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Question 1
Correct
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An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.
Which of the following valve disorders is an absolute contraindication to the use of GTN?Your Answer: Mitral stenosis
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.
Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
1. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension
2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)
3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)The nitrate drugs cause vasodilation via the action of nitric oxide.
The contraindications to the use of nitrate are the following:
1. Allergy to nitrates
2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil
3. Right ventricular infarction
4. Hypertrophic cardiomyopathy
5. Cardiac tamponade
6. Constrictive pericarditis
7. Hypotensive conditions
8. Hypovolaemia
9. Marked anaemia
10. Mitral stenosis
11. Raised intracranial pressure due to cerebral haemorrhage or head trauma
12. Toxic pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 2
Correct
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A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate, nasal regurgitation of food, and nasal quality to the voice.
Which of the following cranial nerves is most likely responsible for the aforementioned features?Your Answer: Vagus nerve
Explanation:The vagus nerve, ‘the wanderer’, contains motor fibres (to the palate and vocal cords), sensory components (posterior and floor of external acoustic meatus) and visceral afferent and efferent fibres.
Palatal weakness can cause nasal speech and nasal regurgitation of food. The palate moves asymmetrically when the patient says ‘ahh’. Recurrent nerve palsy results in hoarseness, loss of volume and ‘bovine cough’.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 3
Correct
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A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve injury. Which of the following will confirm the presence of an ulnar nerve injury?
Your Answer: Claw hand appearance
Explanation:An ulnar injury may result in abnormal sensations in the little finger and ring finger, usually on the palm side, weakness, and loss of coordination of the fingers.
A claw like deformity of the hand and wrist is present. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve are also possible.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Correct
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A 55-year-old woman was complaining of headaches. On examination, the patient is found to have weakness on the left side of her body and her eyes are deviated towards the right hand side. These are signs of damage to which of the following areas?
Your Answer: Frontal lobe
Explanation:Some potential symptoms of frontal lobe damage can include loss of movement, either partial or complete, on the opposite side of the body.
In the patient’s case, it is a result of motor cortex damage on the right side since her left side of the body is affected. The conjugate eye deviation symptom towards the side of the lesion is a result of damage to the frontal eye field.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 5
Correct
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Regarding the partial pressure of gases, which of the following statements is INCORRECT:
Your Answer: At high altitude, the oxygen fraction is reduced.
Explanation:At altitude, the oxygen fraction is unaltered but the barometric pressure and thus partial pressure of oxygen is reduced.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 6
Correct
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A 69-year-old woman with new-onset back pain was diagnosed with osteopenia, osteolytic lesions, and vertebral collapse after undergoing a radiographic examination. Her laboratory results revealed anaemia and hypercalcemia. These findings most likely indicate what condition?
Your Answer: Myeloma
Explanation:Bone pain, pathologic fractures, weakness, anaemia, infection, hypercalcemia, spinal cord compression, and renal failure are all signs and symptoms of multiple myeloma (MM). The patient’s condition matched the signs and symptoms of myeloma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 7
Correct
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Many of the chemical digestion and absorption takes place in the small intestine. Most digestive enzymes in the small intestine are secreted by the pancreas and enter the small intestine through the pancreatic duct.
Which of these digestive enzymes is responsible for breaking down carbohydrates into monosaccharides?Your Answer: Glucoamylase
Explanation:Majority of carbohydrates are broken down into monosaccharides (glucose, fructose galactose) and are absorbed by the small intestine. Enzymes released from the brush border break down carbohydrate. Some carbohydrates, such as cellulose, are not digested at all, despite being made of multiple glucose units. This is because the cellulose is made out of beta-glucose that makes the inter-monosaccharide bindings different from the ones present in starch, which consists of alpha-glucose. Humans lack the enzyme for splitting the beta-glucose-bond.
The principal brush border enzymes are dextranase and glucoamylase. Other brush border enzymes are maltase, sucrase, and lactase.
Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Dextranase and glucoamylase, then further break down oligosaccharides.
Trypsin aids in digestion of protein.
Chymotrypsin is a proteolytic enzyme that digests protein
Carboxypeptidase hydrolyses the first peptide or amide bond at the carboxyl or C-terminal end of proteins and peptides
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 8
Correct
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A 6-year-old female is brought to the Ophthalmology Clinic by her mother with the complaint of itching, redness, and a watery discharge of the right eye. Past medical history revealed an upper respiratory tract infection one week ago.
