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  • Question 1 - The most likely cause of a low p(O2) in arterial blood is: ...

    Correct

    • The most likely cause of a low p(O2) in arterial blood is:

      Your Answer: Hypoxic hypoxia

      Explanation:

      Hypoxia is when the whole body or a region is deprived of adequate oxygen supply. Different types of hypoxia include the following:

      – Hypoxic hypoxia, which occurs due to poor oxygen supply, as a result of low partial pressure of oxygen in arterial blood. This could be due to low partial pressure of atmospheric oxygen (e.g., at high altitude), sleep apnoea, poor ventilation because of chronic obstructive pulmonary disease or respiratory arrest, or shunts. The other types of hypoxia have a normal partial pressure of oxygen.

      – Anaemic hypoxia occurs due to low total oxygen content of the blood, with a normal arterial oxygen pressure.

      – Hyperaemic hypoxia occurs due to poor delivery of oxygen to target tissues, such as in carbon monoxide poisoning or methemoglobinemia.

      – Histotoxic hypoxia results due to inability of the cells to use the delivered oxygen due to disabled oxidative phosphorylation enzymes.

      – Ischaemic (or stagnant) hypoxia occurs due to local flow restriction of well-oxygenated blood, seen in cases like cerebral ischaemia, ischaemic heart disease and intrauterine hypoxia.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      5.4
      Seconds
  • Question 2 - A 55 year old man presented with a 4 day history of cough...

    Correct

    • A 55 year old man presented with a 4 day history of cough and fever. His sputum culture showed the presence of Strep pneumoniae. Which of the following substances produced by the inflammatory cells will result in effective clearance of this organism from the lung parenchyma?

      Your Answer: Hydrogen peroxide

      Explanation:

      Hydrogen peroxide is produced by myeloperoxidase to form a potent oxidant that eliminates bacteria, but is not effective in chronic granulomatous diseases.

      Platelet activating factor will lead to the activation, adhesion and aggregation of platelets but will not directly kill bacteria.

      Prostaglandins cause vasodilation but do not activate neutrophils.

      Kallikrein promotes formation of bradykinin that leads to vasodilation.

      Leukreines increase vascular permeability.

      Cytokines are communicating molecules between immune cells but directly will not kill bacteria.

      Interleukins will regulate the immune response.

    • This question is part of the following fields:

      • Inflammation & Immunology; Respiratory
      • Pathology
      22.6
      Seconds
  • Question 3 - There are several mechanisms involved in the transport of sodium ions from blood...

    Correct

    • There are several mechanisms involved in the transport of sodium ions from blood to interstitial fluid of the muscle cells. Which of the following mechanisms best describes this phenomenon?

      Your Answer: Diffusion through channels between endothelial cells

      Explanation:

      Capillaries are the smallest of the body’s blood vessels, measuring 5–10 μm and they help to enable the exchange of water, oxygen, carbon dioxide, and many other nutrients and waste substances between the blood and the tissues surrounding them. The walls of capillaries are composed of only a single layer of cells, the endothelium. Ion channels are pore-forming proteins that help to establish and control the small voltage gradient that exists across the plasma membrane of all living cells by allowing the flow of ions down their electrochemical gradient. An ion channel is an integral membrane protein or more typically an assembly of several proteins. The archetypal channel pore is just one or two atoms wide at its narrowest point. It conducts a specific ion such as sodium or potassium and conveys them through the membrane in single file.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      40.9
      Seconds
  • Question 4 - A 59-year-old woman with hyperaldosteronism is prescribed a diuretic. Which of the following...

    Correct

    • A 59-year-old woman with hyperaldosteronism is prescribed a diuretic. Which of the following diuretics promotes diuresis by opposing the action of aldosterone?

      Your Answer: Potassium-sparing diuretic

      Explanation:

      The term potassium-sparing refers to an effect rather than a mechanism or location. Potassium-sparing diuretics act by either antagonising the action of aldosterone (spironolactone) or inhibiting Na+ reabsorption in the distal tubules (amiloride). This group of drugs is often used as adjunctive therapy, in combination with other drugs, for the management of chronic heart failure. Spironolactone, the first member of the class, is also used in the management of hyperaldosteronism (including Conn’s syndrome) and female hirsutism (due to additional antiandrogen actions).

    • This question is part of the following fields:

      • Physiology
      • Renal
      9.3
      Seconds
  • Question 5 - Which of the following compensatory parameters is responsible for causing an increase in...

