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  • Question 1 - Activation of nitric oxide synthesis by endothelial cells is triggered by: ...

    Correct

    • Activation of nitric oxide synthesis by endothelial cells is triggered by:

      Your Answer: All of the above

      Explanation:

      Acetylcholine, histamine, bradykinin, vasoactive intestinal peptide (VIP) and shear stress on the endothelial cells causing the release of NO. NO is formed from arginine and causes vasodilatation of the blood vessels.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      14.4
      Seconds

  • Question 2 - Empagliflozin was found to reduce the risk of cardiovascular deaths, non-fatal myocardial infarction...

    Incorrect

    • 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: 200

      Correct 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.

    • This question is part of the following fields:

      • Medicine
      • Research Skills
      9.9
      Seconds

  • Question 3 - Which of the following is responsible for transporting both glucose and fructose into...

    Correct

    • Which of the following is responsible for transporting both glucose and fructose into the interstitium?

      Your Answer: GLUT 2

      Explanation:

      Absorption of glucose involves transport from the intestinal lumen, across the epithelium and into blood. The transporter that carries glucose and galactose into the enterocyte is the sodium-dependent hexose transporter, known as SGLT1. As the name indicates, this molecule transports both glucose and sodium ions into the cell. Once absorbed into the enterocyte, glucose must be exported from the cell into blood. Sodium is rapidly shuttled out in exchange for potassium by Na+/K+ ATPase pumps on the basolateral membrane, and that process maintains the electrochemical gradient across the epithelium. Glucose, galactose and fructose are transported out of the enterocyte into the interstitium and in turn into the blood through another hexose transporter (called GLUT-2) in the basolateral membrane. These monosaccharides then diffuse down a concentration gradient into capillary blood.

    • This question is part of the following fields:

      • Gastrointestinal
      • Medicine
      10.7
      Seconds

  • Question 4 - Which part of the cerebellum is primarily responsible for equilibrium and eye movements?...

    Correct

    • Which part of the cerebellum is primarily responsible for equilibrium and eye movements?

      Your Answer: Vestibulocerebellum

      Explanation:

      The vestibulocerebellum develops at the same time as the vestibular apparatus in the inner ear. Its regulates balance between agonist and antagonist muscle contractions of the spine, hips, and shoulders during rapid movements.

    • This question is part of the following fields:

      • Medicine
      • Neurology
      11.5
      Seconds

  • Question 5 - On which chromosome is the gene for insulin located? ...

    Correct

    • On which chromosome is the gene for insulin located?

      Your Answer: Chromosome 11

      Explanation:

      Humans have 23 pairs of chromosomes, and usually, two pairs of copies of chromosome 11. It is one of the most complex, gene-rich chromosomes in the human genome, and it is associated with a number of diseases. Studies have shown they the human insulin gene is located on the short arm of chromosome 11.

    • This question is part of the following fields:

      • Endocrinology
      • Medicine
      8.6
      Seconds

  • Question 6 - Which of the following is NOT true of the parasympathetic control of the...

    Incorrect

    • Which of the following is NOT true of the parasympathetic control of the heart?

      Your Answer: It affects muscarinic receptors

      Correct Answer: It can be blocked by beta blockers

      Explanation:

      Parasympathetic fibers do not innervate the Beta receptors on the heart. They are innervated by the sympathetic nerve fibers. Then a beta blocker such as propranolol will block the sympathetic outflow and increase the parasympathetic tone of the heart.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      37.9
      Seconds

  • Question 7 - Colipase is secreted in an inactive form. Its activation in the intestinal lumen...

    Incorrect

    • Colipase is secreted in an inactive form. Its activation in the intestinal lumen is by

      Your Answer: Chymotrypsin

      Correct Answer: Trypsin

      Explanation:

      The enzyme trypsin exists in pancreatic juice in the inactive form trypsinogen, it is activated by the intestinal enterokinase in intestinal juice. Trypsin can then activate other protease enzymes and catalyse the reaction pro-colipase → colipase. Colipase is necessary, along with bile salts, to enable lipase function.

