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Question 1
Incorrect
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A patient is found to be anaemic. Which one of the following blood results would favour a diagnosis of anaemia of chronic disease rather than iron deficiency:
Your Answer: MCV < 80 fL
Correct Answer: Low total iron binding capacity (TIBC)
Explanation:Anaemia of chronic disease is one of the most common causes of normocytic anaemia. The anaemia is usually mild (Hb > 90 g/L) and non-progressive. Anaemia of chronic disease is usually associated with low serum iron, low transferrin saturation, and a low total iron binding capacity (TIBC) with normal or raised ferritin which differentiates it from iron deficiency anaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Correct
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Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.
Which of the following statements about aspirin's mechanism of action is correct?Your Answer: Inhibition of cyclo-oxygenase
Explanation:Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 3
Incorrect
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A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb.
The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.
There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers.
Which of these nerve(s) has most likely been affected?
Your Answer: Ulnar nerve
Correct Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:
Loss of sensation to the lateral palm and the lateral three and a half fingers.
Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals.
Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialis
Weakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.
Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Correct
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Which of the following is NOT one of the cardinal features of acute inflammation:
Your Answer: Discharge
Explanation:Classic signs:
Rubor (redness)
Calor (heat)
Dolour (pain)
Tumour (swelling)
Functio laesa (loss of function)
These classic signs are produced by a rapid vascular response and cellular events. The main function of these events is to bring elements of the immune system to the site of injury and prevent further tissue damage. -
This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 5
Incorrect
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A 15-year-old male is admitted to a rehabilitation centre with a history of multiple strokes, myopathy and learning disabilities since childhood. He is under the care of a multidisciplinary team, and his genetic testing reports show the presence of a mitochondrial disorder.
Which one of the following diseases does this patient most likely have?Your Answer: Tay-Sachs disease
Correct Answer: MELAS
Explanation:Mitochondrial diseases are a group of disorders caused by dysfunctional mitochondria. Most cases are maternally inherited, as we inherit our mitochondrial DNA from our mothers only, although mutations in nuclear DNA cause some cases.
Examples of Mitochondrial Diseases include:
1. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)
2. Mitochondrial epilepsy with ragged red fibres (MERRF)
3. Leber’s hereditary optic neuropathy (LHON)
4. Diabetes mellitus and deafness (DAD)
5. Neuropathy, ataxia, retinitis pigmentosa, and ptosis (NARP)
6. Leigh syndrome (subacute sclerosing encephalopathy).Red-green colour blindness and G6PD deficiency have an X-linked recessive pattern of inheritance.
Tay-Sachs Disease and spinal muscular atrophy have an autosomal recessive pattern of inheritance.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 6
Incorrect
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A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.
The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer: The deep branch of the ulnar nerve
Correct Answer: The recurrent branch of the median nerve
Explanation:Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.
Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.
The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 7
Incorrect
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Regarding postural hypotension, which of the following statements is INCORRECT:
Your Answer: Postural hypotension is usually corrected quickly by the baroreceptor reflex.
Correct Answer: Postural hypotension usually causes a reflex bradycardia.
Explanation:On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 8
Correct
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A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered.
Out of the following, which parameter is MOST likely to change due to initiating insulin?Your Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia.
Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity.
It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L
If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 9
Incorrect
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What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient with suspected anaphylactic shock?
Your Answer: 5 milligrams intramuscularly
Correct Answer: 500 micrograms intramuscularly
Explanation:1: 1000 Adrenaline solution dosage for children above the age of 12 and adults, including pregnant women (over 50 kg) is 0.50 mL, which is equivalent to 500 mcg of adrenaline.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 10
Incorrect
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A 28-year-old medical student ate a reheated Chinese takeaway and developed severe vomiting a few hours after.
What is the SINGLE MOST likely causative organism?
Your Answer: Clostridium difficile
Correct Answer: Bacillus cereus
Explanation:Bacillus cereusis is the correct answer. It is a Gram-positive, rod-shaped, beta-haemolytic bacterium that causes ‘fried rice syndrome’.
Hardy spores in rice can survive boiling. When left at room temperature for long periods prior to frying these spores germinate. The emetic enterotoxin-producing strains cause nausea and vomiting between 1 and 6 hours after consumption while the diarrheagenic enterotoxin-producing strains (commonly associated with ingestion of meat, vegetables and dairy products) causes abdominal pain and vomiting, which starts 8-12 hours after ingestion.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 11
Correct
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Regarding gas exchange at the alveolar-capillary membrane, which of the following statements is CORRECT:
Your Answer: Transfer of oxygen is usually perfusion-limited.
Explanation:Gas exchange between alveolar air and blood in the pulmonary capillaries takes place by diffusion across the alveolar-capillary membrane. Diffusion occurs from an area of high partial pressure to an area of low partial pressure, thus the driving force for diffusion is the alveolar-capillary partial pressure gradient. Diffusion occurs until equilibrium is reached, but random movement of particles continues to occur and this is known as dynamic equilibrium. The diffusing capacity for oxygen (DLO2) cannot be measured directly but the rate of diffusion in the lungs can be estimated by measuring the diffusing capacity of the lungs for carbon monoxide (DLCO), not by measuring total lung capacity. The rate of transfer of a gas may be diffusion or perfusion limited; carbon monoxide transfer is diffusion-limited, oxygen transfer is usually perfusion-limited.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 12
Incorrect
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The 'bucket handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The anterior ends of the ribs moving upwards and forwards
Correct Answer: The middles of the shafts of the ribs moving upwards and laterally
Explanation:Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 13
Correct
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Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:
Your Answer: Hyperacusis
Explanation:Hyperacusis is increased acuity of hearing with hypersensitivity to low tones resulting from paralysis of the stapedius muscle, innervated by the facial nerve. General sensation to the face and to the anterior two-thirds of the tongue is carried by the divisions of the trigeminal nerve (although taste to the anterior two-thirds of the tongue is supplied by the facial nerve). Eye movements are mediated by the oculomotor, trochlear and abducens nerve. Ptosis results from paralysis of the levator palpebrae superioris, innervated by the oculomotor nerve, or the superior tarsal muscle, innervated by the sympathetic chain.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 14
Correct
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Which of the following statements regarding forest plots is true? Select ONE answer only.
Which of the following statements regarding forest plots is true? Select ONE answer only.Your Answer: Larger studies are associated with smaller horizontal lines
Explanation:Forest plots are graphical displays designed to illustrate the relative strength of treatment effects in multiple individual studies addressing the same question.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 15
Incorrect
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A patient presents with haemoptysis, weight loss, and night sweats. You suspect he may have tuberculosis. He works at an asylum seeker hostel, and has not received a BCG vaccination. In which of the following patient groups would the BCG vaccine be safe to administer?
Your Answer: The patient is HIV positive and asymptomatic
Correct Answer: The patient is asplenic
Explanation:Persons with chronic diseases. Persons with chronic renal disease or undergoing dialysis, and those with hyposplenism or asplenia, may receive BCG vaccine if indicated.
Only 2 absolute contraindications apply to all vaccines:
- anaphylaxis following a previous dose of the relevant vaccine
- anaphylaxis following any component of the relevant vaccine
2 further contraindications apply to live vaccines (both parenteral and oral):
- People who are significantly immunocompromised should not receive live vaccines. This is regardless of whether the immunocompromising condition is caused by disease or treatment.
- Pregnant women should not receive live vaccines, in general. Women should be advised not to become pregnant within 28 days of receiving a live vaccine.
Use of live vaccines in people who are immunocompromised:
People who are immunocomprised are at risk of adverse events or vaccine-related disease if they receive a live vaccine.Live vaccines include:
BCG (bacille Calmette–Guérin) vaccine
oral cholera vaccine (Vaxchora)
Some Japanese encephalitis virus vaccines
MMR (measles-mumps-rubella) vaccine
rotavirus vaccine
oral typhoid vaccine
varicella vaccine
yellow fever vaccine
zoster vaccine (Zostavax) -
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 16
Correct
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Which among the following antibacterial regimens is considered the most appropriate to prescribe in a patient presenting with clinical signs and symptoms consistent with a diagnosis of pelvic inflammatory disease?
Your Answer: Ceftriaxone plus doxycycline plus metronidazole
Explanation:The endocervix is the most common site of Neisseria gonorrhoeae infection in women. Symptoms of infection, when present, include dysuria, cervical discharge, and lower abdominal pain. However, 50% of cases in women may be asymptomatic leading to complications such as pelvic inflammatory disease (PID), which may cause sterility, ectopic pregnancy, or perihepatitis.
PID is also known as Fitz-Hugh-Curtis syndrome is defined as an inflammation of the upper genital tract due to an infection in women. The disease affects the uterus, fallopian tubes, and ovaries. It is typically an ascending infection, spreading from the lower genital tract.
The recommended intramuscular or oral regimens for PID are as follows:
Ceftriaxone at 500 mg IM in a single dose (for persons weighing ≥150 kg, administer 1 g of ceftriaxone); plus doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 17
Incorrect
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Which of the following immunoglobulins is most important for mast cell degranulation:
Your Answer: IgA
Correct Answer: IgE
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 18
Incorrect
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Insulin is a very important peptide hormone produced by the islets of Langerhans in the pancreas.
Insulin is synthesised by which of the following cell types within the islets of Langerhans? Select ONE answer only.Your Answer: Gamma cells
Correct Answer: Beta cells
Explanation:Insulin is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas. Insulin is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds. Proinsulin is synthesised as a single-chain peptide. Within storage granules, a connecting peptide (C peptide) is removed by proteases to yield insulin. Insulin release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin, but most output is driven by the rise in plasma glucose concentration that occurs after a meal. The effects of insulin are mediated by the receptor tyrosine kinase.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 19
Incorrect
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In adults in the United Kingdom, which of the following pathogens is the most likely cause of viral infectious gastroenteritis:
Your Answer: Adenovirus
Correct Answer: Norovirus
Explanation:Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhoea in community settings. In the United Kingdom, norovirus has become the most common cause of gastroenteritis in adults and children since the introduction of rotavirus vaccination.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 20
Incorrect
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Which of the following is true regarding respiration?
Your Answer: Forced expiration requires the use of pectoralis minor
Correct Answer: The diaphragm is responsible for abdominal breathing
Explanation:The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.
Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.
In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.
Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 21
Incorrect
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Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer: Hypomagnesaemia
Correct Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 22
Incorrect
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A patient with pronounced tremor, muscle contractions, muscle spasms, and slowness of movement is brought in by his family. He has a long history of mental health issues for which he is currently treated with a variety of medications.
Which of the medications listed below is most likely to be the cause of these side effects?Your Answer: Gabapentin
Correct Answer: Haloperidol
Explanation:Acute dyskinesias and dystonic reactions, tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw), Parkinsonism (tremor, bradykinesia, and rigidity), akinesia, akathisia, and neuroleptic malignant syndrome are all examples of extrapyramidal side effects. They are caused by dopamine depletion or blockade in the basal ganglia; this lack of dopamine frequently mimics idiopathic extrapyramidal pathologies.
The first-generation antipsychotics, which are strong dopamine D2 receptor antagonists, are the drugs most commonly associated with extrapyramidal side effects. Haloperidol and fluphenazine are the two drugs in this class that are most commonly associated with extrapyramidal side effects. Extrapyramidal adverse effects are less common in second-generation antipsychotics (e.g., olanzapine) than in first-generation antipsychotics.
Other drugs are linked to extrapyramidal symptoms as well, but at a lower rate. Some antidepressants, lithium, various anticonvulsants, antiemetics, and, in rare cases, oral contraceptive agents are among them.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 23
Correct
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Which of the following is NOT a function of bile:
Your Answer: Digestion of fats into monoglycerides and fatty acids.
Explanation:Bile functions to eliminate endogenous and exogenous substances from the liver (including bilirubin), to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile salts also act as bactericides, destroying many of the microbes that may be present in the food. Bile doesn’t contain digestive enzymes for digestion of lipids into monoglycerides and fatty acids; this is performed mainly by pancreatic lipase.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 24
Incorrect
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Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:
Your Answer: Give 300 mg IV amiodarone after 3 shocks, and then every 3 - 5 minutes thereafter
Correct Answer: Give 300 mg IV amiodarone after 3 shocks
Explanation:After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 25
Incorrect
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A patient has a cardiac output of 4.8 L/min and a heart rate of 80 bpm, therefore their stroke volume is:
Your Answer: 70 mL
Correct Answer: 60 mL
Explanation:Cardiac output (CO) = Stroke volume (SV) x Heart rate (HR).
Therefore SV = CO/HR
= 4.8/80
= 0.06 L = 60 mL. -
This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 26
Incorrect
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The most common site of ectopic pregnancy is?
Your Answer: Infundibulum of Fallopian tube
Correct Answer: Ampulla of Fallopian tube
Explanation:Nearly 95% of ectopic pregnancies are implanted in the various segments of the fallopian tube and give rise to fimbrial, ampullary, isthmic, or interstitial tubal pregnancies. The ampulla is the most frequent site, followed by the isthmus. The remaining 5% of non tubal ectopic pregnancies implant in the ovary, peritoneal cavity, cervix, or prior caesarean scar.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 27
Correct
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A 4-year-old child has been convulsing for 20 minutes. She has received two doses of lorazepam. She takes phenytoin for maintenance therapy, and you draw up a phenobarbitone infusion.
What dose of phenobarbitone is advised in the treatment of the convulsing child that reaches that stage of the APLS algorithm? Select ONE answer only.Your Answer: 20 mg/kg over 30-60 minutes
Explanation:If a convulsing child reaches step 3 of the APLS algorithm, then a phenytoin infusion should be set up at 20 mg/kg over 20 minutes. If they are already taken phenytoin as maintenance therapy, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 28
Correct
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Achlorhydria is diagnosed in a 37-year-old individual who has had recurring episodes of gastroenteritis. This is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production.
Damage to stomach parietal cells will alter the secretion of which other substance?Your Answer: Intrinsic factor
Explanation:Achlorhydria is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production. The parietal cells that have been injured are unable to create the necessary amount of stomach acid. As a result, the pH of the stomach rises, food digestion suffers, and the risk of gastroenteritis rises.
The secretion of hydrochloric acid and intrinsic factor is controlled by the gastric parietal cells, which are epithelial cells in the stomach. These cells can be found in the gastric glands, the fundus lining, and the stomach body.
In response to the following three stimuli, the stomach parietal cells release hydrochloric acid:
H2 Histamine receptors are stimulated by histamine (most significant contribution)
Acetylcholine stimulates M3 Receptors via parasympathetic action.
CCK2 receptors are stimulated by Gastrin.Intrinsic factor, which is essential for vitamin B12 absorption, is also produced by stomach parietal cells.
Omeprazole is a proton pump inhibitor that is both selective and irreversible. It inhibits the H+/K+-ATPase system present on the secretory membrane of gastric parietal cells, which lowers stomach acid secretion.
Ranitidine inhibits histamine H2-receptors in a competitive manner. The reversible inhibition of H2-receptors in gastric parietal cells reduces both the volume and concentration of gastric acid. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 29
Incorrect
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Regarding bile, which of the following statements is CORRECT:
Your Answer: Bile breaks lipids down into monoglycerides and fatty acids.
Correct Answer: Bile passes into the duodenum through the ampulla of Vater.
Explanation:Bile is synthesised in the liver. Bile functions to eliminate endogenous and exogenous substances from the liver, to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile is stored and concentrated in the gallbladder. Bile passes out of the gallbladder via the cystic duct. Bile passes into the duodenum through the ampulla of Vater regulated by the sphincter of Oddi.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 30
Correct
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Regarding cortical areas, which one is found in the posterior part of the inferior frontal gyrus?
Your Answer: Broca’s area
Explanation:Broca’s area is involved in the expressive aspects of spoken and written language (production of sentences constrained by the rules of grammar and syntax). It corresponds to the opercular and triangular parts of the inferior frontal gyrus (BA 44 and 45). These areas are defined by two rami (branches) of the lateral sulcus (one ascending, one horizontal) which ‘slice into’ the inferior frontal gyrus. In keeping with its role in speech and language, Broca’s area is immediately anterior to the motor and premotor representations of the face, tongue and larynx. A homologous area in the opposite hemisphere is involved in non-verbal communication such as facial expression, gesticulation and modulation of the rate, rhythm and intonation of speech.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 31
Correct
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A 70-year-old patient diagnosed with Cushing's syndrome, has a history of weight gain, hypertension, and easy bruising.
Which of the following statements about Cushing's syndrome is NOT true?Your Answer: Menorrhagia is a common feature
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids.
Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome.
Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep. The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.Insulin resistance causes hyperglycaemia, which is a frequent symptom. Insulin resistance can produce acanthosis nigricans in the axilla and around the neck, as well as other skin abnormalities.
