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  • Question 1 - A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
    Which...

    Incorrect

    • A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
      Which of the following is NOT an action of the gluteus maximus muscle? Select ONE answer only.

      Your Answer: Raising the trunk from a flexed position

      Correct Answer: Hip abduction

      Explanation:

      Gluteus maximus is the main extensor muscle of the hip and assists with lateral rotation of the thigh at the hip joint. It also acts as a hip adductor, steadies the thigh, and assists in raising the trunk from a flexed position.
      Gluteus maximus is innervated by the inferior gluteal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      34.4
      Seconds
  • Question 2 - Which of the following does not increase renal phosphate excretion? ...

    Incorrect

    • Which of the following does not increase renal phosphate excretion?

      Your Answer: Parathyroid hormone

      Correct Answer: Vitamin D

      Explanation:

      PO43-renal excretion is regulated several mechanisms. These include:
      -parathyroid hormone – increases excretion by inhibiting reabsorption in the proximal tubule
      -acidosis – increases excretion
      -glucocorticoids – increases excretion
      -calcitonin – increases excretion
      -activated vitamin D – decreases excretion by increasing reabsorption in the distal tubule

    • This question is part of the following fields:

      • Physiology
      • Renal
      16.2
      Seconds
  • Question 3 - A 60-year-old man diagnosed with chronic kidney disease has an elevated creatinine level...

    Correct

    • A 60-year-old man diagnosed with chronic kidney disease has an elevated creatinine level and a reduced glomerular filtration rate (GFR).

      Which statement concerning glomerular filtration is true?

      Your Answer: Creatinine is freely filtered at the glomerulus

      Explanation:

      Glomerular filtration is a passive process. It depends on the net hydrostatic pressure across the glomerular capillaries, the oncotic pressure, and the intrinsic permeability of the glomerulus.

      The mean values for glomerular filtration rate (GFR) in young adults are 130 ml/min/1.73m2 in males and 120 ml/min/1.73m2in females.

      The GFR declines with age after the age of 40 at a rate of approximately 1 ml/min/year.

      The Cockcroft and Gault formula overestimates creatinine in obese patients. This is because their endogenous creatinine production is less than that predicted by overall body weight.

      Creatinine is used in the estimation of GFR because it is naturally produced by muscle breakdown, not toxic, not produced by the kidney, freely filtered at the glomerulus, not reabsorbed from the nephron, and does not alter GFR.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      44.8
      Seconds
  • Question 4 - Which of the following is NOT a common side effect of antihistamines: ...

    Incorrect

    • Which of the following is NOT a common side effect of antihistamines:

      Your Answer: Blurred vision

      Correct Answer: Tremor

      Explanation:

      Common side effects of antihistamines may include:
      Anticholinergic effects (blurred vision, dry mouth, urinary retention)
      Headache
      Gastrointestinal disturbances
      Psychomotor impairment (sedation, dizziness and loss of appetite)
      These side effects are significantly reduced with second-generation agents.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      31.8
      Seconds
  • Question 5 - The interquartile range (IQ) is often displayed using which of the following: ...

    Correct

    • The interquartile range (IQ) is often displayed using which of the following:

      Your Answer: Box and whisker plot

      Explanation:

      A boxplot is a vertical or horizontal rectangle used to display the interquartile range, with the ends of the rectangle corresponding to the upper and lower quartiles of the data values. The box contains 50% of the data values. A line drawn through the rectangle corresponds to the median value. Whiskers, starting at the ends of the rectangle usually indicate the minimum and maximum values, therefore the entire box and whisker plot represents the range. Any outliers can be plotted independent of the box and whisker plot.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      15.5
      Seconds
  • Question 6 - At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts...

    Incorrect

    • At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts for around 50% of body weight. This can increase to nearly 80% of cardiac output during exercise. Skeletal muscle circulation is highly controlled and has a number of specialized adaptations as a result of this high degree of disparity during exercise, in combination with the diversity in the size of skeletal muscle around the body.

