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  • Question 1 - Infection with Campylobacter jejuni is one of the most common risk factors for...

    Incorrect

    • Infection with Campylobacter jejuni is one of the most common risk factors for which of the following conditions?

      Your Answer: Rheumatic fever

      Correct Answer: Guillain-Barre syndrome

      Explanation:

      One of the most common risk factors for GBS is infection with Campylobacter jejuni, which causes diarrhoea.

      Guillain-Barré syndrome (GBS) is a rare autoimmune disorder in which the body’s immune system attacks the nerves, resulting in muscle weakness and paralysis.

      Infection with Streptococcus pyogenes can cause acute glomerulonephritis and rheumatic fever.

      Haemolytic uraemic syndrome is commonly linked to E. coli infection.

      Following measles infection, subacute sclerosing panencephalitis develops.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      145.8
      Seconds

  • Question 2 - A 59-year-old otherwise well woman presents with a history of polydipsia and...

    Incorrect

    • A 59-year-old otherwise well woman presents with a history of polydipsia and polyuria. There is a past history of kidney stones, and blood tests done reveal the following:

      Na: 147 mmol/L (135-147 mmol/L)
      K: 4.0 mmol/L (3.5-5.5 mmol/L)
      Urea: 7.3 mmol/L (2.0-6.6 mmol/L)
      Creatinine: 126 mmol/L (75-125 mmol/L)
      Fasting blood glucose: 5.0 mmol/L (3.4-5.5 mmol/L)
      Corrected calcium: 3.21 mmol/L (2.05-2.60 mmol/L)
      Phosphate: 0.70 mmol/L (0.8-1.4 mmol/L)
      Parathyroid hormone: 189 ng/L (10-60 ng/L)

      The most likely diagnosis is?

      Your Answer: Primary hypoparathyroidism

      Correct Answer: Primary hyperparathyroidism

      Explanation:

      ​Primary hyperparathyroidism the commonest cause of hypercalcaemia. It is commonest in women aged 50 to 60.
      The commonest cause of primary hyperparathyroidism is a solitary adenoma of the parathyroid gland (approximately 85% of cases).

      Primary hyperparathyroidism may present with features of hypercalcaemia such as polyuria, polydipsia, renal stones, bone and joint pain, constipation, and psychiatric disorders.

      In primary Hyperparathyroidism:
      PTH is elevated
      Calcium is elevated
      Phosphate is lowered

      In secondary Hyperparathyroidism:
      PTH is elevated
      Calcium is low or low-normal
      Phosphate is raised in CRF

      In tertiary Hyperparathyroidism:
      PTH is elevated
      Calcium is elevated
      Phosphate is lowered in CRF

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      118.7
      Seconds

  • Question 3 - A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part...

    Incorrect

    • A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part in a powerlifting competition, he felt a painful snap at the front of his shoulder and chest. There is also the presence of bruising and swelling over the left side of his chest. A ruptured pectoralis major muscle was suspected upon examining the injured area.

      Which of the following statements regarding the surface markings of the pectoralis major muscle is considered correct?

      Your Answer:

      Correct Answer: It inserts into the lateral lip of the bicipital groove of the humerus

      Explanation:

      The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.

      Its origin lies anterior surface of the medial half of the clavicle, the anterior surface of the sternum, the first 7 costal cartilages, the sternal end of the sixth rib, and the aponeurosis of the external oblique of the anterior abdominal wall.
      The insertion of the pectoralis major is at the lateral lip of the intertubercular sulcus of the humerus. There are 2 heads of the pectoralis major, the clavicular and the sternocostal, which reference their area of origin.
      The function of the pectoralis major is 3-fold and dependent on which heads of muscles are involved:
      – Flexion, adduction and medial rotation of the arm at the glenohumeral joint
      – Clavicular head causes flexion of the extended arm
      – Sternoclavicular head causes extension of the flexed arm

      Arterial supply of the pectoralis major, the pectoral artery, arises from the second branch of the axillary artery, the thoracoacromial trunk.

      The 2 heads of the pectoralis major have different nervous supplies. The clavicular head derives its nerve supply from the lateral pectoral nerve. The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the medial pectoral nerve arises from the medial cord.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 4 - You see a patient in the ED with photophobia, petechial rash, headache and...

