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Question 1
Correct
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A 28 year old female with a history of psoriatic arthritis would most likely have which of the following hand conditions?
Your Answer: Nail dystrophy
Explanation:Nail dystrophy (pitting of nails, onycholysis, subungual hyperkeratosis), dactylitis, sausage shaped fingers are most commonly seen with psoriatic arthropathy. There is asymmetric joint involvement most commonly distal interphalangeal joints. Uveitis and sacroiliitis may also occur. Arthritis mutilans may occur but is very rare. Cutaneous lesions may or may not develop. When they do, its usually much after the symptoms of arthritis.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 2
Correct
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Regarding DNA cloning and sequencing, all of the following are true, except:
Your Answer: Yeast artificial chromosomes ( yacs) are vectors
Explanation:Yeast chromosomes cannot be used as a vector. All the rest are true. Vectors can be bacteria, viruses and plasmids. DNA ligase binds the DNA fragment to the host DNA after insertion. Fluorescence can be used to visualize them.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 3
Incorrect
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Which of the following drugs have the best gram positive cover?
Your Answer: Cephalosporin
Correct Answer: Glycopeptides
Explanation:Cephalosporin has a mixed coverage of gram positive and negative organisms. Aminoglycosides are active against gram negative aerobic bacteria. Quinolones mainly cover gram negative bacteria. Monobactams primarily cover infections caused by gram negative bacteria. Glycopeptides are antibiotics effective primarily against gram positive cocci.
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This question is part of the following fields:
- Infectious Diseases
- Medicine
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Question 4
Incorrect
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Which of the following factors serve to decrease cardiac output?
Your Answer: Increased ambient temperature
Correct Answer: Standing from a lying position
Explanation:Sleep has no effect on the cardiac output. Anxiety, excitement, increased body temperature and pregnancy will increase the cardiac output. Standing from a lying position will decrease the cardiac output transiently.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 5
Correct
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During strenuous exercise the following arterial change can take place in a fit athlete:
Your Answer: No change takes place
Explanation:The changes which occur in arterial pH, PO2 and PCO2 values during exercise are usually small. Arterial PO2 often rises slightly because of hyperventilation although it may eventually fall at high work rates. During vigorous exercise, when sufficient oxygen for flux through the Krebs cycle is not available, the increased reliance on glycolysis results in increased accumulation of lactic acid, which initially leads to an increase in PaCO2 . However, this is counteracted by the stimulation of ventilation and as a result PaCO2 is decreased. This provides some respiratory compensation for further lactic acid production and prevents a decline in blood pH, which remains nearly constant during moderate exercise.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 6
Correct
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A 35-year-old male was brought to you in a confused state. Although not your patient, you can make out that the man has a history of schizophrenia, and has recently had his medications altered. Clinically, you find evidence of a lower respiratory tract infection, and blood investigations indicate a neutropenic picture.What is the most likely drug causing the neutropenia?
Your Answer: Clozapine
Explanation:Clozapine can cause neutropenia or agranulocytosis.Clozapine is an atypical antipsychotic used in the treatment of schizophrenia, and in patients who are intolerant to, or unresponsive to other antipsychotics. It is a weak D2-receptor and D1-receptor blocking activity, with noradrenolytic, anticholinergic, and antihistaminic properties.Many antipsychotic drugs can occasionally cause bone marrow depression, but agranulocytosis is particularly associated with clozapine.Other side effects include:Hypotension, tachycardiaFever, sedation, seizures (with high doses)Appetite increaseConstipationHeartburnWeight gainExtrapyramidal symptomsAgranulocytosisNeuroleptic malignant syndrome
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 7
Correct
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With regard to X linked disorders which of the following are true
Your Answer: X linked recessive disorders usually present in males and only very rarely present in homozygous females
Explanation:All are true for autosomal recessive disorders. Dominance rules for sex-linked gene loci are determined by their behaviour in the female: because the male has only one allele (except in the case of certain types of Y chromosome aneuploidy), that allele is always expressed regardless of whether it is dominant or recessive.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 8
Correct
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In DNA cloning and sequencing, the bases in nucleotides chains are bound together by:
Your Answer: Hydrogen bonding.