      What is the primary mechanism for boosting skeletal muscle blood flow during exercise?

      Your Answer: Sympathetic stimulation

      Correct Answer: Metabolic hyperaemia

      Explanation:

      In skeletal muscle, blood flow is closely related to metabolic rate. Due to the contraction of precapillary sphincters, most capillaries are blocked off from the rest of the circulation at rest and are not perfused. This causes an increase in vascular tone and vessel constriction. As metabolic activity rises, this develops redundancy in the system, allowing it to cope with greater demand. During exercise, metabolic hyperaemia, which is induced by the release of K+, CO2, and adenosine, recruits capillaries. Sympathetic vasoconstriction in the active muscles is overridden by this. Simultaneously, blood flow in non-working muscles is restricted, preserving cardiac output. During exercise, muscle contractions pump blood through the venous system, raising the pressure differential between arterioles and venules and boosting blood flow via capillaries.

      Capillary angiogenesis is evident when muscles are used repeatedly (e.g. endurance training). It is a long-term effect, not a quick fix for increased blood flow.

      The local partial pressure of alveolar oxygen is the primary intrinsic control of pulmonary blood flow (pAO2). Low pAO2 promotes arteriole vasoconstriction and vice versa. The hypoxic pulmonary vasoconstriction (HPV) reflex allows blood flow to be diverted away from poorly ventilated alveoli and towards well-ventilated alveoli in order to maximize gaseous exchange.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      126
      Seconds
  • Question 7 - A 36-year-old man who works in a farm presents with a deep laceration...

    Incorrect

    • A 36-year-old man who works in a farm presents with a deep laceration over the palm of his hand. A median nerve block was performed at his wrist to facilitate wound exploration and closure.

      Which of the following statements regarding median nerve blocks at the wrist is considered correct?

      Your Answer: The needle should be inserted between the tendons of palmaris longus and flexor carpi ulnaris

      Correct Answer: The needle should be inserted approximately 2.5 cm proximal to flexor retinaculum

      Explanation:

      A median nerve block is a simple, safe, and effective method of obtaining anaesthesia to the palmar aspect of the thumb, index finger, middle finger, radial portion of the palm and ring finger. The median nerve lies deep to the flexor retinaculum and about one centimetre under the skin of the volar wrist.
      The palmaris longus tendon lies superficial to the retinaculum and is absent in up to 20% of patients.
      The median nerve is located slightly lateral (radial) to the palmaris longus tendon and medial (ulnar) to the flexor carpi radialis tendon.

      The procedure is as follows:
      – Check sensation and motor function of the median nerve. Wear gloves and use appropriate barrier precautions.
      – Locate the flexor carpi radialis and palmaris longus tendons, which become prominent when the patient flexes the wrist against resistance. The palmaris longus tendon is usually the more prominent of the two tendons.
      – Needle-entry site: The needle will be inserted adjacent to the radial (lateral) border of the palmaris longus tendon just proximal to the proximal wrist crease. If the palmaris longus tendon is absent, the needle-entry site is about 1 cm ulnar to the flexor carpi radialis tendon.
      – Cleanse the site with antiseptic solution. Place a skin wheal of anaesthetic, if one is being used, at the needle-entry site.
      – Insert the needle perpendicularly through the skin and advance it slowly until a slight pop is felt as the needle penetrates the flexor retinaculum. When paraesthesia in the distribution of the median nerve confirms proper needle placement, withdraw the needle 1 to 2 mm.
      – Aspirate to exclude intravascular placement and then slowly (i.e., over 30 to 60 seconds) inject about 3 mL of anaesthetic. If the patient does not feel paraesthesia, redirect the needle in an ulnar direction, under the palmaris longus tendon. If paraesthesia is still not felt, slowly inject 3 to 5 mL of anaesthetic in the proximity of the nerve 1 cm deep to the tendon.
      – Allow about 5 to 10 minutes for the anaesthetic to take effect.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      50.5
      Seconds
  • Question 8 - This anatomic part lies at the heart of the tooth. ...

