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Question 1
Correct
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C3 deficiency leads to particular susceptibility of infection with which of the following:
Your Answer: Encapsulated bacteria
Explanation:Macrophages and neutrophils have C3b receptors and they phagocytose C3b-coated cells. C3 deficiency thus leads to increased susceptibility of infection with encapsulated organisms (e.g. S. pneumoniae, H. influenzae).The early stages of the complement cascade leading to coating of the cells with C3b can occur by two different pathways:The classical pathway usually activated by IgG or IgM coating of cellsThe alternative pathway which is more rapid and activated by IgA, endotoxin and other factors
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 2
Incorrect
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A 68-year-old man with multiple myeloma presents with complaints of abdominal pain and malaise. A series of blood tests is done and his calcium level is 2.96 mmol/l.
What effect will this blood test result have on gastric secretions?
Your Answer: Inhibit the release of pepsinogen
Correct Answer: Stimulate the release of gastrin
Explanation:Hypercalcaemia stimulates the release of gastrin from the G-cells in the pyloric antrum of the stomach, the duodenum and the pancreas.
Gastrin is also released in response to:
Stomach distension
Vagal stimulation
The presence of amino acids.Gastrin release is inhibited by the presence of acid and somatostatin.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 3
Correct
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All of the following cause bronchodilation, EXCEPT for:
Your Answer: Stimulation of irritant receptors
Explanation:Factors causing bronchodilation: Via beta2-adrenoceptors
Sympathetic stimulation:
Adrenaline (epinephrine)
Beta2-adrenergic agonists e.g. salbutamol
Anticholinergic and muscarinic antagonists e.g. ipratropium -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 4
Correct
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A 5 day old, full term neonate is with a unilateral purulent eye discharge noticed earlier that day is brought in. On gram stain of the exudate, no bacteria are seen.
What is the most likely causative pathogen?
Your Answer: Chlamydia trachomatis
Explanation:Conjunctivitis occurring in the first 28 days of life (Ophthalmia neonatorum) is most commonly caused by Chlamydia trachomatis in the UK.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
Incorrect
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The role of the juxtaglomerular (granular) cells of the juxtaglomerular apparatus is:
Your Answer: Detection of tubular NaCl concentration
Correct Answer: Production of renin
Explanation:Juxtaglomerular cells synthesise renin. These cells are specialised smooth muscle cells that are located in the walls of the afferent arterioles, and there are some in the efferent arterioles.
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This question is part of the following fields:
- Physiology
- Renal
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Question 6
Incorrect
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A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic reaction after being stung by a bee. She responded well to initial treatment but developed anaphylactic symptoms after 6 hours. Her symptoms were resolved after a further dose of adrenaline. Her family threatened legal action as they thought she had not received adequate treatment but withdrew their accusation after the attending physician explained that the woman had suffered a biphasic reaction.
What is the approximate percentage of people who suffer this type of reaction?Your Answer: 30%
Correct Answer: 20%
Explanation:Anaphylactic reactions are Type 1 hypersensitivity reactions IgE-mediated and can be potentially life-threatening if not treated promptly. There are four well-recognized patterns of anaphylaxis:
1) Uniphasic
2) Biphasic
3) Protracted
4) RefractoryBiphasic reactions occur in 20% of the population, although their mechanism is poorly understood. The symptoms of anaphylaxis recur within 4-6 hours, although they may also recur up to 72 hours later. All patients discharged from the hospital after an anaphylactic shock must:
1) Be warned to return to the hospital immediately if symptoms recur
2) Have a treatment plan in place
3) Have a follow-up appointment
4) Be considered for an adrenaline auto-injector
5) Referred to an allergy clinic -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 7
Correct
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A somatostatinoma is diagnosed in a 74-year-old patient who has recently developed diabetes mellitus, recurrent episodes of gallstones, and Steatorrhoea. She also has a tumour in the head of her pancreas.
Which of the following is the most likely effect of this tumour?Your Answer: Inhibit gastric acid secretion
Explanation:Somatostatin-producing cells present in the pyloric antrum, duodenum, and pancreatic islets are known as D-cells or delta-cells. Somatostatin inhibits gastric acid secretion by acting directly on acid-producing parietal cells in the stomach via a G-protein coupled receptor.
Somatostatin affects hormones in the following ways:
Inhibits the anterior pituitary’s secretion of growth hormone.