    • This question is part of the following fields:

      • Gastrointestinal
      • Medicine
      11.1
      Seconds

  • Question 8 - The AV Node: ...

    Correct

    • The AV Node:

      Your Answer: It decelerates impulses passing to the ventricles

      Explanation:

      The action potentials in the sinoatrial (SA) and atrioventricular (AV) nodes are largely due to Ca2+, with no contribution by Na+ influx. The depolarization continues to conduct slowly through the atrioventricular (AV) node. The AV node is located in the right posterior portion of the interatrial septum. This is small and bean-shaped. The atrial conductive system is organized so that the cardiac impulse does not travel from the atria into the ventricles too rapidly; this delay allows the atria to empty before ventricular contraction begins. It is the AV node and its adjacent conductive fibers that delay this transmission into the ventricles. Conduction through the AV Node is represented on the ECG by the PR interval.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      38.6
      Seconds

  • Question 9 - Where does protein digestion begin? ...

    Correct

    • Where does protein digestion begin?

      Your Answer: Stomach

      Explanation:

      Digestion typically begins in the stomach when pepsinogen is converted to pepsin by the action of hydrochloric acid, and continued by trypsin and chymotrypsin in the small intestine.

    • This question is part of the following fields:

      • Gastrointestinal
      • Medicine
      5.9
      Seconds

  • Question 10 - Under normal conditions (where n represents the number of chromosome pairs), just before...

    Correct

    • Under normal conditions (where n represents the number of chromosome pairs), just before mitosis begins, how many chromosomes are contained in the nucleus of each somatic cell:

      Your Answer: 4n

      Explanation:

      In a normal somatic cell there are 2n chromosome but in a replicating cell just before mitosis the chromosomes duplicate but are still joined via the centrosome. Thus there are 4n chromosomes. After completion of mitosis the number goes back to 2n.

    • This question is part of the following fields:

      • Genetics
      • Medicine
      9.9
      Seconds

  • Question 11 - What is a characteristic findings on ECG in hyperkalaemia? ...

    Correct

    • What is a characteristic findings on ECG in hyperkalaemia?

      Your Answer: Tall, tented T waves

      Explanation:

      Hyperkalaemia leads to:

      – Prolonged PR interval

      – Small P waves

      – Tall, tented T waves

      – Widened QRS complexes and eventually asystole.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      5.5
      Seconds

  • Question 12 - The steps of cardiac cycle in sequence are: ...

    Incorrect

    • The steps of cardiac cycle in sequence are:

      Your Answer: Ejection, isovolumetric relaxation, passive ventricular filling, isovolumetric contraction, active ventricular filling.

      Correct Answer: Isovolumic contraction, ejection, isovolumic relaxation, passive ventricular filling, active ventricular filling.

      Explanation:

      The cardiac cycle refers to a complete heartbeat from its generation to the beginning of the next beat, and so includes the diastole, the systole, and the intervening pause.1st stage: diastole, or passive filling is when the semilunar valves (the pulmonary valve and the aortic valve) close, the atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the whole heart is relaxed. 2nd stage: atrial systole, is when the atrium contracts, and blood flows from atrium to the ventricle (active filling).3rd stage: isovolumic contraction is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. 4th stage: ventricular ejection, is when the ventricles are contracting and emptying, and the semilunar valves are open. 5th stage: isovolumic relaxation time, pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      9.2
      Seconds

  • Question 13 - All valves are closed in which phase of the cardiac cycle? ...

    Correct

    • All valves are closed in which phase of the cardiac cycle?

