-
Question 1
Correct
-
All of the following are physiological effects of thyroid hormones except:
Your Answer: Increased glycogenesis
Explanation:Thyroid hormones have multiple physiological effects on the body. These include:
1. Heat production (thermogenesis)
2. Increased basal metabolic rate
3. Metabolic effects:
(a) Increase in protein turnover (both synthesis and degradation are increased, although overall effect is catabolic)
(b) Increase in lipolysis
(c)Increase in glycogenolysis and gluconeogenesis
4. Enhanced catecholamine effect – Increase in heart rate, stroke volume and thus cardiac output
5. Important role in growth and development -
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 2
Incorrect
-
A 62-year-old woman has reduced urine output, nausea, and confusion. Renal function tests and other investigations done leads to a diagnosis of acute kidney injury (AKI). Which one of these is consistent with a diagnosis of AKI?
Your Answer: A 25% decrease in GFR within the preceding month
Correct Answer: A rise in serum creatinine of 26 μmol/L within 48 hours
Explanation:AKI is diagnosed based on an acutely rising serum creatinine and/or reduction in urine output.
-
AKI can often be non-oliguric.
AKI is present if any one or more of the following criteria is met:
-
A rise in serum creatinine of ≥26 micromol/L (≥0.3 mg/dL) within 48 hours
-
A rise in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the past 7 days (in practice you can use the lowest value from the past 3 months as the baseline for the patient)
-
Urine volume <0.5 ml/kg/hour for at least 6 hours.
-
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 3
Incorrect
-
Regarding Helicobacter pylori, which of the following statements is INCORRECT:
Your Answer: It expresses urease.
Correct Answer: It is found as part of normal colonic flora.
Explanation:Helicobacter pyloriis a Gram-negative, helix shaped (curved rod), microaerophilic bacterium. It typically has 4-6 lophotrichous flagellae and is therefore highly motile. It has an outer membrane consisting of phospholipids and lipopolysaccharide.
Helicobacter pyloriIs found in the upper gastrointestinal tract of approximately 50% of the population.
Colonization withHelicobacter pyloriconfers a 10-20% lifetime risk of developing peptic ulcers and a 1-2% lifetime risk of developing gastric cancer.
There is a strong association between mucosa-associated lymphoid tissue (MALT) lymphoma andHelicobacter pyloricolonization.
The most reliable method for testing for colonization withHelicobacter pyloriis by biopsy during endoscopy and histological examination.
Typically eradication requires a 14-day course of triple therapy with amoxicillin, clarithromycin and a proton pump inhibitor. Metronidazole is also often used as an alternative antibiotic in a triple therapy regime.
Serum antibody levels fall slowly and therefore cannot be used to accurately assess eradication. Either of the 13C-urea breath test or the stool antigen test are viable options for assessing successful eradication. -
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 4
Incorrect
-
A medical student is reviewing the chart of a patient who has recently been diagnosed with leukaemia. The chief resident asks him to identify ONE feature that will most support acute leukaemia diagnosis in contrast to chronic leukaemia.
Which one of the following options will he pick?Your Answer: Hepatosplenomegaly present
Correct Answer: The patient is a child
Explanation:Acute lymphocytic leukaemia (ALL) is more common in children than chronic leukaemias, which generally occur in adults. Bone marrow failure occurs early on in the course of the disease in acute leukaemias, and there is the massive proliferation of undifferentiated cells with functioning cells being crowded out. Hepatosplenomegaly occurs in both acute and chronic forms of leukaemia and is not a differentiating feature.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 5
Correct
-
Alpha cells of the endocrine pancreas produce which of the following hormones:
Your Answer: Glucagon
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 6
Correct
-
Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 7
Correct
-
All of the following single clinical risk groups is considered eligible to receive the seasonal influenza vaccination, except:
Your Answer: Patients with hypertension
Explanation:The following is the list of all the health and age factors that are known to increase a person’s risk of getting serious complications from flu:
– Adults 65 years and older
– Children younger than 2 years old
– Asthma
– Neurological and neurodevelopmental conditions
– Blood disorders (such as sickle cell disease)
– Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
– Endocrine disorders (such as diabetes mellitus)
– Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
– Kidney diseases
– Liver disorders
– Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
– People who are obese with a body mass index [BMI] of 40 or higher
– People younger than 19 years old on long-term aspirin- or salicylate-containing medications.