    Correct

    • Which of the following compensatory parameters is responsible for causing an increase in the blood pressure in a 30 year old patient with a BP of 40 mmHg?

      Your Answer: Baroreceptor reflex

      Explanation:

      The baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for regulating blood pressure. It provides a negative feedback response in which an elevated blood pressure will causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise. The system relies on specialised neurones (baroreceptors) in the aortic arch, carotid sinuses and elsewhere to monitor changes in blood pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated by the autonomic nervous system. Baroreceptors include those in the auricles of the heart and vena cava, but the most sensitive baroreceptors are in the carotid sinuses and aortic arch. The carotid sinus baroreceptors are innervated by the glossopharyngeal nerve (CN IX); the aortic arch baroreceptors are innervated by the vagus nerve (CN X).

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      11.2
      Seconds
  • Question 6 - Purkinje fibres in the heart conduct action potentials at the rate of: ...

    Correct

    • Purkinje fibres in the heart conduct action potentials at the rate of:

      Your Answer: 1.5–4.0 m/s

      Explanation:

      Purkinje fibres control the heart rate along with the sinoatrial node (SA node) and the atrioventricular node (AV node). The QRS complex is associated with the impulse passing through the Purkinje fibres. These fibres conduct action potential about six times faster than the velocity in normal cardiac muscle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      6.5
      Seconds
  • Question 7 - A 60-year-old man complains of pain in his left thigh. An X-ray reveals...

    Correct

    • A 60-year-old man complains of pain in his left thigh. An X-ray reveals bowing of the affected femur, increased bone density, bony enlargement, abnormal bone architecture with coarse cortical trabeculations, and stress microfractures. Which is the most likely diagnosis in this case?

      Your Answer: Paget’s disease of bone

      Explanation:

      Paget’s disease of bone is a chronic disorder of the adult skeleton in which bone turnover is accelerated in localised areas, replacing normal matrix with softened and enlarged bone and causing gradual pain and deformity in some cases. It is more predominant in men over the age of 40. Characteristic X-ray findings include increased bone density, abnormal architecture with coarse cortical trabeculation or cortical thickening, bowing and bony enlargement; there might also be stress microfractures of the tibia or femur.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      19.9
      Seconds
  • Question 8 - Intravenous diazepam was administered to a man who was brought to the emergency...

    Correct

    • Intravenous diazepam was administered to a man who was brought to the emergency department with status epilepticus. He was administered 15 l/min oxygen via a reservoir bag mask. Blood investigations showed sodium = 140 mmol/l, potassium = 4 mmol/l and chloride = 98 mmol/l. His arterial blood gas analysis revealed pH 7.08, p(CO2)= 61.5 mmHg, p(O2) = 111 mmHg and standard bicarbonate = 17 mmol/l. This patient had:

      Your Answer: Mixed acidosis

      Explanation:

      Acidosis with high p(CO2) and low standard bicarbonate indicates mixed acidosis. Lower p(O2) is due to breathing of 70% oxygen. The prolonged seizures lead to lactic acidosis and the intravenous diazepam is responsible for the respiratory acidosis. Treatment includes airway manoeuvres and oxygen, assisted ventilation if needed, and treatment with fluids.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      72.6
      Seconds
  • Question 9 - An ECG of a 30 year old woman revealed low voltage QRS complexes....

    Correct

    • An ECG of a 30 year old woman revealed low voltage QRS complexes. This patient is most probably suffering from?

      Your Answer: Pericardial effusion

      Explanation:

      The QRS complex is associated with current that results in the contraction of both the ventricles. As ventricles have more muscle mass than the atria, they result in a greater deflection on the ECG. The normal duration of a QRS complex is 10s. A wide and deep Q wave depicts myocardial infarction. Abnormalities in the QRS complex maybe indicative of a bundle block, ventricular tachycardia or hypertrophy of the ventricles. Low voltage QRS complexes are characteristic of pericarditis or a pericardial effusion.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      9.4
      Seconds
  • Question 10 - The most important difference between interstitial fluid and plasma is the: ...

    Correct

    • The most important difference between interstitial fluid and plasma is the:

      Your Answer: Protein concentration

      Explanation:

      Interstitial fluid (or tissue fluid or intercellular fluid) is a solution that surrounds the cells of multicellular animals. It is the main component of the extracellular fluid, which also includes plasma, lymph and transcellular fluid. Plasma, the major component in blood, communicates freely with interstitial fluid through pores and intercellular clefts in capillary endothelium. Interstitial fluid consists of a water solvent containing amino acids, sugars, fatty acids, coenzymes, hormones, neurotransmitters, salts, as well as waste products from the cells. Red blood cells, platelets and plasma proteins cannot pass through the walls of the capillaries. The resulting mixture that does pass through is essentially blood plasma without the plasma proteins. Tissue fluid also contains certain types of white blood cells. Once the extracellular fluid collects into small vessels it is considered to be lymph, and the vessels that carry it back to the blood are called the lymphatic vessels. The lymphatic system returns protein and excess interstitial fluid to the circulation.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      36.7
      Seconds
  • Question 11 - A 40-year old lady with a flail chest due to trauma was breathing...

    Correct

    • A 40-year old lady with a flail chest due to trauma was breathing with the help of a mechanical ventilator in the ICU, and was heavily sedated on muscle relaxants. Due to sudden power failure, a nurse began to hand-ventilate the patient with a Ambu bag. What change will occur in the following parameters: (Arterial p(CO2), pH) in the intervening period between power failure and hand ventilation?

      Your Answer: Increase, Decrease

      Explanation:

      Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg). The given problem represents acute respiratory acidosis and thus, will show a increase in arterial p(CO2) and decrease in pH.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      10.7
      Seconds
  • Question 12 - QT interval in the electrocardiogram of a healthy individual is normally: ...

    Correct

    • QT interval in the electrocardiogram of a healthy individual is normally:

      Your Answer: 0.40 s

      Explanation:

      QT interval extends from beginning of the QRS complex till the end of he T-wave and normally lasts for 0.40 s. It is important in the diagnosis of long-QT and short-QT syndrome. The QT interval varies on the basis of heart rate and may need to be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      4.5
      Seconds
  • Question 13 - A 50-year-old woman goes to the doctor complaining of myalgia, muscle cramps, and...

    Correct

    • A 50-year-old woman goes to the doctor complaining of myalgia, muscle cramps, and weakness; she is diagnosed with severe hypokalaemia. Which of the following is the most common cause of hypokalaemia?

      Your Answer: Prolonged vomiting

      Explanation:

      Potassium is one of the body’s major ions. Nearly 98% of the body’s potassium is intracellular. The ratio of intracellular to extracellular potassium is important in determining the cellular membrane potential. Small changes in the extracellular potassium level can have profound effects on the function of the cardiovascular and neuromuscular systems. Hypokalaemia may result from conditions as varied as renal or gastrointestinal (GI) losses, inadequate diet, transcellular shift (movement of potassium from serum into cells) and medications. The important causes of hypokalaemia are:

      Renal losses: renal tubular acidosis, hyperaldosteronism, magnesium depletion, leukaemia (mechanism uncertain).

      GI losses: vomiting or nasogastric suctioning, diarrhoea, enemas or laxative use, ileal loop.

      Medication effects: diuretics (most common cause), β-adrenergic agonists, steroids, theophylline, aminoglycosides.

      Transcellular shift: insulin, alkalosis.

      Severe hypokalaemia, with serum potassium concentrations of 2.5–3 meq/l, may cause muscle weakness, myalgia, tremor, muscle cramps and constipation.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      24.8
      Seconds
  • Question 14 - A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness....

    Correct

    • A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:

      Your Answer: Metabolic acidosis

      Explanation:

      Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      7.8
      Seconds
  • Question 15 - A 40 year old man suffered severe trauma following an MVA. His BP...

    Correct

    • A 40 year old man suffered severe trauma following an MVA. His BP is 70/33 mmhg, heart rate of 140 beats/mins and very feeble pulse. He was transfused 3 units of blood resulting in his BP returning to 100/70 and his heart rate to 90 beats/min. What decreased following transfusion?

      Your Answer: Total peripheral resistance

      Explanation:

      The patient is in hypovolemic shock, he is transfused with blood to replace the volume lost. It is important not only to replace fluids but stop active bleeding in resuscitation. Fluid replacement will result in a decreased sympathetic discharge and adequate ventricular filling thus reducing total peripheral resistance and increasing cardiac output and cardiac filling pressures.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      5.2
      Seconds
  • Question 16 - Chest X-ray of a 45-year old gentleman with a week history of pleurisy...