    Incorrect

    • You see a patient in the ED with photophobia, petechial rash, headache and neck stiffness, and suspect a diagnosis of meningococcal meningitis.

      What is the most appropriate initial management?

      Your Answer:

      Correct Answer: Give ceftriaxone 2 g IV

      Explanation:

      Treatment should be commenced with antibiotics immediately before laboratory confirmation due to the potentially life-threatening nature of the disease.

      In a hospital setting, 2g of IV ceftriaxone (80 mg/kg for a child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the drugs of choice.
      In the prehospital setting, IM benzylpenicillin can be given as an alternative.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 5 - A 41-year-old female patient presents with jaundice. She tells you that she is...

    Incorrect

    • A 41-year-old female patient presents with jaundice. She tells you that she is known to have a chronic hepatitis B infection.
      Which of the following hepatitis B serology results is consistent with a patient that is chronically infected? Select ONE answer only.

      Your Answer:

      Correct Answer: HBsAg positive, anti-HBc positive, IgM anti-HBc negative

      Explanation:

      Hepatitis B surface antigen (HBsAg) is a protein on the surface of the hepatitis B virus, that is the first serologic marker to appear in a new acute infection.It can be detected as early as 1 week and as late as 9 weeks. It can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine.
      Hepatitis B surface antibody (anti-HBs) indicates recovery and immunity from the hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.
      Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame. It is not present following hepatitis B vaccination.
      IgM antibody to hepatitis B core antigen (IgM anti-HBc) indicates recent infection with hepatitis B virus (<6 months). Its presence indicates acute infection.
      The following table summarises the presence of hepatitis B markers according to each situation:
      Susceptible to infection:
      HBsAg = Negative
      Anti-HBc = Negative
      Anti-HBs = Negative

      Immune due to natural infection:
      HBsAg = Negative
      Anti-HBc = Positive
      Anti-HBs = Positive

      Immune due to vaccination:
      HBsAg = Negative
      Anti-HBc = Negative
      Anti-HBs = Positive

      Acute infection:
      HBsAg = Positive
      Anti-HBc = Positive
      Anti-HBs = Negative
      IgM anti-HBc = Positive

      Chronic infection:
      HBsAg = Positive
      Anti-HBc = Positive
      Anti-HBs = Negative
      IgM anti-HBc = Negative

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 6 - Which of the following side effects is more common of etomidate than other...

    Incorrect

    • Which of the following side effects is more common of etomidate than other intravenous induction agents:

      Your Answer:

      Correct Answer: Extraneous muscle movements

      Explanation:

      Etomidate is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Etomidate causes less hypotension than thiopental sodium and propofol during induction. Etomidate is associated with rapid recovery without a hangover effect. The rate of respiratory depression and tachycardia is not higher in etomidate.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 7 - Swelling of the lips, tongue, and face is observed in a 59-year-old African-American...

    Incorrect

    • Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.

      Which of the following drugs is most likely to have caused her symptoms?

      Your Answer:

      Correct Answer: Ramipril

      Explanation:

      Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.

      Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.

      Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.

      The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.

      Other medications that are less frequently linked to angioedema include:
      Angiotensin-receptor blockers (ARBs)
      Nonsteroidal anti-inflammatory drugs (NSAIDs)
      Bupropion (e.g. Zyban and Wellbutrin)
      Beta-lactam antibiotics
      Statins
      Proton pump inhibitors

      The majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 8 - Which of the following pathogens causes tetanus: ...

    Incorrect

    • Which of the following pathogens causes tetanus:

      Your Answer:

      Correct Answer: Clostridium tetani

      Explanation:

      Tetanus is caused by Clostridium tetani, a bacterium. Tetanus can cause mild spasms to severe whole-body contractions, suffocation, and heart attack.

      Gas gangrene and food poisoning are both caused by Clostridium perfringens.

      Pseudomembranous colitis is caused by Clostridium difficile.

      Urinary tract infections, respiratory infections, dermatitis, soft tissue infections, bacteraemia, bone and joint infections, gastrointestinal infections, and a variety of systemic infections are all caused by Pseudomonas aeruginosa.

