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  • Question 1 - A patient with a wound infection on his right leg has reddening and...

    Incorrect

    • A patient with a wound infection on his right leg has reddening and oedema of the surrounding muscles. His condition has worsened considerably over the past few hours with the area now appearing blackened. There is also palpable crepitus under the skin. You suspect gas gangrene.

      Which statement about Clostridium perfringens is true?

      Your Answer: Spores are destroyed by cooking

      Correct Answer: Gas gangrene is caused by the release of an alpha-toxin

      Explanation:

      Clostridium perfringens, a Gram-positive, anaerobic, spore forming rod-shaped, pathogenic bacterium is the most commonly associated with gas gangrene (85-90% of cases), although other species can also be implicated.

      Clostridium perfringens is capsulate and produces a range of toxins. Alpha-toxin is the most important and is the cause of gas gangrene.

      Gas gangrene develops when a devitalized wound becomes infected with Clostridium perfringens spores from the environment. The spores germinate and multiplies in the ischaemic conditions, releasing toxins, which further damage tissues.

      Usually, the clinical features of gas gangrene appear within 24 hours of injury.

      Clostridium perfringens spores are not destroyed by cooking. During slow cooling and unrefrigerated storage, they germinate to form vegetative cells.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      6.5
      Seconds

  • Question 2 - Regarding cortical areas, which one is found in the posterior part of the...

    Incorrect

    • Regarding cortical areas, which one is found in the posterior part of the inferior frontal gyrus?

      Your Answer: Wernicke’s area

      Correct Answer: Broca’s area

      Explanation:

      Broca’s area is involved in the expressive aspects of spoken and written language (production of sentences constrained by the rules of grammar and syntax). It corresponds to the opercular and triangular parts of the inferior frontal gyrus (BA 44 and 45). These areas are defined by two rami (branches) of the lateral sulcus (one ascending, one horizontal) which ‘slice into’ the inferior frontal gyrus. In keeping with its role in speech and language, Broca’s area is immediately anterior to the motor and premotor representations of the face, tongue and larynx. A homologous area in the opposite hemisphere is involved in non-verbal communication such as facial expression, gesticulation and modulation of the rate, rhythm and intonation of speech.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      4.2
      Seconds

  • Question 3 - Which of the following is NOT a common effect of etomidate: ...

    Correct

    • Which of the following is NOT a common effect of etomidate:

      Your Answer: Significant hypotension

      Explanation:

      Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it 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. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      2.9
      Seconds

  • Question 4 - A patient suffers an injury to the nerve that innervates piriformis.
    The piriformis muscle...

    Incorrect

    • A patient suffers an injury to the nerve that innervates piriformis.
      The piriformis muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer: Femoral nerve

      Correct Answer: Nerve to piriformis

      Explanation:

      Piriformis is innervated by the nerve to piriformis, which is a direct branch from the sacral plexus (S1 and S2).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      3.3
      Seconds

  • Question 5 - You are taking care of a 55-year-old male patient with a direct inguinal...

    Incorrect

    • You are taking care of a 55-year-old male patient with a direct inguinal hernia. In explaining his hernia, which of the following layers was compromised and had resulted in his condition?

      Your Answer: Lacunar ligament

      Correct Answer: Transversalis fascia

      Explanation:

      Direct inguinal hernias are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or heavy lifting.

      A direct inguinal hernia protrudes through the Transversalis fascia.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      5.3
      Seconds

  • Question 6 - The only statement that is correct regarding diffusion is which of the following?...

    Incorrect

    • The only statement that is correct regarding diffusion is which of the following?

      Your Answer: Passive diffusion refers to movement from an area of low concentration to an area of high concentration.

      Correct Answer: The permeability of a membrane is related to the membrane thickness and composition.

      Explanation:

      Passive diffusion is a process that describes the movement down a concentration gradient. This process accounts for movement across small distances like within the cytosol or across membranes. Factors that affect the diffusion of a substance across a membrane are the permeability (p) of the membrane, a difference in concentration across the membrane and the membrane area over which diffusion occurs. The membrane thickness and composition, and the diffusion coefficient of the substance also affects the permeability. Fick’s law describes the rate of diffusion of a substance within a solution, which can be modified to describe the rate of diffusion across a membrane.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      6.1
      Seconds

  • Question 7 - Which of the following is NOT an advantage of a case-control study used...