On examination of the right eye, there is mild erythema of the palpebral conjunctiva and visible follicles seen on eversion of the eyelid, lid oedema, and subconjunctival petechial haemorrhages. The discharge is watery and not purulent.
You diagnose her with viral conjunctivitis. According to the current NICE guidelines, which ONE of the following management options would NOT be included for this patient?Your Answer: The child should be excluded from school until the infection has resolved
Explanation:The NICE guidelines do NOT recommend isolating a patient with viral conjunctivitis from others or skipping school or work. The disease is contagious, but the spread of the disease can be controlled by maintaining good hygiene practices such as:
1. frequent hand washing
2. use of separate flannels and towels
3. Avoid close contact with othersAntibiotic prescriptions are not part of the NICE guidelines for viral conjunctivitis as they will not affect the course of the disease. Most cases of viral conjunctivitis are self-limiting and resolve within one to two weeks.
The NICE guidelines recommend that symptoms may be eased with self-care measures such as:
1. Bathing/cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge
2. Cool compresses applied gently around the eye area
3. Use of lubricating drops or artificial tears -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 9
Incorrect
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and superior oblique
Correct Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 10
Correct
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A patient suffers an injury to his thigh that damages the nerve that innervates pectineus.
Which of the following nerves has been damaged in this case? Select ONE answer only.Your Answer: Femoral nerve
Explanation:Pectineus is innervated by the femoral nerve. It may also receive a branch from the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 11
Correct
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A 12-year-old boy presents to you with a history of fever. A rash began as small red dots on the face, scalp, torso, upper arms and legs shortly afterwards and has now progressed to small blisters and pustules. You make a diagnosis of chickenpox.
The following complications of chickenpox is the LEAST likely.
Your Answer: Bronchospasm
Explanation:Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.
Some recognized complications of chickenpox are:
Orchitis
Hepatitis
Pneumonia
Encephalitis
Infected spots
Otitis media
Myocarditis
Glomerulonephritis
Appendicitis
Pancreatitis -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 12
Correct
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Which of the following statements accurately describes the number needed to harm?
Your Answer: The NNH is the number of patients that need to be treated for one to experience the side effect
Explanation:Number needed to harm (NNH) corresponds to the number of individuals that must be treated, so that one of them presents an adverse reaction accountable to the treatment.
Hence, a NNH of 100 means that 100 individuals need to be treated in order to produce an adverse effect of the treatment in one individual.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 13
Incorrect
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Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?
Your Answer: The dorsal column-medial lemniscal pathway
Correct Answer: The lateral spinothalamic tract
Explanation:The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 14
Correct
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Which of the following statements accurately describes the flexor digitorum superficialis muscle?
Your Answer: It flexes the middle phalanges of the medial four fingers at the proximal interphalangeal joints
Explanation:Flexor digitorum superficialis is the largest muscle of the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, together with pronator teres, flexor carpi radialis, flexor carpi ulnaris and palmaris longus. Some sources alternatively classify this muscle as an independent middle/intermediate layer of the anterior forearm, found between the superficial and deep groups.
Flexor digitorum superficialis is innervated by muscular branches of the median nerve, derived from roots C8 and T1 that arises from the medial and lateral cords of the brachial plexus. The skin that overlies the muscle is supplied by roots C6-8 and T1.
The primary arterial blood supply to the flexor digitorum superficialis is derived from the ulnar artery and its anterior recurrent branch. In addition to branches of the ulnar artery, the anterior and lateral surfaces of the muscle are supplied by branches of the radial artery; and its posterior surface also receives branches from the median artery.
The main function of flexor digitorum superficialis is flexion of the digits 2-5 at the proximal interphalangeal and metacarpophalangeal joints. Unlike the flexor digitorum profundus, flexor digitorum superficialis has independent muscle slips for all four digits. This allows it to flex the digits individually at their proximal interphalangeal joints. In addition, flexor digitorum superficialis aids the aids flexion of the wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 15
Incorrect
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A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone.
Which one of the following conditions will this woman NOT have?Your Answer: Peripheral neuropathy
Correct Answer: Xanthopsia
Explanation:Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias.