Explanation:Nucleotides will always bind together via hydrogen bonds. There are two hydrogen bonds present between thymine and adenine and three hydrogen bonds present between guanine and cytosine.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 9
Incorrect
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The chromosomes that principally encode for proteins or RNA molecules involved in mitochondrial function are found:
Your Answer: In the mitochondria of the cell
Correct Answer: In the nucleus of each diploid cell
Explanation:While mitochondria have their own small circular DNA (mtDNA) that encodes some of the proteins and RNAs required for mitochondrial function, the majority of proteins involved in mitochondrial function are encoded by nuclear DNA. These nuclear genes are transcribed in the nucleus and then translated into proteins in the cytoplasm. The proteins are subsequently imported into the mitochondria.
Therefore, the correct answer is:
- In the nucleus of each diploid cell
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This question is part of the following fields:
- Genetics
- Medicine
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Question 10
Incorrect
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Café-au-lait spots are seen in each of the following, except:
Your Answer: Hunter syndrome
Correct Answer: Friedreich's ataxia
Explanation:Café-au-lait spots are hyperpigmented lesions that vary in colour from light brown to dark brown, with borders that may be smooth or irregular.
Causes include:
- Neurofibromatosis type I
- McCune–Albright syndrome
- Legius syndrome
- Tuberous sclerosis
- Fanconi anaemia
- Idiopathic
- Ataxia-telangiectasia
- Basal cell nevus syndrome
- Benign congenital skin lesion
- Bloom syndrome
- Chediak-Higashi syndrome
- Congenital nevus
- Gaucher disease
- Hunter syndrome
- Maffucci syndrome
- Multiple mucosal neuroma syndrome
- Noonan syndrome
- Pulmonary Stenosis
- Silver–Russell syndrome
- Watson syndrome
- Wiskott–Aldrich syndrome
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 11
Incorrect
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Where is the melanocortin system located?
Your Answer: Pituitary
Correct Answer: Hypothalamus
Explanation:The melanocortin system is a group of hormones which include hormones from the pro-opiomelanocortin (POMC)-expressing neurons, the neuropeptide Y (NPY) and agouti-related peptide (AgRP)-co-expressing neurons. This system is located in the hypothalamic arcuate nucleus; it also includes the hypothalamic arcuate nucleus and the melanocortin 4 receptor (MC4R)-expressing neurons located in the hypothalamic paraventricular nucleus. The system regulates energy expenditure and food intake.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 12
Correct
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The principal enzyme of lipid digestion is:
Your Answer: Lipase
Explanation:Lipase is the principle enzyme that digest lipids. Amylase digest carbohydrates. Colipase is a co-enzyme that optimize the activity of lipase. Trypsin digest proteins and cholesterol esterase digest cholesterol.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 13
Correct
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When looking at the JVP what does the c wave signify:
Your Answer: Isovolumetric ventricular contraction
Explanation:The C wave signifies a rise in the atrial pressure during isovolumetric contraction due to the tricuspid valve bulging into the atria.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 14
Correct
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H+ ions used in the production of acid by parietal cells is produced with the help of which enzyme?
Your Answer: Carbonic anhydrase ii
Explanation:Carbonic anhydrase enzyme catalyses the rapid interconversion of carbon dioxide and water to bicarbonate and protons (or vice versa). This is a reversible reaction that takes place in the gastric parietal cells.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 15
Correct
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The major factor in controlling coronary artery blood flow is considered to be?
Your Answer: Metabolites of oxygen consumption
Explanation:There is a strong relationship between myocardial blood flow and oxygen consumption. This indicates that products of metabolism may cause vasodilation of the coronary artery.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 16
Incorrect
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A 56 year old woman taking procainamide develops drug induced erythematosus. Which of the following features is the most characteristic of this condition?
Your Answer: It commonly involves the kidneys
Correct Answer: It may occur with chlorpromazine
Explanation:Drug induced lupus is usually positive for antinuclear and antihistone antibodies, typically without renal or neurologic involvement. However, pulmonary involvement is common. Drugs that can induce lupus include isoniazid, hydralazine, procainamide, chlorpromazine, and other anticonvulsants.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 17
Incorrect
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The main efferent input of the posterior pituitary gland comes from:
Your Answer: Paracrine hormones secreted from the hypothalamus via diffusion
Correct Answer: Paracrine hormones secreted from the hypothalamus via axons.