Inhibits the anterior pituitary’s secretion of thyroid-stimulating hormone.The secretion of various gastrointestinal hormones is inhibited (including gastrin, CCK, secretin, motilin, VIP and GIP)
Reduces the rate at which the stomach empties.
Inhibits the release of insulin and glucagon from the pancreas.The pancreas’ exocrine secretory activity is inhibited.
Somatostatin can also slow the digestive process by suppressing the production of hormones such gastrin, secretin, and histamine, which reduces gastric acid secretion.A somatostatinoma is a cancerous tumour of the endocrine pancreas’ D-cells, which make somatostatin. Somatostatin inhibits pancreatic and gastrointestinal hormones when levels are high. The following clinical characteristics are related with somatostatinomas:
Insulin secretion blockage causes diabetes mellitus.
Gallstones by inhibition of CCK and secretin Steatorrhoea via inhibition of CCK and secretinHypochlorhydria is caused by the suppression of gastrin, a hormone that increases gastric acid output regularly.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 8
Incorrect
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Which of the following is NOT a feature characteristic of intravascular haemolysis:
Your Answer: Haemoglobinuria
Correct Answer: Bilirubinuria
Explanation:Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria
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This question is part of the following fields:
- Haematology
- Pathology
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Question 9
Correct
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An 11-year-old girl presents with a 5-day history of persistent fever despite regular paracetamol, throbbing left ear pain, ear discharge and deafness. Her parents have observed that she is not her usual self, not eating well, and has been lethargic. On examination there is a tender swelling in the post auricular region on the left hand side.
What is the most likely causative organism?
Your Answer: Streptococcus pneumonia
Explanation:Acute mastoiditis is a complication (rare) of acute otitis media (AOM) and the commonest causative organism is Streptococcus pneumoniae.
Generally, acute mastoiditis presents with:
Pyrexia
Recent history of AOM
Mastoid swelling and erythema
Otalgia
Otorrhoea and perforation of tympanic membrane
Post-auricular pain
Protrusion of the ears -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 10
Incorrect
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The following statements are not true of the flexor digiti minimi brevis, except?
Your Answer: It is innervated by the superficial branch of the ulnar nerve
Correct Answer: It is situated on the radial border of abductor digiti minimi
Explanation:Flexor digiti minimi brevis muscle is located on the ulnar side of the palm, lying on the radial border of the abductor digiti minimi. Together with the abductor digiti minimi and opponens digiti minimi muscles, it forms the hypothenar eminence. The muscle is situated inferior and lateral to adductor digiti minimi muscle and superior and medial to opponens digiti minimi muscle. The proximal parts of flexor digiti minimi brevis and abductor digiti minimi muscles form a gap through which deep branches of the ulnar artery and ulnar nerve pass.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 11
Incorrect
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Injury to which nerve can lead to weakness or paralysis of the brachialis muscle?
Your Answer: The median nerve
Correct Answer: The musculocutaneous nerve
Explanation:The brachialis muscle is a prime flexor of the forearm at the elbow joint. It is fusiform in shape and located in the anterior (flexor) compartment of the arm, deep to the biceps brachii. The brachialis is a broad muscle, with its broadest part located in the middle rather than at either of its extremities. It is sometimes divided into two parts, and may fuse with the fibres of the biceps brachii, coracobrachialis, or pronator teres muscles. It also functions to form part of the floor of the cubital fossa.
The brachialis is primarily supplied by the musculocutaneous nerve (C5, C6). In addition, a small lateral portion of the muscle is innervated by the radial nerve (C7).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Incorrect
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Which of the following classes of drugs may predispose to lithium toxicity:
Your Answer: Beta-2 agonists
Correct Answer: Thiazide diuretics
Explanation:Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 13
Correct
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Langhans giant cells, seen in granulomatous inflammation. are:
Your Answer: Multinucleated cells formed from fusion of epithelioid cells
Explanation:A granuloma is a collection of five or more epithelioid macrophages, with or without attendant lymphocytes and fibroblasts; epithelioid macrophages are altered macrophages which have turned themselves over to becoming giant phagocytosing and killing machines, they often fuse to become multinucleate (Langhans) giant cells.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 14
Incorrect
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A patient presents with a lump for a dermatological examination. There is a circumscribed skin elevation measuring 0.3 cm in diameter seen on examination.
Which one of these best describes the lump you have found on examination?Your Answer: Nodule
Correct Answer: Papule
Explanation:A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.
A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.
A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.
A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.
A pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 15
Incorrect
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A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You plan on using propofol as the sedative agent.
