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Question 1
Correct
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Cholinergic neurons that pass into a retrograde direction activate neurons that release:
Your Answer: Substance P and acetyl choline
Explanation:Serotonin activates sensory neurons that activate the myenteric plexus. Cholinergic neurons passing in a retrograde direction in the myenteric plexus activate neurons that release substance P and acetylcholine, causing smooth muscle contraction.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 2
Incorrect
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The chromosomes that principally encode for proteins or RNA molecules involved in mitochondrial function are found:
Your Answer: In the rough endoplasmic reticulum
Correct Answer: In the mitochondria of the cell
Explanation:DNA is found in chromosomes and in the mitochondria of a cell. The only way for the protein or RNA to be formed is by transcription via the DNA and translation into proteins.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 3
Correct
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Which one of these features is typical of dermatomyositis?
Your Answer: Gottron's papules over knuckles of fingers
Explanation:The main symptom of dermatomyositis include skin rash and symmetric proximal muscle weakness (in over 90% of patients) which may be accompanied by pain and tenderness. It occurs more commonly in females. Skin findings include:Gottron’s sign – an erythematous, scaly eruption occurring in symmetric fashion over the MCP and interphalangeal jointsHeliotrope or lilac rash – a violaceous eruption on the upper eyelids and in rare cases on the lower eyelids as well, often with itching and swellingShawl (or V-) sign is a diffuse, flat, erythematous lesion over the back and shoulders or in a V over the posterior neck and back or neck and upper chest, which worsens with UV light. Erythroderma is a flat, erythematous lesion similar to the shawl sign but located in other areas, such as the malar region and the forehead. Periungual telangiectasias and erythema occur.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 4
Incorrect
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A 33 year old female presents with dyspnoea, myalgia, arthralgia and a skin rash. The presence of which of the following antibodies would be the most specific for SLE?
Your Answer: ANA
Correct Answer: Anti-Sm
Explanation:Anti-Sm antibodies are essential for diagnosis of SLE, especially in anti-dsDNA-negative patients. ANA are also found in 95% of the patients with SLE but they may also occur with other conditions like Juvenile inflammatory arthritis, chronic activity hepatitis, and Sjogren’s syndrome. Anti-Ro, although also found with SLE are more characteristic of Sjogren Syndrome. RF is usually associated with rheumatoid arthritis and cANCA with Wegener’s granulomatosis, Churg Strauss, and microscopic polyangiitis.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 5
Incorrect
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Which of the following is not secreted by cells in the antrum of the stomach?
Your Answer: Somatostatin
Correct Answer: Hydrochloric acid
Explanation:Cells in the body of the stomach secrete mucus, HCl and pepsinogen. Cells in the antrum secrete pepsinogen, gastrin and mucus.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 6
Correct
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The bradycardia that occurs in patients with raised intracranial pressure is a result of the?
Your Answer: Cushing reflex
Explanation:When intracranial pressure is increased, the blood supply to RVLM neurons is compromised. This results in an increase in their discharge as a result of hypoxia and hypercapnia. The resultant rise in systemic arterial pressure (Cushing reflex) tends to restore the blood flow to the medulla.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 7
Correct
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Which enzyme is responsible for the conversion of testosterone to dihydrotestosterone?
Your Answer: 5α-reductase
Explanation:The enzyme 5α-reductase synthesizes DHT from testosterone in the prostate, testes, hair follicles, and adrenal glands. This enzyme reduces the 4,5 double-bond of the testosterone. Relative to testosterone, DHT is much more potent as an agonist of the androgen receptor.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 8
Correct
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Question 9
Correct
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What are the major motor proteins that interact with microtubules?
Your Answer: Kinesin and dynein
Explanation:The major motor proteins that interact with microtubules are kinesin, which usually moves toward the (+) end of the microtubule, and dynein, which moves toward the (−) end.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 10
Incorrect
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With regards to P53, which statement is NOT true?
Your Answer: P53’s own expression is induced by broken DNA
Correct Answer: P53 is a RNA binding protein
Explanation:P53 is a tumour suppressor gene. It is not an RNA binding protein. It has been implicated in almost all tumours. It regulates the progression from G1 to the S phase of the cell cycle and is activated in response to damaged DNA.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 11
Correct
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The role of the hemidesmosome is?
Your Answer: Attaches cells to underlying basal lamina
Explanation:Hemidesmosomes connect the basal surface of epithelial cells via intermediate filaments to the underlying basal lamina. The transmembrane proteins of hemidesmosomes are not cadherins, but another type of protein called integrin.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 12
Correct
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Regarding cardiac contractility, catecholamines exert their inotropic effect via:
Your Answer: Β1-adrenergic receptors and gs
Explanation:Catecholamines exert their inotropic effect on the heart via the B1 adrenergic receptors and Gs, stimulating adenyl cyclase and increasing the production of cAMP.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 13
Incorrect
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Question 14
Incorrect
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Conjugation of proteins to which polypeptide marks them for degradation?
Your Answer:
Correct Answer: Ubiquitin
Explanation:Ubiquitin is a small regulatory protein that affects proteins in many ways: it can mark them for degradation via the proteasome, alter their cellular location, affect their activity, and promote or prevent protein interactions. Ubiquitination involves three main steps: activation, conjugation, and ligation,
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 15
Incorrect
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Question 16
Incorrect
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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:
Correct 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 17
Incorrect
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Which of the following runs in the upper part of the falx cerebri?
Your Answer:
Correct Answer: Superior sagittal sinus
Explanation:Falx cerebri is a sickle cell fold of dura between the two hemispheres. Its posterior part blends with the superior part of the tentorium cerebelli. The superior sagittal sinus runs in its upper fixed margin, the inferior sagittal sinus in the free concave margin and the straight sinus along its attachment to the tentorium cerebelli.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 18
Incorrect
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A 22 year old man is being evaluated for chronic lower backache. Which of the following would most strongly point towards the diagnosis of ankylosing spondylitis?
Your Answer:
Correct Answer: Reduced lateral flexion of the lumbar spine
Explanation:Ankylosing spondylitis (spondylarthritis) is a chronic inflammatory disease of the axial skeleton that leads to partial or even complete fusion and rigidity of the spine. Males are disproportionately affected and upwards of 90% of patients are positive for the HLA-B27 genotype, which predisposes to the disease. The most characteristic early finding is pain and stiffness in the neck and lower back, caused by inflammation of the vertebral column and the sacroiliac joints. The pain typically improves with activity and is especially prominent at night. Other articular findings include tenderness to percussion and displacement of the sacroiliac joints (Mennell’s sign), as well as limited spine mobility, which can progress to restrictive pulmonary disease. The most common extra-articular manifestation is acute, unilateral anterior uveitis. Diagnosis is primarily based on symptoms and x-ray of the sacroiliac joints, with HLA-B27 testing and MRI reserved for inconclusive cases. There is no curative treatment, but regular physiotherapy can slow progression of the disease. Additionally, NSAIDs and/or tumour necrosis factor-α inhibitors may improve symptoms. In severe cases, surgery may be considered to improve quality of life. The spine adopts a bamboo shape, not lordosis. The pain usually improves as the day progresses. leg raise test causes pain in cases of meningitis etc not in this case.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 19
Incorrect
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Which of the following is NOT a cause of onycholysis?
Your Answer:
Correct Answer: Mycoplasma pneumonia
Explanation:Onycholysis is the separation of the distal edge of the nail from the vascular nailbed causing whiteness of the free edge. Causes include:- Idiopathic- Trauma, excessive manicuring- Infection: especially fungal- Skin disease: psoriasis, dermatitis- Impaired peripheral circulation e.g. Raynaud’s- Systemic disease: hyper/hypothyroidism, reactive arthritis, porphyria cutanea tarda- Sometimes a reaction to detergents (e.g. washing dishes with bare hands, using detergent-based shampoos or soaps).- Patients with hepatocellular dysfunction may develop hair-thinning or hair loss and nail changes such as clubbing, leukonychia (whitening), or onycholysis.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 20
Incorrect
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A 23 year old man presents with a painful right elbow and left Achilles tendon. He also gives history of dysuria, fever and conjunctivitis. Examination reveals macules and pustules on his hands. He has returned from a trip to Far East 3 weeks ago and admits to having unprotected sex. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Reactive arthritis
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. Other STDs including HIV, syphilis have different presentations. Psoriatic arthritis is not commonly associated with urethritis and conjunctivitis.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 21
Incorrect
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The febrile response to PGE2 will be impaired with the knockout of which one of the following prostaglandin receptors?
Your Answer:
Correct Answer: Ep3
Explanation:Prostaglandin EP3 receptor is a receptor for prostaglandin E2. Fever occurs as a result of the action of prostaglandin E2 and requires EP3 receptors in the preoptic area. Therefore, if there is an absence of EP3 receptors, fever caused by prostaglandin E2 will not occur.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 22
Incorrect
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Which neuron secretes glutamate as its neurotransmitter?
Your Answer:
Correct Answer: A delta and C pain fibers
Explanation:A delta and C fibers use glutamate as their primary neurotransmitter where it acts as a fast acting localized neurotransmitter.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 23
Incorrect
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Critical shortening of Telomeres result in:
Your Answer:
Correct Answer: Inactivation of p 53 and prb and cell crisis
Explanation:Telomere length shortens with age. Progressive shortening of telomeres leads to senescence, apoptosis, or oncogenic transformation of somatic cells, affecting the health and lifespan of an individual. Telomeres prevent the chromosomes from shortening and prevent the coding portion of the DNA from being lost, thus allowing the cell to replicate indefinitely. During replication telomeres may be lost resulting in cell death.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 24
Incorrect
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Lymphoid stem cells give rise to the following cells.
Your Answer:
Correct Answer: T cells, b cells and natural killer cells
Explanation:T Cells, B Cells and NK Cells (and all other Innate lymphoid cells) are unique to the lymphocyte family, but dendritic cells are not. Dendritic cells of identical appearance but different markers are spread throughout the body, and come from either lymphoid and myeloid lineages
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This question is part of the following fields:
- Haematology
- Medicine
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Question 25
Incorrect
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Question 26
Incorrect
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Organophosphates, such as Sarin, have been used as chemical-warfare agents by terrorists. Which of the following statements is true concerning organophosphate poisoning?
Your Answer:
Correct Answer: Atropine is useful in the management of organophosphate poisoning
Explanation:The principal action of organophosphates is the inhibition of acetylcholinesterase’s, therefore leading to the accumulation of acetylcholine at muscarinic receptors (miosis, hypersalivation, sweating, diarrhoea, excessive bronchial secretions), nicotinic receptors (muscle fasciculations and tremor) and in the central nervous system (anxiety, loss of memory, headache, coma). Removal from the source of the organophosphate, adequate decontamination, supplemental oxygen and atropine are the initial treatment measures. Pralidoxime, an activator of cholinesterase, should be given to all symptomatic patients.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 27
Incorrect
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Bone marrow barrier is important to:
Your Answer:
Correct Answer: Allow mature red blood cells to pass into circulation
Explanation:The blood vessels of the bone marrow constitute a barrier, inhibiting immature blood cells from leaving the marrow. Only mature blood cells contain the membrane proteins, such as aquaporin and glycophorin, that are required to attach to and pass the blood vessel endothelium.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 28
Incorrect
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Which of the following prevents auto-digestion of the stomach by gastric secretions:
Your Answer:
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 29
Incorrect
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Which one of the following is most likely to be seen in a patient with multiple endocrine neoplasia (MEN) type I?
Your Answer:
Correct Answer: Insulinoma
Explanation:Multiple endocrine neoplasia type 1 (MEN-1 syndrome) or Wermer’s syndrome is part of a group of disorders, the multiple endocrine neoplasias, that affect the endocrine system through development of neoplastic lesions in the ‘three P’s’:Parathyroid (>90%): hyperparathyroidism due to parathyroid hyperplasiaPituitary (15-42%)Pancreas (60-70%, e.g. insulinoma, gastrinoma)
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 30
Incorrect
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Which of the following is responsible for converting inactive cortisone to active cortisol in the adrenal gland?
Your Answer:
Correct Answer: 11βHSD type 1
Explanation:11β-Hydroxysteroid dehydrogenase, also known as HSD-11β or 11β-HSD, is a group of enzymes which catalyse the interconversion of active cortisol and corticosterone with inert cortisone and 11-dehydrocorticosterone.
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This question is part of the following fields:
- Endocrinology
- Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