      Pharyngitis, skin infections, acute rheumatic fever, scarlet fever, poststreptococcal glomerulonephritis, toxic shock–like syndrome, and necrotizing fasciitis can all be caused by Streptococcus pyogenes infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 9 - What is the main mechanism of action of metoclopramide: ...

    Incorrect

    • What is the main mechanism of action of metoclopramide:

      Your Answer:

      Correct Answer: Dopamine antagonist

      Explanation:

      Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 10 - You suspected a fungal nail infection in a 50-year-old man who presented with...

    Incorrect

    • You suspected a fungal nail infection in a 50-year-old man who presented with an itchy, scaly rash between his toes and a thicker, discoloured nail on his big toe that has been there for almost one month already. Which of the following tests is most likely to confirm your suspected diagnosis?

      Your Answer:

      Correct Answer: Nail clippings for microscopy and culture

      Explanation:

      Nail clippings for microscopy and culture are a diagnostic test for fungal infection. Because some fungi are restricted to the lower parts of the nail, clippings should be taken from the discoloured or brittle parts and cut back as far as possible from the free edge.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 11 - You are instructed by a senior to administer Mannitol to an RTA patient...

    Incorrect

    • You are instructed by a senior to administer Mannitol to an RTA patient with increased intracranial pressure.

      Mannitol is a low molecular weight compound that freely filters at the glomerulus and is not reabsorbed.
      Out of the following, which is a contraindication to the use of mannitol?

      Your Answer:

      Correct Answer: Severe pulmonary oedema

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.

      Mannitol has several contraindications and some of them are listed below:
      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 12 - A 29-year-old male presents with a 3-day history of bloody diarrhoea and abdominal...

    Incorrect

    • A 29-year-old male presents with a 3-day history of bloody diarrhoea and abdominal pain.

      All the following are causes of infectious bloody diarrhoea EXCEPT?

      Your Answer:

      Correct Answer: Enterotoxigenic Escherichia coli

      Explanation:

      Infective causes of bloody diarrhoea include:
      Salmonella spp
      Campylobacter spp
      Schistosomiasis
      Entamoeba histolytica (Amoebiasis )
      Shigella spp
      Clostridium difficile
      Yersinia spp
      Enteroinvasive Escherichia coli

      Enterotoxigenic Escherichia coli is non-invasive and does not cause inflammation of the gut and bloody diarrhoea. It presents with copious watery diarrhoea and usually are not associated with abdominal cramping.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 13 - What proportion of peripheral blood leukocytes are monocytes? ...

    Incorrect

    • What proportion of peripheral blood leukocytes are monocytes?

      Your Answer:

      Correct Answer: 5 - 10%

      Explanation:

      Monocytes account for around 5 to 10% of peripheral white cells. Monocytes in peripheral blood are generally bigger than other leukocytes and feature a large central oval or indented nucleus with clumped chromatin. The abundant cytoplasm staining blue and containing numerous fine vacuoles gives the appearance of ground glass. Cytoplasmic granules are another type of granule.

      Monocytes evolve from the granulocyte-macrophage progenitor to become monoblasts, promonocytes, monocytes, and tissue macrophages (in increasing order of maturity). Monocytes only stay in the bone marrow for a short time before exiting to circulate in the bloodstream for 20-40 hours before becoming macrophages.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 14 - A 7-year-old girl is admitted to the hospital with a persistently high temperature....

    Incorrect

    • A 7-year-old girl is admitted to the hospital with a persistently high temperature. To help her reduce her fever, you decide to give her paracetamol and ibuprofen.

      What are the effects of paracetamol and ibuprofen on fever?

      Your Answer:

      Correct Answer: Reduction in prostaglandin synthesis

      Explanation:

      Interleukin-1, which is released by leukocytes and acts on the thermoregulatory centre of the hypothalamus, causes fever. Because prostaglandins mediate this process, antipyretics such as NSAIDs, paracetamol, and aspirin reduce prostaglandin levels by inhibiting cyclooxygenase enzymes. Malignant disease secretes interleukins, which cause the B-symptoms seen in lymphoma, for example. Bacterial toxins can also cause interleukins to be produced.

      Pyrexia of unknown origin (PUO) is defined as a fever of greater than 38.3 degrees Celsius that lasts for more than 2-3 weeks with no clear diagnosis despite extensive investigation.