    Incorrect

    • Chest X-ray of a 45-year old gentleman with a week history of pleurisy showed a small pneumothorax with moderate-sized pleural effusion. Arterial blood gas analysis showed p(CO2) = 23 mmHg, p(O2) = 234.5 mmHg, standard bicarbonate = 16 mmol/l. What are we most likely dealing with?

      Your Answer: Compensated respiratory acidosis

      Correct Answer: Compensated respiratory alkalosis

      Explanation:

      Normal pH with low p(CO2) and low standard bicarbonate could indicate either compensated respiratory alkalosis or a compensated metabolic acidosis. However, the history of hyperventilation for 5 days (pleurisy) favours compensated respiratory alkalosis. Compensated metabolic acidosis would have been likely in a diabetic patient with fever, vomiting and high glucose (diabetic ketoacidosis).

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      6.8
      Seconds
  • Question 17 - Renal function is an indication of the state of the kidney, measured by glomerular...

    Correct

    • Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by: 

      Your Answer: Substantial increases in renal blood flow

      Explanation:

      An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.

    • This question is part of the following fields:

      • Physiology
      • Renal
      13.1
      Seconds
  • Question 18 - In which of the following conditions will the oxygen-haemoglobin dissociation curve shift to...

    Correct

    • In which of the following conditions will the oxygen-haemoglobin dissociation curve shift to the right?

      Your Answer: Exercise

      Explanation:

      The oxygen-haemoglobin dissociation curve plots saturated haemoglobin against the oxygen tension and is usually a sigmoid plot. Each molecule of haemoglobin can bind to four molecules of oxygen reversibly. Factors that can influence the binding include: pH, concentration of 2,3-diphosphoglycerate (2,3-DPG), temperature, type of haemoglobin molecules, and presence of toxins, especially carbon monoxide. Shape of the curve is due to interaction of bound oxygen molecules with the incoming molecules. The binding of first molecule is difficult, with easier binding of the second and third molecule and increase in difficulty with the fourth molecule – partly as a result of crowding and partly as a natural tendency of oxygen to dissociate.

      Left shift of curve indicates haemoglobin’s increased affinity for oxygen (seen at lungs). Right shift indicates decreased affinity and is seen with an increase in body temperature, hydrogen ions, 2,3-diphosphoglycerate (DPG), carbon dioxide concentration and exercise. Under normal resting conditions in a healthy individual, the normal position of the curve is at a pH of 7.4. A shift in the position of the curve with a change in pH is called the Bohr effect. Left shift occurs in acute alkalosis, decrease in p(CO2), decrease in temperature and decrease in 2,3-DPG. The fetal haemoglobin curve is to the left of the adult haemoglobin to allow for oxygen diffusion across the placenta. The curve for myoglobin is even further to the left. Carbon monoxide has a much higher affinity for haemoglobin than oxygen does. Thus, carbon monoxide poisoning leads to hypoxia.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      2.8
      Seconds
  • Question 19 - A new-born was found to have an undeveloped spiral septum in the heart....

    Correct

    • A new-born was found to have an undeveloped spiral septum in the heart. This is characteristic of which of the following?

      Your Answer: Persistent truncus arteriosus

      Explanation:

      Persistent truncus arteriosus is a congenital heart disease that occurs when the primitive truncus does not divide into the pulmonary artery and aorta, resulting in a single arterial trunk. The spiral septum is created by fusion of a truncal septum and the aorticopulmonary spiral septum. Incomplete development of these septa results in incomplete separation of the common tube of the truncus arteriosus and the aorticopulmonary trunk.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      8.2
      Seconds
  • Question 20 - A 23-year-old woman decides to donate a kidney through a kidney chain. Which...

    Correct

    • A 23-year-old woman decides to donate a kidney through a kidney chain. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?

      Your Answer: Creatinine clearance

      Explanation:

      Since medication to prevent rejection is so effective, donors do not need to be similar to their recipient. Most donated kidneys come from deceased donors; however, the utilisation of living donors is on the rise. Most problems encountered with live donation are associated with the donor. Firstly, there are the potentially harmful investigative procedures carried out in the assessment phase, the most hazardous being renal angiography, where there is cannulation of the artery and injection of a radio-opaque dye to determine the blood supply to the kidney. Secondly, there are the short-term risks of nephrectomy surgery. According to the literature, there is a mortality rate of between 1 in 1600 and 1 in 3000, but this is no more than is associated with any anaesthetic. In the initial postoperative period creatinine clearance may be decreased but this recovers fully over a few weeks to months. Long-term complications include prolonged wound pain.