Propofol works as a result of action on what type of receptor? Select ONE answer only.Your Answer: Dopamine
Correct Answer: Gamma-aminobutyric acid (GABA)
Explanation:Propofol (2,6-diisopropylphenol) is a short-acting phenol derivative that is primarily used for the induction of anaesthesia.
Its mechanism of action is unclear but is thought to act by potentiating the inhibitory neurotransmitters GABA and glycine, which enhances spinal inhibition during anaesthesia.
The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.
Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.
The main side effects of propofol are:
Pain on injection (in up to 30%)
Hypotension
Transient apnoea
Hyperventilation
Coughing and hiccough
Headache
Thrombosis and phlebitis -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 16
Correct
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Which of the following is an example of continuous data:
Your Answer: Height
Explanation:Continuous data is data where there is no limitation on the numerical value that the variable can take e.g. weight, height.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 17
Correct
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Low levels of which of the following arterial blood gas parameters stimulate the peripheral chemoreceptors?
Your Answer: Arterial pO 2
Explanation:Chemoreceptors are activated when the chemical composition of their immediate surroundings changes.
Peripheral chemoreceptors, together with central chemoreceptors, regulate respiratory functions. They detect changes in arterial blood oxygen levels. Decreased arterial Po2 (partial pressure of oxygen) reflexly stimulates peripheral chemoreceptors.
When peripheral chemoreceptors detect changes in arterial blood oxygen, they will trigger cardiorespiratory changes such as an increase in breathing and blood pressure. These reflexes are important for maintaining homeostasis during hypoxemia.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 18
Incorrect
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Regarding CSF (cerebrospinal fluid) production, approximately how much is produced per day?
Your Answer: 50 ml
Correct Answer: 500 ml
Explanation:CSF fills the ventricular system, a series of interconnected spaces within the brain, and the subarachnoid space directly surrounding the brain. The intraventricular CSF reflects the composition of the brain’s extracellular space via free exchange across the ependyma, and the brain “floats” in the subarachnoid CSF to minimize the effect of external mechanical forces. The volume of CSF within the cerebral ventricles is approximately 30 mL, and that in the subarachnoid space is about 125 mL. Because about 0.35 mL of CSF is produced each minute, CSF is turned over more than three times daily. Approximately 500 mL of CSF is produced per day, at a rate of about 25 mL per hour.
CSF is a filtrate of capillary blood formed largely by the choroid plexuses, which comprise pia mater, invaginating capillaries, and ependymal cells specialized for transport. The choroid plexuses are located in the lateral, third, and fourth ventricles. The lateral ventricles are situated within the two cerebral hemispheres. They each connect with the third ventricle through one of the interventricular foramina (of Monro). The third ventricle lies in the midline between the diencephalon on the two sides. The cerebral aqueduct (of Sylvius) traverses the midbrain and connects the third ventricle with the fourth ventricle. The fourth ventricle is a space defined by the pons and medulla below and the cerebellum above. The central canal of the spinal cord continues caudally from the fourth ventricle, although in adult humans the canal is not fully patent and continues to close with age.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 19
Incorrect
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A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.
Which of the following muscles is most likely to be involved? Select ONE answer only.Your Answer: Sternocleidomastoid
Correct Answer: Sternohyoid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
Contents:
Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 20
Incorrect
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Urine flow rate = 2 ml/min
Urine concentration of creatinine = 18 mg/ml
Plasma concentration of creatinine = 0.25 mg/ml
What is the estimated glomerular filtration rate (eGFR)?
Your Answer: 40 ml/min
Correct Answer: 144 ml/min
Explanation:GFR can be estimated by:
GFR = UCr x V / PCr
Where:
UCr = urine concentration of creatinine
PCr = plasma concentration of creatinine
V = rate of urine flowIn this case GFR = (18 x 2) / 0.25 = 144 ml/min
Note: Creatinine is used to estimate GFR because it is an organic base naturally produced by muscle breakdown, it is freely filtered at the glomerulus, it is not reabsorbed from the nephron, it is not produced by the kidney, it is not toxic, and it doesn’t alter GFR.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 21
Incorrect
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The medial and lateral pterygoid muscles are innervated by which of the following nerves:
Your Answer: Spinal accessory 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.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 22
Incorrect
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What is the direct mechanism of action of digoxin as a positive inotrope:
Your Answer: Beta-adrenoceptor agonist
Correct Answer: Inhibition of Na+/K+ ATPase pump
Explanation:Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 23
Incorrect
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A newborn baby is referred by the community midwife who is concerned the baby is jaundiced because of the yellow appearance of his eyes and skin following a postnatal home visit. The jaundice is visible in the baby’s feet making her worried.