Explanation:The posterior pituitary or neurohypophysis consists of a collection of axonal projections emerging from the hypothalamus. It releases hormones directly from these axonal endings into circulation; these hormones are oxytocin and vasopressin.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 18
Incorrect
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Question 19
Correct
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Glucose is typically removed from the urine by…?
Your Answer: Secondary active transport
Explanation:Glucose, amino acids, inorganic phosphate, and some other solutes are resorbed via secondary active transport through co-transporters driven by the sodium gradient out of the nephron.
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This question is part of the following fields:
- Medicine
- Renal
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Question 20
Incorrect
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The pressure in the sinusoids is normally:
Your Answer: The same as portal venous pressure
Correct Answer: Lower than portal venous pressure
Explanation:The direction of transport of nutrients in the portal vein occurs from the portal vein to the hepatic sinusoids. Thus, he pressure of sinusoids should be lower than the pressure of he portal vein.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 21
Incorrect
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Question 22
Correct
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The approximate incidence of deep venous thrombosis (DVT) in the general population each year is:
Your Answer: 1 per 1000
Explanation:About 1 in 1000 adults per year has DVT, but as of 2011, available data is dominated by North American and European populations. DVT is rare in children, with an incidence of about 1 in 100,000 a year. From childhood to old age, incidence increases by a factor of about 1000, with almost 1% of the elderly experiencing DVTs yearly.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 23
Incorrect
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A patient has been diagnosed with multi-drug resistant tuberculosis and is currently bring treated with rifampicin, isoniazid, and pyrazinamide. He is commenced on streptomycin.Which among the following is the most likely neurological side-effect of streptomycin?
Your Answer: Cochlear damage
Correct Answer: Vestibular damage
Explanation:Vestibular damage is a neurological side effect of streptomycin.Streptomycin is an aminoglycoside bactericidal antibiotic. It is used in the treatment of tularaemia and resistant mycobacterial infections.The most common neurological side-effect is vestibular damage leading to vertigo and vomiting. Cochlear damage is less frequent and results in deafness. Other side-effects include rashes, angioneurotic oedema, and nephrotoxicity.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 24
Correct
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A 85 year old male with a history of Alzheimer's dementia was brought into Casualty by family members, who stated that he had episodes of aggression. Which of the following drugs is most suitable as the pharmacological management for this presentation?
Your Answer: Risperidone
Explanation:Regarding the pharmacological management, Risperidone is the most suitable drug from the given answers as it is recommended for the treatment of aggression associated with moderate to severe Alzheimer’s disease. Quetiapine and Benzodiazepine are not recommended.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 25
Correct
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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.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 26
Incorrect
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Which of the following predominate in the adrenal medulla?
Your Answer: Norepinephrine secreting cells
Correct Answer: Epinephrine secreting cells
Explanation:Chromaffin cells, also known as pheochromocytes, are cells located in the adrenal medulla which specialize in the synthesis, storage, and secretion of catecholamines: 80% epinephrine and 20% norepinephrine is released into the bloodstream. For this reason, they are considered to be neuroendocrine cells.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 27
Correct
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In meiosis, the period of prophase 1 involves:
Your Answer: Replicated DNA condensing to form visible chromosomes
Explanation:Prophase 1 has been divided into five different stages (laptotene, zygotene, pachytene, diplotene and diakinesis). In prophase 1, chromosomes are going to condense to become visible, each chromosome will contain two chromatids that are joined at the centromere.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 28
Correct
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Absolute refractory period in a cardiac action potential graph occurs during.
Your Answer: All of the above
Explanation:Absolute refractory period (ARP): the cell is completely unexcitable to a new stimulus and occurs from phase 0 – 2 i.e. depolarisation, early repolarisation and plateau phase.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 29
Incorrect
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What is troponin?
Your Answer: A component of thick filaments
Correct Answer: A component of thin filaments
Explanation:Skeletal muscle cytoplasmic proteins include myosin and actin (also known as thick and thin filaments, respectively) which are arranged in a repeating unit called a sarcomere. Troponin is a component of thin filaments (along with tropomyosin), and is the protein to which calcium binds.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 30
Correct
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Lipid- lowering drugs like Lovastatin reduce cholesterol synthesis by inhibiting which enzyme?
