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Question 1
Correct
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The process in which tissue thromboplastin activates factor VII is best known as:
Your Answer: The extrinsic pathway
Explanation:In the tissue factor pathway (extrinsic), following damage to the blood vessel, FVII leaves the circulation and comes into contact with tissue factor (TF) expressed on tissue-factor-bearing cells (stromal fibroblasts and leukocytes), forming an activated complex (TF-FVIIa).
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This question is part of the following fields:
- Haematology
- Medicine
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Question 2
Correct
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The proportion of individuals within a population affected by disease at a specific time point, based on positive testing for serum antibodies is known as:
Your Answer: Sero-Prevalence
Explanation:In immunology, seroconversion is the time period during which a specific antibody develops and becomes detectable in the blood. After seroconversion has occurred, the disease can be detected in blood tests for the antibody. Sero-prevalence includes individuals who are antibody positive for a specific infection at a specific point in time.
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This question is part of the following fields:
- Infectious Diseases
- Medicine
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Question 3
Correct
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The triangle with the heart at its centre, using limb leads is called:
Your Answer: Einthoven
Explanation:The Einthoven triangle is formed by placing the limb leads on both the arms and on the left leg with the heart in the centre.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 4
Correct
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Which of the following involving the scalp may produce alopecia (hair loss)?
Your Answer: Discoid lupus erythematosus
Explanation:Causes of hair loss include:
- Dissecting cellulitis
- Fungal infections (such as tinea capitis)
- Folliculitis
- Secondary syphilis
- Demodex folliculorum
- Lupus erythematosus (hair loss may be permanent due to scarring of the hair follicles).
Psoriasis and seborrheic dermatitis commonly involve the scalp but do not produce hair loss.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 5
Correct
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Empagliflozin was found to reduce the risk of cardiovascular deaths, non-fatal myocardial infarction and non-fatal stroke when added to standard treatment plans in patients with type 2 diabetes mellitus. This information was shared in 2015 by The New England Journal of Medicine and the results were expressed per 1000 patient years. In fact, empagliflozin had an event rate of 37.3/1000 patient years and placebo an event rate of 43.9/1000 patient years. How many patients who are at high cardiovascular risk need to be treated with empagliflozin to prevent a cardiovascular death, a non-fatal myocardial infarction or a non-fatal stroke?
Your Answer: 150
Explanation:The number needed to treat (NNT) is an absolute effect measure that has been used to assess beneficial and harmful effects of medical interventions. In this case the NNT can be calculated as follows: NNT = 1/ Absolute risk reduction (ARR). ARR=(Control event rate expressed per 1000 patient years) – (Experimental event rate expressed per 1000 patient years) = 43.9-37.3 = 6.6/1000 patient yearsNNT=(Patient years)/ARR = 1000/ 6.6 = 151.5. The closest to 151.5 is 150, thus it is the correct answer.
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This question is part of the following fields:
- Medicine
- Research Skills
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Question 6
Correct
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Which among the following antihypertensives is centrally acting?
Your Answer: Moxonidine
Explanation:Moxonidine and alpha-methyl dopa are centrally acting antihypertensives and modify blood pressure through modifying sympathetic activity.Other options:Verapamil is a calcium antagonist.Minoxidil and hydralazine are both vasodilators.Phenoxybenzamine is an alpha-blocker.Adverse effects:Dry mouth and somnolence were the most frequently reported adverse events, followed by headache, dizziness, nausea and allergic skin reactions.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 7
Correct
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The largest energy reserves among both lean and obese subjects are from?
Your Answer: Fatty acids
Explanation:The energy required for sustained exercise is provided by the oxidation of two fuels, glucose stored as glycogen in the liver and muscle, and long-chain fatty acids, stored as adipose tissue triglycerides. The latter provides the largest energy reserve in the body.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 8
Incorrect
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With regard to carbohydrate absorption, which sodium-dependent glucose transporter (SGLT) is responsible for the uptake of dietary glucose from the gut?