In contrast to menorrhagia, elevated testosterone levels are more likely to produce amenorrhoea or oligomenorrhoea. Infertility in women of reproductive age can also be caused by high androgen levels.
A dexamethasone suppression test or a 24-hour urine free cortisol collection can both be used to establish the existence of Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 32
Incorrect
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All of the following statements are correct with regards to protection of the gastric mucosa except which of the following?
Your Answer: Surface cells secrete HCO 3 - which helps prevent autodigestion by creating a less favourable environment for gastric proteases.
Correct Answer: NSAIDs directly stimulate increased parietal cell acid production.
Explanation:Prostaglandin production, which usually inhibits acid secretion and increases mucus and bicarbonate secretion, is inhibited by NSAIDs.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 33
Correct
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One of the following statements about acute lymphoblastic leukaemia(ALL) is true.
Your Answer: It is classified using the FAB classification
Explanation:ALL affects children predominantly.
The CNS is commonly involved in ALL.
The Philadelphia chromosome is present in 25% of adult ALL and 5% of childhood ALL cases.
The cure rate in children is approximately 80% in children and 50% in adults.
ALL is classified into 3 groups using the French-American-British (FAB) classification:
ALL-L1: small uniform cells
ALL-L2: large varied cells
ALL-L3: large varied cells with vacuoles. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 34
Incorrect
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What type of visual field defect are you most likely to see in a lesion of the parietal optic radiation:
Your Answer: Bitemporal hemianopia
Correct Answer: Contralateral homonymous inferior quadrantanopia
Explanation:A lesion of the parietal optic radiation will result in a contralateral homonymous inferior quadrantanopia.
A lesion of the temporal optic radiation will result in a contralateral homonymous superior quadrantanopia. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 35
Incorrect
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Regarding antacids, which of the following statements is CORRECT:
Your Answer: Antacids act to inhibit H2-receptors on gastric parietal cells.
Correct Answer: Antacids should not be taken at the same time as other drugs as they impair absorption.
Explanation:Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids act by neutralising stomach acid. They are used for symptomatic relief in dyspepsia, but are not first line for proven peptic ulcer disease where antisecretory drugs have a better healing effect. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are contraindicated in hypophosphataemia.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 36
Incorrect
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You are prescribing ipratropium bromide for a patient who has presented with an exacerbation of her COPD. What is the mechanism of action of ipratropium bromide:
Your Answer: Beta-2 agonist
Correct Answer: Muscarinic antagonist
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma) -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 37
Incorrect
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A 55-year-old male diabetic patient presents to the Emergency Room complaining of severe chest pain. His medical record shows that he had coronary angioplasty one week ago, during which he was administered abciximab.
Which of the following haematological diseases has a similar mechanism of action to this drug?Your Answer: Haemophilia A
Correct Answer: Glanzmann’s thrombasthenia
Explanation:Abciximab is glycoprotein IIb/IIIa receptor antagonist that decreases aggregation of platelets by prevent their cross-linking. In Glanzmann’s thrombasthenia there are low levels of these same receptors leading to decreased bridging of platelets as fibrinogen cannot attach. There is increased bleeding time both in this disease and when there is use of abciximab.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 38
Incorrect
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Which of the following infections is vancomycin most likely prescribed for?
Your Answer: Meningococcal meningitis
Correct Answer: Clostridium difficile colitis
Explanation:125 mg PO q6hr for 10 days is indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhoea
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 39
Incorrect
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In patients who are not at risk of hypercapnic respiratory failure but are requiring oxygen, the oxygen saturations should be maintained at which of the following?
Your Answer: 92 - 96%
Correct Answer: 94 - 98%
Explanation:Oxygen saturation should be 94 – 98% in most acutely ill patients with a normal or low arterial carbon dioxide (PaCO2). In some clinical situations, however, like cardiac arrest and carbon monoxide poisoning, it is more appropriate to aim for the highest possible oxygen saturation until the patient is stable.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 40
Incorrect
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Which of the following pathogens causes tetanus:
Your Answer: Pseudomonas aeruginosa
Correct Answer: Clostridium tetani
Explanation:Tetanus is caused by Clostridium tetani, a bacterium. Tetanus can cause mild spasms to severe whole-body contractions, suffocation, and heart attack.