Jaundice are visible in the extremities of neonates at what approximate threshold bilirubin level?Your Answer: 185 μmol/L
Correct Answer: 255 μmol/L
Explanation:Newborn babies have a higher concentration of red blood cells with shorter lifespan leading to higher bilirubin levels than in adults. This condition is short-lived and harmless but with potential serious causes that need to be assessed for if present.
The most obvious physical sign of jaundice is a yellow discolouration of the sclera, skin and mucous membranes. At a bilirubin level of 35 μmol/L or higher, the eye is affected. The bilirubin level will need to be higher than 255 μmol/L for the feet and extremities to be affected.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 24
Incorrect
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You've been asked to visit a 20-year-old patient who has been complaining of stomach pain, diarrhoea, and bloating. The GP recently saw the patient and is now looking into numerous possible reasons for stomach hypermotility.
Which of the following factors contributes to increased stomach motility?Your Answer: Insulin
Correct Answer: Gastrin
Explanation:Gastrin is a peptide hormone that aids in gastric motility by stimulating the generation of gastric acid by the parietal cells of the stomach. G-cells in the stomach’s pyloric antrum, the duodenum, and the pancreas release it.
The following stimuli cause the release of gastrin:
Stimulation of the vagus nerve
Hypercalcaemia
stomach bloating
Proteins that have been partially digested, particularly amino acids.
The presence of acid and somatostatin inhibits the release of gastrin.
Gastrin’s main actions are as follows:
Gastric parietal cells are stimulated to release hydrochloric acid.
ECL cells are stimulated to produce histamine.
Gastric parietal cell maturation and fundal growth stimulation
Causes the secretion of pepsinogen by the gastric chief cells.
Improves antral muscle mobility
stimulates gastric contractions
Increases gastric emptying rate and stimulates pancreatic secretion
Gallbladder emptying is induced. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 25
Correct
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.
The stomach G-cells are responsible for which of the following?Your Answer: Secretion of gastrin
Explanation:G-cells are a type of cell found in the stomach’s pyloric antrum, duodenum, and pancreas. The secretion of the peptide hormone gastrin is their major function.
The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:
Cell type/ Substance secreted/ Function of secretion
Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
Chief cells/ Pepsinogen/ Protein digestion
Chief cells/ Gastric lipase/ Fat digestion
G-cells/ Gastrin/ Stimulates gastric acid secretion
Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
D-cells/ Somatostatin/ Inhibits gastric acid secretion -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 26
Incorrect
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An injury to which nerve affects innervation to the adductor portion of the adductor magnus?
Your Answer: Anterior branch of the obturator nerve
Correct Answer: Posterior branch of the obturator nerve
Explanation:The nerves that supply the adductor magnus muscle have an embryologic origin from the anterior divisions of the lumbosacral plexus and include the obturator nerve, posterior division (L2-4), and the tibial portion of the sciatic nerve (L4). It is innervated by the posterior division of the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 27
Incorrect
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An elderly female has a bacterial infection and you are asked to prescribe an antibiotic to her. This antibiotic is a nucleic acid synthesis inhibitor.
Which of the following antimicrobial drugs will be prescribed to this patient?Your Answer: Chloramphenicol
Correct Answer: Metronidazole
Explanation:Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Erythromycin inhibits protein synthesis and blocks translocation by binding to the 23S rRNA of the 50S ribosomal subunit.
Chloramphenicol blocks peptidyl transferase at 50S ribosomal subunit.
Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA and thus preventing initiation of protein synthesis.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
1. Inhibition of cell wall synthesis
– Penicillins
– Cephalosporins
– Vancomycin
2. Disruption of cell membrane function
– Polymyxins
– Nystatin
– Amphotericin B
3. Inhibition of protein synthesis
– Macrolides
– Aminoglycosides
– Tetracyclines
– Chloramphenicol
4. Inhibition of nucleic acid synthesis
– Quinolones
– Trimethoprim
– 5-nitroimidazoles
– Rifampicin
5. Anti-metabolic activity
– Sulphonamides
– Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 28
Correct
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A patient has an elevated potassium level of 6.7 mmol/L. All of the following conditions may cause elevated potassium levels, except for which one?