Your Answer: SGLT 3
Correct Answer: SGLT 1
Explanation:SGLT- Sodium-dependent glucose cotransporter or sodium-glucose linked transporter are family of proteins of different types. SGLT1 transporter is found in the intestinal mucosa of the small intestine.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 9
Incorrect
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Which inhibitor of gastric enzyme secretion is released by the presence of fat in the jejunum?
Your Answer: Guanylin
Correct Answer: Peptide yy
Explanation:Peptide yy is secreted from the jejunum due to the presence of fat. It inhibits gastric acid secretion and motility.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 10
Incorrect
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Choose the most correct missing words to complete the statement: A portion of circulating growth hormone is bound to the ____ receptor and activates the ____ pathway that mediates its effect.
Your Answer: Growth hormone receptor (intracellular domain), jak 2stat
Correct Answer: Growth hormone receptor (extracellular domain), jak 2stat
Explanation:The growth hormone receptor is a transmembrane protein involved in the STATs, MAPK and PI3-kinase/Akt pathways. The JAK-STAT signalling pathway is activated by different ligands, such as growth hormone, interferon and interleukin. This pathway is involved in the expression of genes associated with oncogenesis, immunity, proliferation, differentiation and apoptosis. Errors in these pathways can produce leukaemia’s and other myeloproliferative disorders.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 11
Correct
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A 55 year old female presents with progressive dyspnoea, dry cough and fever. She started methotrexate therapy six weeks ago. The current regimen includes methotrexate 15 mg/ week, folic acid 5 mg/day and aspirin 75 mg/day. There is no history of any other chronic illness. Vitals are as follows: Temp: 37.8C, pulse: 100 beats/min, BP: 110/80mmHg and SaO2: 90% on air. Examination reveals synovitis in both wrists, and metacarpophalangeal joints. On auscultation, there are scattered crepitations. Blood test reports are given below:Haemoglobin: 13.1g/dl (13.0 – 18.0 g/dL)WBC: 8.2 x109/l (4 – 11 x 109/l)Neutrophils: 5.1×109/l (1.5 – 7 x 109/l)Platelets: 280 x109/l (150 – 400 x 109/L)ESR: 48 mm/hr (0 – 30 mm/1st hr)Urea, electrolytes and creatinine: normalCXR: patchy airspace shadows bilaterallyWhat is the most likely diagnosis?
Your Answer: Methotrexate pneumonitis
Explanation:Pneumonitis is a serious and unpredictable side-effect of treatment with methotrexate (MTX) that may become life-threatening. The typical clinical symptoms include progressive shortness of breath and cough, often associated with fever. Hypoxaemia and tachypnoea are always present and crackles are frequently audible. Chest radiography reveals a diffuse interstitial or mixed interstitial and alveolar infiltrate, with a predilection for the lower lung fields. Pulmonary function tests show a restrictive pattern with diminished diffusion capacity. Lung biopsy reveals cellular interstitial infiltrates, granulomas or a diffuse alveolar damage pattern accompanied by perivascular inflammation. Most patients present in the first few months of starting methotrexate. It is important that all patients receiving methotrexate be educated concerning this potential adverse reaction and instructed to contact their physicians should significant new pulmonary symptoms develop while undergoing therapy. If methotrexate pneumonitis is suspected, methotrexate should be discontinued, supportive measures instituted and careful examination for different causes of respiratory distress conducted. This may be treated with corticosteroids once underlying infection has been excluded.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 12
Incorrect
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A 30-year-old woman is admitted for drainage of an abscess in her left forearm. She has revealed that she was regular heroin user and has stopped for the past few days. Clinical signs are pointing towards opioid withdrawal. What is the next step in managing this patient?
Your Answer: Give her a bottle containing 100 mg of methadone syrup and tell her to adjust the dosage herself
Correct Answer: Give her 10 mg of methadone syrup and wait 60 min to determine its effect
Explanation:The next step in managing this patient is to give 10 mg and continue administering in 10 mg increments each hour until symptoms are under control.Methadone alleviates opioid withdrawal symptoms and reduces cravings. Methadone is useful for detoxification from longer-acting opioids such as morphine or methadone itself.Methadone should be used with caution if the patient has:Respiratory deficiencyAcute alcohol dependenceHead injuryTreatment with monoamine oxidase inhibitors (MAOIs)Ulcerating colitis or Crohn’s diseaseSevere hepatic impairmentThe dose must be reviewed on a daily basis and adjusted based upon how well the symptoms are controlled and the presence of side effects. The greater the dose of opioids used by the patient, the greater the dose of methadone required to control withdrawal symptoms. To avoid the risk of overdose in the first days of treatment The recommended dosing of methadone is 30mg in two doses of 15mg morning and evening.It is important to note that a methadone dose equivalent to what the patient reports they are taking should never be given. It is rare to need more than 40 mg per 24 hours: beware of overdosing which can lead to respiratory arrest.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 13
Correct
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Which of the following hormones would stimulate secretion of TSH?
Your Answer: TRH
Explanation:Thyrotropin-releasing hormone, also known as TRH, thyrotropin-releasing factor, TRF is a hormone produced by the hypothalamus. It functions as a releasing hormone, promoting the production of thyroid-stimulating hormone or thyrotropin and prolactin.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 14
Incorrect
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Neurons that are inactive during quiet breathing, become active when the respiratory drive for increased ventilation becomes greater than normal. These are located in the:
Your Answer: Apneustic centre
Correct Answer: Ventral respiratory group
Explanation:The mechanism of control of ventilation is an interplay of multiple regions in the brain. Medullary respiratory centre sets the basic rhythm of breathing. The dorsal respiratory group integrates input from the stretch receptors and the chemoreceptors in the periphery and is composed mainly of inspiratory neurons which controls the basic rhythm of breathing. The ventral respiratory group generates breathing rhythm and integrates data coming in to the medulla. It contains both inspiratory and expiratory neurons. They are primarily active in exercise and stress.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 15
Incorrect
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Defects in chromosomal structure (and examples) include those mentioned below except:
Your Answer: Robertsonian translocation (down syndrome in subsequent generation)
Correct Answer: Lyonization (x-linked disorders)
Explanation:All are true except for A) Lyonization which is the inactivation of the X chromosomes in a female. It is not a chromosomal abnormality.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 16
Correct
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Among the following which is the beneficial effect of nitro-glycerine?
Your Answer: Dilation of systemic veins
Explanation:Dilation of systemic veins is a beneficial effect of nitro-glycerine.Administration of nitro-glycerine results in the dilation of systemic veins and decrease of myocardial wall tension and oxygen demand. Dilatation of systemic veins can cause reduced systemic vascular resistance leading to reduced cardiac workload thus reducing anginal symptoms secondary to demand ischemia.This is accompanied by vasodilation of large and medium-sized coronary arteries with increased coronary blood flow to the sub endocardium.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 17
Correct
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Which of the following structures lie in close proximity to the thyroid?
Your Answer: All of the options
Explanation:The thyroid gland receives its blood supply from the inferior and superior thyroid arteries. The recurrent laryngeal nerves emerges from the superior thoracic outlet bounded in part by the thyroid lobe. Two pairs of parathyroid glands lie near the thyroid. The common carotid artery splits into its external and internal branches at the upper border of the thyroid cartilage; these branches are separated by the gland.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 18
Incorrect
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The residual cleft of the intermediate lobe of the pituitary is lined by follicles resembling which human gland?
Your Answer: Adrenal medulla
Correct Answer: Thyroid
Explanation:The cells located between the two main pituitary lobes form what is known as the intermediate pituitary. This area secretes melanocyte-stimulating hormone and it is only a few cell layers thick. It is rich in follicles filled with colloid, and lined by basophilic cells. This configuration resembles that of another important gland: the thyroid.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 19
Incorrect
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Generalized vasoconstrictors include:
Your Answer: Histamine, bradykinin, niacin
Correct Answer: Norepinephrine, endothelin, angiotensin ii
Explanation:Vasopressin, angiotensin II, adrenaline and endothelin are generalized vasoconstrictors.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 20
Correct
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Which of the following is an incorrect statement regarding the structure of DNA?
Your Answer: The two strands of DNA are held together by cysteine bonds.
Explanation:The two strands of DNA are held together by hydrogen bonds formed between the nucleotide bases.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 21
Incorrect
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Which of the following prevents auto-digestion of the stomach by gastric secretions:
Your Answer: Ecl cells product
Correct Answer: Trefoil peptides and mucus- bicarbonate layer.
Explanation:Pepsinogen is the inactive form of pepsin, a protein digesting enzyme. Bombesin is a peptide which stimulates gastrin secreting cells in the stomach increasing production of gastric acid. Ecl or enterochromaffin cells are neuroendocrine cells that aid in the production of gastric acid via the release of histamine. Oxyntic cells are also known as parietal cells and are the main cells secreting gastric hydrochloric acid (HCl). Gastric acid and pepsin are harmful agents for the gastric mucosa and can result in autodigestion. It is therefore protected by several agents including bicarbonate which neutralizes the acidity of gastric acid while Trefoil peptides are a component of gastric mucosa that form a gel like layer in the gastric epithelium protecting it from harmful agents.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 22
Correct
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Which of the following foods contain Vitamin B 12?
Your Answer: Liver, meat
Explanation:No fungi, plants, nor animals (including humans) are capable of producing vitamin B12. Only bacteria and archaea have the enzymes needed for its synthesis. Proved food sources of B12 are animal products (meat, fish, dairy products).
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This question is part of the following fields:
- Haematology
- Medicine
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Question 23
Incorrect
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A clinical trial is conducted to study the benefits of a new oral medication to improve the symptoms of patients with asthma. In the trial 400 patients with asthma, half were given the new medication and half a placebo. Three months later they are asked to rate their symptoms using the following scale: much improved, slight improvement, no change, slight worsening, significantly worse. What is the most appropriate statistical test to see whether the new medication is beneficial?
Your Answer: Student's t-test (unpaired)
Correct Answer: Mann-Whitney U test
Explanation:The type of significance test used depends on whether the data is parametric (can be measured, usually normally distributed) or non-parametric.Parametric tests:Student’s t-test – paired or unpaired*Pearson’s product-moment coefficient – correlationNon-parametric tests:Mann-Whitney U test – unpaired dataWilcoxon signed-rank test – compares two sets of observations on a single samplechi-squared test – used to compare proportions or percentagesSpearman, Kendall rank – correlation.The outcome measured is not normally distributed, i.e. it is non-parametric. This excludes the Student’s t-tests. We are not comparing percentages/proportions so the chi-squared test is excluded. The Mann–Whitney U test is a nonparametric test of the null hypothesis that it is equally likely that a randomly selected value from one sample will be less than or greater than a randomly selected value from a second sample.This test can be used to investigate whether two independent samples were selected from populations having the same distribution.
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This question is part of the following fields:
- Medicine
- Research Skills
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Question 24
Incorrect
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Which area in the GIT lacks Basic Electrical Rhythm?
Your Answer: Small intestine
Correct Answer: Oesophagus
Explanation:The basal or basic electrical rhythm acts to coordinate peristalsis and are initiated in the interstitial cells of Cajal, specialized pacemaker cells located in the wall of the stomach, below the oesophagus.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 25
Incorrect
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In which organelle is the intrinsic apoptotic pathway initiated?