Gas gangrene and food poisoning are both caused by Clostridium perfringens.
Pseudomembranous colitis is caused by Clostridium difficile.
Urinary tract infections, respiratory infections, dermatitis, soft tissue infections, bacteraemia, bone and joint infections, gastrointestinal infections, and a variety of systemic infections are all caused by Pseudomonas aeruginosa.
Pharyngitis, skin infections, acute rheumatic fever, scarlet fever, poststreptococcal glomerulonephritis, toxic shock–like syndrome, and necrotizing fasciitis can all be caused by Streptococcus pyogenes infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 41
Incorrect
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Which of the following nerves has been damaged when a patient presents with a foot drop?
Your Answer: Sural nerve
Correct Answer: Common peroneal nerve
Explanation:The common peroneal nerve often referred to as the common fibular nerve, is a major nerve that innervates the lower extremity. It is one of the two major branches off the sciatic nerve and receives fibres from the posterior divisions of L4 through S2 nerve roots. The common peroneal nerve separates from the sciatic nerve in the distal posterior thigh proximal to the popliteal fossa. After branching off of the sciatic nerve, it continues down the thigh, running posteroinferior to the biceps femoris muscle, and crosses laterally to the head of the lateral gastrocnemius muscle through the posterior intermuscular septum. The nerve then curves around the fibular neck before dividing into two branches, the superficial peroneal nerve (SPN) and the deep peroneal nerve (DPN). The common peroneal nerve does not have any motor innervation before dividing; however, it provides sensory innervation to the lateral leg via the lateral sural nerve.
The superficial peroneal nerve innervates the lateral compartment of the leg, and the deep peroneal nerve innervates the anterior compartment of the leg and the dorsum of the foot. These two nerves are essential in the eversion of the foot and dorsiflexion of the foot, respectively. The superficial and deep peroneal nerves provide both motor and sensory innervation.
The most common presentation with common peroneal nerve injury or palsy is acute foot drop, although symptoms may be progressive and can include sensory loss or pain. Weakness in foot eversion may occur if the superficial peroneal nerve component is involved.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 42
Incorrect
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A patient presents with a gastrointestinal infection. Which of the following microbes attaches to gut mucosa via a specialised sucking disc:
Your Answer: Escherichia coli
Correct Answer: Giardia lamblia
Explanation:Giardia lambliainfection occurs through the ingestion of dormant microbial cysts in contaminated water, food or via faceo-oral transmission via poor hygiene.
Following ingestion of the cysts, the trophozoite emerges to an active state of feeding and motility. After the feeding stage they undergo asexual replication through longitudinal binary fission.
They attach to the intestinal wall via a specialised sucking disc. The mechanism for diarrhoea in giardiasis remains unknown but could possibly be due to direct cytotoxicity.
Giardial trophozoites and cysts pass through the digestive system in the faeces and are excreted. While the trophozoites may be found in the faeces, only the cysts are adapted for long-term survival outside the host. -
This question is part of the following fields:
- Microbiology
- Principles
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Question 43
Incorrect
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Needle thoracentesis in a patient with a tension pneumothorax is performed at which anatomical landmark?
Your Answer: 3rd intercostal space mid-axillary line
Correct Answer: 4th or 5th intercostal space mid-axillary line
Explanation:Tension pneumothorax is a fatal disease causing acute and severe compromise of patients’ ventilation and circulation, in which case immediate decompression is necessary for better prognosis [6]. A previous study has shown that the incidence of tension pneumothorax varies from 0.2% to 1.7% in patients with prehospital trauma. Several trauma guidelines recommend needle thoracostomy as a life-saving intervention, with placement in the second intercostal space at the midclavicular line (second ICS-MCL), the fourth intercostal space at the anterior axillary line (fourth ICS-AAL), or the fifth intercostal space at the midaxillary line (fifth ICS-MAL) for tension pneumothorax in a prehospital environment.
In 2018, according to newly issued the Advanced Trauma Life Support (ATLS) guidelines, the fifth ICS-MAL was suggested as the preferred place, and an 8 cm needle rather than the common 5 cm needle was proved to increase success rate of adults’ decompression.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 44
Incorrect
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A patient is sent in by her GP with suspected ectopic pregnancy. Tubal ectopic pregnancies occur most commonly in which part of the uterine tube:
Your Answer: Fimbriae
Correct Answer: Ampulla
Explanation:Ectopic pregnancy most commonly occurs in the ampulla (70% of cases).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 45
Incorrect
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Which of these cell types in the stomach releases pepsinogen?