Your Answer: Bartter’s syndrome
Explanation:Bartter’s syndrome is an autosomal recessive renal tubular disorder characterized by hypokalaemia, hypochloraemia, metabolic alkalosis, and hyperreninemia with normal blood pressure. The underlying kidney abnormality results in excessive urinary losses of sodium, chloride, and potassium.
Bartter’s syndrome does not cause an elevated potassium level, but instead causes a decrease in its concentration (hypokalaemia). The other choices are causes of hyperkalaemia or elevated potassium levels.
Renal failure, Addison’s disease (adrenal insufficiency), congenital adrenal hyperplasia, renal tubular acidosis (type 4), rhabdomyolysis, burns and trauma, tumour syndrome, and acidosis are non-drug causes of hyperkalaemia. On the other hand, drugs that can cause hyperkalaemia include ACE inhibitors, angiotensin receptor blockers, NSAIDs, beta-blockers, digoxin, and suxamethonium.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 29
Incorrect
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.
The gastric ECL cells secrete which of the following substances?
Your Answer: Mucous
Correct Answer: Histamine
Explanation:Enterochromaffin-like cells (ECL cells) are a type of neuroendocrine cell located beneath the epithelium in the stomach glands. They’re most typically located near the parietal cells of the stomach. The ECL cells’ primary role is to produce histamine, which stimulates the formation of stomach acid by the parietal cells.
The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:
Cell type/ Substance secreted/ Function of secretion
Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
Chief cells/ Pepsinogen/ Protein digestion
Chief cells/ Gastric lipase/ Fat digestion
G-cells/ Gastrin/ Stimulates gastric acid secretion
Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
D-cells/ Somatostatin/ Inhibits gastric acid secretion -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 30
Correct
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A 24-year-old patient is suspected to have a possible acute hepatitis B infection and is currently under investigation.
Which of the following markers is considered the earliest indicator of acute infection in acute Hepatitis B?Your Answer: Hepatitis B surface Ag
Explanation:HBsAg is the serological hallmark of HBV infection. After an acute exposure to HBV, HBsAg appears in serum within 1 to 10 weeks. Persistence of this marker for more than 6 months implies chronic HBV infection.
Anti-HBs is known as a neutralizing antibody, and confers long-term immunity. In patients with acquired immunity through vaccination, anti-HBs is the only serological marker detected in serum.
HBcAg is an intracellular presence in infected hepatocyte, thus it is not identified in the serum. During acute infection, anti-HBc IgM and IgG emerges 1–2 weeks after the presence of HBsAg along with raised serum aminotransferase and symptoms. After 6 months of acute infection, anti-HBc IgM wears off. Anti-HBc IgG continues to detect in both patients with resolved HBV infection and chronic hepatitis B.
Hepatitis D virus, also known as the delta hepatitis virus, is a defective ssRNA virus that requires HBV for replication. The infection can occur in one of two clinical forms, co-infection or superinfection. In a co-infection, the patient is simultaneously infected with HBV and HDV. In a superinfection, an HDV infection develops in a patient with a chronic HBV infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 31
Incorrect
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A 72-year-old man presents with chest pain that is characteristic of angina. You administer a dose of glyceryl trinitrate (GTN), which rapidly resolved his symptoms. Unfortunately, he also develops an unpleasant side effect.
Which of the following side effects is he most likely to have developed? Select ONE answer only.Your Answer: Cyanosis
Correct Answer: Headache
Explanation:Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.
The following are common or very common side effects of nitrates
Arrhythmias
Asthenia
Cerebral ischaemia
Dizziness
Drowsiness
Flushing
Headache
Hypotension
Nausea and vomiting
Diarrhoea, syncope and cyanosis can occur, but these are rare side effects. Dry eyes, bradycardia and metabolic acidosis have not been reported. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 32
Incorrect
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A 45-year-old African American male presents to your clinic complaining of swelling of his feet for the past six months. On examination, there is periorbital and pedal oedema. A 24-hour urine collection is ordered, which shows 8 g of protein. The serum cholesterol is ten mmol/L. You order a renal biopsy to confirm the diagnosis.
Which one of the following findings are you most likely to see in this patient's biopsy?Your Answer: Minimal change disease
Correct Answer: Focal segmental glomerulosclerosis
Explanation:This patient has Nephrotic Syndrome confirmed by the presence of 1. Heavy proteinuria (greater than 3-3.5 g/24 hours)
2. Hypoalbuminemia (serum albumin < 25 g/L)
3. Generalised oedema (often with periorbital involvement)
4. Severe hyperlipidaemia (total cholesterol is often > 10 mmol/L).Focal Segmental Glomerulosclerosis will be the most likely answer as it is the most common cause of Nephrotic Syndrome in African American adults.