Side effects include:
1. pulmonary fibrosis
2. blue discolouration of the skin
3. phototoxicity
4. corneal deposits
5. hepatic necrosis
6. thyroid dysfunction
7. sleep disturbances
8. peripheral neuropathy.Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Correct
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During swallowing, which of the following structures primarily closes the tracheal opening:
Your Answer: Epiglottis
Explanation:The vocal cords of the larynx are strongly
approximated, and the larynx is pulled upward
and anteriorly by the neck muscles. These actions,
combined with the presence of ligaments that
prevent upward movement of the epiglottis, cause
the epiglottis to swing back over the opening
of the larynx. All these effects acting together
prevent the passage of food into the nose and
trachea. Most essential is the tight approximation
of the vocal cords, but the epiglottis helps to
prevent food from ever getting as far as the vocal
cords. Destruction of the vocal cords or of the
muscles that approximate them can cause
strangulation. -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 17
Correct
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A 45-year-old man had a painless superficial inguinal lymphadenopathy. It was later found to be malignant. Which of the following parts of the body is most likely the origin of this cancerous lymph node?
Your Answer: Anal canal
Explanation:A cancer of the anal canal below the pectinate line would spread to the superficial inguinal lymph nodes.
Anal cancer often spreads through lymphatic drainage to the internal iliac lymph nodes in lesions above the pectinate line and to the superficial inguinal lymph nodes in lesions below the pectinate line.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 18
Correct
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In a 7-year-old child with chickenpox, which of the following would you advise the mother NOT to do?
Your Answer: Give ibuprofen for the fever
Explanation:Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.
Some recognized complications of chickenpox are:
Orchitis
Hepatitis
Pneumonia
Encephalitis
Infected spots
Otitis media
Myocarditis
Glomerulonephritis
Appendicitis
PancreatitisTreatment is symptomatic and includes using paracetamol to manage fever. There is a link between use of ibuprofen in patients with chicken-pox and necrotizing fasciitis so Ibuprofen should NOT be used.
An emollient and antihistamine can be used to ease the itchy rash and oral hydration is encouraged.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 19
Incorrect
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A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago.
Which ONE of the following options is FALSE with regards to this disorder?Your Answer: Most individuals with G6PD deficiency are asymptomatic
Correct Answer: Acute haemolysis can be triggered by cephalosporin antibiotics
Explanation:Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.
Triggers include:
1) Fava beans
2) Sulphonamides
3) Primaquine
4) Anti-TB drugs
5) InfectionsMost individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 20
Correct
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Intrinsic factor is secreted by which of the following cell types in the stomach:
Your Answer: Parietal cells
Explanation:Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 21
Correct
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A 53-year-old man arrives at the emergency department complaining of visual impairment in his right eye. On examination, you notice that neither his right nor left pupil constricts when you shine a light in his right eye. When you flash a light in his left eye, the pupils of both his left and right eyes constrict. Which of the following nerves is the most likely to be affected:
Your Answer: Optic nerve
Explanation:In full optic nerve palsy, the afferent pupillary light reflex is lost. Because the afferent optic nerve does not sense light flashed in the afflicted eye, the ipsilateral direct and contralateral consensual reflexes are gone. However, the contralateral direct and ipsilateral consensual reflexes are intact because the efferent oculomotor nerve is normal.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 22
Correct
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Which of the following clotting factors is NOT vitamin K-dependent:
Your Answer: V
Explanation:Fat-soluble vitamin K is obtained from green vegetables and bacterial synthesis in the gut. Deficiency may present in the newborn (haemorrhagic disease of the newborn) or in later life. Deficiency may be caused by an inadequate diet, malabsorption or inhibition of vitamin K by drugs such as warfarin. The activity of factors II, VII, IX and X are vitamin K dependent as well as that of protein C and protein S. Both PT and APTT are prolonged.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 23
Correct
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Streptococcus pyogenes is commonly implicated in all of the following infective diseases EXCEPTÂ for:
Your Answer: Gas gangrene
Explanation:Gas gangrene is a life-threatening infection caused by toxin-producing Clostridium species, primarily Clostridium perfringens, and characterised by rapidly progressive muscle necrosis, gas production and sepsis.
Gas gangrene is not a notifiable disease. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 24
Correct
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An ambulance transports a 23-year-old woman who has taken a witnessed overdose of her mother's diazepam tablets. She has no significant medical history and does not take any medications on a regular basis.