– People with a weakened immune system due to disease (such as people with HIV or AIDS, or some cancers such as leukaemia) or medications (such as those receiving chemotherapy or radiation treatment for cancer, or persons with chronic conditions requiring chronic corticosteroids or other drugs that suppress the immune system)
– People who have had a stroke
– Pregnant people and people up to 2 weeks after the end of pregnancy
– People who live in nursing homes and other long-term care facilities -
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
-
-
Question 8
Incorrect
-
Foetal haemoglobin (HbF) comprises about how much of the total haemoglobin in adults:
Your Answer: 3 - 5%
Correct Answer: 0.5 - 0.8%
Explanation:Foetal haemoglobin (HbF) makes up about 0.5 – 0.8 % of total adult haemoglobin and consists of two α and two gamma (γ) globin chains.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 9
Correct
-
Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely caused by which of the following:
Your Answer: Diabetes mellitus
Explanation:Compressive causes of CN III palsy cause early pupillary dilatation because the parasympathetic fibres run peripherally in the nerve and are easily compressed. In diabetes mellitus the lesions are ischaemic rather than compressive and therefore typically affect the central fibres resulting in pupillary sparing.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 10
Incorrect
-
Nitric oxide release from endothelium is stimulated by all of the following EXCEPT for:
Your Answer: Bradykinin
Correct Answer: Noradrenaline
Explanation:Nitric oxide (NO) production by the endothelium is increased by factors that elevate intracellular Ca2+, including local mediators such as bradykinin, histamine and serotonin, and some neurotransmitters (e.g. substance P). Increased flow (shear stress) also stimulates NO production and additionally activates prostacyclin synthesis. The basal production of NO continuously modulates vascular resistance; increased production of nitric oxide acts to cause vasodilation. Nitric oxide also inhibits platelet activation and thrombosis.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 11
Correct
-
Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.
Explanation:A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 12
Correct
-
Thyroid cancer has spread to the regional lymph nodes of a patient as seen in a staging CT scan.
The lymph from the thyroid gland will drain directly to which of the following nodes?Your Answer: Deep lateral cervical lymph nodes
Explanation:Lymphatic drainage of the thyroid gland involves the lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes. The paratracheal and lower deep cervical nodes, specifically, receive lymphatic drainage from the isthmus and the inferior lateral lobes. The superior portions of the thyroid gland drain into the superior pretracheal and cervical nodes.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 13
Incorrect
-
The parasympathetic supply to the rectum is from which of the following:
Your Answer: Inferior hypogastric nerves
Correct Answer: Pelvic splanchnic nerves
Explanation:Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 14
Incorrect
-
Regarding skeletal muscle, which of the following best describes the Z-line:
Your Answer: A line in the middle of the H-zone that holds the myosin filament in position
Correct Answer: A line dividing muscle fibres into sarcomeres
Explanation:Each muscle fibre is divided at regular intervals along its length into sarcomeres separated by Z-lines. The sarcomere is the functional unit of the muscle.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 15
Correct
-
Hepatitis A is transmitted by which of the following routes:
Your Answer: Faecal-oral route
Explanation:Hepatitis A transmission is by the faecal-oral route; the virus is excreted in bile and shed in the faeces of infected people.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 16
Incorrect
-
A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.
Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?Your Answer: Set up an adrenaline infusion at 2-10 mcg/min
Correct Answer: Give atropine 500 mcg
Explanation:Atropine is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.
If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of atropine 500 mcg IV:
Shock
Syncope
Myocardial ischemia
Insufficiency of the heartIf this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.
The ALS bradycardia algorithm also suggests the following interim measures:
Transcutaneous pacing
Isoprenaline infusion 5 mcg/min
Adrenaline infusion 2-10 mcg/minutes
Alternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate) -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 17
Incorrect
-
A 45-year-old man had a painless superficial inguinal lymphadenopathy. It was later found to be malignant. Which of the following parts of the body is most likely the origin of this cancerous lymph node?
Your Answer: Testes
Correct Answer: Anal canal
Explanation:A cancer of the anal canal below the pectinate line would spread to the superficial inguinal lymph nodes.
Anal cancer often spreads through lymphatic drainage to the internal iliac lymph nodes in lesions above the pectinate line and to the superficial inguinal lymph nodes in lesions below the pectinate line.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 18
Correct
-
What is the interquartile range of the following data set: 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70
Your Answer: 30
Explanation:5, 10, 15 /20, 25, 30 /35, 40, 45 /50, 60, 70
Sample size (n) = 12
Median = [(n+1)/2]th value
= (12+1)/2 = 6.5
= halfway between 6th and 7th value
= (30 +35)/2 = 32.5
The lower (first) quartile = halfway between 15 and 20
= 17.5
The upper (third) quartile = halfway between 45 and 50
= 47.5
The interquartile range is the difference between the upper quartile and lower quartile
= 47.5 – 17.5 = 30 -
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 19
Correct
-
Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.
Which of the following drugs is most likely to have caused her symptoms?Your Answer: Ramipril
Explanation:Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.
Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.
Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.
The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.
Other medications that are less frequently linked to angioedema include:
Angiotensin-receptor blockers (ARBs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Bupropion (e.g. Zyban and Wellbutrin)
Beta-lactam antibiotics
Statins
Proton pump inhibitorsThe majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.
-
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 20
Correct
-
Which of the following is NOT a typical feature of an abducens nerve palsy:
Your Answer: Inability to look up
Explanation:CN VI palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 21
Correct
-
Which of the following is NOT a contraindication to the use of diazepam:
Your Answer: Acute alcohol withdrawal
Explanation:Benzodiazepines are used to treat symptoms in patients with acute alcohol withdrawal syndrome.
