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Question 1
Correct
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Question 2
Incorrect
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In the event of an overdose, haemodialysis is ineffective as a treatment modality for which of the following drugs?
Your Answer: Lithium
Correct Answer: Tricyclics
Explanation:Tricyclic compounds can’t be cleared by haemodialysis.Drugs that can be cleared with haemodialysis include: (BLAST)- Barbiturate- Lithium- Alcohol (inc methanol, ethylene glycol)- Salicylates- Theophyllines (charcoal hemoperfusion is preferable)Drugs which cannot be cleared with haemodialysis include:- Tricyclics- Benzodiazepines- Dextropropoxyphene (Co-proxamol)- Digoxin- Beta-blockers
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 3
Correct
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Myocardial oxygen consumption is increased by:
Your Answer: An increase in after load
Explanation:Cardiac oxygen consumption is directly related to the amount of tension that develops in the ventricles. It is increased by an increased size of heart, increased afterload, increased contractility and increased heart rate.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 4
Correct
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Which of the following is a precursor to the tissue macrophage?
Your Answer: Monocyte
Explanation:Monocytes are a type of white blood cell, or leukocyte. They are the largest type of leukocyte and can differentiate into macrophages or dendritic cells.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 5
Incorrect
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With regards to the cell cycle, which phase represents period of cell growth that divides the end of DNA synthesis and the beginning of somatic cell division?
Your Answer: S Phase
Correct Answer: Gap 2
Explanation:Interphase is divided into three phases: G1 (first gap), S (synthesis), and G2 (second gap). During all three parts of interphase, the cell grows by producing proteins and cytoplasmic organelles. However, chromosomes are replicated only during the S phase. Thus, a cell grows (G1), continues to grow as it duplicates its chromosomes (S), grows more and prepares for mitosis (G2), and finally divides (M) before restarting the cycle.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 6
Correct
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What is found in the posterior cavity of the eye?
Your Answer: Vitreous humor
Explanation:The eye ball contains an anterior cavity and a posterior cavity. The anterior cavity once again is divided into the anterior chamber and posterior chamber. The anterior cavity is filled with aqueous humor whereas the posterior cavity contains vitreous humor.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 7
Incorrect
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Question 8
Correct
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A 36 year old man arrives at the clinic complaining of pain and swelling of the left knee, ankles and right hallux. He has acute conjunctivitis, and dysuria. He suffered from an episode of gastroenteritis two weeks back. Clinical examination shows left Achilles tendonitis and right plantar fasciitis. Radiological examination reveals left sacroiliitis, with evidence of enthesitis, joint erosions and periostitis. HLA-B27 is positive. Which of the following is the most likely diagnosis?
Your Answer: Reiter’s syndrome
Explanation:Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. extraarticular dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum), oral ulcers.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 9
Correct
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A 49 year old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?
Your Answer: Resisted wrist extension with the elbow extended
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 10
Incorrect
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A 32 year old female is diagnosed with SLE based on her complaints of polyarthralgia, mouth ulcers and ANA positivity. Labs reveal normal urinalysis, urea and electrolytes. ESR is 90mm in the first hour. How will you manage this patient?
Your Answer: Prednisolone 30 mg/day
Correct Answer: Hydroxychloroquine 200 mg/day
Explanation:Hydroxychloroquine is used in the management of SLE as it prevents disease progression and has relatively mild side effects, for instance headache, nausea etc. Its use reduces the usage of corticosteroids. It is particularly effective when the disease is less severe and there is no organ involvement. Cyclophosphamide and prednisolone are indicated in cases of renal, neurological and lung involvement.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 11
Incorrect
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A son has brought his 72-year-old mother to clinic. He is concerned about her short-term memory problems for the past 10 months. He has to remind her to take her medications and she has had two incidents of falling over in the last 10 months. Which of the following assists in the diagnosis of above condition?
Your Answer: Loss of control of bladder
Correct Answer: Progressive loss of function
Explanation:The clinical presentation is dementia. To differentiate Alzheimer disease and vascular dementia, the progressive loss of function is important. Progressive loss of function is usually associated with vascular dementia and rest of the responses are associated with Alzheimer disease.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 12
Correct
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Question 13
Correct
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Select one true statement about haemoglobin synthesis…
Your Answer: Occurs in the cytosol of developing red cells.
Explanation:Haemoglobin (Hb) is synthesized in a complex series of steps. The haem part is synthesized in a series of steps in the mitochondria and the cytosol of immature red blood cells, while the globin protein parts are synthesized by ribosomes in the cytosol. Production of Hb continues in the cell throughout its early development from the proerythroblast to the reticulocyte in the bone marrow.
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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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Which of the following is a method for measurement of cardiac output?