In this case, what is the SINGLE MOST APPROPRIATE FIRST DRUG TREATMENT?Your Answer: Flumazenil IV 200 μg
Explanation:Flumazenil is a benzodiazepine antagonist that can be helpful in some overdose situations. It works quickly (in less than a minute), but the effects are fleeting, lasting less than an hour. The dose is 200 micrograms every 1-2 minutes with a maximum dose of 3 milligrams per hour.
Flumazenil should be avoided by patients who are addicted to benzodiazepines or who take tricyclic antidepressants because it can cause withdrawal symptoms. It can cause seizures or cardiac arrest in these situations.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 25
Correct
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CSF is reabsorbed from subarachnoid space via which of the following structures:
Your Answer: Arachnoid granulations
Explanation:From the subarachnoid cisterns in the subarachnoid space, CSF is reabsorbed via arachnoid granulations which protrude into the dura mater, into the dural venous sinuses and from here back into the circulation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 26
Correct
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Which of the following statements is correct regarding hyponatraemia?
Your Answer: Correction of serum sodium that is too rapid can precipitate central pontine myelinolysis.
Explanation:Hyponatraemia refers to a serum sodium concentration < 135 mmol/L.
It is safer to quickly correct acute hyponatremia than chronic hyponatremia but correction should not be too fast, especially in chronic hyponatraemia, because of the risk of central pontine myelinolysis. Hyponatraemia is usually associated with a low plasma osmolality.
Under normal circumstances, if serum osmolality is low, then urine osmolality should also be low because the kidneys should be trying to retain solute.
In SIADH, excess ADH causes water retention, but not the retention of solute. Therefore, urine that is concentrated and relatively high in sodium is produced, even though the serum sodium is low (urine osmolality > 100 mosmol/kg). -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 27
Correct
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A well recognised adverse effect of metoclopramide is which of the following?
Your Answer: Acute dystonic reaction
Explanation:Side effects of metoclopramide are commonly associated with extrapyramidal effects and hyperprolactinemia. Therefore its use must be limited to short-term use. Metoclopramide can induce acute dystonic reactions which involve facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young girls and young women, and in the very old. These symptoms usually occur shortly after starting treatment with this drug and subside within 24 hours of stopping it. Abortion of dystonic attacks can be carried out by injection of an antiparkinsonian drug like procyclidine.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 28
Correct
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Which of the following best describes an intention to treat analysis:
Your Answer: All patients are included in the analysis according to the group into which they were randomised even if they are withdrawn from the study.
Explanation:An intention to treat (ITT) analysis is one in which all patients are included in the analysis, classified according to the group into which they were randomised, even if they were withdrawn from the study and did not actually receive the treatment, did not comply with treatment or drop-out. Intention to treat analysis is a more reliable estimate of true treatment effectiveness by replicating what happens in the ‘real world’ (e.g. noncompliance and protocol violations commonly affect therapies).
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 29
Correct
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Naloxone is a reversal agent for which of the following groups of drugs:
Your Answer: Opioids
Explanation:Naloxone is a specific antagonist of mu(μ)-opioid receptors, the specific antidote for opioid overdose and will reverse respiratory depression and coma if given at sufficient dosage. The initial dose is usually 0.8 mg (2 mL) intravenously (the dose range suggested by BNF is 0.4-2 mg). It can also be given by intramuscular injection if the intravenous route is not feasible.
As naloxone has a shorter duration of action than most opioids, close monitoring and repeated injections are necessary according to the respiratory rate and depth of coma. The dose is generally repeated every 2-3 minutes to a maximum of 10 mg. When repeated doses are needed, naloxone may be given by a continuous infusion adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
In opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 30
Correct
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A dermatological examination on a patient presenting with a skin lesion which shows a solid, well circumscribed, lump measuring 0.8 cm in diameter. Which one of these best describes the lump you have found on examination?
Your Answer: Papule
Explanation:Macule— a small patch of skin that is altered in colour, but is not elevated.
Patch — a large area of colour change, with a smooth surface.
Papule— elevated, solid, palpable lesion that is ≤ 1 cm in diameter. They may be solitary or multiple. Papules may be:
Nodule — elevated, solid, palpable lesion > 1 cm usually located primarily in the dermis and subcutis (deeper layers of the skin). The greatest portion of the lesion may be above or beneath the skin surface.
Vesicle — a small blister. It is a circumscribed lesion ≤ 1 cm in diameter that contains liquid (clear, serous or haemorrhagic).
Cyst — papule or nodule that contains fluid or semi-fluid material so is fluctuant
Plaque — a circumscribed, palpable lesion more than 1 cm in diameter; most plaques are elevated.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 31
Correct
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Which one of the listed cells are typically found in a granuloma?
Your Answer: Epithelioid cells
Explanation:Typically, a granuloma has Langhan’s cells (large multinucleated cells) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.
Antigen presenting monocytic cells are found in the skin are known as Langerhan’s cells.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 32
Correct
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Regarding carbon dioxide transport in the blood, which of the following statements is CORRECT:
Your Answer: Deoxygenated haemoglobin acts as a buffer for H+ ions.
Explanation:CO2generated in the tissues and water combine to form carbonic acid which readily dissociates to form HCO3-and H+. The first part of this reaction is very slow in plasma, but is accelerated dramatically by the enzyme carbonic anhydrase present in red blood cells. Bicarbonate is therefore formed preferentially in red cells, from which it freely diffuses down its concentration gradient into plasma where it is transported to the lungs. The red cell membrane is impermeable to H+ions which remain in the cell. To maintain electroneutrality, Cl-ions diffuse into the cell to replace HCO3-, an effect known as the chloride shift. Deoxygenated haemoglobin acts as a buffer for H+, allowing the reaction to continue.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 33
Correct
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A 22-year-old man arrives at the emergency department with a sore throat, low-grade fever, and malaise. His partner has infectious mononucleosis, which was recently diagnosed. In this situation, which of the following cells is the most proliferative:
Your Answer: Lymphocytes
Explanation:Histologic findings in EBV infectious mononucleosis: Oropharyngeal epithelium demonstrates an intense lymphoproliferative response in the cells of the oropharynx. The lymph nodes and spleen show lymphocytic infiltration primarily in the periphery of a lymph node.
Relative lymphocytosis (≥ 60%) plus atypical lymphocytosis (≥ 10%) are the characteristic findings of Epstein Barr virus (EBV) infectious mononucleosis. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 34
Correct
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Which of the following causes increased aldosterone secretion:
Your Answer: Decreased blood volume
Explanation:Decreased blood volume stimulates the secretion of renin (because of decreased renal perfusion pressure) and initiates the renin-angiotensin-aldosterone cascade. Angiotensin-converting enzyme (ACE) inhibitors block the cascade by decreasing the production of angiotensin. Hyperosmolarity stimulates antidiuretic hormone (ADH) [not aldosterone] secretion. Hyperkalaemia, not hypokalaemia, directly stimulates aldosterone secretion by the adrenal cortex. ANPÂ inhibits renin secretion, thereby inhibiting the production of angiotensin and aldosterone.
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This question is part of the following fields:
- Physiology
- Renal
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Question 35
Incorrect
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The transport of oxygen from maternal to fetal circulation is made possible by fetal haemoglobin. Which of the statements about fetal haemoglobin (HbF) is also correct?
Your Answer: It has a higher affinity for oxygen than myoglobin
Correct Answer: The oxygen dissociation curve for foetal haemoglobin is shifted to the left of that of adult haemoglobin
Explanation:Fetal haemoglobin is the most common type of haemoglobin found in the foetus during pregnancy. It transports oxygen from the maternal circulation to the fetal circulation. It can easily bind to oxygen from the maternal circulation because it has a high affinity for oxygen. From 10 to 12 weeks of pregnancy to the first six months after birth, the erythroid precursor cells produce fetal haemoglobin. In comparison to adult haemoglobin, fetal haemoglobin has two alpha and two gamma subunits, whereas adult haemoglobin has two alpha and two beta subunits in its major form.
And, unlike adult haemoglobin, the oxygen dissociation curve of fetal haemoglobin is left-shifted. Myoglobin is an oxygen storage molecule with a very high affinity for oxygen. Only when the partial pressure of oxygen is exceeded does it release oxygen.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 36
Correct
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A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been going on for 3 days.