    • This question is part of the following fields:

      • Physiology
      • Renal
      8.8
      Seconds
  • Question 21 - During cardiac catheterisation, if the blood sample from the catheter shows an oxygen...

    Correct

    • During cardiac catheterisation, if the blood sample from the catheter shows an oxygen saturation of 70%, and the pressure ranging from 12 to 24 mm Hg, it implies that the catheter tip is located in the:

      Your Answer: Pulmonary artery

      Explanation:

      Normal values for various parameters are as follows:

      Systolic arterial blood pressure (SBP): 90–140 mmHg.

      Diastolic arterial blood pressure: 60–90 mmHg.

      Mean arterial blood pressure (MAP): SBP + (2 × DBP)/3 (normal range: 70-105 mmHg).

      Right atrial pressure (RAP): 2–6 mmHg.

      Systolic right ventricular pressure (RVSP): 15–25 mmHg.

      Diastolic right ventricular pressure (RVDP): 0–8 mmHg.

      Pulmonary artery pressure (PAP): Systolic (PASP) is 15-25 mmHg and Diastolic (PADP) is 8–15 mmHg.

      Pulmonary artery wedge pressure (PAWP): 6–12 mmHg.

      Left atrial pressure (LAP): 6–12 mmHg.

      Thus, the given value indicates that the position of catheter tip is likely to be in the pulmonary artery.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      13.2
      Seconds
  • Question 22 - In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of...

    Correct

    • In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of the:

      Your Answer: Distal convoluted tubule

      Explanation:

      In the kidney, the macula densa is an area of closely packed specialised cells lining the region of the distal convoluted tubule (DCT) lying next to the glomerular vascular pole. The cells of the macula densa are sensitive to the ionic content and water volume of the fluid in the DCT, producing signals that promote renin secretion by other cells of the juxtaglomerular apparatus.

    • This question is part of the following fields:

      • Physiology
      • Renal
      27.8
      Seconds
  • Question 23 - A 56-year-old man undergoes tests to determine his renal function. His results over...

    Correct

    • A 56-year-old man undergoes tests to determine his renal function. His results over a period of 24 hours were:

      Urine flow rate: 2. 0 ml/min

      Urine inulin: 1.0 mg/ml

      Plasma inulin: 0.01 mg/ml

      Urine urea: 260 mmol/l

      Plasma urea: 7 mmol/l

      What is the glomerular filtration rate?

      Your Answer: 200 ml/min

      Explanation:

      Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. GFR is equal to the inulin clearance because inulin is freely filtered into Bowman’s capsule but is not reabsorbed or secreted. The clearance (C) of any substance can be calculated as follows: C = (U × V)/P, where U and P are the urine and plasma concentrations of the substance, respectively and V is the urine flow rate. Thus, glomerular filtration rate = (1.0 × 2. 0)/0.01 = 200 ml/min.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      27.7
      Seconds
  • Question 24 - A 40-year old gentleman, known with a history of peptic ulcer disease, was...

    Correct

    • A 40-year old gentleman, known with a history of peptic ulcer disease, was brought to the clinic in a dehydrated state with persistent vomiting. His blood investigations revealed:
      • sodium = 142 mmol/l
      • potassium = 2.6 mmol/l
      • chloride = 85 mmol/l
      • pH = 7.55
      • p(CO2) = 50 mmHg
      • p(O2) = 107 mmHg
      • standard bicarbonate = 40 mmol/l
      This patient has a:

      Your Answer: Metabolic alkalosis

      Explanation:

      High pH with high standard bicarbonate indicates metabolic alkalosis. The pa(CO2) was appropriately low in compensation. This is hypokalaemic hypochloraemic metabolic acidosis due to prolonged vomiting. Treatment includes treating the cause and intravenous sodium chloride with potassium.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      37.3
      Seconds
  • Question 25 - In a cardiac cycle, what event does the opening of the atrioventricular (AV)...

    Incorrect

    • In a cardiac cycle, what event does the opening of the atrioventricular (AV) valves coincide with?

