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Question 1
Correct
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Where is the myenteric plexus (Auerbach’s plexus) located in the GIT?
Your Answer: Between the outer longitudinal and middle circular muscle layers.
Explanation:A part of the enteric nervous system, the myenteric plexus exists between the longitudinal and circular layers of muscularis externa in the gastrointestinal tract. It is found in the muscles of the oesophagus, stomach, and intestine.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 2
Correct
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Question 3
Correct
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A 53 year old female, longstanding case of rheumatoid arthritis comes for a review. Which of the following features are commonly associated with her condition?
Your Answer: Proximal interphalangeal joint involvement in the hands
Explanation:Rheumatoid arthritis is a polyarthritis that results in symmetrical pain and swelling of the affected joints (also at rest). It particularly affects the metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs), not the distal interphalangeal joints (DIPs). Ulcerative colitis and IBD are associated with seronegative arthritides, not RA. The condition can also cause various extra-articular manifestations such as ocular symptoms, rheumatoid nodules and pulmonary fibrosis. Scleritis, episcleritis and keratoconjunctivitis sicca are more common than uveitis. Early intervention with disease-modifying antirheumatic drugs (DMARDs) plays a decisive role in successful treatment.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 4
Correct
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Where would one normally find venous valves?
Your Answer: Saphenous vein
Explanation:The intima of the limb veins is folded at intervals to form venous valves that prevent retrograde flow. There are no valves present in the very small veins, the great veins, or the veins in the brain and viscera.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 5
Incorrect
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In which cell would you find a Nissl body?
Your Answer: Astrocyte
Correct Answer: Bipolar neuron
Explanation:Nissl bodies are the structures of protein synthesis in neurones. They are granular bodies of Rough Endoplasmic Reticulum and ribosomes. Astrocytes, Microglia, Schwann cell, oligodendrocytes are collectively known as glia or supporting cells of the nervous system.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 6
Correct
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When looking at the JVP what does the c wave signify:
Your Answer: Isovolumetric ventricular contraction
Explanation:The C wave signifies a rise in the atrial pressure during isovolumetric contraction due to the tricuspid valve bulging into the atria.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 7
Incorrect
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Which enzyme is responsible for the formation of the active endopeptidases from their inactive precursors?
Your Answer: Trypsin
Correct Answer: Enterokinase
Explanation:Enterokinase is a brush border enzyme of the duodenum that activates proteolytic enzymes for further digestion of proteins. Trypsinogen is converted to trypsin by the action of enterokinase. Trypsin and chymotrypsin are secreted by the pancreatic acinar cells and are enzymes that aid in protein digestion. Pepsin is secreted by chief cells of gastric mucosa. Procarboxydase is the inactive form of carboxypeptidase which is converted to its active form by trypsin and is secreted by pancreatic acinar cells.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 8
Incorrect
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Question 9
Correct
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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: 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 10
Incorrect
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Which of the following factors is not completely produced in the liver?
Your Answer: Factor v
Correct Answer: Factor viii
Explanation:Factor VIII is produced in liver sinusoidal cells and endothelial cells outside of the liver throughout the body. This protein circulates in the bloodstream in an inactive form, bound to another molecule called von Willebrand factor, until an injury that damages blood vessels occurs.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 11
Correct
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Which of the following statements regarding psoriasis is incorrect?
Your Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease which is characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly commonly on the extensor surfaces. Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression. Psoriatic arthritis affects up to 30% of individuals with psoriasis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response, rather than type 2 helper T cells
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 12
Correct
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A 35 year old female, known case of anti phospholipid syndrome, arrives at the clinic due to a swollen and painful left leg. Doppler ultrasonography confirms the diagnosis of a deep vein thrombosis. She was previously diagnosed with DVT 4 months back and was on warfarin therapy (target INR 2-3) when it occurred. How should her anticoagulation be managed?
Your Answer: Life-long warfarin, increase target INR to 3 - 4
Explanation:If the INR in the range of 2-3 has still resulted in thrombosis, the target INR is increased to 3-4. However, because the risk of bleeding increases as the INR rises, the INR is closely monitored and adjustments are made as needed to maintain the INR within the target range.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 13
Incorrect
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Mean intra pleural pressure at rest with inspiration can reach:
Your Answer: -10 mmHg
Correct Answer: -6 mmHg
Explanation:It is a negative pressure as it is lower than the atmospheric pressure. It can start from -2.5 and reach around -6 mmHg
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 14
Correct
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Where is the carotid sinus located?
Your Answer: After the bifurcation of the carotid artery, on the internal carotid
Explanation:The carotid sinus is a small dilation in the internal carotid artery just above its bifurcation into the external and internal carotid branch. Baroreceptors are present at this dilation.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 15
Correct
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Most of the venous blood returns to the heart through the:
Your Answer: Coronary sinus and anterior cardiac veins
Explanation:Most of the venous blood returns to the heart via the coronary sinus and the anterior cardiac veins which drain into the right atrium.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 16
Correct
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Choose the correct statement regarding the protein C/S system?
Your Answer: The protein C/S complex inactivates factor Va and VIIIa
Explanation:The best characterized function of Protein S is its role in the anti coagulation pathway, where it functions as a cofactor to Protein C in the inactivation of Factors Va and VIIIa.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 17
Incorrect
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Which of the following portocaval anastomoses can cause problems in preterm infants?
Your Answer: Paraumbilical
Correct Answer: Patent ductus venosus.
Explanation:The ductus venosus is open at the time of the birth and closes during the first week of life in most full-term neonates; however, it may take much longer to close in pre-term neonates. After it closes, the remnant is known as ligamentum venosum. If the ductus venosus fails to occlude after birth, it remains patent (open), and the individual is said to have a patent ductus venosus and thus an intrahepatic portosystemic shunt (PSS).
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 18
Incorrect
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A 30-year-old female presented with upper abdominal pain. She was diagnosed with an unknown coagulopathy and has a previous history of stroke. She has been on warfarin therapy for the past 4 months. Her international normalised ratio (INR) was stabilised between 2.5 and 3.0. Noticing abnormal coagulation results, her surgeon has requested a medical consult.Her blood investigations revealed:White cell count: 13 × 109/lHaemoglobin (Hb): 11 g/dlActivated partial thromboplastin time (APTT): NormalPlatelets: 140 × 109/lINR: 6.0Pancreatic enzymes and liver function tests were normal.Other investigations:An ultrasound of the abdomen was normal.An upper GI endoscopy revealed mild gastritis. What is the most appropriate step to be taken regarding warfarin therapy?
Your Answer: Give vitamin K 5.0 mg intravenously
Correct Answer: Stop warfarin and observe
Explanation:The most appropriate treatment in this patient would be to stop warfarin therapy and keep the patient under observation.The drugs that lead to enhanced potency of warfarin include: disulfiram, trimethoprim-sulphamethoxazole, metronidazole, phenylbutazone, aspirin, heparin, and clofibrate. Liver disease, thrombocytopenia, hyperthyroidism also increase the oral anticoagulant potency.If the patient has minor bleeding and the international normalized ratio (INR) is >6.0, warfarin should be stopped; the INR should be rechecked daily and in addition to the stoppage of warfarin, vitamin K 2.5 mg oral or 0.5 mg intravenously should also be administered.In a patient with INR of 2.0 or 3.0, it takes two or three times longer for that individual’s blood to clot than someone who is not taking any anticoagulants. Most patients on warfarin have an INR goal of 2 to 3.If there is major bleeding then prothrombin complex concentrates 50 u/kg or fresh-frozen plasma 15 ml/kg may be considered.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 19
Correct
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Where is the lower border of the liver usually found?
Your Answer: 10th rib anterior axillary line on right
Explanation:Assessment of liver margins is important clinically to determine the size of the liver and is done via percussion during the physical examination. The liver typically extends from the fifth intercostal space or 6th rib to the right costal margin in the midclavicular line and the 10th rib on anterior axillary line.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 20
Correct
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Adrenergic stimulation will lead to myocyte relaxation via the following mechanisms
Your Answer: Increased phosphorylation of phosholamban
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).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 21
Correct
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When oxygen supply is restored, lactate formed during anaerobic metabolism is converted back to?