Among the following microorganisms, which is considered to be a cause of infectious bloody diarrhoea?Your Answer: Entamoeba histolytica
Explanation:The following are organisms that are capable of producing acute, bloody diarrhoea:
– Campylobacter jejuni
– Escherichia coli O157:H7
– Salmonella species
– Shigella species
– Yersinia species
– Entamoeba histolyticaOther E. coli strains, Giardia, Vibrio, and other parasites are associated with watery, but not bloody, diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 37
Correct
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You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.
Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?Your Answer: Lidocaine works by blocking fast voltage-gated sodium channels
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 38
Correct
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What proportion of peripheral blood leukocytes are monocytes?
Your Answer: 5 - 10%
Explanation:Monocytes account for around 5 to 10% of peripheral white cells. Monocytes in peripheral blood are generally bigger than other leukocytes and feature a large central oval or indented nucleus with clumped chromatin. The abundant cytoplasm staining blue and containing numerous fine vacuoles gives the appearance of ground glass. Cytoplasmic granules are another type of granule.
Monocytes evolve from the granulocyte-macrophage progenitor to become monoblasts, promonocytes, monocytes, and tissue macrophages (in increasing order of maturity). Monocytes only stay in the bone marrow for a short time before exiting to circulate in the bloodstream for 20-40 hours before becoming macrophages.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 39
Correct
-
Which of the following side effects is most likely caused by erythromycin:
Your Answer: QT - prolongation
Explanation:The side effects of erythromycin include abdominal pain, anaphylaxis,
cholestatic hepatitis, confusion,
diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss,
headache, hypertrophic pyloric stenosis, hypotension, Interstitial
nephritis, mild allergic reactions, nausea, nervous system effects,
including seizures, pain, pruritus, pseudomembranous colitis,
QT prolongation, rash, skin eruptions, tinnitus, urticaria,
ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 40
Correct
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A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.
Your Answer: Atelectasis is an example of a perfusion defect
Explanation:Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 41
Incorrect
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When a child has mumps, how long should he or she be off from school?
Your Answer: 4 days from onset of rash
Correct Answer: 5 days from onset of swelling
Explanation:To avoid the spread of infection, infected patients should be isolated. Patients should avoid going to school, childcare, or job for five days after the swelling has occurred.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 42
Incorrect
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Dysuria and urinary frequency are symptoms of a 29-year-old woman. A urine dipstick is used to detect the presence of blood, protein, leucocytes, and nitrites in the urine. You diagnose a urinary tract infection and give antibiotics to the patient.
In the United Kingdom, which of the following antibiotics has the highest percentage of E.coli resistance?Your Answer: Co-amoxiclav
Correct Answer: Trimethoprim
Explanation:In the United Kingdom, antibiotic resistance is becoming a significant factor in the treatment of urinary tract infections and pyelonephritis. E. coli (the main causative organism of both urinary tract infections and acute pyelonephritis) resistance to the following antibiotics in laboratory-processed urine specimens is:
30.3 percent trimethoprim (varies by area from 27.1 to 33.4 percent )
19.8 percent co-amoxiclav (varies by area from 10.8 to 30.7 percent )
Ciprofloxacin (Cipro): 10.6% (varies by area from 7.8 to 13.7 percent )
Cefalexin has a concentration of 9.9%. (varies by area from 8.1 to 11.4 percent ) -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 43
Incorrect
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Regarding hepatitis B, which of the following statements is CORRECT:
Your Answer: Antivirals are indicated for acute hepatitis B infection.
Correct Answer: Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months.
Explanation:Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months. Hepatitis B has a long incubation period of about 2 – 6 months. Hepatitis B vaccine has recently been introduced to the routine childhood immunisation schedule – given at 2, 3 and 4 months. It is also given to babies born to hepatitis B infected mothers at birth, four weeks and 12 months old. Treatment of acute hepatitis is supportive. Treatment with antivirals should be considered in chronic infection as responders have a reduced risk of liver damage and liver cancer in the long term.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 44
Incorrect
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You review an 83-year-old woman who has stage 5 chronic kidney disease. She has a number of electrolyte problems.
Which ONE of the following decreases the renal reabsorption of phosphate?Your Answer: Vasopressin
Correct Answer: Parathyroid hormone
Explanation:Parathyroid hormone (PTH) is a polypeptide containing 84 amino acids. It is the principal controller of free calcium in the body.
The main actions of parathyroid hormone are:
Increases plasma calcium concentration
Decreases plasma phosphate concentration
Increases osteoclastic activity (increasing calcium and phosphate resorption from bone)
Increases renal tubular reabsorption of calcium
Decreases renal phosphate reabsorption
Increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)
Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol) -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 45
Incorrect
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An elderly man with chronic heart and lung disease develops Legionnaires' disease. Which of the following clinical features is NOT typical of Legionnaires' disease:
Your Answer: Progressive dyspnoea
Correct Answer: Confusion
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.
The clinical features of the pneumonic form of Legionnaires’ disease include:
Mild flu-like prodrome for 1-3 days
Cough (usually non-productive and occurs in approximately 90%)
Pleuritic chest pain
Haemoptysis
Headache
Nausea, vomiting and diarrhoea
AnorexiaLegionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 46
Correct
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A patient suffers an injury to the nerve that innervates piriformis.
The piriformis muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer: Nerve to piriformis
Explanation:Piriformis is innervated by the nerve to piriformis, which is a direct branch from the sacral plexus (S1 and S2).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 47
Incorrect
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Question 48
Incorrect
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Which of the following statements is correct regarding the lymphatic system?
Your Answer: About 2 L is filtered by the microcirculation per day.
Correct Answer: Lymphatic vessels contain both smooth muscle and unidirectional valves.
Explanation:Fluid filtration out of the capillaries is usually slightly greater than fluid absorption into the capillaries. About 8 L of fluid per day is filtered by the microcirculation and returns to the circulation by the lymphatic system. Lymphatic capillaries drain into collecting lymphatics, then into larger lymphatic vessels. Both of these containing smooth muscle and unidirectional valves. From this point, lymph is propelled by smooth muscle constriction and vessel compression by body movements into afferent lymphatics. It then goes to the lymph nodes where phagocytes remove bacteria and foreign materials. It is here that most fluid is reabsorbed by capillaries, and the remainder returns to the subclavian veins via efferent lymphatics and the thoracic duct. The lymphatic system has a major role to play in the body’s immune defence and also has a very important role in the absorption and transportation of fats.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 49
Correct
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Which of the following anatomic structures will gallstones most likely lodge into, and cause cholestasis?
Your Answer: Hartmann’s pouch
Explanation:Hartmann’s pouch is a diverticulum that can occur at the neck of the gallbladder. It is one of the rarest congenital anomalies of the gallbladder. Hartmann’s gallbladder pouch is a frequent but inconsistent feature of normal and pathologic human gallbladders. It is caused by adhesions between the cystic duct and the neck of the gallbladder. As a result, it is classified as a morphologic rather than an anatomic entity.
There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 50
Incorrect
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A 29-year-old female with chronic anaemia secondary to sickle cell disease is being transfused. A few minutes after starting the blood transfusion, she develops widespread itching with urticarial rash, wheezing, nausea and chest pain. Her BP reduces to 60/40 mmHg.
What is the most appropriate treatment?Your Answer: Stop the transfusion and administer diuretics
Correct Answer: Stop the transfusion and administer adrenaline
Explanation:Anaphylaxis transfusion reaction occurs when an individual has previously been sensitized to an allergen present in the blood and, on re-exposure, releases IgE or IgG antibodies. Patients with anaphylaxis usually develop laryngospasm, bronchospasm, abdominal pain, nausea, vomiting, hypotension, shock, and loss of consciousness. The transfusion should be stopped immediately and the patient should be treated with adrenaline, oxygen, corticosteroids, and antihistamines.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 51
Correct
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A 29 year old patient with known inflammatory bowel disease presents to ED with surgical complications following his recent ileocaecal resection. Removal of the terminal ileum may result in the malabsorption of which of the following:
Your Answer: Vitamin B12
Explanation:On ingestion, vitamin B12 is bound to R protein found in saliva and gastric secretions, which protects it from digestion in the stomach. Intrinsic factor is secreted by gastric parietal cells. Receptors for the IF-B12 complex are present in the membrane of epithelial cells of the terminal ileum, which bind the complex and allow uptake of vitamin B12 across the apical membrane by endocytosis. Vitamin B12 is then transported across the basal membrane into the portal blood where it is bound to transcobalamin II and processed by the liver. In pernicious anaemia, there are autoantibodies against gastric parietal cells and intrinsic factor, resulting in vitamin B12 deficiency anaemia.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 52
Incorrect
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Regarding gastric motility and emptying, which of the following statements is CORRECT:
Your Answer: Cholecystokinin enhances gastric motility and gastric emptying.
