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Question 1
Correct
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Erythropoietin is synthesized by which cells of the nephron?
Your Answer: Tubular interstitial cells
Explanation:Erythropoietin is produced by interstitial fibroblasts in the kidney in close association with peritubular capillary and proximal convoluted tubule. It is also produced in perisinusoidal cells in the liver. While liver production predominates in the fetal and perinatal period, renal production is predominant during adulthood.
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This question is part of the following fields:
- Medicine
- Renal
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Question 2
Incorrect
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A 45 year old man presents with fever, malaise, weight loss and myalgias that have been occurring for a month. You suspect polyarteritis nodosa and arrange for some lab investigations. Which of the following abnormality would most likely be present?
Your Answer: Leukopenia
Correct Answer: Elevated creatinine
Explanation:People with polyarteritis nodosa often exhibit anaemia of chronic disease. Leucocytosis and eosinophilia may also be present. ANCA is only rarely positive. As polyarteritis nodosa affects the kidneys as well, the creatinine is elevated in most cases.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 3
Correct
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A typical sleep cycle from stage 1 to the end of REM sleep in a normal adult is approximately how long?
Your Answer: 90 min
Explanation:A single sleep cycle has stages 1, 2, 3, 4 and REM (Rapid eye movement). These stages progress cyclically from 1 through to REM and then begin again with stage 1. A complete sleep cycle takes an average of 90-110 minutes, with each stage lasting between 5 to 15 minutes.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 4
Incorrect
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Which of the following does not contribute to increased stroke volume during exercise?
Your Answer:
Correct Answer: Increased length of filling time during diastole
Explanation:Prolonged aerobic exercise training may also increase stroke volume, which frequently results in a lower (resting) heart rate. Reduced heart rate prolongs ventricular diastole (filling), increasing end-diastolic volume, and ultimately allowing more blood to be ejected.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 5
Incorrect
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During strenuous exercise the following arterial change can take place in a fit athlete:
Your Answer:
Correct 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
Incorrect
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The infoldings or spaces between the bases of the villi are known as
Your Answer:
Correct Answer: Crypts of Lieberkühn
Explanation:An intestinal gland (also crypt of Lieberkühn and intestinal crypt) is a gland found in the intestinal epithelium lining of the small intestine and large intestine (colon) between the villi.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 7
Incorrect
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Cyclic AMP is formed from ATP via which enzyme
Your Answer:
Correct Answer: Adenylate cyclase
Explanation:Cyclic AMP is synthesized from ATP by adenylate cyclase located on the inner side of the plasma membrane and anchored at various locations in the interior of the cell.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 8
Incorrect
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VIP, GIP and somatostatin play an inhibitory role in gastric acid secretion by inactivating?
Your Answer:
Correct Answer: G cells
Explanation:Gastrin is secreted from the G cells. VIP, GIP and somatostatin all inhibit acid production by inhibiting the G cells.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 9
Incorrect
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An 87-year-old woman had to double up her dosage of morphine 60mg into 120mg twice a day, in addition to another 10mg oral Morphine 6 times a day. What is the best method of management?
Your Answer:
Correct Answer: Subcutaneous morphine infusion
Explanation:Stable dose of Morphine is essential for chronic cases of pain that are non-malignant in origin. Using the SC route avoids having to intravenously cannulate a patient and allows for a continuous infusion of drugs over a calculated period of time providing constant dosing A significant advantage is that plasma levels of a drug are much more stable, and appropriate symptom control can be achieved without the toxic effects of the peaks and troughs resulting from episodic drug administration.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 10
Incorrect
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Of the daily production of CSF, the vast majority is produced in the:
Your Answer:
Correct Answer: Choroid plexus
Explanation:About 80% of CSF is produced by the choroid plexus. It is also produced by a single layer of column shaped ependymal cells.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 11
Incorrect
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The conversion of fructose to fructose 1-phosphate is catalysed by:
Your Answer:
Correct Answer: Fructokinase
Explanation:The first step in the metabolism of fructose is the phosphorylation of fructose to fructose 1-phosphate by fructokinase.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 12
Incorrect
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A 72 year old retired fisherman presents with weakness of shoulders and hips over the last four months. Finger flexion is also weak but the extension is normal. There has been some difficulty swallowing liquids. Past medical history is not significant except for sexually transmitted disease that he caught some 40 years ago in South Pacific and got treated with antibiotics. He smokes and drinks one or two tots of rum at the weekend. Creatine kinase level is 125. Which of the following investigations is most significant in establishing a diagnosis?
