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Question 1
Incorrect
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.
The stomach D-cells secrete which of the following substances?
Your Answer: Pepsinogen
Correct Answer: Somatostatin
Explanation:Somatostatin-producing cells present in the pyloric antrum, duodenum, and pancreatic islets are known as D-cells or delta-cells. Somatostatin inhibits gastric acid secretion by acting directly on acid-producing parietal cells in the stomach via a G-protein coupled receptor. By suppressing the release of other hormones such as gastrin, secretin, and histamine, somatostatin can indirectly reduce stomach acid output, slowing the digesting process.
The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretion
Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
Chief cells/ Pepsinogen/ Protein digestion
Chief cells/ Gastric lipase/ Fat digestion
G-cells/ Gastrin/ Stimulates gastric acid secretion
Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
D-cells/ Somatostatin/ Inhibits gastric acid secretion -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 2
Correct
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Mannitol is primarily indicated for which of the following:
Your Answer: Cerebral oedema
Explanation:Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. Mannitol is a low molecular weight compound and is, therefore, freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain-barrier (BBB).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 3
Incorrect
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A 29-year-old woman presents with night sweats, fever, and haemoptysis. A diagnosis of tuberculosis was suspected.
Which of the following statements regarding the diagnosis of tuberculosis is considered correct?Your Answer: Nucleic acid amplification testing takes 4-6 weeks
Correct Answer: Mycobacteria tuberculosis can be typed using a RFLP method
Explanation:Although a variety of clinical specimens may be submitted to the
laboratory to recover MTB and NTM, respiratory secretions such
as sputum and bronchial aspirates are the most common. An
early-morning specimen should be collected on three consecutive
days, although recent studies have suggested that the addition of
a third specimen does not significantly increase the sensitivity
of detecting Mycobacteria.Mycobacterium tuberculosis appear red on acid-fast staining because they take up the primary stain, which is carbolfuchsin, and is not decolorized by the acid alcohol anymore.
Culture on Lowenstein-Jensen medium should be read within 5 to 7 days after inoculation and once a week thereafter for up to 8 weeks.
Nucleic acid amplification assays designed to detect M. tuberculosis complex
bacilli directly from patient specimens can be performed in as little as 6 to 8 hours on processed specimens. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 4
Correct
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Which of the following classes of drugs may predispose to lithium toxicity:
Your Answer: Thiazide diuretics
Explanation:Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 5
Correct
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You've been summoned to a young man in the resus area who is experiencing an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.
Which of the following is the correct adenosine mechanism of action?Your Answer: Opens K + channels in the heart
Explanation:The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.
Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.
The use of adenosine is contraindicated in the following situations:
Asthma
COPD (chronic obstructive pulmonary disease)
Decompensated heart failureÂ
Long QT syndrome
AV block in the second or third degree
Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
Hypotension that is severe -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Incorrect
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A 70-year-old woman presents with right-sided loss of pain and temperature sense on the body as well as left-sided loss of pain and temperature sense on the face. She also has complaints of vertigo, nausea, and tinnitus. Further examination of her cranial nerves suggest the presence of Horner's Syndrome. An MRI and CT scan was ordered and results showed that she is suffering from a left-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer: Anterior spinal artery
Correct Answer: Posterior inferior cerebellar artery
Explanation:Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. It is the most common posterior circulation ischemic stroke syndrome. The primary pathology of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches.
It is characterized by vertigo with nystagmus, nausea and vomiting, and sometimes hiccups, dysphonia, dysarthria, and dysphagia often present with ipsilateral loss of gag reflex, ipsilateral ataxia with a tendency to fall to the ipsilateral side, pain and numbness with impaired facial sensation on the face, impaired taste sensation, and impaired pain and temperature sensation in the arms and legs.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 7
Correct
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Low levels of which of the following arterial blood gas parameters stimulate the peripheral chemoreceptors?
Your Answer: Arterial pO 2
Explanation:Chemoreceptors are activated when the chemical composition of their immediate surroundings changes.
Peripheral chemoreceptors, together with central chemoreceptors, regulate respiratory functions. They detect changes in arterial blood oxygen levels. Decreased arterial Po2 (partial pressure of oxygen) reflexly stimulates peripheral chemoreceptors.
When peripheral chemoreceptors detect changes in arterial blood oxygen, they will trigger cardiorespiratory changes such as an increase in breathing and blood pressure. These reflexes are important for maintaining homeostasis during hypoxemia.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 8
Incorrect
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A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.
Which statement about ipratropium bromide is true?Your Answer: It is a muscarinic agonist
Correct Answer: It can trigger acute closed-angle glaucoma
Explanation:Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD.
It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.
The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists.
It can trigger acute closed-angle glaucoma in patients that are susceptible.
First-line treatment for moderate asthma attacks is short-acting β2agonists.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.
Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 9
Correct
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The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian man is 152/96 mmHg (ABPM).
The first-line drug treatment for this patient would be which of the following? Please only choose ONE answer.Your Answer: Amlodipine
Explanation:An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.
A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 59-year-old Caucasian man.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 10
Correct
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Which of the following occurs at the transverse thoracic plane:
Your Answer: Bifurcation of the trachea
Explanation:A way to help remember the structures transected by the transverse thoracic plane is CLAPTRAP:
C: cardiac plexus
L: ligamentum arteriosum
A: aortic arch (inner concavity)
P: pulmonary trunk
T: tracheal bifurcation (carina)
R: right-to-left movement of the thoracic duct (posterior to the oesophagus)
A: azygos vein drains into superior vena cava
P: pre-vertebral fascia and pre-tracheal fascia end -
This question is part of the following fields:
- Anatomy
- Thorax
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Question 11
Incorrect
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A 45-year-old African American male presents to your clinic complaining of swelling of his feet for the past six months. On examination, there is periorbital and pedal oedema. A 24-hour urine collection is ordered, which shows 8 g of protein. The serum cholesterol is ten mmol/L. You order a renal biopsy to confirm the diagnosis.