Correct Answer: Gastric emptying is inhibited by the presence of the products of fat digestion in the duodenum.
Explanation:Gastric emptying is decreased by the presence of fats in the duodenum (by stimulating release of cholecystokinin). Mixing of the food with gastric secretions takes place in the distal body and antrum of the stomach where the muscularis externa layer is thicker. The stomach has an additional inner oblique smooth muscle layer (in addition to the inner circular layer and outer longitudinal layer). Gastric emptying is increased by a low gastric pH and decreased by a low duodenal pH.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 53
Correct
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Which of the following is NOT a typical electrolyte disturbance caused by furosemide:
Your Answer: Hypercalcaemia
Explanation:Adverse effects of loop diuretics include:
Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathy
Hyperglycaemia
Acute urinary retention
Water and electrolyte imbalance
Hyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolism
Metabolic alkalosis
Hyperuricaemia
Blood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)
Visual disturbance, tinnitus and deafness
Hypersensitivity reactions -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 54
Incorrect
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Regarding acute idiopathic thrombocytopaenic purpura (ITP), which of the following statements is CORRECT:
Your Answer: It is usually idiopathic with no precipitating cause.
Correct Answer: Over 80% of children recover without treatment.
Explanation:Acute ITP is most common in children. In approximately 75% of cases, the episode follows vaccination or infection such as chicken pox or glandular fever. Most cases are caused by non-specific immune complex attachment to platelets. Acute ITP usually has a very sudden onset and the symptoms usually disappear in less than 6 months (often within a few weeks). It is usually a self-limiting condition and over 80% of children recover without treatment; in 5 – 10% of cases a chronic form of the disease develops.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 55
Incorrect
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Insulin is produced by which of the following pancreatic cells:
Your Answer: Acinar cells
Correct Answer: β cells
Explanation:Insulin is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas. Insulin is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds. Proinsulin is synthesised as a single-chain peptide. Within storage granules, a connecting peptide (C peptide) is removed by proteases to yield insulin. Insulin release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin, but most output is driven by the rise in plasma glucose concentration that occurs after a meal. The effects of insulin are mediated by the receptor tyrosine kinase.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 56
Incorrect
-
Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?
Your Answer: Anterior
Correct Answer: Posterior
Explanation:The periurethral portion of the prostate gland increases in size during puberty and after the age of 55 years due to the growth of non-malignant cells in the transition zone of the prostate that surrounds the urethra. Most cancers develop in the posterior lobe, and cancers in this location may be palpated during a digital rectal examination (DRE).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 57
Correct
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The fracture of the medial epicondyle will cause damage to the ulnar nerve. Which of the following motions would be impaired by this type of injury?
Your Answer: Adduction of the thumb
Explanation:Fracture of the medial epicondyle is most likely to result in damage to the ulnar nerve.
The three hypothenar muscles, two medial lumbricals, seven interossei, the adductor pollicis, and the deep head of the flexor pollicis brevis are all innervated by the deep branch of the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 58
Incorrect
-
Which of the following is NOT an adverse effect associated with statin therapy:
Your Answer: Interstitial lung disease
Correct Answer: Aplastic anaemia
Explanation:Adverse effects of statins include:, Headache, Epistaxis, Gastrointestinal disorders (such as constipation, flatulence, dyspepsia, nausea, and diarrhoea), Musculoskeletal and connective tissue disorders (such as myalgia, arthralgia, pain in the extremity, muscle spasms, joint swelling, and back pain), Hyperglycaemia and diabetes, Myopathy and rhabdomyolysis, Interstitial lung disease and Hepatotoxicity
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 59
Correct
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A 42-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip adduction, but normal hip flexion.
Which of the following muscles was most likely injured in this case?Your Answer: Pectineus
Explanation:The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.
The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 60
Incorrect
-
Which of the following muscles is least likely to be involved in forceful expiration:
Your Answer:
Correct Answer: External intercostal muscles
Explanation:Forceful expiration is primarily produced by the deeper thoracic muscles (internal and innermost intercostal muscles, subcostals and transversus thoracis) aided by contraction of the abdominal wall muscles which increase intra-abdominal pressure thus further reducing the volume of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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SESSION STATS - PERFORMANCE PER SPECIALTY