Your Answer:
Correct Answer: Muscle biopsy with electron microscopy
Explanation:Inclusion body myositis (IBM) is a progressive muscle disorder characterized by muscle inflammation, weakness, and atrophy (wasting). It is a type of inflammatory myopathy. IBM develops in adulthood, usually after age 50. The symptoms and rate of progression vary from person to person. The most common symptoms include progressive weakness of the legs, arms, fingers, and wrists. Some people also have weakness of the facial muscles (especially muscles controlling eye closure), or difficulty swallowing (dysphagia). Muscle cramping and pain are uncommon, but have been reported in some people. The underlying cause of IBM is poorly understood and likely involves the interaction of genetic, immune-related, and environmental factors. Some people may have a genetic predisposition to developing IBM, but the condition itself typically is not inherited. Elevated creatine kinase (CK) levels in the blood (at most ,10 times normal) are typical in IBM. Muscle biopsy may display several common findings including; inflammatory cells invading muscle cells, vacuolar degeneration, inclusions or plaques of abnormal proteins.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 13
Incorrect
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Which of the following is not true regarding mitochondrial chromosome disorders?
Your Answer:
Correct Answer: Because mitochondrial chromosomes have no introns in their genes, any point mutation has a low likelihood of having an effect.
Explanation:Any point mutation in any part of the mitochondrial DNA will lead to a mutated mitochondria and will likewise have its ill effect on the body.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 14
Incorrect
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A 39-year-old accountant with long-standing gastro-oesophageal reflux disease is reviewed in clinic. He has recently switched from ranitidine to omeprazole. What is the main benefit of omeprazole compared to ranitidine?
Your Answer:
Correct Answer: Irreversible blockade of H+/K+ ATPase
Explanation:Proton pump inhibitors can reduce gastric acid secretion by up to 99%. Acid production resumes following the normal renewal of gastric parietal cells.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 15
Incorrect
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A 67 year old man reports weight loss. Labs show a raised alkaline phosphatase at 290 U/L (normal range 35-120). Plain radiographs reveal sclerotic lesions of the bone. Which of the following is the most likely cause of these findings?
Your Answer:
Correct Answer: Prostate cancer
Explanation:Osteoblastic (or sclerotic) bony metastases, characterized by deposition of new bone, present in prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma or medulloblastoma. The other cancers listed in the options are osteolytic.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 16
Incorrect
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Which of the following skin conditions is not associated with diabetes mellitus?
Your Answer:
Correct Answer: Sweet's syndrome
Explanation:Diabetic dermadromes constitute a group of cutaneous conditions commonly seen in people with diabetes with longstanding disease. Conditions included in this group are:- Acral dry gangrene- Carotenosis- Diabetic dermopathy- Diabetic bulla- Diabetic cheiroarthropathy- Malum perforans- Necrobiosis lipoidica- Limited joint mobility- Scleroderma- Waxy skin is observed in roughly 50%. Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia. It is not associated with diabetes mellitus.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 17
Incorrect
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Peristalsis is an example of:
Your Answer:
Correct Answer: Enteric nervous system
Explanation:Peristalsis is a type of contraction where radial symmetrical contraction and relaxation of muscles propagates food in a downward wave through the gut. The enteric nervous system is one of the main divisions of the nervous system and consists of a mesh-like system of neurons that controls the function of the gastrointestinal tract. It has an independent reflex activity. The neurons of this system re collected into two types of ganglia: myenteric (or Auerbach’s) and submucosal (or Meissner’s plexuses). Myenteric plexuses are located between the inner and outer layers of the muscularis externa, while submucosal plexuses are located in the submucosa.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 18
Incorrect
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Concerning protein digestion:
Your Answer:
Correct Answer: Most protein digestion occurs in the duodenum
Explanation:Human pepsinogens can be divided into two immunochemically distinct groups: Pepsinogen I (PG I) and Pepsinogen II (PGII). PG I is secreted mainly by chief cells in the fundic mucosa whereas PGII is secreted by the pyloric glands and the proximal duodenal mucosa. Maximal acid secretion correlates with PG I. Most protein digestion occurs in the duodenum/jejunum. Pepsin functions best in an acidic environment and specifically at a pH of 1.5 to 3.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 19
Incorrect
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A 56 year old obese female presents due to moderate pain in her finger joints which occurs mostly at the end of the day which gets better with rest. There is also some associated swelling. On examination, there is enlargement of her distal interphalangeal joints and tenderness to palpation. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Osteoarthritis
Explanation:Osteoarthritis (OA) is a disabling joint disease characterized by a noninflammatory degeneration of the joint complex (articular cartilage, subchondral bone, and synovium) that occurs with old age or from overuse. It mainly affects the weight-bearing and high-use joints, such as the hip, knee, hands, and vertebrae. Despite the widespread view that OA is a condition caused exclusively by degenerative “wear and tear” of the joints, newer research indicates a significant heterogeneity of causation, including pre-existing peculiarities of joint anatomy, genetics, local inflammation, mechanical forces, and biochemical processes that are affected by proinflammatory mediators and proteases. Major risk factors include advanced age, obesity, previous injuries, and asymmetrically stressed joints. In early-stage osteoarthritis, patients may complain of reduced range of motion, joint-stiffness, and pain that is aggravated with heavy use. As the disease advances, nagging pain may also occur during the night or at rest. Diagnosis is predominantly based on clinical and radiological findings. Classic radiographic features of OA do not necessarily correlate with clinical symptoms and appearance. RA involves proximal interphalangeal joints not distal. Gout occurs as a result of overproduction or underexcretion of uric acid and frequently involves first toe. Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 20
Incorrect
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Question 21
Incorrect
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A 50-year-old man is admitted with nausea and excessive drowsiness after taking an antihistamine tablet with grapefruit juice. Which of the following liver enzyme systems is affected by grapefruit juice causing the given side effect?
Your Answer:
Correct Answer: Cytochrome p450 3A4
Explanation:The cytochrome p450 3A4 enzyme system in the liver is affected by grapefruit juice. Patients taking antihistamines should be advised to avoid drinking grapefruit juice. This is because constituents of grapefruit juice such as naringin and bergamottin inhibit CYP3A4 in the liver, particularly at high doses, leading to decreased drug elimination via hepatic metabolism and can increase potential drug toxicities. Inhibition of this enzyme system leads to reduced metabolism of antihistamines leading to an increased incidence of side effects like excessive drowsiness and nausea as in this patient.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 22
Incorrect
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The main breakdown of fatty acids (by B-oxidation) occurs in which part of the cell?
Your Answer:
Correct Answer: Mitochondria
Explanation:Once inside the mitochondria, the β-oxidation of fatty acids occurs via five recurring steps:Activation by ATPOxidation by FAD,Hydration,Oxidation by NAD+,Thiolysis,The final product is acetyl-CoA, the entry molecule for the citric acid cycle.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 23
Incorrect
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Afferent fibers from the baroreceptors of the great arteries form branches of which cranial nerves?
Your Answer:
Correct Answer: Glossopharyngeal and vagus nerves
Explanation:The receptors of the carotid sinus are innervated by the carotid sinus nerve, a branch of the glossopharyngeal nerve. The aortic arch receptors located in the arch of the aorta are innervated by the aortic depressor nerve, a branch of the vagus nerve.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 24
Incorrect
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Excitation-contraction coupling in cardiac muscle involves all of the following except:
Your Answer:
Correct Answer: Binding of Ca2+ to calmodulin
Explanation:In the excitation contraction coupling model, an action potential is transmitted to the fibrils of a fiber through the T tubule system. It triggers the release of Ca 2+ from the terminal cisterns. Depolarization of the T tubules activates the sarcoplasmic reticulum through the dihydropyridine receptors. These are voltage gates calcium channels. Calcium binds to calmodulin during contraction of the smooth muscle and not the cardiac muscles.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 25
Incorrect
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Regarding taste threshold and intensity discrimination:
Your Answer:
Correct Answer: 30% change in concentration of substance tasted is necessary before an intensity difference can be detected
Explanation:The ability of humans to differentiate differences in intensity of taste is poor. A 30% change in the concentration of the substance being tasted is required before an intensity difference is perceived.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 26
Incorrect
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The following are Gram-negative cocci:
Your Answer:
Correct Answer: Neisseria
Explanation:Gram-negative cocci include the four types that cause a sexually transmitted disease (Neisseria gonorrhoeae), a meningitis (Neisseria meningitidis), and respiratory symptoms (Moraxella catarrhalis, Haemophilus influenzae).
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This question is part of the following fields:
- Infectious Diseases
- Medicine
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Question 27
Incorrect
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Intermediate filaments achieve cell to cell contact via:
Your Answer:
Correct Answer: Desmosomes
Explanation:At the plasma membrane, some keratins interact with desmosomes (cell-cell adhesion) and hemidesmosomes (cell-matrix adhesion) via adapter proteins.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 28
Incorrect
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The primary auditory cortex is:
Your Answer:
Correct Answer: Brodmann area 41
Explanation:A Brodmann area in the brain is defined by cytoarchitecture, histology and organization of cells:Primary Sensory 3,1,2Primary Motor 4Premotor 6Primary Visual 17Primary Auditory 41Brocas 44
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This question is part of the following fields:
- Medicine
- Neurology
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Question 29
Incorrect
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Select the correct pairing regarding the surface of the cerebral hemispheres.
Your Answer:
Correct Answer: Parietal lobe : primary somatosensory cortex
Explanation:Parietal lobe: The primary somatosensory cortex is located in the postcentral gyrus of the parietal lobe. It is responsible for processing sensory information from the body.
Frontal lobe: The primary motor cortex is located in the precentral gyrus of the frontal lobe. The frontal lobe also contains the premotor cortex, which is involved in planning movements. The primary visual cortex is located in the occipital lobe, not the frontal lobe.
Temporal lobe: The primary auditory cortex is located in the superior temporal gyrus of the temporal lobe. The primary motor and premotor cortices are located in the frontal lobe, not the temporal lobe.
Occipital lobe: The primary visual cortex is located in the occipital lobe. The primary auditory cortex is located in the temporal lobe, not the occipital lobe.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 30
Incorrect
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A 24 year old male, known case of hereditary angioneurotic oedema presents with recurrent fever and arthralgia which is accompanied by a rash on face and upper chest. These attacks have been refractory to treatment and have occurred recurrently requiring adrenaline on several occasions. Lab results reveal persistently reduced C4 levels. Which of the following is most likely causing his current symptoms?
Your Answer:
Correct Answer: Systemic lupus erythematosus
Explanation:Angioedema secondary to C1 inhibitor deficiency has been rarely reported to be associated with systemic lupus erythematosus. A genetic defect of C1 inhibitor produces hereditary angioedema, which is usually presented with cutaneous painless oedema, but oedema of the genital area, gastrointestinal and laryngeal tracts have also been reported. In lupus patients, angioedema may be the result of an acquired type of C1 inhibitor deficiency, most probably due to antibody formation directed against the C1 inhibitor molecule.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