    Correct

    • This anatomic part lies at the heart of the tooth.

      Your Answer: The pulp cavity

      Explanation:

      Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      36.7
      Seconds
  • Question 9 - A man presents to the emergency department with a hand laceration that has...

    Incorrect

    • A man presents to the emergency department with a hand laceration that has damaged the opponens digiti minimi muscle.

      All of the following statements regarding the opponens digiti minimi muscle is considered correct, except:

      Your Answer: It is a triangular-shaped muscle in the hand

      Correct Answer: It is innervated by the superficial branch of the ulnar nerve

      Explanation:

      Opponens digiti minimi (ODM) is an intrinsic muscle of the hand. It’s a triangular muscle that extends between the hamate bone (carpal bone) and the 5th metacarpal bone. It forms the hypothenar muscle group together with the abductor digiti minimi and flexor digiti minimi brevis, based on the medial side of the palm (hypothenar eminence). These muscles act together in moving the little finger. The opponens digiti minimi is responsible for flexion, lateral rotation and opposition of the little finger.
      Its origin is the hook of hamate and flexor retinaculum. It inserts into the medial border of 5th metacarpal bone. It is innervated by the deep branch of the ulnar nerve, which stems from the brachial plexus (C8, T1 spinal nerves).
      Its blood supply is by the deep palmar branch of ulnar artery and deep palmar arch, which is the terminal branch of the radial artery.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      88.5
      Seconds
  • Question 10 - In inserting a nasogastric tube, which area is least likely to be a...

    Correct

    • In inserting a nasogastric tube, which area is least likely to be a site of resistance when the tube goes from the nose to the stomach?

      Your Answer: In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk

      Explanation:

      In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk offers the least resistance when nasogastric tube is inserted from the nose to the stomach.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      108.6
      Seconds
  • Question 11 - If the ejection fraction increases, there will be a decrease in: ...

    Correct

    • If the ejection fraction increases, there will be a decrease in:

      Your Answer: End-systolic volume

      Explanation:

      An increase in ejection fraction means that a higher fraction of the end-diastolic volume is ejected in the stroke volume (e.g. because of the administration of a positive inotropic agent). When this situation occurs, the volume remaining in the ventricle after systole, the end-systolic volume, will be reduced. Cardiac output, stroke volume, and mean arterial pressure will be increased.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      50.6
      Seconds
  • Question 12 - A patient presents with a cough, productive of green sputum and fever. He...

    Correct

    • A patient presents with a cough, productive of green sputum and fever. He was commenced on antibiotics 4 days earlier, but his condition has worsened. There is a documented history of penicillin allergy, and the GP prescribed erythromycin.

      Erythromycin exert its pharmacological effect by binding to?

      Your Answer: The 50S subunit of the bacterial ribosome

      Explanation:

      Macrolides are bacteriostatic antibiotics. They act by binding to the 50S subunit of the bacterial ribosome and inhibit translocation, therefore, inhibiting protein synthesis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      23
      Seconds
  • Question 13 - All of the statements regarding vascular tone are correct except: ...

    Correct

    • All of the statements regarding vascular tone are correct except:

      Your Answer: Most endogenous vasodilators act by decreasing levels of cAMP or cGMP.

      Explanation:

      Most vasoconstrictors bind to G-protein coupled receptors. These mediate elevation in intracellular [Ca2+] which leads to vascular smooth muscle contraction. Important vasoconstrictors include noradrenaline, endothelin-1 and angiotensin II.