Which one of the following findings are you most likely to see in this patient's biopsy?Your Answer: Minimal change disease
Correct Answer: Focal segmental glomerulosclerosis
Explanation:This patient has Nephrotic Syndrome confirmed by the presence of 1. Heavy proteinuria (greater than 3-3.5 g/24 hours)
2. Hypoalbuminemia (serum albumin < 25 g/L)
3. Generalised oedema (often with periorbital involvement)
4. Severe hyperlipidaemia (total cholesterol is often > 10 mmol/L).Focal Segmental Glomerulosclerosis will be the most likely answer as it is the most common cause of Nephrotic Syndrome in African American adults.
Minimal change disease is the most common cause of nephrotic syndrome in children.
Membranous glomerulonephritis is the most common cause of Nephrotic Syndrome in Caucasian adults.
In IgA nephropathy, patients will complain of cola-coloured urine.
Mesangiocapillary glomerulonephritis presents with features of Nephritic Syndrome.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 12
Incorrect
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A 35-year-old lady has suffered a serious brain injury. Her uvula has deviated to the right, according to inspection. Which of the following nerves is likely to be affected?
Your Answer: Right glossopharyngeal nerve
Correct Answer: Left vagus nerve
Explanation:When the vagus nerve is damaged, the soft palate is paralyzed and the uvula is shifted away from the affected side. The vagus nerve innervates the uvulae muscle, which forms the uvula’s core. If only one side is innervated, contraction of the active muscle will draw the uvula towards it.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 13
Correct
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Question 14
Correct
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The following are all examples of type III hypersensitivity EXCEPT for:
Your Answer: Goodpasture's syndrome
Explanation:Examples of type III reactions include:
Extrinsic allergic alveolitis
Systemic lupus erythematosus (SLE)
Post-streptococcal glomerulonephritis
Reactive arthritis
Rheumatoid arthritis -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 15
Correct
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The most common cause of anaemia worldwide is which of the following?
Your Answer: Iron deficiency anaemia
Explanation:The most common cause of microcytic anaemia and of any anaemia worldwide is iron deficiency anaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 16
Incorrect
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The QRS duration of a broad-complex tachyarrhythmia is:
Your Answer: Greater than 0.12 s
Correct Answer: Greater than or equal to 0.12 s
Explanation:It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 17
Incorrect
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A 32-year-old woman suffers a deep wound to her thigh while she was climbing over a barbed wire fence. As a consequence of her injury, the nerve that was severed innervates the gracilis muscle.
In which of the following nerves is the gracilis muscle innervated by?Your Answer: Posterior branch of the obturator nerve
Correct Answer: Anterior branch of the obturator nerve
Explanation:The gracilis muscles is innervated by the anterior branch of the obturator nerve (L2-L4).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 18
Correct
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Approximately how long is the duration of a lidocaine block (when given with adrenaline):
Your Answer: 90 minutes
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 19
Incorrect
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A patient is diagnosed with a Klebsiella pneumoniae infection.
Which SINGLE statement regarding Klebsiella pneumoniae is FALSE?Your Answer: It is routinely found in the nose, mouth and gastrointestinal tract as normal flora
Correct Answer: Species with ESBLs are sensitive to cefotaxime
Explanation:Klebsiellais a genus of non-motile,Gram-negative, rod-shaped bacteriawith a prominent polysaccharide-based capsule. They are routinely found in the nose, mouth and gastrointestinal tract as normal flora, however, they can also behave as opportunistic pathogens.
Infections with Klebsiella spp. areusually nosocomial. They are an important cause of ventilator-associated pneumonia (VAP), urinary tract infection, wound infection and bacteraemia. Outbreaks of infections with Klebsiellaspp. in high-dependency units have been described and are associated with septicaemia and high mortality rates. Length of hospital stay and performance of invasive procedures are risk factors forKlebsiellainfections.
Primary pneumonia withKlebsiella pneumoniaeis a rare,severe, community-acquired infection associated with a poor outcome.
Klebsiella rhinoscleromatis causes a progressive granulomatous infection of the nasal passages and surrounding mucous membranes. This infection is mainly seen in the tropics.
Klebsiella ozanae is a recognised cause of chronic bronchiectasis.
Klebsiella organisms are resistant to multiple antibiotics including penicillins. This is thought to be a plasmid-mediated property. Agents with high intrinsic activity againstKlebsiellapneumoniaeshould be selected for severely ill patients. Examples of such agents include third-generation cephalosporins (e.g cefotaxime), carbapenems (e.g. imipenem), aminoglycosides (e.g. gentamicin), and quinolones (e.g. ciprofloxacin). These agents may be used as monotherapy or combination therapy. Aztreonam may be used in patients who are allergic to beta-lactam antibiotics.
Species with ESBLs (Extended spectrum beta-lactamase) are resistant to penicillins and also cephalosporins such as cefotaxime and ceftriaxone
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 20
Correct
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Which of the following does not increase renal phosphate excretion?
Your Answer: Vitamin D
Explanation:PO43-renal excretion is regulated several mechanisms. These include:
-parathyroid hormone – increases excretion by inhibiting reabsorption in the proximal tubule
-acidosis – increases excretion
-glucocorticoids – increases excretion
-calcitonin – increases excretion
-activated vitamin D – decreases excretion by increasing reabsorption in the distal tubule -
This question is part of the following fields:
- Physiology
- Renal
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SESSION STATS - PERFORMANCE PER SPECIALTY