Your Answer: ECL cells
Correct Answer: Chief cells
Explanation:The gastric chief cells in the stomach wall releases pepsinogen. Pepsinogen is a proenzyme. It mixes with hydrochloric acid in the stomach and is converted to pepsin. Pepsin breaks down proteins into peptides aiding protein digestion.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 46
Incorrect
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Which of the following statement is correct with regards to the female urethra?
Your Answer: The internal urethral sphincter surrounds the urethra as it passes through the pelvic floor.
Correct Answer: The urethra opens in the vestibule that lies between the labia minora.
Explanation:The urethra in women is short (about 4 cm long), and begins at the base of the bladder. Its course runs inferiorly through the urogenital diaphragm, then into the perineum. It then opens in the vestibule which lies between the labia minora. The inferior aspect of the urethra is bound to the anterior surface of the vagina. The urethral opening is anterior to the vaginal opening in the vestibule. As the urethra passes through the pelvic floor, it is surrounded by the external urethral sphincter.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 47
Incorrect
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At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts for around 50% of body weight. This can increase to nearly 80% of cardiac output during exercise. Skeletal muscle circulation is highly controlled and has a number of specialized adaptations as a result of this high degree of disparity during exercise, in combination with the diversity in the size of skeletal muscle around the body.
What is the primary mechanism for boosting skeletal muscle blood flow during exercise?
Your Answer: Sympathetic stimulation
Correct Answer: Metabolic hyperaemia
Explanation:In skeletal muscle, blood flow is closely related to metabolic rate. Due to the contraction of precapillary sphincters, most capillaries are blocked off from the rest of the circulation at rest and are not perfused. This causes an increase in vascular tone and vessel constriction. As metabolic activity rises, this develops redundancy in the system, allowing it to cope with greater demand. During exercise, metabolic hyperaemia, which is induced by the release of K+, CO2, and adenosine, recruits capillaries. Sympathetic vasoconstriction in the active muscles is overridden by this. Simultaneously, blood flow in non-working muscles is restricted, preserving cardiac output. During exercise, muscle contractions pump blood through the venous system, raising the pressure differential between arterioles and venules and boosting blood flow via capillaries.
Capillary angiogenesis is evident when muscles are used repeatedly (e.g. endurance training). It is a long-term effect, not a quick fix for increased blood flow.
The local partial pressure of alveolar oxygen is the primary intrinsic control of pulmonary blood flow (pAO2). Low pAO2 promotes arteriole vasoconstriction and vice versa. The hypoxic pulmonary vasoconstriction (HPV) reflex allows blood flow to be diverted away from poorly ventilated alveoli and towards well-ventilated alveoli in order to maximize gaseous exchange.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 48
Incorrect
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Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:
Your Answer: Ca 2+ release from T-tubules
Correct Answer: Ca 2+ release from sarcoplasmic reticulum
Explanation:Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). APs travel down invaginations of the sarcolemma called T-tubules, which are close to, but do not touch, the terminal cisternae of the SR. During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. The amount of Ca2+released is dependent on how much is stored, and on the size of the initial Ca2+influx during the AP.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 49
Incorrect
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Regarding a case-control study, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: The usual outcome measure is the relative risk.
Explanation:A case-control study is a longitudinal, retrospective, observational study which investigates the relationship between a risk factor and one or more outcomes. This is done by selecting patients who already have a specific disease (cases), matching them to patients who do not (controls) and then collecting data from the patients to compare past exposure to a possible risk factor. The usual outcome measure is the odds ratio.
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 50
Incorrect
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All of the following statements are incorrect about insulin except:
Your Answer:
Correct Answer: Proinsulin is cleaved into insulin and C peptide.
Explanation:Proinsulin is synthesised as a single-chain peptide. A connecting peptide (C peptide) within storage granules is removed by proteases to yield insulin.
Insulin:
1. is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds.
2. is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas.
3. release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin. However, most output is driven by the rise in plasma glucose concentration that occurs after a meal.
4. effects are mediated by the receptor tyrosine kinase. -
This question is part of the following fields:
- Endocrine
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