      Your Answer: Isovolumetric relaxation

      Explanation:

      The cardiac cycle refers to a complete heartbeat from its generation to the beginning of the next beat, and so includes the diastole, the systole, and the intervening pause.The first stage, diastole, is when the semilunar valves (the pulmonary valve and the aortic valve) close, the atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the whole heart is relaxed. The second stage, atrial systole, is when the atrium contracts, and blood flows from atrium to the ventricle.The third stage, isovolumic contraction is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. The fourth stage, ventricular ejection, is when the ventricles are contracting and emptying, and the semilunar valves are open. During the fifth stage, isovolumic relaxation time, pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      10.4
      Seconds

  • Question 14 - In a 30 year old male with hypertrophic obstructive cardiomyopathy (HOCM), which of...

    Correct

    • In a 30 year old male with hypertrophic obstructive cardiomyopathy (HOCM), which of the following is not associated with increased risk of sudden death?

      Your Answer: Age

      Explanation:

      Hypertrophic cardiomyopathy (HCM) is a disease in which a portion of the myocardium (heart muscle) is enlarged without any obvious cause, creating functional impairment of the heart. It is the leading cause of sudden death in young athletes. The major risk factors for sudden death (SD) are recent unexplained syncope unlikely to be neurocardiogenic; HCM-related SD in first-degree or other close relatives; repetitive and/or prolonged nonsustained ventricular tachycardia (NSVT) episodes on Holter or extended ambulatory monitoring; massive left ventricular hypertrophy (LVH) (wall thickness ≥30 mm); extensive/diffuse late gadolinium enhancement (LGE); end-stage heart failure usually with systolic dysfunction; and thin-walled akinetic LV apical aneurysm with regional scarring.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      7.7
      Seconds

  • Question 15 - A 78-year-old male with long-standing Alzheimer's disease is being reviewed in your clinic....

    Incorrect

    • A 78-year-old male with long-standing Alzheimer's disease is being reviewed in your clinic. Which among the following is true regarding memantine, a drug which has been approved for the management of dementia?

      Your Answer: Amantadine can increase its unwanted effects

      Correct Answer: It is an NMDA-receptor antagonist

      Explanation:

      Memantine is an antagonist of the NMDA (N-Methyl-D-Aspartate)-receptor subtype of glutamate receptor. It is used to slow the neurotoxicity thought to be involved in Alzheimer’s disease and other neurodegenerative diseases.

      Drug interactions:

      • When given concomitantly with other NMDA-receptor antagonists (e.g., ketamine, amantadine) there is increased risk of psychosis.
      • Dopamine agonists, L-dopa, and anticholinergics enhance effects of memantine.
      • Antispasmodics (e.g., baclofen) enhance effects, as memantine has some antispasmodic effects.
      • Drugs excreted by cationic transporters in the kidney (e.g. quinine, cimetidine, ranitidine) reduce excretion.
      • Common adverse effects include dizziness, headache, confusion, diarrhoea, and constipation.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      25.9
      Seconds

  • Question 16 - The majority striatal neurons, called medium spiny neurons, utilizes which neurotransmitter? ...

    Correct

    • The majority striatal neurons, called medium spiny neurons, utilizes which neurotransmitter?

      Your Answer: GABA

      Explanation:

      Medium spiny neurons are inhibitory neurons which use GABA (gamma-aminobutyric acid) which exerts inhibitory actions. These cells represent 95% of neurones within the human striatum found in basal ganglia.

    • This question is part of the following fields:

      • Medicine
      • Neurology
      9.6
      Seconds

  • Question 17 - A 45 year old man presents with fever, malaise, weight loss and myalgias...

    Correct

    • A 45 year old man presents with fever, malaise, weight loss and myalgias that have been occurring for a month. You suspect polyarteritis nodosa and arrange for some lab investigations. Which of the following abnormality would most likely be present?

      Your Answer: Elevated creatinine

      Explanation:

      People with polyarteritis nodosa often exhibit anaemia of chronic disease. Leucocytosis and eosinophilia may also be present. ANCA is only rarely positive. As polyarteritis nodosa affects the kidneys as well, the creatinine is elevated in most cases.