Your Answer: Indicator dilution method
Explanation:There are two methods of calculating the cardiac output in humans other than doppler with echocardiography: The direct Fick’s method and the indicator dilution method. In the indicator dilution technique, a known amount of a substance such as a dye or, more commonly, a radioactive isotope is injected into an arm vein and the concentration of the indicator in serial samples of arterial blood is determined. The output of the heart is equal to the amount of indicator injected divided by its average concentration in arterial blood after a single circulation through the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 15
Correct
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The growth promoting protein anabolic effects of insulin are mediated by:
Your Answer: Phosphatidylinositol 3-kinase
Explanation:Phosphatidylinositol 3-kinase or PI-3Ks are a group of enzymes which are involved in a number of different cellular functions. PI-3Ks interact with insulin and the insulin receptor substrate, regulating glucose uptake. They are an important element in the insulin signalling pathway.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 16
Incorrect
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Erythropoietin is synthesized by which cells of the nephron?
Your Answer: Principal cells in collecting ducts
Correct 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 17
Incorrect
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Which of the following normally has a slow depolarizing “prepotential”?
Your Answer: Purkinje fibers
Correct Answer: Sinoatrial node
Explanation:There are 2 main types of action potentials (AP) in the heart, the slow response and the fast response:The slow response is initiated by the slow calcium-sodium channels, found in the SA node (which is the natural pacemaker of the heart) and the conduction fibers of the AV node.The fast response occurs in the atrial and ventricles muscle cells and the purkinje fibers.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 18
Correct
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A 28 year old man presents to the clinic with fatigue, exertional dyspnoea, abdominal discomfort, xerophthalmia and xerostomia. Examination reveals enlargement of the parotid glands bilaterally, hepatomegaly and peripheral motor neuropathy. Lab results are negative for RF, ANA, SS-A and SS-B antibodies. What is the most likely diagnosis?
Your Answer: Diffuse infiltrative lymphocytic syndrome (DILS)
Explanation:The Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a rare multisystemic syndrome described in HIV-infected patients. It is characterised by CD8(+) T-cell lymphocytosis associated with a CD8(+) T-cell infiltration of multiple organs. DILS is usually seen in uncontrolled or untreated HIV infection but can also manifest itself independently of CD4(+) T-cell counts. The syndrome may present as a Sjögren-like disease that generally associates sicca signs with bilateral parotiditis, lymphadenopathy, and extra glandular organ involvement. The latter may affect the lungs, nervous system, liver, kidneys, and digestive tract. Anomalies of the respiratory system are often identified as lymphocytic interstitial pneumonia. Facial nerve palsy, aseptic meningitis or polyneuropathy are among the more frequent neurological features. Hepatic lymphocytic infiltration, lymphocytic interstitial nephropathy and digestive tract lymphocytic infiltration account for more rarely noted complications. Sicca syndrome, organomegaly and/or organ dysfunction associated with polyclonal CD8(+) T-cell organ-infiltration are greatly suggestive of DILS in people living with HIV.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 19
Incorrect
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The neurotransmitter utilised by the Purkinje cells is:
Your Answer: Glycine
Correct Answer: GABA
Explanation:The cerebellar cortex consist of 3 layers: the molecular layer, the granular cell layer and the Purkinje cell layer. Purkinje cells play a fundamental role in controlling motor movement. They release a neurotransmitter called GABA (gamma-aminobutyric acid) which exerts inhibitory actions thereby reducing transmission of impulses. These inhibitory functions enable purkinje cells to regulate and coordinate motor movements.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 20
Correct
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When observing a JVP, which of the following would lead to prominent v waves?
Your Answer: Tricuspid regurgitation
Explanation:The v wave corresponds to Venous filling when the tricuspid valve is closed and venous pressure increases from venous return. In Tricuspid regurgitation there is additional blood from the regurgitant flow and thus this leads to a more prominent V wave.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 21
Correct
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On a mountain the atmospheric pressure is 700 mmHg and the humidity close to zero, the partial pressure of oxygen is:
Your Answer: 147 mmHg
Explanation:Natural air includes approximately 21% of oxygen. If humidity is zero, the partial pressure of oxygen is 700 × 21% = 147 mmHg
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 22
Correct
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The internodal tract of Bachman:
Your Answer: Connects the SA node to the AV node
Explanation:Internodal tract of Bachman connects the SA node to the AV node conducting the electrical impulses generated from the SA node to the AV node and from the AV node to the rest of the electrical complex of the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 23
Correct
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In a patient with prostate cancer, what is the mechanism by which goserelin acts?