Your Answer: Peroxisome
Correct Answer: Mitochondria
Explanation:Apoptosis is a programmed form of cell death involving the degradation of cellular constituents by a group of cysteine proteases called caspases. The caspases can be activated through either the intrinsic (mitochondrial mediated) or extrinsic (death receptor mediated) apoptotic pathways.
The intrinsic apoptotic pathway, also known as the mitochondrial pathway, is primarily initiated within the mitochondria. This pathway is activated in response to various internal stimuli, such as DNA damage, oxidative stress, and other cellular stresses.
When the intrinsic pathway is triggered, several events occur in the mitochondria:
- Release of cytochrome c: Cytochrome c is released from the mitochondrial intermembrane space into the cytoplasm.
- Formation of the apoptosome: Cytochrome c in the cytoplasm binds to apoptotic protease activating factor-1 (Apaf-1) and procaspase-9, forming a complex known as the apoptosome.
- Activation of caspase-9: The apoptosome activates caspase-9, an initiator caspase.
- Caspase cascade: Activated caspase-9 then activates executioner caspases, such as caspase-3, leading to the execution phase of apoptosis, which results in the orderly dismantling of the cell.
The mitochondria play a crucial role in this pathway by regulating the release of pro-apoptotic factors that are essential for the activation of downstream apoptotic processes.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 26
Incorrect
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Which of the following best describe N. Meningitides?
Your Answer: Gram positive cocci
Correct Answer: Gram negative cocci
Explanation:Neisseria meningitidis, often referred to as meningococcus, is a gram negative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcaemia, a life-threatening sepsis. The bacterium is referred to as a coccus because it is round, and more specifically, diplococcus because of its tendency to form pairs. About 10% of adults are carriers of the bacteria in their nasopharynx.
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This question is part of the following fields:
- Infectious Diseases
- Medicine
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Question 27
Correct
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What happens first during depolarisation of the membrane potential?
Your Answer: Gated Na channels open allowing the influx of Na
Explanation:Generation of an action potential in response to a stimulus is a result of a previously maintained resting membrane potential (RMP). Generation of resting membrane potential is mediated mainly by potassium ions. Several membrane proteins maintain RMP by transport of ions in and out of cell. Na+/K+ ATPase pump maintains a concentration gradient of Na+ and K+ ions. Na+ concentration in extracellular fluid is higher compared to intracellular fluid and K+ ion concentration is higher intracellularly. Generation of an action potential facilitates opening of Na+ ion channels which allow for Na+ to diffuse inside the cell according to the concentration gradient.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 28
Incorrect
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Which one of the following ECG findings is least associated with digoxin use?
Your Answer: Bradycardia
Correct Answer: Prolonged QT interval
Explanation:Digoxin ECG features:• ST depression (‘reverse tick’)• flattened/inverted T waves• Prolonged PR interval• short QT interval• arrhythmias e.g. AV block, bradycardia, ventricular tachycardia or fibrillation (for example paroxysmal atrial tachycardia with A-V block – so-called PAT with block) is said to be pathognomonic (i.e. diagnostic) of digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 29
Incorrect
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In addition to its role in digestion and absorption of fats, bile:
Your Answer: Causes stones
Correct Answer: Is the major excretory route for lipid-soluble waste products
Explanation:The end product of haem metabolism is bilirubin and jaundice is caused by increased bilirubin levels in the blood. Gallstones are mainly caused by cholesterol and bile pigments. Bile is the main route of excretion for lipid soluble waste products whereas urine is the main route of excretion of water soluble waste products.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 30
Incorrect
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Which of the following causes the closure of the ductus arteriosus during birth?
Your Answer:
Correct Answer: Reduced levels of prostaglandins
Explanation:Ductus arteriosus is kept open by the prostaglandin E2 which is a vasodilator. At birth the high levels of cyclooxygenase blocks the production of prostaglandins which results in the closure of the ductus arteriosus.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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