      Your Answer: First heart sound

      Correct Answer: Beginning of diastole

      Explanation:

      Cardiac diastole refers to the time period when the heart is relaxed after contraction and is preparing to refill with blood. Both ventricular and atrial diastole are together known as complete cardiac diastole. At its beginning, the ventricles relax, causing a drop in the ventricular pressure. As soon as the left ventricular pressure drops below that in left atrium, the mitral valve opens and there is ventricular filling of blood. Similarly, the tricuspid valve opens filling the right atrium.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      6.4
      Seconds
  • Question 26 - An enlarged lymph node which shows well-defined, prominent paracortical follicles with germinal centres...

    Correct

    • An enlarged lymph node which shows well-defined, prominent paracortical follicles with germinal centres is most likely from which of the following patients?

      Your Answer: A 5-year-old boy with a sore throat and runny nose

      Explanation:

      Lymphadenopathy is common in children and is usually reactive in nature. The description fits that of a benign, reactive lymph node.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      10
      Seconds
  • Question 27 - An abnormal opening of the urethra on the under surface of the penis...

    Correct

    • An abnormal opening of the urethra on the under surface of the penis (ventral surface) is known as:

      Your Answer: Hypospadias

      Explanation:

      Hypospadias is the condition where the urethra opens along the underside or ventral aspect of penile shaft. First-degree hypospadias is seen in 50-75% cases, where the urethra open on the glans penis. Second-degree hypospadias is seen in 20% cases where the urethra opens on the shaft, and third-degree in 30% cases with the urethra opening on the perineum. The severe cases are usually associated with undescended testis (cryptorchidism) or chordee, where the penis is tethered downwards and not completely separated from the perineum.

      It is a common male genital birth defect but varying incidences are noted in different countries. There is no obvious inheritance pattern noted. No exact cause has been determined, however several hypotheses include poor response to androgen, or interference by environmental factors.

    • This question is part of the following fields:

      • Pathology
      • Urology
      25.2
      Seconds
  • Question 28 - A patient with Paget's disease of the bone is predisposed to developing which...

    Correct

    • A patient with Paget's disease of the bone is predisposed to developing which type of cancer?

      Your Answer: Osteosarcoma

      Explanation:

      Paget’s disease of bone (PDB) is a focal disorder of bone. It is presumed benign in nature and mediated by abnormal osteoclast function. However osteosarcomas may occur in <1% of patients with Paget's disease of the bone. Osteosarcomas are osteogenic in origin, and consistently arise in sites of pagetic bone. This is not to be confused with Paget's disease of the breast.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      39.5
      Seconds
  • Question 29 - A 30 year old female presented in the emergency with an irregular pulse....

    Correct

    • A 30 year old female presented in the emergency with an irregular pulse. Her ECG showed absent P-waves with irregular RR interval. What is the most likely diagnosis?

      Your Answer: Atrial fibrillation

      Explanation:

      Atrial fibrillation is one of the most common cardiac arrhythmias. It is often asymptomatic but may present with symptoms of palpitations, fainting, chest pain and heart failure. Characteristic findings are: absence of P-waves, unorganised electrical activity in their place, irregularity of RR interval due to irregular conduction of impulses to the ventricles and if paroxysmal AF is suspected, episodes may be documented with the use of Holter monitoring

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      8.8
      Seconds
  • Question 30 - A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken...

    Correct

    • A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken to measure serum aldosterone and another substance. Which is most likely to be the other test that was prescribed to this patient?

      Your Answer: Plasma renin

      Explanation:

      The evaluation of a patient in whom hyperaldosteronism is first to determine that hyperaldosteronism is present (serum aldosterone) and, if it is present, to differentiate primary from secondary causes of hyperaldosteronism. The aldosterone-to-renin ratio (ARR) is the most sensitive means of differentiating primary from secondary causes of hyperaldosteronism as it is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin levels in secondary hyperaldosteronism.

    • This question is part of the following fields:

      • Physiology
      • Renal
      11.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Physiology (22/24) 92%
Respiratory (5/6) 83%
Inflammation & Immunology; Respiratory (1/1) 100%
Pathology (6/6) 100%
Fluids & Electrolytes (5/5) 100%
Renal (5/5) 100%
Cardiovascular (8/9) 89%
Orthopaedics (1/1) 100%
Haematology (1/1) 100%
Urology (1/1) 100%
Neoplasia (1/1) 100%
Passmed