Your Answer: HMG-CoA reductase
Explanation:Statins, also known as HMG-CoA reductase inhibitors, are a class of lipid-lowering medications. Statins have been found to reduce cardiovascular disease (CVD) and mortality in those who are at high risk.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 31
Incorrect
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Afferent A δ fibers from nociceptors terminate primarily on neurons in which lamina:
Your Answer: III and IV
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 32
Incorrect
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The enzyme located on the brush border of the small intestine activating the proteolytic enzymes for further digestion of proteins is called?
Your Answer: Pepsin
Correct Answer: Enterokinase
Explanation:Enterokinase is a brush border enzyme of the duodenum that activates proteolytic enzymes for further digestion of proteins. Trypsinogen is converted to trypsin by the action of enterokinase. Trypsin and chymotrypsin are secreted by the pancreatic acinar cells and are enzymes that aid in protein digestion. Pepsin is secreted by chief cells of the gastric mucosa. Procarboxydase is the inactive form of carboxypeptidase which is converted to its active form by trypsin and is secreted by pancreatic acinar cells.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 33
Incorrect
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Activation of nitric oxide synthesis by endothelial cells is triggered by:
Your Answer: Shear stress
Correct Answer: All of the above
Explanation:Acetylcholine, histamine, bradykinin, vasoactive intestinal peptide (VIP) and shear stress on the endothelial cells causing the release of NO. NO is formed from arginine and causes vasodilatation of the blood vessels.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 34
Correct
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Which of the following structures is not part of the conducting system of the heart?
Your Answer: Ventricular wall
Explanation:The conduction system of the heart consists of the SA node, AV node, internodal pathway between these two nodes, Bundle of His and the purkinje fibers
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 35
Incorrect
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In most somatic cells telomeres progressively shorten as:
Your Answer: The cell ages
Correct Answer: The cell divides
Explanation:Telomere length shortens with age. Progressive shortening of telomeres leads to senescence, apoptosis, or oncogenic transformation of somatic cells, affecting the health and lifespan of an individual. Telomeres prevent the chromosomes from shortening and prevent the coding portion of the DNA from being lost, thus allowing the cell to replicate indefinitely. During replication telomeres may be lost resulting in cell death.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 36
Incorrect
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Phosphate absorption in the proximal tubules is via which transporting molecule?
Your Answer: Pi/Ca exchanger
Correct Answer: Na/Pi co transporter
Explanation:Sodium/phosphate cotransporters are located in the renal proximal tubular brush border, and are the key elements in proximal tubular phosphate reabsorption and phosphate homeostasis.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 37
Incorrect
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Question 38
Correct
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A 34 year old female presents to the clinic with skin tightness. On examination she has sclerodactyly, thickened skin of the shoulders and bi-basal crepitations. Her HRCT chest shows ground glass changes. Raynaud phenomenon is suspected and she is started on a monthly dose of IV cyclophosphamide (1 gm/month) for 6 months and a daily dose of 10 mg of oral prednisolone. However, she returned over a period of few weeks after developing exertional dyspnoea, pedal oedema and feeling unwell. On examination, JVP is raised, there is marked pedal oedema and bi basal crepitations on chest auscultation. Urine dipstick shows haematuria (++) and proteinuria (++). What in your opinion is the most likely cause of her deteriorating renal function?
Your Answer: Scleroderma renal crisis
Explanation:Scleroderma renal crisis (SRC) is a rare but severe complication in patients with systemic sclerosis (SSc). It is characterized by malignant hypertension, microangiopathic haemolytic anaemia with schistocytes and oligo/anuric acute renal failure. SRC occurs in 5% of patients with systemic scleroderma, particularly in the first years of disease evolution and in the diffuse form. Patients may develop symptoms of fluid overload.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 39
Correct
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The internodal tract of Bachman:
Your Answer: Connects the SA node to the AV node
Explanation:Internodal tract of Bachman connects the SA node to the AV node conducting the electrical impulses generated from the SA node to the AV node and from the AV node to the rest of the electrical complex of the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 40
Correct
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Which of the following is a form of synaptic plasticity?
Your Answer: Working memory
Explanation:Synaptic plasticity is an important neurochemical foundation of working memory and generation of memory. Synaptic plasticity is the ability of synapses to strengthen or weaken over time in response to increases or decreases in their activity.
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This question is part of the following fields:
- Medicine
- Neurology
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