      Increased intracellular Ca2+ is as a result of the release of Ca2+from the sarcoplasmic reticulum and depolarisation and entry of Ca2+via L-type voltage-gated Ca2+channels. Most types of vascular smooth muscle do not generate action potentials – instead, the depolarisation is graded, which allows graded entry of Ca2+.
      sequestration by the sarcoplasmic reticulum Ca2+ATPase, removal from the cell by a plasma membrane Ca2+ATPase and Na+/Ca2+exchange decreases intracellular Ca2+, resulting in vasodilation. Relaxation is a result of most endogenous vasodilators when there is an increase in cyclic guanosine monophosphate (cGMP) like nitric oxide) or cyclic adenosine monophosphate (cAMP) like prostacyclin and beta-adrenergic receptor agonists. These activate protein kinases causing substrate level phosphorylation.
      Clinically effective vasodilators are L-type Ca2+channel blocker drugs.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      82.9
      Seconds
  • Question 14 - A 24-year-old student with red and painful right eye presents. Conjunctival erythema, mucopurulent...

    Incorrect

    • A 24-year-old student with red and painful right eye presents. Conjunctival erythema, mucopurulent discharge and lid crusting are seen on examination, and patient denies presence of itching of the eye. All his observations are normal, he has no fever and is otherwise well.

      Which of these is the most likely causative organism?

      Your Answer: Staphylococcus epidermidis

      Correct Answer: Haemophilus influenzae

      Explanation:

      The most frequent cause of red eye is conjunctivitis. It is caused by inflammation of the conjunctiva which can be infective or allergic and accounts for about 35% of all eye problems presenting to general practice.

      Viral conjunctivitis is commonly caused by adenoviruses and it is the most common infectious conjunctivitis.

      The common bacterial causes of conjunctivitis are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.

      The clinical features of infective conjunctivitis include:
      Acute onset of conjunctival erythema
      Feeling ‘grittiness’, ‘foreign body’ or ‘burning’ sensation in the eye.
      Watering and discharge which may cause transient blurring of vision

      The discharge for viral conjunctivitis is less than that of bacterial conjunctivitis and usually watery.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      27.8
      Seconds
  • Question 15 - By what mechanism does Vibrio cholerae causes diarrhoea? ...

    Incorrect

    • By what mechanism does Vibrio cholerae causes diarrhoea?

      Your Answer: Inhibits cyclic adenosine monophosphate (cAMP) production in intestinal epithelial cells

      Correct Answer: Increases Cl- secretory channels in crypt cells

      Explanation:

      Cholera is a severe diarrheal illness caused by the Vibrio cholerae bacteria infecting the bowel. Ingesting cholera-infected food or drink is the a way to contract the disease. In the intestinal crypt cells, the toxigenic bacterium Vibrio cholera activates adenylate cyclase and raises cyclic adenosine monophosphate (cAMP).

      cAMP stimulates the Cl-secretory channels in crypt cells, resulting in the secretion of chloride with sodium ions and water. The toxin it produces causes the body to secrete massive amounts of water, resulting in diarrhoea and significant fluid and electrolyte loss.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      28.9
      Seconds
  • Question 16 - You suspect that your patient with polycystic kidney disease has developed a berry...

    Correct

    • You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?

      Your Answer: Anterior communicating artery

      Explanation:

      One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm.

      A berry aneurysm is the most common type of brain aneurysm.

      The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      19.1
      Seconds
  • Question 17 - Which of the following is first-line for management of status epilepticus: ...

    Correct

    • Which of the following is first-line for management of status epilepticus:

      Your Answer: Intravenous lorazepam

      Explanation:

      First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      9.4
      Seconds
  • Question 18 - Which of the following drug classes may cause bronchoconstriction: ...

    Correct

    • Which of the following drug classes may cause bronchoconstriction:

      Your Answer: Beta-blockers

      Explanation:

      Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      16.2
      Seconds
  • Question 19 - Which of the following causes the first heart sound? ...

    Correct

    • Which of the following causes the first heart sound?

      Your Answer: Closing of the atrioventricular valves

      Explanation:

      The heart sounds are as a result of the various parts of the cardiac cycle.
      Heart Sound – Phase of Cardiac Cycle – Mechanical Event:
      1st heart sound – Systole starts – there is closure of the atrioventricular (mitral & tricuspid) valves
      2nd heart sound – Systole ends – there is closure of the semilunar (aortic and pulmonary) valves
      3rd heart sound – Early diastole – this is caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase
      4th heart sound – Late diastole – this is caused by filling of an abnormally stiff ventricle in atrial systole

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      15.4
      Seconds
  • Question 20 - Which of the following statements is not true regarding ion channels? ...

    Correct

    • Which of the following statements is not true regarding ion channels?

      Your Answer: Ion channels provide a charged, hydrophobic pore through which ions can diffuse across the lipid bilayer.

      Explanation:

      Ion channels are pore-forming protein complexes that facilitate the flow of ions across the hydrophobic core of cell membranes. They are present in the plasma membrane and membranes of intracellular organelles of all cells, and perform essential physiological functions. They provide a charged, hydrophilic pore through which ions can move across the lipid bilayer. They are selective for particular ions and their pores may be opened or closed. Because of this ability to open and close, ion channels allow the cell to have the ability to closely control the movement of ions across the membrane. Gating refers to the transition between an open and closed ion channel state, and is brought about by a conformationational change in the protein subunits that open or close the ion-permeable pore.
      Ion channels can be:
      1. voltage-gated these are regulated according to the potential difference across the cell membrane or
      2. ligand-gated – these are regulated by the presence of a specific signal molecule.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      60.4
      Seconds
  • Question 21 - An analytical study is conducted to compare the risk of stroke between Ticagrelor...

    Incorrect

    • An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:

      No. of patients who took Ticagrelor: 300
      No. of patients who took Ticagrelor and suffered a stroke: 30

      No. of patients who took Warfarin: 500
      No. of patients who took Warfarin and suffered a stroke: 20

      Compute for the risk ratio of a stroke.

      Your Answer: 0.06

      Correct Answer: 2.5

      Explanation:

      Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.

      RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).

      RR = ART/ARC
      RR = (30/300) / (20/500)
      RR = 2.5

      Recall that:

      If RR < 1, then the intervention reduces the risk of the outcome.
      If RR = 1, then the treatment has no effect on the outcome.
      If RR > 1, then the intervention increases the risk of the outcome.

    • This question is part of the following fields:

      • Evidence Based Medicine
      93.6
      Seconds
  • Question 22 - Which of the following is NOT a typical complication associated with mumps: ...

    Incorrect

    • Which of the following is NOT a typical complication associated with mumps:

      Your Answer: Meningitis

      Correct Answer: Subacute sclerosing panencephalitis

      Explanation:

      Complications of mumps include meningitis, post meningitis deafness, encephalitis, pancreatitis, orchitis and oophoritis. Subacute sclerosing panencephalitis is a complication typically associated with measles infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      21.6
      Seconds
  • Question 23 - A 44 year old woman sustains an injury to the median nerve at...

    Correct

    • A 44 year old woman sustains an injury to the median nerve at the elbow after falling awkwardly. Which of the following clinical features are you LEAST likely to see on examination:

      Your Answer: Loss of flexion of the medial two digits

      Explanation:

      Flexion of the index and middle fingers at the IPJs is lost due to paralysis of the flexor digitorum superficialis and the lateral half of the flexor digitorum profundus. Flexion of the MCPJs of the index and middle fingers are lost due to paralysis of the lateral two lumbrical muscles. Flexion of the ring and little fingers are preserved as these are supported by the medial half of the flexor digitorum profundus and the medial two lumbrical muscles, innervated by the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      57.7
      Seconds
  • Question 24 - Which of the following is NOT a typical side effect of opioid analgesics:...

    Correct

    • Which of the following is NOT a typical side effect of opioid analgesics:

      Your Answer: Diarrhoea

      Explanation:

      All opioids have the potential to cause:
      Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
      Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
      Cardiovascular effects – Peripheral vasodilation, postural hypotension
      Dependence and tolerance

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      14
      Seconds
  • Question 25 - What is the main mechanism of action of cyclizine: ...

    Correct

    • What is the main mechanism of action of cyclizine:

      Your Answer: Histamine-H1 antagonist

      Explanation:

      Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      5.4
      Seconds
  • Question 26 - A 23-year-old male presents to his family physician with the complaint of repeated...

    Correct

    • A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia.

      Which one of the following disorders is this patient most likely to have?

      Your Answer: Paroxysmal nocturnal haemoglobinuria

      Explanation:

      Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight.

      Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.

      Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections.

      Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections.

      Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      37.5
      Seconds
  • Question 27 - A man presents to the emergency department with an injury that has damaged...

    Correct

    • A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.

      Which of the following statements regarding the opponens pollicis muscle is considered correct?

      Your Answer: It flexes the first metacarpal bone at the carpometacarpal joint

      Explanation:

      Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.

      Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.

      It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      26.9
      Seconds
  • Question 28 - A young female was diagnosed with a urinary tract infection and was sent...

    Incorrect

    • A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.

      She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer: Ciprofloxacin

      Correct Answer: Fosfomycin

      Explanation:

      The NICE guidelines for women with lower UTIs who are not pregnant are:
      1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
      2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibiotic

      The first choice of antibiotics for non-pregnant women aged 16 years and over is:
      1. Nitrofurantoin
      100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
      2. Trimethoprim
      200 mg PO BD for three days

      The second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
      1. Nitrofurantoin
      100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
      2. Pivmecillinam
      400 mg PO initial dose, then 200 mg PO TDS for three days
      3. Fosfomycin 3 g single sachet dose

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      36.3
      Seconds
  • Question 29 - Regarding hepatitis C, which of the following statements is INCORRECT: ...

    Correct

    • Regarding hepatitis C, which of the following statements is INCORRECT:

      Your Answer: Anti-HCV IgG antibodies are diagnostic of acute infection.

      Explanation:

      Anti-HCV IgG antibodies indicate exposure to hepatitis C but this could be acute, chronic or resolved infection. If the antibody test is positive, HCV RNA should be tested for, which if positive indicates that a person has current infection with active hepatitis C.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      24.5
      Seconds
  • Question 30 - A 59-year-old man presents with increased sweating, weight loss, and palpitations. A...

    Correct

    • A 59-year-old man presents with increased sweating, weight loss, and palpitations. A series of blood tests done found a very low TSH level and a diagnosis of hyperthyroidism is made.

      What is the commonest cause of hyperthyroidism?

      Your Answer: Graves’ disease

      Explanation:

      Hyperthyroidism results from an excess of circulating thyroid hormones. It is commoner in women, and incidence increases with age.

      Hyperthyroidism can be subclassified into:
      Primary hyperthyroidism – the thyroid gland itself is affected
      Secondary hyperthyroidism – the thyroid gland is stimulated by excessive circulating thyroid-stimulating hormone (TSH).

      Graves’ disease is the most common cause of hyperthyroidism (estimates are that it causes between 50 and 80% of all cases).

      Although toxic multinodular goitre, thyroiditis,TSH-secreting pituitary adenoma and drug-induced hyperthyroidism also causes hyperthyroidism, the commonest cause is Graves’ disease.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      22.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (5/8) 63%
Lower Limb (0/1) 0%
Physiology (6/9) 67%
Renal (0/1) 0%
Renal Physiology (1/1) 100%
Pharmacology (5/7) 71%
Respiratory (0/1) 0%
Evidence Based Medicine (1/2) 50%
Statistics (1/1) 100%
Cardiovascular Physiology (0/1) 0%
Upper Limb (2/4) 50%
Head And Neck (1/1) 100%
Thorax (1/1) 100%
Cardiovascular (4/4) 100%
Infections (1/2) 50%
Microbiology (1/3) 33%
Specific Pathogen Groups (0/1) 0%
Gastrointestinal (0/1) 0%
Central Nervous System (4/4) 100%
Basic Cellular (1/1) 100%
Pathogens (1/2) 50%
Haematology (1/1) 100%
Pathology (1/1) 100%
Endocrine Physiology (1/1) 100%
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