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Question 1
Correct
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A 75 year old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?
Your Answer: Urinary incontinence
Explanation:Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 2
Incorrect
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A 68 year old female is on long term prednisolone therapy for polymyalgia rheumatica. Which of the following would be the most suitable protection against osteoporosis?
Your Answer: Calcium and vitamin D
Correct Answer: Oral bisphosphonate
Explanation:Prevention of osteoporosis associated with chronic glucocorticoid therapy is done by administrating bisphosphonates. Oral bisphosphonates are indicated for patients aged above 65 who have been on steroid therapy for over 3 months, so as to reduce the risk of steroid induced osteoporosis. HRT is usually done in post menopausal women who have oestrogen related bone resorption.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 3
Incorrect
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What is the mechanism of action of sumatriptan?
Your Answer: 5-HT2 antagonist
Correct Answer: 5-HT1 agonist
Explanation:Triptans are specific 5-HT1 agonists used in the acute treatment of migraine. They are generally used as first-line therapy in combination with an NSAID or paracetamol.
Sumatriptan acts as an agonist on 5-HT1B/1D receptors by inducing vasoconstriction in the basilar artery and blood vessels within the dura mater. The drug reduces peripheral nociception either by selective cranial vasoconstriction or by affecting trigeminovascular nerves.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 4
Correct
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The cavernous sinus is?
Your Answer: Lateral to the body of the sphenoid
Explanation:It is a venous sinus which creates a cavity called the lateral sellar compartment bordered by the temporal bone and the sphenoid bone. There are 2 on either side. It is about 1cm wide and extends from the posterior aspect of the orbit to the petrous part of the temporal bone. They sit on either side or lateral to the sphenoid bone.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 5
Incorrect
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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: Glomerulonephritis
Correct 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 6
Correct
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A patient with achalasia
Your Answer: Has decreased production of vasoactive intestinal polypeptide (VIP)
Explanation:Oesophageal achalasia is an oesophageal motility disorder involving the smooth muscle layer of the oesophagus and the lower oesophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the oesophagus (inability of smooth muscle to move food down the oesophagus) in the absence of other explanations like cancer or fibrosis. In achalasia, there is loss of nitric oxide (NO) and vasoactive intestinal polypeptide (VIP) releasing inhibitory neurons.
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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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Which one of the following features is least associated with primary hyperparathyroidism?
Your Answer: Peptic ulceration
Correct Answer: Sensory loss
Explanation:The signs and symptoms of primary hyperparathyroidism are those of hypercalcemia. They are classically summarized by stones, bones, abdominal groans, thrones and psychiatric overtones.
Stones refers to kidney stones, nephrocalcinosis, and diabetes insipidus (polyuria and polydipsia). These can ultimately lead to renal failure.
Bones refers to bone-related complications: osteitis fibrosa cystica, osteoporosis, osteomalacia, and arthritis.
Abdominal groans refers to gastrointestinal symptoms of constipation, indigestion, nausea and vomiting. Hypercalcemia can lead to peptic ulcers and acute pancreatitis.
Thrones refers to polyuria and constipation
Psychiatric overtones refers to effects on the central nervous system. Symptoms include lethargy, fatigue, depression, memory loss, psychosis, ataxia, delirium, and coma.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 8
Incorrect
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Oxidation is defined as a:
Your Answer: Loss of oxygen from substances
Correct Answer: Loss of electrons from molecules
Explanation:Oxidation is the loss of electrons or an increase in oxidation state by a molecule, atom, or ion.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 9
Correct
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When is the blood pressure at its lowest during pregnancy?
Your Answer: Second trimester
Explanation:It is lowest during the second trimester.
Previous studies have reported changes in blood pressure (BP) throughout pregnancy, and it was generally accepted that in clinically healthy pregnant women, BP falls gradually at first trimester, reaching the lowest around 22–24 weeks, rising again from 28 weeks, and reaching preconception levels by 36 weeks of gestation
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 10
Correct
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Which substance has the lowest taste threshold concentration, in other words which substance can be present in the lowest concentration before taste buds will respond?
Your Answer: Strychnine hydrochloride (bitter)
Explanation:The lowest concentration of a gustatory stimulus to which the taste buds respond is considered to be the threshold concentration for that substance. The threshold concentration for strychnine is 0.0001 mm; this is because it allows the body to detect potentially dangerous substances (bitter plant components) at lower concentrations.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 11
Correct
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The pyloric sphincter is largely made up of thickening of
Your Answer: The circular muscle layer
Explanation:The pyloric sphincter, or valve, is a strong ring of smooth muscle (circular muscle layer) at the end of the pyloric canal which lets food pass from the stomach to the duodenum. It controls the outflow of gastric contents into the duodenum. It receives sympathetic innervation from the celiac ganglion.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 12
Incorrect
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Approximately what percentage of the world is infected with tuberculosis:
Your Answer: 40%
Correct Answer: 25%
Explanation:The WHO report states that about one-quarter of the world’s population is infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis. This means approximately 25% of people globally have latent TB infection, which can potentially progress to active TB disease.
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This question is part of the following fields:
- Infectious Diseases
- Medicine
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Question 13
Incorrect
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Which one of the following is true about bone marrow?
Your Answer: Yellow marrow is mainly fat cells with scanty blood vessels and capillaries
Correct Answer: At birth the bone marrow is entirely red marrow and is converted to yellow marrow with age
Explanation:The two types of bone marrow are red marrow, which consists mainly of hematopoietic tissue, and yellow marrow, which is mainly made up of fat cells. Red blood cells, platelets, and most white blood cells arise in red marrow. Both types of bone marrow contain numerous blood vessels and capillaries. At birth, all bone marrow is red. With age, more and more of it is converted to the yellow type; only around half of adult bone marrow is red.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 14
Correct
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Select a factor which stimulates glucagon secretion.
Your Answer: Protein meal
Explanation:Several studies have shown that glucagon levels are increased in individuals with a high protein diet. It is still debated, however, whether this type of diet affects insulin levels as well.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 15
Correct
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Select the correct statement regarding portal hypertension.
Your Answer: The total vascular resistance of the hepatic sinusoids is increased.
Explanation:Portal hypertension is increased blood pressure within the portal venous system. This happens mainly due to liver damage which increases the vascular resistance of hepatic sinusoids by interfering with the normal blood flow. Portal blood pressure increases and flow through the liver decreases. Normal portal venous pressure is between 5-10 mmHg and in portal hypertension it’s usually more than 10 mmHg. This high pressure can cause accumulation of fluid in the peritoneal cavity known as ascites. To overcome the pressure, the portal vein starts to drain blood to systemic circulation via porto-systemic shunts. The connection between the portal vein and inferior vena cava is known as the porto caval shunt. Due to damaged hepatocytes, detoxification of substances absorbed in the intestine is impaired and the former shunt mixes non-detoxified blood with the systemic circulation. These toxic substances may affect neurons causing hepatic encephalopathy which is a major complication of portal hypertension.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 16
Incorrect
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Cholinergic neurons that pass into a retrograde direction activate neurons that release:
Your Answer: Acetyl choline
Correct Answer: Substance P and acetyl choline
Explanation:Serotonin activates sensory neurons that activate the myenteric plexus. Cholinergic neurons passing in a retrograde direction in the myenteric plexus activate neurons that release substance P and acetylcholine, causing smooth muscle contraction.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 17
Correct
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Closure of the tricuspid valve is marked by which of the following features of the jugular venous waveform?
Your Answer: c wave
Explanation:The jugular venous pressure (JVP) classically has three upward deflections and two downward deflections. The upward deflections are the a (atrial contraction), c (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and v = venous filling. The downward deflections of the wave are the x (the atrium relaxes and the tricuspid valve moves downward) and the y descent (filling of ventricle after tricuspid opening).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 18
Incorrect
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer: Chest CT
Correct Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 19
Correct
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Carotid bodies...
Your Answer: Are located near the bifurcation of the carotid arteries bilaterally
Explanation:The carotid body is a small cluster of chemoreceptors and supporting cells located near the fork (bifurcation) of the carotid artery (which runs along both sides of the throat).The carotid body detects changes in the composition of arterial blood flowing through it, mainly the partial pressure of oxygen, but also of carbon dioxide. Furthermore, it is also sensitive to changes in pH and temperature. Carotid bodies trigger an action potential through the afferent fibers of the glossopharyngeal nerve,
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 20
Incorrect
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Which serotonergic receptor is associated with vomiting?
Your Answer: 5ht2a
Correct Answer: 5ht3
Explanation:5ht3 is a receptor strongly associated with vomiting, present in vagal afferents, the solitary tract nucleus (STN), and the area posterior. For this reason, 5ht3 antagonists are commonly used as antiemetic drugs. They include ondansetron, tropisetron, and granisetron.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 21
Correct
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In the basal ganglia, the Lentiform nucleus is formed by which two nuclei?
Your Answer: Putamen and Globus pallidus
Explanation:The Basal Ganglia are composed of the following structures: Caudate, putamen, Globus pallidus, subthalamic nucleus and substantia nigra.
The Lentiform nucleus is a biconvex structure located within the basal ganglia of the brain. It is composed of two nuclei:
- Putamen: This is the outer part of the Lentiform nucleus and is involved in regulating movements and various types of learning.
- Globus pallidus: This is the inner part of the Lentiform nucleus and is divided into two segments: the external segment (GPe) and the internal segment (GPi). It plays a key role in the regulation of voluntary movement.
These two structures together form the Lentiform nucleus, which is an integral part of the basal ganglia system involved in motor control.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 22
Correct
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In increasing order of concentration, the main anions in plasma are:
Your Answer: Proteins-, HCO3-, Cl-,
Explanation:Anions are negatively charged ions and include: chloride Cl-, bicarbonate HCO3-, sulphate SO4-2, phosphate HPO4-2, and protein anions. Chloride it the most abundant anion followed by bicarbonate and then protein anions.
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This question is part of the following fields:
- Medicine
- Renal
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Question 23
Correct
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Regarding Gene Knockout Mouse Models, all are true except:
Your Answer: In knockout mouse models a gene is turned on through targeted mutation
Explanation:In knockout mouse models, a gene is not turned on but rather turned off or “knocked out” through targeted mutation. This involves disrupting or deleting the gene to study the effects of its loss of function. Knockout models are crucial for understanding the roles of specific genes, particularly those with unknown functions.
The other statements are true:
- Knockout models are important in studying the roles of sequenced genes with unknown function.
- RFLP (Restriction Fragment Length Polymorphisms) can be subcategorized as SLP (single locus probe) and MLP (multi locus probe).
- RFLP analysis is slow and cumbersome and is now largely obsolete, having been replaced by more efficient techniques.
- Sequence changes involved in RFLP can be analyzed more quickly by PCR (Polymerase Chain Reaction).
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This question is part of the following fields:
- Genetics
- Medicine
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Question 24
Incorrect
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Question 25
Incorrect
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Which is the commonest cardiovascular abnormality seen in an adult patient with Marfan’s syndrome?
Your Answer: Mitral regurgitation
Correct Answer: Aortic aneurysm
Explanation:Marfan syndrome (MFS) is a genetic disorder of connective tissue. The degree to which people are affected varies. People with Marfan’s tend to be tall, and thin, with long arms, legs, fingers and toes. They also typically have flexible joints and scoliosis. The most serious complications involve the heart and aorta with an increased risk of mitral valve prolapse and aortic aneurysm.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 26
Correct
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Normal parents have a child with a recessive condition, Tay Sachs. The chance of them having a normal child is?
Your Answer: 75%
Explanation:The chance for normal parents having a child with a recessive disease is 1:4 or 25%. As both the parents are heterozygous for this condition. They have a 3:4 chance of having a normal child or 75%.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 27
Correct
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Question 28
Incorrect
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A 30-year-old female presents with a 4-day history of diarrhoea and vomiting. She has been unable to keep fluids down for 4 days and has been treated with metoclopramide. She develops a dystonic reaction. What is the most appropriate treatment for this woman?
Your Answer: Domperidone
Correct Answer: Benztropine
Explanation:Acute dystonic reactions (extrapyramidal symptoms) such as spasmodic torticollis, trismus, and oculogyric crises can occur following the administration of metoclopramide or stemetil and thus, neither is recommended for the treatment of nausea in young women.
Such reactions respond well to treatment with benztropine or procyclidine.
– Benztropine: It is an anticholinergic medication with significant CNS penetration. A single dose of benztropine 1 to 2 mg IV followed by 1 to 2 mg p.o twice a day for up to 7 days to prevent a recurrence. Subsequently, both the offending agent and those from the same group should be avoided.
– Alternatively, diphenhydramine can be used intravenously (up to a dose of 50mg) or intramuscularly followed by p.o therapy every 6 hours for 1 to 2 to prevent a recurrence.- Second-line therapy with IV benzodiazepines is reserved for those patients who do not respond to anticholinergics.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 29
Incorrect
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A 30-year-old female was brought to the ER in a confused state. The patient works in a photograph development laboratory. On admission, she was hypoxic and hypotensive. A provisional diagnosis of cyanide poisoning was made. What is the definitive treatment?
Your Answer: Haemodialysis
Correct Answer: Hydroxocobalamin
Explanation:Cyanide poisoning: Aetiology:Smoke inhalation, suicidal ingestion, and industrial exposure (specific industrial processes involving cyanide include metal cleaning, reclaiming, or hardening; fumigation; electroplating; and photo processing) are the most frequent sources of cyanide poisoning. Treatment with sodium nitroprusside or long-term consumption of cyanide-containing foods is a possible source.Cyanide exposure most often occurs via inhalation or ingestion, but liquid cyanide can be absorbed through the skin or eyes. Once absorbed, cyanide enters the blood stream and is distributed rapidly to all organs and tissues in the body. Pathophysiology:Inside cells, cyanide attaches itself to ubiquitous metalloenzymes, rendering them inactive. Its principal toxicity results from inactivation of cytochrome oxidase (at cytochrome a3), thus uncoupling mitochondrial oxidative phosphorylation and inhibiting cellular respiration, even in the presence of adequate oxygen stores.Presentation:• ‘Classical’ features: brick-red skin, smell of bitter almonds• Acute: hypoxia, hypotension, headache, confusion• Chronic: ataxia, peripheral neuropathy, dermatitisManagement:• Supportive measures: 100% oxygen, ventilatory assistance in the form of intubation if required.• Definitive: Hydroxocobalamin (iv) is considered the drug of choice and is approved by the FDA for treating known or suspected cyanide poisoning. • Coadministration of sodium thiosulfate (through a separate line or sequentially) has been suggested to have a synergistic effect on detoxification.Mechanism of action of hydroxocobalamin: • Hydroxocobalamin combines with cyanide to form cyanocobalamin (vitamin B-12), which is renally cleared.• Alternatively, cyanocobalamin may dissociate from cyanide at a slow enough rate to allow for cyanide detoxification by the mitochondrial enzyme rhodanese.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 30
Correct
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The central veins in the liver:
Your Answer: Coalesce to form the hepatic vein
Explanation:The central veins coalesce to form the hepatic vein which in turn drains into the inferior vena cava. The portal vein mainly carries blood from different parts of the GIT and is not drained to the inferior vena cava.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