    • This question is part of the following fields:

      • Connective Tissue
      • Medicine
      21.5
      Seconds

  • Question 18 - A 36 year old man arrives at the clinic complaining of pain and...

    Correct

    • A 36 year old man arrives at the clinic complaining of pain and swelling of the left knee, ankles and right hallux. He has acute conjunctivitis, and dysuria. He suffered from an episode of gastroenteritis two weeks back. Clinical examination shows left Achilles tendonitis and right plantar fasciitis. Radiological examination reveals left sacroiliitis, with evidence of enthesitis, joint erosions and periostitis. HLA-B27 is positive. Which of the following is the most likely diagnosis?

      Your Answer: Reiter’s syndrome

      Explanation:

      Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. extraarticular dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum), oral ulcers.

    • This question is part of the following fields:

      • Connective Tissue
      • Medicine
      53.6
      Seconds

  • Question 19 - Which of the following is a form of synaptic plasticity? ...

    Incorrect

    • Which of the following is a form of synaptic plasticity?

      Your Answer: Déjà vu

      Correct Answer: Working memory

      Explanation:

      Synaptic plasticity is an important neurochemical foundation of working memory and generation of memory. Synaptic plasticity is the ability of synapses to strengthen or weaken over time in response to increases or decreases in their activity.

    • This question is part of the following fields:

      • Medicine
      • Neurology
      22.8
      Seconds

  • Question 20 - A 45 year old male presents with lower backache and pain in his...

    Incorrect

    • A 45 year old male presents with lower backache and pain in his hips. Blood tests are normal except for elevated serum alkaline phosphatase which is 1200 IU/l (45-105). Radiological examination shows combined osteolytic and osteosclerotic lesions. What is the most common site of occurrence of this disease?

      Your Answer: Lumbar spine

      Correct Answer: Pelvis

      Explanation:

      The patient most likely suffers from Paget’s disease of the bone as his radiological examination shows both osteolytic and osteosclerotic lesions. Any bone or bones can be affected, but Paget’s disease occurs most frequently in the pelvis > lumbar spine > femur > thoracic spine > sacrum > skull > tibia.

    • This question is part of the following fields:

      • Connective Tissue
      • Medicine
      32.2
      Seconds

  • Question 21 - The initial rapid depolarization in the action potential of cardiac muscle cells is...

    Correct

    • The initial rapid depolarization in the action potential of cardiac muscle cells is due to:

      Your Answer: Opening of voltage-gated Na+ channels

      Explanation:

      The initial depolarization of the action potential in a cardiac muscle cell is due to the sodium current generated by opening of the voltage gated sodium channels leading to an influx of sodium ions into the cell and raising the membrane potential towards threshold.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      10.3
      Seconds

  • Question 22 - Erythropoietin is synthesized by which cells of the nephron? ...

    Correct

    • Erythropoietin is synthesized by which cells of the nephron?

      Your Answer: Tubular interstitial cells

      Explanation:

      Erythropoietin is produced by interstitial fibroblasts in the kidney in close association with peritubular capillary and proximal convoluted tubule. It is also produced in perisinusoidal cells in the liver. While liver production predominates in the fetal and perinatal period, renal production is predominant during adulthood.

    • This question is part of the following fields:

      • Medicine
      • Renal
      16.3
      Seconds

  • Question 23 - Which of the following affects the magnitude of the action potential? ...

    Incorrect

    • Which of the following affects the magnitude of the action potential?

      Your Answer: Changes in the intracellular K+ concentration

      Correct Answer: Changes in the external Na+ concentration

      Explanation:

      The magnitude of the action potential is determined by the sodium current. Increase in external sodium will result in increased influx of sodium and hence generation of a stronger action potential.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      17.3
      Seconds

  • Question 24 - What effect does osmotic diuresis have on net Na+ excretion? ...

    Incorrect

    • What effect does osmotic diuresis have on net Na+ excretion?

      Your Answer: Markedly decreased Na+ excretion

      Correct Answer: Markedly increased Na+ excretion 

      Explanation:

      Osmotic diuresis is the increase of urination rate caused by the presence of certain substances in the small tubes of the kidneys. The excretion occurs when substances such as glucose enter the kidney tubules and cannot be reabsorbed (due to a pathological state or the normal nature of the substance). The substances cause an increase in the osmotic pressure within the tubule, causing retention of water within the lumen, and thus reduces the reabsorption of water, increasing urine output (i.e. diuresis). Sodium, chloride, potassium are markedly excreted in osmotic diuresis.

    • This question is part of the following fields:

      • Medicine
      • Renal
      10
      Seconds

  • Question 25 - Transport of Ca2+ into the reticulum to initiate cardiac muscle relaxation in via:...

    Incorrect

    • Transport of Ca2+ into the reticulum to initiate cardiac muscle relaxation in via:

      Your Answer: Dihydropyridine receptors

      Correct Answer: Serca (sarcoplasmic or endoplasmic reticulum Ca2+ ATPase)

      Explanation:

      Phosphorylation of phospholamban, which increases calcium ATPase activity and sequestration of calcium in the sarcoplasmic reticulum. An increased rate of relaxation is explained because cAMP also activates the protein phospholamban, situated on the membrane of the SR, that controls the rate of uptake of calcium into the SR. The latter effect explains enhanced relaxation (lusitropic effect).

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      16
      Seconds

  • Question 26 - Where is the site of action of spironolactone? ...

    Correct

    • Where is the site of action of spironolactone?

      Your Answer: Distal convoluted tubule

      Explanation:

      Spironolactone is an aldosterone antagonist which acts act in the distal convoluted tubule.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      8.3
      Seconds

  • Question 27 - The major factor in controlling coronary artery blood flow is considered to be?...

    Correct

    • The major factor in controlling coronary artery blood flow is considered to be?

      Your Answer: Metabolites of oxygen consumption

      Explanation:

      There is a strong relationship between myocardial blood flow and oxygen consumption. This indicates that products of metabolism may cause vasodilation of the coronary artery.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      12.5
      Seconds

  • Question 28 - Which is the primary lymphoid organ? ...

    Correct

    • Which is the primary lymphoid organ?

      Your Answer: Thymus

      Explanation:

      Lymphoid organs consist of lymph nodes, the thymus, spleen and tonsils. The thymus is the primary lymphoid organ as it is the organ in which the T cells mature.

    • This question is part of the following fields:

      • Immunology
      • Medicine
      4.5
      Seconds

  • Question 29 - Which of the following is true with AV nodal delay? ...

    Incorrect

    • Which of the following is true with AV nodal delay?

      Your Answer: The delay is about 0.01s

      Correct Answer: Shortened by sympathetic stimulation

      Explanation:

      AV nodal delay Is about 0.1s before the action potential spreads to the ventricles. It is shortened by stimulation of the sympathetic nervous system and lengthened by stimulation of the parasympathetic system.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      17.5
      Seconds

  • Question 30 - Regarding the cardiac muscle striations as viewed under the microscope, which areas are...

    Incorrect

    • Regarding the cardiac muscle striations as viewed under the microscope, which areas are dark?

      Your Answer: I band and z line

      Correct Answer: A band and z line

      Explanation:

      Dark bands: a, h. Dark line: z. Clear band: i, m

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      10
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (7/13) 54%
Medicine (18/30) 60%
Research Skills (0/1) 0%
Gastrointestinal (2/3) 67%
Neurology (2/3) 67%
Endocrinology (1/1) 100%
Genetics (1/1) 100%
Pharmacology (1/2) 50%
Connective Tissue (2/3) 67%
Renal (1/2) 50%
Immunology (1/1) 100%
Passmed
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