      Investigation necessitates a thorough understanding of the conditions that can cause febrile illness, which may be missed during an initial investigation, as well as a thorough history, examination, and investigation centred on that list.

      Pyrexia of unknown origin has a wide differential diagnosis, which includes:
      Infection
      Bacterial
      Pyogenic abscess
      Tuberculosis
      Infective endocarditis
      Brucellosis
      Lyme disease
      Viral
      HIV
      Epstein Barr Virus
      Cytomegalovirus
      Parasite
      Toxoplasmosis
      Malignancy
      Leukaemia
      Lymphoma
      Renal cell carcinoma
      Hepatocellular carcinoma
      Vasculitides
      Still’s disease
      Granulomatosis with polyangiitis (formerly Wegener’s)
      Systemic lupus erythematosus
      Giant cell arteritis
      Rheumatoid arthritis
      Polymyalgia rheumatica
      Miscellaneous
      Drug induced fevers
      Familial Mediterranean fever
      Thyrotoxicosis
      Inflammatory bowel disease
      Sarcoidosis
      Factitious fever
      Exaggerated normal circadian fluctuation

      The patient might need to be admitted to the hospital for observation and further investigation. Because infection is still a possibility, blood cultures should be repeated on a regular basis, and inflammatory markers should be closely monitored. CT, PET, and MRI imaging have largely replaced diagnostic laparotomy as a diagnostic tool.

    • This question is part of the following fields:

      • Pathology
      • Pathology Of Infections
      0
      Seconds

  • Question 15 - Which of the following is NOT a notifiable disease: ...

    Incorrect

    • Which of the following is NOT a notifiable disease:

      Your Answer:

      Correct Answer: HIV

      Explanation:

      HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.
      HIV is not a notifiable disease.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 16 - You review a 46-year-old woman who has recently been prescribed antibiotics for a...

    Incorrect

    • You review a 46-year-old woman who has recently been prescribed antibiotics for a urinary tract infection. She suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, she has been experiencing nausea, vomiting and abdominal pain.
      Which of the following antibiotics is she MOST LIKELY to have been prescribed for her UTI? Select ONE answer only .

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.
      This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.
      The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:
      Drugs increasing plasma concentration of theophylline
      Drugs decreasing plasma concentration of theophylline
      Calcium channel blockers, e.g. Verapamil
      Cimetidine
      Fluconazole
      Macrolides, e.g. erythromycin
      Quinolones, e.g. ciprofloxacin
      Methotrexate
      Barbiturates
      Carbamazepine
      Phenobarbitol
      Phenytoin (and fosphenytoin)
      Rifampicin
      St. John’s wort

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      0
      Seconds

  • Question 17 - All of the muscles of the tongue (other than the palatoglossus) are innervated...

    Incorrect

    • All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:

      Your Answer:

      Correct Answer: Hypoglossal nerve

      Explanation:

      All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

  • Question 18 - A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of...

    Incorrect

    • A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.
      Iliacus is innervated by which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Femoral nerve

      Explanation:

      Iliacus is innervated by the femoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 19 - An 18-year-old patient was brought to the ER after falling off of his...

    Incorrect

    • An 18-year-old patient was brought to the ER after falling off of his skateboard. He is unable to flex the distal interphalangeal joint of his index finger. You suspect that he suffers from a supracondylar fracture. Which of the following conditions would confirm supracondylar fracture?

      Your Answer:

      Correct Answer: Inability to oppose the thumb

      Explanation:

      A supracondylar fracture is a fracture that occurs through the thin section of the distal humerus above the growth plate.

      A supracondylar fracture is most usually associated with median nerve injury. A medial nerve damage causes paralysis of the thenar muscles, as well as loss of thumb opposition.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 20 - Which of the following is required for vitamin B12 absorption: ...

    Incorrect

    • Which of the following is required for vitamin B12 absorption:

      Your Answer:

      Correct Answer: Intrinsic factor

      Explanation:

      Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
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SESSION STATS - PERFORMANCE PER SPECIALTY

Microbiology (1/1) 100%
Pathogens (1/1) 100%
Cardiovascular Pharmacology (0/1) 0%
Pharmacology (0/1) 0%
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