Your Answer: Pyruvate
Explanation:During intense exercise, when the rate of demand for energy is high, glucose is broken down and oxidized to pyruvate, and lactate is then produced from the pyruvate faster than the body can process it, causing lactate concentrations to rise. The resulting lactate can be used in two ways:1. Oxidation back to pyruvate by well-oxygenated muscle cells, heart cells, and brain cells. Pyruvate is then directly used to fuel the Krebs cycle2. Conversion to glucose via gluconeogenesis in the liver and release back into circulation.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 22
Correct
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The layers of the neocortex from the 1st to the 6th are arranged as follows:
Your Answer: Molecular, external granular, external pyramidal, internal granular, internal pyramidal, multiform
Explanation:The layers of neocortex from outermost to innermost include: the molecular, external granular layer, external pyramidal, internal granular, internal pyramidal and multiform layer.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 23
Correct
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Which of the following is correctly paired?
Your Answer: F cells : pancreatic polypeptide
Explanation:Pancreatic polypeptide is secreted by F-cells, which represent the smallest proportion of islet cells in the pancreas. These cells establish the embryological origin of the pancreas. Pancreatic polypeptide regulates endocrine and exocrine activities by the pancreas.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 24
Correct
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Where is the most erythropoietin produced?
Your Answer: Kidneys
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.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 25
Correct
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The cell membrane:
Your Answer: Is a bilayer of amphipathic lipids
Explanation:The cell membrane consists of a bilayer of amphipathic lipids with embedded proteins. The basic function of the cell membrane is to protect the cell from its surroundings. It is selectively permeable to ions and organic molecules. The entire membrane is held together via non-covalent interaction of hydrophobic tails, however the structure is quite fluid and not fixed rigidly in place. Membranes are typically 7.5–10 nm in thickness and typically have a large content of proteins, around 50% of membrane volume.
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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 lipoprotein is responsible for lowering of plasma lipids?
Your Answer: Chylomicrons
Correct Answer: HDL
Explanation:High-density lipoproteins (HDL) are one of the five major groups of lipoproteins. Lipoproteins are complex particles composed of multiple proteins which transport all fat molecules (lipids) around the body within the water outside cells. Unlike the larger lipoprotein particles which deliver fat molecules to cells, HDL particles remove fat molecules from cells.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 27
Incorrect
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Male to male transmission is a key factor of which type of inheritance?
Your Answer: None of the above
Correct Answer: Autosomal dominant
Explanation:Autosomal dominant type of inheritance can include both sexes in the same ratio. There is no skipping a generation and father to son transmission is common. The passing of the trait is sex independent.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 28
Correct
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According to Poiseuille’s formula, which 1 of the following will lead to increased flow?
Your Answer: Shorter tube
Explanation:V = π p r4 / 8 η lwhere V = discharge volume flow (m3/s)p = pressure difference between the ends of the pipe (N/m2, Pa)r = internal radius of pipe (m)l = length of pipe (m)η = viscosity of fluid
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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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Which enzyme deficiency can lead to ammonia intoxication?
Your Answer: Amino acyl transferase
Correct Answer: Ornithine transcarbamylase
Explanation:Ornithine transcarbamylase deficiency also known as OTC deficiency is the most common urea cycle disorder in humans. Ornithine transcarbamylase, the defective enzyme in this disorder is the final enzyme in the proximal portion of the urea cycle, responsible for converting carbamoyl phosphate and ornithine into citrulline. OTC deficiency is inherited in an X-linked recessive manner, meaning males are more commonly affected than females.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 30
Correct
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A 28 year old male arrives at the clinic complaining of fever, arthralgia and urethritis. On examination, the ankle is swollen and there is a pustular rash on the dorsal foot. What is the most likely diagnosis?
Your Answer: Disseminated gonorrhoea
Explanation:DGI presents as two syndromes: 1) a bacteremic form that includes a triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis and 2) a septic arthritis form characterized as a purulent arthritis without associated skin lesions. Many patients will have overlapping features of both syndromes. Time from infection to clinical manifestations may range from 1 day to 3 months. There is no travel history and the rash of Lyme disease is not purulent. Reactive arthritis presents with conjunctivitis, urethritis and arthritis usually with a red hot tender and swollen joint.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