    Incorrect

    • Which of the following is NOT an advantage of a case-control study used to identify past exposure to a risk factor in patients with a disease:

      Your Answer: Relative quick, cheap and easy to perform

      Correct Answer: Can directly measure absolute and relative risk of a disease

      Explanation:

      Advantages:relatively quickrelatively cheap and easy to performparticularly suitable for studying associations between an exposure and an outcome when the outcome is uncommon or if the outcome occurs decades after exposurea wide range of risk factors can be investigated in each studyDisadvantages:subject to recall biasunlike in a whole population study, absolute risk cannot be quantifiedtemporal relationship between exposure and outcome can be difficult to establishunsuitable for rare risk factorsprone to confounding

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      2.6
      Seconds

  • Question 8 - Nitrous oxide is associated with which of the following adverse effects: ...

    Incorrect

    • Nitrous oxide is associated with which of the following adverse effects:

      Your Answer: Hypotension

      Correct Answer: Megaloblastic anaemia

      Explanation:

      Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      4.4
      Seconds

  • Question 9 - Tiredness, night sweats, and easy bruising are symptoms of a 58-year-old woman. Splenomegaly...

    Correct

    • Tiredness, night sweats, and easy bruising are symptoms of a 58-year-old woman. Splenomegaly is observed during the examination.

      Which of the following diagnoses is the SINGLE MOST LIKELY?

      Your Answer: Chronic myeloid leukaemia (CML)

      Explanation:

      CML is a myeloproliferative disorder characterised by an abnormal pluripotent haemopoietic stem cell. A cytogenetic abnormality known as the Philadelphia chromosome, which results from a reciprocal translocation between the long arms of chromosomes 9 and 22, causes more than 80% of cases of CML.

      CML is a disease that develops slowly over several years. This is known as the ‘chronic stage.’ This stage is usually asymptomatic, and 90 percent of patients are diagnosed at this point, with the disease being discovered frequently as a result of a routine blood test. During this stage, the bone marrow contains less than 10% immature white cells (blasts).

      When CML cells expand, symptoms typically begin to appear. The ‘accelerated stage’ is what it’s called. Approximately 10% of people are diagnosed at this point. During this stage, between 10% and 30% of blood cells in the bone marrow are blasts. During this stage, common clinical features include:
      Fatigue and exhaustion
      Night sweats and fever
      Distension of the abdomen
      Pain in the left upper quadrant (splenic infarction)
      Splenomegaly (commonest examination finding)
      Hepatomegaly
      Bruising is simple.
      Gout is a type of arthritis that affects (rapid cell turnover)
      Hyperviscosity is a condition in which the viscosity of (CVA, priapism)
      A small percentage of patients experience a ‘blast crisis’ (blast stage). More than 30% of the blood cells in the bone marrow are immature blast cells at this stage. Patients with severe constitutional symptoms (fever, weight loss, bone pain), infections, and bleeding diathesis typically present at this stage.

      In CML, laboratory findings include:
      White cell count is abnormally high (often greater than 100 x 109/l).
      Increased number of immature leukocytes causes a left shift.
      Anaemia that is mild to moderately normochromic and normocytic.
      Platelets can be low, normal, or elevated, and the Philadelphia chromosome can be found in > 80% of patients.
      Serum uric acid and ALP levels are frequently elevated.
      Tyrosine kinase inhibitors (TKIs), such as imatinib and dasatinib, are the current mainstay of CML treatment.
      Allogenic bone marrow transplantation is now only used in cases where TKIs have failed to work.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      11.9
      Seconds

  • Question 10 - A 69-year-old woman with new-onset back pain was diagnosed with osteopenia, osteolytic lesions,...

    Incorrect

    • A 69-year-old woman with new-onset back pain was diagnosed with osteopenia, osteolytic lesions, and vertebral collapse after undergoing a radiographic examination. Her laboratory results revealed anaemia and hypercalcemia. These findings most likely indicate what condition?

      Your Answer: Chronic myeloid leukaemia

      Correct Answer: Myeloma

      Explanation:

      Bone pain, pathologic fractures, weakness, anaemia, infection, hypercalcemia, spinal cord compression, and renal failure are all signs and symptoms of multiple myeloma (MM). The patient’s condition matched the signs and symptoms of myeloma.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      5.6
      Seconds

  • Question 11 - A 18 year old university student develops facial swelling and dark frothy urine. Urine...

    Incorrect

    • A 18 year old university student develops facial swelling and dark frothy urine. Urine dipstick demonstrates haematuria and proteinuria. Approximately 3 weeks ago, he was treated with oral antibiotics for a sore throat. His condition is most likely to be secondary to infection with:

      Your Answer: Staphylococcus aureus

      Correct Answer: Streptococcus pyogenes

      Explanation:

      Post-streptococcal glomerulonephritis is a postinfectious immune-mediated reaction secondary to infection with Streptococcus pyogenes. It typically occurs 2 weeks or more after acute/initial infection, and presents with haematuria, reduced urine output, peripheral oedema, proteinuria, and hypertension. Permanent kidney damage is rare.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      5
      Seconds

  • Question 12 - For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the...

    Incorrect

    • For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:

      Your Answer: Lidocaine

      Correct Answer: Synchronised DC shock

      Explanation:

      If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      3
      Seconds

  • Question 13 - A 45-year-old businessman returns from a trip to West Africa with headaches and...

    Correct

    • A 45-year-old businessman returns from a trip to West Africa with headaches and intermittent fevers. Thick and thin films are sent to the lab and a diagnosis is made of malaria. The patient is started on treatment but his condition deteriorates and he develops jaundice, renal failure and haemoglobinuria.
      Which of the following is the MOST likely causative organism? Select ONE answer only.

      Your Answer: Plasmodium falciparum

      Explanation:

      Malaria is an infectious disease transmitted by female of theAnophelesgenus of mosquito. It is a parasitic infection caused by the genusPlasmodium. Five species are recognized as causing disease in humans;Plasmodium falciparum,Plasmodium ovale,Plasmodium vivax,Plasmodium malariaeandPlasmodium knowlesi.
      The classic symptom of malaria is the malarial paroxysm, a cyclical occurrence of a cold phase, where the patient experiences intense chills, a hot stage, where the patient feels extremely hot and finally a sweating stage, where the fever declines and the patient sweats profusely. On examination the patient may show signs of anaemia, jaundice and have hepatosplenomegaly without evidence of lymphadenopathy.

      Plasmodium falciparum is the most serious form and is responsible for most deaths. Severe or complicated malaria is suggested by the presence of impaired consciousness, seizures, hypoglycaemia, anaemia, renal impairment, respiratory distress and spontaneous bleeding.
      Plasmodium falciparum is the most likely type in this case in view of the presentation.
      Haemoglobinuria and renal failure following treatment is suggestive of blackwater fever, which is caused byPlasmodium falciparum. An autoimmune reaction between the parasite and quinine causes haemolysis, haemoglobinuria, jaundice and renal failure. This can be fatal.
      The benign malarias: P.vivax, P. malariae and P.ovale are usually treated with chloroquine. A course of primaquine is also required in P.vivax and P.ovale infection. Artesunate is the drug treatment of choice for Plasmodium falciparum malaria. Quinine can still be used where artesunate is not available. Often combination therapy with drugs such as doxycycline or fansidar is also required.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      5
      Seconds

  • Question 14 - Which of the following serology results is consistent with chronic hepatitis B infection:...

    Incorrect

    • Which of the following serology results is consistent with chronic hepatitis B infection:

      Your Answer: HBsAg positive and anti-HBc IgM positive

      Correct Answer: HBsAg positive and anti-HBc IgG positive

      Explanation:

      Disease state vs Serology
      Acute hepatitis: BHBsAg, HBeAg, anti-HBc IgM
      Chronic hepatitis B (low infectivity): HBsAg (>6/12), anti-HBe, anti-HBc IgG
      Chronic hepatitis B (high infectivity): HBsAg (>6/12), HBeAg, anti-HBc IgG
      Cleared infection: Anti-HBs, anti-HBe, anti-HBc IgG
      Vaccinated: Anti-HBs

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      6.3
      Seconds

  • Question 15 - A 55-year-old female is urgently rushed into the Emergency Department as she complains...

    Incorrect

    • A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.

      She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.

      Which of the following statements is true regarding heparin?

      Your Answer: It inhibits clotting factors II, VII, IX and X

      Correct Answer: It activates antithrombin III

      Explanation:

      Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
      1. Unfractionated: widely varying polymer chain lengths
      2. Low molecular weight: Smaller polymers only

      Heparin works by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.

      Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.

      Heparin is used for:
      1. Prevention and treatment of venous thromboembolism
      2. Treatment of disseminated intravascular coagulation
      3. Treatment of fat embolism
      4. Priming of haemodialysis and cardiopulmonary bypass machines

      There is no evidence that heparin is superior to low-molecular-weight heparins in preventing mortality from thrombosis.

      Vitamin K is used to reverse the effects of warfarin but not heparin. For heparin, protamine sulphate is used to counteract its effects.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      6.1
      Seconds

  • Question 16 - A patient presents with epistaxis. She tells you that she has a rare...

    Incorrect

    • A patient presents with epistaxis. She tells you that she has a rare platelet disorder and gives you her haematology outpatient letter that contains information about it. You learn that her disorder is caused by low levels of glycoprotein IIb/IIIa.
      What is the SINGLE most likely diagnosis?

      Your Answer: Idiopathic thrombocytopaenic purpura

      Correct Answer: Glanzamann’s thromboasthenia

      Explanation:

      Glanzmann’s thromboasthenia is a rare platelet disorder in which platelets contain defective or low levels of glycoprotein IIb/IIIa.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      2.6
      Seconds

  • Question 17 - The most common source of healthcare-associated bacteraemia is: ...

    Incorrect

    • The most common source of healthcare-associated bacteraemia is:

      Your Answer: Food

      Correct Answer: Intravenous cannula

      Explanation:

      Healthcare-associated bacteraemia is most commonly caused by intravenous access. Any intravenous device that is left in place for a long time increases the risk of infection. It allows bacteria like Staphylococcus aureus and Staphylococcus epidermidis to enter the body.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      2.6
      Seconds

  • Question 18 - A 70 year old man who has a previous history of small cell...

    Incorrect

    • A 70 year old man who has a previous history of small cell lung cancer was found to have severe hyponatraemia on a recent blood test and he is sent to the emergency room. In the nephron, where is the likely cause of this abnormality?

      Your Answer: Proximal Tubule

      Correct Answer: Distal nephron

      Explanation:

      In the cancer patient, hyponatremia is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH). This develops more frequently with small cell lung cancer (SCLC) than with other malignancies. The pathogenesis of this is as a result of the process whereby ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, resulting in elevation of cAMP levels. Increased cAMP levels cause fusion of intracellular vesicles with the apical membrane. There are water channels called aquaporins in their membranes of these vesicles, and these increase the water permeability, thus facilitating increased water reabsorption and urine concentration. Thus, by increasing water retention, ADH causes blood to be diluted, which then decreases the concentration of solutes like sodium.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      4.2
      Seconds

  • Question 19 - Regarding endothelin-1, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding endothelin-1, which of the following statements is INCORRECT:

      Your Answer: Endothelin-1 release is stimulated by angiotensin II and antidiuretic hormone.

      Correct Answer: Endothelin-1 release is inhibited by noradrenaline.

      Explanation:

      Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      4.3
      Seconds

  • Question 20 - Which of the following is NOT a typical clinical feature of beta-thalassaemia major:...

    Correct

    • Which of the following is NOT a typical clinical feature of beta-thalassaemia major:

      Your Answer: Increased bleeding tendency

      Explanation:

      Features include:
      – severe anaemia (becoming apparent at 3 – 6 months when the switch from gamma-chain to beta-chain production takes place)
      – failure to thrive
      – hepatosplenomegaly (due to excessive red cell destruction, extramedullary haemopoiesis and later due to transfusion related iron overload)
      – expansion of bones (due to marrow hyperplasia, resulting in bossing of the skull and cortical thinning with tendency to fracture)
      – increased susceptibility to infections (due to anaemia, iron overload, transfusion and splenectomy)
      – osteoporosis
      – hyperbilirubinaemia and gallstones
      – hyperuricaemia and gout
      – other features of haemolytic anaemia
      – liver damage and other features of iron overload

    • This question is part of the following fields:

      • Haematology
      • Pathology
      4.5
      Seconds

  • Question 21 - Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the...

    Incorrect

    • Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the following locations is most likely to be the organism's origin?

      Your Answer: Colon

      Correct Answer: Oral cavity

      Explanation:

      Streptococci that are alpha-haemolytic, such as Streptococcus viridans, are major components of the flora in the oral cavity.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      7.8
      Seconds

  • Question 22 - The medial and lateral pterygoid muscles are innervated by which of the following...

    Incorrect

    • The medial and lateral pterygoid muscles are innervated by which of the following nerves:

      Your Answer: Glossopharyngeal nerve

      Correct Answer: Mandibular division of the trigeminal nerve

      Explanation:

      Both the medial and lateral pterygoids are innervated by the mandibular division of the trigeminal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      6.3
      Seconds

  • Question 23 - A 53-year-old man arrives at the emergency department complaining of visual impairment in...

    Incorrect

    • A 53-year-old man arrives at the emergency department complaining of visual impairment in his right eye. On examination, you notice that neither his right nor left pupil constricts when you shine a light in his right eye. When you flash a light in his left eye, the pupils of both his left and right eyes constrict. Which of the following nerves is the most likely to be affected:

      Your Answer: Abducens nerve

      Correct Answer: Optic nerve

      Explanation:

      In full optic nerve palsy, the afferent pupillary light reflex is lost. Because the afferent optic nerve does not sense light flashed in the afflicted eye, the ipsilateral direct and contralateral consensual reflexes are gone. However, the contralateral direct and ipsilateral consensual reflexes are intact because the efferent oculomotor nerve is normal.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      6.8
      Seconds

  • Question 24 - A 59-year-old woman presents with a history of tiredness and weight gain and...

    Incorrect

    • A 59-year-old woman presents with a history of tiredness and weight gain and a diagnosis of hypothyroidism is suspected.

      Which of these changes is likely to appear first in primary hypothyroidism?

      Your Answer: Reduced thyroid-binding globulin (TBG)

      Correct Answer: Increased thyroid-stimulating hormone (TSH)

      Explanation:

      The earliest biochemical change seen in hypothyroidism is an increase in thyroid-stimulating hormone (TSH) levels.

      Triiodothyronine (T3) and thyroxine (T4) levels are normal in the early stages.

      TBG levels are generally unchanged in primary hypothyroidism.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      16.5
      Seconds

  • Question 25 - You assess a patient that has suffered a nerve injury that has paralysed...

    Incorrect

    • You assess a patient that has suffered a nerve injury that has paralysed her left latissimus dorsi muscle.
      Latissimus dorsi receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer: Nerve to subclavius

      Correct Answer: Thoracodorsal nerve

      Explanation:

      Latissimus dorsi originates from the lower part of the back, where it covers a wide area. It lies underneath the inferior fibres of trapezius superiorly, and trapezius is the most superficial back muscle.
      Superficial muscles of the back showing latissimus dorsi (from Gray’s Anatomy)
      Latissimus dorsi has a broad origin, arising from the spinous processes of T6-T12, the thoracolumbar fascia, the iliac crest and the inferior 3 or 4 ribs. The fibres converge into a tendon that inserts into the intertubercular groove of the humerus.
      Latissimus dorsi is innervated by the thoracodorsal nerve.
      Latissimus dorsi acts to extend, adduct and medially rotate the humerus. It, therefore, raises the body towards the arm during climbing.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      3
      Seconds

  • Question 26 - Your consultant requests that you do a lumbar puncture on a patient who...

    Correct

    • Your consultant requests that you do a lumbar puncture on a patient who is suspected of having meningitis. This patient, a 15-year-old female, presented to the emergency department with a fever, headache, and neck stiffness. Where should you aspirate a sample of CSF?

      Your Answer: Subarachnoid space

      Explanation:

      A lumbar puncture, also known as a spinal tap, is a procedure that involves inserting a needle into the lower back’s lumbar region.

      A needle is inserted into the space between the arachnoid mater and the pia mater, also known as the subarachnoid space, to remove a sample of cerebrospinal fluid.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      6
      Seconds

  • Question 27 - A 18 year old male presents to the GP with painless asymmetrical cervical...

    Incorrect

    • A 18 year old male presents to the GP with painless asymmetrical cervical lymphadenopathy. Histological examination of a biopsied lymph node demonstrates Reed-Sternberg cells. What is the most likely diagnosis:

      Your Answer: Myelofibrosis

      Correct Answer: Hodgkin lymphoma

      Explanation:

      Hodgkin’s lymphoma is a malignant tumour of the lymphatic system that is characterised histologically by the presence of Reed-Sternberg cells (multinucleated giant cells). The peak incidence is in young adults aged 20-35, and there is a slight male predominance.

      The following are recognised risk factors for Hodgkin’s lymphoma:
      Male gender
      Age 20-35
      Positive family history
      Epstein-Barr virus infection
      Immunosuppression including HIV infection
      Prolonged use of human growth hormone
      Most patients present with an enlarged, but otherwise asymptomatic lymph node. The most commonly affected lymph nodes are in the supraclavicular and lower cervical areas. Other common clinical features include shortness of breath and chest discomfort secondary to mediastinal mass. Mediastinal masses are sometimes discovered as incidental findings on routine chest X-rays. Approximately 30% of patients with Hodgkin’s lymphoma develop splenomegaly.
      ‘B’ symptoms occur in approximately 25% of patients. The ‘B’ symptoms of Hodgkin’s lymphoma are:
      Fever (>38ºC)
      Night sweats
      Weight loss (>10% over 6 months)
      Pain after alcohol consumption is a pathognomonic sign of Hodgkin’s lymphoma, it is, however, not a ‘B’ symptom. It is rare though, only occurring in 2-3% of patients with Hodgkin’s lymphoma.

      The Ann Arbour clinical staging is as follows:
      Stage I: one involved lymph node group
      Stage II two involved lymph node groups on one side of the diaphragm
      Stage III: lymph node groups involved on both sides of the diaphragm
      Stage IV: Involvement of extra-nodal tissues, such as the liver or bone marrow
      Diagnosis is made by lymph node biopsy, which should be taken from a sufficiently large specimen or excisional biopsy, as opposed to a fine needle biopsy. The Reed-Sternberg cell is the most useful diagnostic feature. This is a giant cell with twin mirror-image nuclei and prominent ‘owl’s eye’ nucleoli.
      The Reed-Sternberg cell of Hodgkin’s Lymphoma
      Histological typing depends upon the other cells within the diseased tissue. Nodular sclerosing is the most common type of Hodgkin’s lymphoma. Lymphocyte-depleted and lymphocyte-predominant are rare subtypes.
      The majority of cases can be successfully treated, and unlike many other malignancies even if the first-line treatment fails, a cure can often be achieved with second-line therapies. Stage 1 Hodgkin’s lymphoma is usually treated with radiotherapy alone, but more advanced stages require combination chemotherapy. In localised disease treated with irradiation, there is a 5-year survival rate of greater than 80%. In disseminated disease treated with chemotherapy, the 5-year survival falls to around 50%. Overall, a 5-year survival of >70% should be achieved.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      3.9
      Seconds

  • Question 28 - The interquartile range (IQ) is often displayed using which of the following: ...

    Incorrect

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

      Your Answer: Scatter plot

      Correct 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
      13.5
      Seconds

  • Question 29 - A 32-year-old woman suffers a deep wound to her thigh while she was...

    Incorrect

    • A 32-year-old woman suffers a deep wound to her thigh while she was climbing over a barbed wire fence. As a consequence of her injury, the nerve that was severed innervates the gracilis muscle.

      In which of the following nerves is the gracilis muscle innervated by?

      Your Answer: Femoral nerve

      Correct Answer: Anterior branch of the obturator nerve

      Explanation:

      The gracilis muscles is innervated by the anterior branch of the obturator nerve (L2-L4).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      3.3
      Seconds

  • Question 30 - Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for: ...

    Incorrect

    • Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:

      Your Answer:

      Correct Answer: Hypocalcaemia

      Explanation:

      Common side effects of thiazide diuretics include:
      Excessive diuresis, postural hypotension, dehydration, renal impairment
      Acid-base and electrolyte imbalance
      Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosis
      Metabolic imbalance
      Hyperuricaemia and gout
      Impaired glucose tolerance and hyperglycaemia
      Altered plasma-lipid concentrations
      Mild gastrointestinal disturbances

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (8/8) 100%
Central Nervous System (1/1) 100%
Anaesthesia (2/2) 100%
Pharmacology (5/5) 100%
Lower Limb (2/2) 100%
Abdomen (1/1) 100%
Basic Cellular (1/1) 100%
Physiology (4/4) 100%
Evidence Based Medicine (2/2) 100%
Study Methodology (1/1) 100%
Haematology (5/5) 100%
Pathology (5/5) 100%
Microbiology (4/5) 80%
Pathogens (1/2) 50%
Cardiovascular (3/3) 100%
Specific Pathogen Groups (1/1) 100%
Cardiovascular Pharmacology (1/1) 100%
Principles (1/1) 100%
Endocrine (1/1) 100%
Infections (1/1) 100%
Head And Neck (2/2) 100%
Cranial Nerve Lesions (1/1) 100%
Endocrine Physiology (1/1) 100%
Upper Limb (1/1) 100%
Statistics (1/1) 100%
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