Benzodiazepines are contraindicated in:
Respiratory depression
Marked neuromuscular respiratory weakness, such as unstable myasthenia gravis
Obstructive sleep apnoea syndrome (symptoms may be aggravated)
Severe hepatic impairment (the elimination half-life of diazepam may be prolonged; increased risk of coma)
Phobic or obsessional states, chronic psychosis or hyperkinesis (paradoxical reactions may occur). -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 22
Correct
-
By which of the following is mean arterial pressure (MAP) primarily determined?
Your Answer: Total peripheral resistance and cardiac output
Explanation:Mean arterial pressure (MAP) = Cardiac output (CO) x Total peripheral resistance (TPR).
Cardiac output is dependent on the central venous pressure (CVP). CVP, in turn, is highly dependent on the blood volume.
Any alterations of any of these variables will likely change MAP. -
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 23
Incorrect
-
Which of the following is NOT an advantage of a case-control study used to identify past exposure to a risk factor in patients with a disease:
Your Answer: Particularly suitable for studying association between an exposure and an outcome when the outcome is uncommon
Correct Answer: Can directly measure absolute and relative risk of a disease
Explanation:Advantages:relatively quickrelatively cheap and easy to performparticularly suitable for studying associations between an exposure and an outcome when the outcome is uncommon or if the outcome occurs decades after exposurea wide range of risk factors can be investigated in each studyDisadvantages:subject to recall biasunlike in a whole population study, absolute risk cannot be quantifiedtemporal relationship between exposure and outcome can be difficult to establishunsuitable for rare risk factorsprone to confounding
-
This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
-
-
Question 24
Correct
-
When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle' should be identified. Which of the following forms the inferior border of the 'safe triangle'?
Your Answer: 5 th intercostal space
Explanation:Care and management of the thoracostomy tubes (chest tubes) are subject to the direction and practice pattern of the responsible physician. Therefore, it is difficult to make a “one size fits all” set of instructions about the specific management recommendations for all chest tubes. It is recommended to discuss specific expectations for management with the patient’s attending physician. Facility specific Clinical Practice Guidelines (CPGs) may provide further guidance for one’s practice.
Placement of the appropriately sized chest tube is performed on the affected side. The typical landmark for placement is the 4th or 5th intercostal space (nipple line for males, inframammary fold for females) at the anterior axillary line. The space above the 5th intercostal space and below the base of the axilla that is bordered posteriorly by the trapezius and anteriorly by the pectoralis muscle has recently been described as the safe triangle. Tubes are positioned anteriorly for pneumothoraces and posteriorly for fluid processes.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 25
Correct
-
Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 26
Incorrect
-
The second generation antihistamine, cetirizine is a less-sedating antihistamine than the older antihistamine, chlorphenamine because:
Your Answer: It has less anticholinergic effect.
Correct Answer: It is less lipid-soluble so less able to cross the blood brain barrier.
Explanation:All older antihistamines such as chlorphenamine cause sedation. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent.
-
This question is part of the following fields:
- Pharmacology
- Respiratory
-
-
Question 27
Incorrect
-
Which of the following statements about vitamin B12 absorption is TRUE:
Your Answer: Receptors for the vitamin B12/Intrinsic factor complex are found in the duodenum allowing uptake of vitamin B12.
Correct Answer: On ingestion, vitamin B12 is bound to R protein which protects it from digestion in the stomach.
Explanation:The substance intrinsic factor,
essential for absorption of vitamin B12 in the ileum, is
secreted by the parietal cells along with the secretion of
hydrochloric acid. When the acid-producing parietal
cells of the stomach are destroyed, which frequently
occurs in chronic gastritis, the person develops not only
achlorhydria (lack of stomach acid secretion) but often
also pernicious anaemia because of failure of maturation
of the red blood cells in the absence of vitamin B12 stimulation of the bone marrow. -
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 28
Correct
-
During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.
Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.
The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:
L– lateral two lumbricals
O– Opponens pollicis
A– Abductor pollicis
F– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.
Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 29
Incorrect
-
Which of the following is NOT mainly characterised by intravascular haemolysis:
Your Answer: Glucose-6-phosphate dehydrogenase deficiency
Correct Answer: Beta-Thalassaemia
Explanation:Causes of intravascular haemolysis:
Haemolytic transfusion reactions
G6PD deficiency
Red cell fragmentation syndromes
Some severe autoimmune haemolytic anaemias
Some drug-and infection-induced haemolytic anaemias
Paroxysmal nocturnal haemoglobinuria -
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 30
Correct
-
A 35-year-old man is feeling unwell following his return from a business trip. He is diagnosed with a vector transmitted disease.
Which of these organisms is commonly spread by vector-borne transmission?Your Answer: Borrelia burgdorferi
Explanation:Borrelia burgdorferiis, primarily spread by ticks and lice, is a zoonotic, vector-borne organism that causes Lyme disease.
Neisseria meningitidis and Bordetella pertussis are droplet borne infections (airborne particle > 5 µm)
Vibrio cholerae and Ascaris lumbricoides are spread by the faeco-oral route
-
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