Your Answer: GnRH agonist
Explanation:Androgen deprivation therapy (ADT) for prostate cancer:Goserelin (Zoladex) is a synthetic gonadotropin-releasing hormone (GnRH) analogue; chronic stimulation of goserelin results in suppression of LH, FSH serum levels thereby preventing a rise in testosterone.Dosage form: 3.6 mg/10.8mg implants.Adverse effects include flushing, sweating, diarrhoea, erectile dysfunction, less commonly, rash, depression, hypersensitivity, etc.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 24
Correct
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Which one of the following is necessary to activate plasminogen to plasmin?
Your Answer: tPA
Explanation:In circulation, plasminogen adopts a closed, activation resistant conformation. Upon binding to clots, or to the cell surface, plasminogen adopts an open form that can be converted into active plasmin by a variety of enzymes, including tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), kallikrein, and factor XII (Hageman factor).
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This question is part of the following fields:
- Haematology
- Medicine
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Question 25
Correct
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Which of the following is NOT an effect of a positive inotropic agent on the heart?
Your Answer: It decreases the rate of rise in ventricular blood pressure during systole
Explanation:Inotropic agents increase the contractility of the heart as well as the rate of rise in ventricular blood pressure during systole, generating a greater pressure and increasing the stroke volume e.g. like catecholamines do.
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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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A patient who has mild benign prostatic hyperplasia has been advised to take finasteride.The mechanism of action of this drug involves inhibition of the production of which of the following androgens?
Your Answer: Dihydrotestosterone
Explanation:Finasteride inhibits the formation of dihydrotestosterone.Finasteride is a 5α-reductase inhibitor and thus, inhibits the conversion of testosterone to dihydrotestosterone (DHT). DHT is much more active than testosterone and binds more avidly to cytoplasmic receptors. DHT stimulates prostate growth and may be responsible for benign prostatic hyperplasia in the elderly. Thus, finasteride can cause a reduction in prostatic volume and help in managing a patient with benign prostatic hyperplasia.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 27
Correct
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When one of the two copies of the autosomes has a mutation and the protein produced by the normal form of the gene cannot compensate. The affected individual has an:
Your Answer: Autosomal dominant disorder
Explanation:An autosomal dominant trait will be expressed no matter the consequence. If one chromosome has a mutation the other will not be able to compensate for the mutation hence the protein formed will be mutated and will not function properly.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 28
Correct
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In both innate and humoral immunity, receptors involved recognize:
Your Answer: The shape of the antigen
Explanation:Antigen receptors recognize the shape of the antigen. They identify specific epitopes and are found on T cells.
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This question is part of the following fields:
- Immunology
- Medicine
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Question 29
Correct
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A 50-year-old woman under treatment for manic-depressive psychosis presents in an unconscious state after an episode of seizure on the street. Her husband who accompanied her into the ER reported that they argued about 6-7 hours ago. On examination, she is found to be hypertonic with a GCS of 8, BP: 90/60 mmHg and a pulse of 105 bpm. Blood investigations revealed a lithium level of 3.2 mmol/L. She was intubated and ventilated. Which of the following is the most appropriate immediate management in this case?
Your Answer: N saline should be started iv
Explanation:- Normal saline (N saline) should be started IV: Intravenous normal saline is recommended to enhance renal excretion of lithium. Adequate hydration is crucial because lithium is primarily excreted by the kidneys, and maintaining good urine output can help reduce lithium levels.
- Dialysis: This is considered the most effective treatment for severe lithium toxicity, especially when serum levels are significantly elevated (typically >2.5 mmol/L) and the patient presents with severe symptoms such as seizures, altered mental status, or renal impairment. Given the patient’s lithium level of 3.2 mmol/L and her critical condition, dialysis is necessary to rapidly reduce lithium levels.
The other options are less appropriate or ineffective in this context:
- Gastric lavage should be considered: This is not typically recommended for lithium poisoning because lithium is rapidly absorbed and lavage is unlikely to be effective several hours post-ingestion.
- Activated charcoal is likely to be effective: Activated charcoal does not effectively bind lithium and is not recommended for lithium poisoning.
- 5% dextrose should be started IV: While maintaining hydration is important, normal saline is preferred over dextrose solutions in this context to promote renal excretion of lithium.
- Dialysis is not normally required unless levels are above 5 mmol/L: This statement is incorrect. Dialysis is often required at lower levels, particularly in cases of severe toxicity or if the patient is symptomatic, as seen in this case.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 30
Incorrect
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Which of the following do not pass through the cavernous sinus?
Your Answer: CN 3
Correct Answer: CN 2
Explanation:Oculomotor nerve (N3), trochlear nerve (N4), ophthalmic and mandibular divisions of the trigeminal nerve (N5) pass along its lateral border. The abducent nerve (N6) passes through it along with the internal carotid artery.
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This question is part of the following fields:
- Medicine
- Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY
