the heart via the B1 adrenergic receptors and Gs, stimulating adenyl cyclase and increasing the production of cAMP.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 13
Correct
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A 25-year-old male presented to accident and emergency 4 days ago, following an intentional paracetamol overdose. He had taken 20x 500mg tablets, all at once. He denies any alcohol intake. Blood investigations 4 hours after ingestion showed:Paracetamol: 14 mg/lINR: 1Liver enzymes: No abnormality detectedBilirubin: Mild elevationHe was seen by the mental health team and discharged. The blood investigations were repeated:Bilirubin: Within normal limitsUrea: 21 mmol/lCreatinine: 300 µmol/lWhat is the likely cause of these results?
Your Answer: Delayed paracetamol nephrotoxicity
Explanation:The most likely cause for these results is delayed paracetamol nephrotoxicity.The blood investigations of this patient are highly suggestive of acute kidney injury. Paracetamol overdose is well known to cause hepatotoxicity, but not for its delayed nephrotoxicity, especially in significant overdose. Appropriate monitoring of a patient’s blood tests is important.Management:NAC (N-Acetyl cysteine) has a clear role in preventing acetaminophen-induced liver necrosis. Although NAC has not been proven to be harmful to the kidney, its role in patients without hepatoxicity and only isolated renal dysfunction is uncertain.Other options:-There are no features in the history that are suggestive of dehydration and pre-renal AKI presenting in this manner in a 25-year-old would be very unusual.- Minimal change nephropathy typically presents with a nephrotic picture of kidney injury.- Berger’s more commonly presents with isolated haematuria.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 14
Correct
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The thalamus is a large collection of neuronal groups within the diencephalons which participates in:
Your Answer: Sensory, motor and limbic
Explanation:The thalamus has multiple functions. It is the relay station for every sensory system (except olfactory, regulates the sleep-wake cycle and consciousness and also relays motor information.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 15
Correct
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The structure of haemoglobin A in adults includes
Your Answer: Haem, globin polypeptide chains α and β
Explanation:Haemoglobin A (HbA), also known as adult haemoglobin or α2β2, is the most common human haemoglobin tetramer, comprising over 97% of the total red blood cell haemoglobin. It consists of two alpha chains and two beta chains.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 16
Incorrect
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Which of the following does not lower ventricular rate in atrial fibrillation?
Your Answer: Acetylcholine
Correct Answer: Adrenaline
Explanation:Adrenaline is a sympathetic neurotransmitter which increases the heart rate. During atrial fibrillation the atria is contracting at more than 200 beats/min. Acetylcholine is a parasympathetic neurotransmitter decreasing the heart rate. Digital also depresses the conduction at the AV conduction. Vagal discharge and occulocardiac reflux decrease the heart rate and convert the tachycardia into normal sinus rhythm.
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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 receptor type is associated with uterine contracture in pregnancy?
Your Answer: Β2
Correct Answer: Α1
Explanation:Alpha-1 adrenergic receptors cause uterine contraction during pregnancy. They are linked to Gq-proteins that activate smooth muscle contraction through the IP3 signal transduction pathway.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 18
Correct
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Question 19
Correct
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A 50-year-old male was under treatment for bipolar disease. He was brought to the emergency department as he had become increasingly confused over the past two days. He had vomiting and diarrhoea. He was also consuming and passing a lot of water.On examination, he was disoriented. He had vertical nystagmus and was ataxic.What two investigations are likely to lead to the correct diagnosis?
Your Answer: Desmopressin test and serum lithium level
Explanation:Desmopressin test (done to differentiate nephrogenic diabetes insipidus from central diabetes insipidus), and serum lithium levels can together confirm a diagnosis of lithium-induced nephrogenic diabetes insipidus.Bipolar disease is most often managed with mood stabilizers like lithium. This patient develops gastrointestinal symptoms followed by an acute confusional state associated with polyuria and polydipsia. These symptoms are suggestive of diabetes insipidus.In a case where these symptoms occur in a bipolar patient under treatment, lithium-induced nephrogenic diabetes insipidus should be considered as the most probable cause.Lithium intoxication can present with symptoms of nausea, vomiting, mental dullness, action tremor, weakness, ataxia, slurred speech, blurred vision, dizziness, especially vertical nystagmus and stupor or coma. Diffuse myoclonic twitching and nephrogenic diabetes insipidus can also occur. Such a clinical syndrome occurs above the serum level of lithium of 1.5–2.0 mEq/L.Management: – Correcting electrolyte abnormalities in patients with acute disease is critical and often life-saving.- Treatment should be initiated with parenteral fluids to replete hypovolemia (normal saline at 200-250 mL/h), followed by administration of hypotonic fluid (0.5% normal saline). – On the restoration of the volume status of the patient forced diuresis should be initiated by the administration of parenteral furosemide or bumetanide accompanied by continued intravenous hypotonic fluid administration to maintain volume status.- Polyuria is managed with hydrochlorothiazide combined with amiloride, acetazolamide.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 20
Incorrect
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According to the Vaughan William's classification of antiarrhythmic agents, lidocaine is a:
Your Answer: Class Ic agent
Correct Answer: Class Ib agent
Explanation:Lidocaine is an example of class IB antiarrhythmics.The Vaughan-Williams classification of antiarrhythmicsI: Membrane stabilizing agentsIA: Quinidine, Procainamide, DisopyramideIB: Lidocaine, MexiletineIC: Propafenone, Flecainide II: β blockers – Propranolol, EsmololIII: Agents widening AP – Amiodarone, Dronedarone, Dofetilide, Ibutilide, SotalolIV: Calcium channel blockers – Verapamil, DiltiazemV: Miscellaneous – Digoxin, adenosine, magnesium
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 21
Correct
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A 72 year old female, known with rheumatoid arthritis for last 17 years, presents with recurrent attacks of red eyes with a sensation of grittiness. Which of the following is most likely cause of the red eyes?
Your Answer: keratoconjunctivitis sicca
Explanation:Rheumatoid arthritis is an inflammatory systemic disease associated with some extraarticular manifestations. Keratoconjunctivitis sicca, episcleritis, scleritis, corneal changes, and retinal vasculitis are the most common ocular complications among extraarticular manifestations of RA. The overall prevalence of keratoconjunctivitis sicca also known as dry eye syndrome among patients of RA is 21.2% and is the most common with sense of grittiness in the eyes.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 22
Incorrect
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A 74 year old man presents with 12 kg weight loss and persistent back pain that is unrelated to activity for the past several months. Laboratory findings show :WCC: 6.7 x 109/l (5.4 neutrophils, 1.2 lymphocytes and 0.2 monocytes)Haemoglobin: 11.2 g/dlhaematocrit: 33.3%MCV: 88 flPlatelet count: 89 x 109/l.The biochemistry shows:sodium 144 mmol/lpotassium 4.5 mmol/lchloride 100 mmol/lbicarbonate 26 mmol/lurea 14 mmol/lcreatinine 90 μmol/la glucose of 5.4 mmol/l.A CT scan of the spine reveals scattered 0.4 to 1.2 cm bright lesions in the vertebral bodies.Which of the following additional laboratory test findings is he most likely to have?
Your Answer: Parathyroid hormone, intact, of 100 pg/ml (normal <65)
Correct Answer: Serum prostate specific antigen of 35 microgram/l
Explanation:Old age, persistent backache, weight loss, and osteosclerotic lesions make prostatic adenocarcinoma the most likely diagnosis. The sequelae include severe pain, pathological fractures, hypercalcemia and cord compression. Prostatic adenocarcinoma is detected by elevated levels of prostate specific antigen. Positive serology for borrelia burgdorferi would hint at Lyme disease which does not cause osteosclerotic bone lesions, neither would Neisseria gonorrhoeae have such a presentation.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 23
Incorrect
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A 26 year old woman is 32 weeks pregnant. She has a history of Sjogren Syndrome. The foetus would be at a risk for which of the following?
Your Answer: Complete heart block
Correct Answer: All correct
Explanation:Women with Sjögren syndrome are likely to experience more complications during pregnancy than women without an autoimmune disease as the anti-Ro and anti-La antibodies cross the placenta and lead to various life threatening complications. Studies show a high incidence of poor fetal outcomes for these patients. Congenital heart block, neonatal lupus, congestive cardiac failure, hydrops fetalis can all be caused as a result of Sjogren syndrome.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 24
Incorrect
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Neurons that are inactive during quiet breathing, become active when the respiratory drive for increased ventilation becomes greater than normal. These are located in the:
Your Answer: Nucleus of the tractus solitaries
Correct Answer: Ventral respiratory group
Explanation:The mechanism of control of ventilation is an interplay of multiple regions in the brain. Medullary respiratory centre sets the basic rhythm of breathing. The dorsal respiratory group integrates input from the stretch receptors and the chemoreceptors in the periphery and is composed mainly of inspiratory neurons which controls the basic rhythm of breathing. The ventral respiratory group generates breathing rhythm and integrates data coming in to the medulla. It contains both inspiratory and expiratory neurons. They are primarily active in exercise and stress.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 25
Incorrect
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In the urea cycle, which substance is formed in the mitochondria?
Your Answer: Arginine
Correct Answer: Carbamoyl phosphate
Explanation:Before the urea cycle begins ammonia is converted to carbamoyl phosphate in the mitochondria.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 26
Incorrect
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Which statement is correct about the clinical state of methemoglobinemia?
Your Answer: It cannot be precipitated by certain drugs.
Correct Answer: May arise due to a hereditary deficiency of NADH.
Explanation:Methaemoglobin is a form of haemoglobin that contains ferric [Fe3+] iron and has a decreased ability to bind oxygen. Spontaneously formed methaemoglobin is normally reduced by protective enzyme systems, e.g., NADH methaemoglobin reductase, hence a deficiency of NADH may result in increased levels of methaemoglobin
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This question is part of the following fields:
- Haematology
- Medicine
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Question 27
Correct
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Which of the following is not secreted by cells in the antrum of the stomach?
Your 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 28
Incorrect
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The function of the Golgi apparatus is
Your Answer: Cellular detoxification and drug metabolism
Correct Answer: Maturation of peptides secreted by the rER into functional proteins by glycosylation
Explanation:Steroidogenesis is a multi-step process that occurs in two organelles, the endoplasmic reticulum (ER) and the mitochondrion. The Golgi apparatus is a major collection and dispatch station of protein products received from the endoplasmic reticulum (ER). Proteins synthesized in the ER are packaged into vesicles, which then fuse with the Golgi apparatus. The majority of proteins synthesized in the rough ER undergo glycosylation which occurs in the Golgi apparatus. Glycosylation mainly refers in particular to the enzymatic process that attaches glycans to proteins, lipids, or other organic molecules. These cargo proteins are modified and destined for secretion via exocytosis or for use in the cell. The Golgi apparatus is also involved in lipid transport and lysosome formation.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 29
Incorrect
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Where is thyroglobulin produced?
Your Answer: Posterior pituitary
Correct Answer: Thyrocytes
Explanation:Thyroglobulin, or Tg, is a protein that functions as the precursor to thyroid hormones. It is synthesized by thyrocytes and then secreted into the colloid. It also functions as a negative-feedback regulator of thyroid hormone biosynthesis.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 30
Incorrect
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Choose the correct answer: The cerebrocerebellum…
Your Answer:
Correct Answer: All options are correct
Explanation:Cerebrocerebellum is comprised of two lateral regions, the cerebellar hemispheres and communicates with the cerebral cortex. It is principally responsible for controlling coordination of movement. Three fiber bundles carry the input and output of the cerebellum. There are three cerebellar peduncles with different connections and functions. The three are mainly, superior, middle and inferior. The superior cerebellar peduncle is also known as the “Brachium conjunctivum”. It predominantly contains efferent fibers from the cerebellar nuclei, as well as some afferents from the spinocerebellar tract. The efferent pathways include cerebellorubral, dentatothalamic, and fastigioreticular fibers. These are tracts projecting from the deep cerebellar nuclei to the thalamus and red nucleus. The middle cerebellar peduncle connects to the pontine nucleus and the dorsal spinocerebellar tracts run through the superior cerebellar peduncle
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This question is part of the following fields:
- Medicine
- Neurology
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