Minimal change disease is the most common cause of nephrotic syndrome in children.
Membranous glomerulonephritis is the most common cause of Nephrotic Syndrome in Caucasian adults.
In IgA nephropathy, patients will complain of cola-coloured urine.
Mesangiocapillary glomerulonephritis presents with features of Nephritic Syndrome.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 33
Incorrect
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A 15-year-old male is admitted to a rehabilitation centre with a history of multiple strokes, myopathy and learning disabilities since childhood. He is under the care of a multidisciplinary team, and his genetic testing reports show the presence of a mitochondrial disorder.
Which one of the following diseases does this patient most likely have?Your Answer: Glucose-6-phosphate dehydrogenase deficiency
Correct Answer: MELAS
Explanation:Mitochondrial diseases are a group of disorders caused by dysfunctional mitochondria. Most cases are maternally inherited, as we inherit our mitochondrial DNA from our mothers only, although mutations in nuclear DNA cause some cases.
Examples of Mitochondrial Diseases include:
1. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)
2. Mitochondrial epilepsy with ragged red fibres (MERRF)
3. Leber’s hereditary optic neuropathy (LHON)
4. Diabetes mellitus and deafness (DAD)
5. Neuropathy, ataxia, retinitis pigmentosa, and ptosis (NARP)
6. Leigh syndrome (subacute sclerosing encephalopathy).Red-green colour blindness and G6PD deficiency have an X-linked recessive pattern of inheritance.
Tay-Sachs Disease and spinal muscular atrophy have an autosomal recessive pattern of inheritance.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 34
Incorrect
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Which of the following statements is correct regarding the partial pressure of oxygen during respiration?
Your Answer: Exhaled PO 2 > Inhaled PO 2
Correct Answer: Exhaled PO 2 > Alveolar PO 2
Explanation:Because of humidification, inspired PO2 in the airways is less than inhaled PO2.
Because of gas exchange, alveolar PO2 is less than inhaled or inspired PO2.
Because of mixing with anatomical dead space (air that has not taken part in gas exchange, exhaled PO2 is greater than alveolar O2, and therefore that has relatively higher PO2 on the way out, but is less than inhaled or inspired PO2.
Typical values for a resting young healthy male (in kPa) are shown below:
-Inhaled air: PO221.2, PCO20.0
-Inspired air in airways (after humidification): PO219.9, PCO20.0
-Alveolar air (after equilibrium with pulmonary capillaries): PO213.3, PCO25.3
-Exhaled air (after mixing with anatomical dead space air): PO215.5, PCO24.3 -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 35
Incorrect
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Which extraocular muscle is entrapped in a patient with a blowout fracture?
Your Answer: Inferior oblique
Correct Answer: Inferior rectus
Explanation:A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. The common mechanisms are falls, high-velocity ball-related sports, traffic accidents, and interpersonal violence.
The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bones. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles.
The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. Finally, the orbital injury can lead to retinal oedema, hyphema, and significant loss of vision.
While some cases may be managed with conservative care, others may require some type of surgical intervention.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 36
Incorrect
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In the ventricular myocyte action potential, depolarisation occurs through the opening of:
Your Answer: Voltage-gated Ca 2+ channels
Correct Answer: Voltage-gated Na + channels
Explanation:An action potential (AP) is initiated when the myocyte is depolarised to a threshold potential of about -65 mV, as a result of transmission from an adjacent myocyte via gap junctions. Fast voltage-gated Na+channels are activated and a Na+influx depolarises the membrane rapidly to about +30 mV. This initial depolarisation is similar to that in nerve and skeletal muscle, and assists the transmission to the next myocyte.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 37
Correct
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Which of the following statements is correct regarding anti-D immunoglobulin?
Your Answer: It is administered as part of routine antenatal care for rhesus-negative mothers.
Explanation:In all non-sensitised pregnant women who are RhD-negative, it is recommended that routine antenatal anti-D prophylaxis is offered. Even if there is previous anti-D prophylaxis, use of routine antenatal anti-D prophylaxis should be given for a sensitising event early in the same pregnancy. Postpartum anti-D prophylaxis should also be given even if there has been previous routine antenatal anti-D prophylaxis or antenatal anti-D prophylaxis for a sensitising event in the same pregnancy.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 38
Incorrect
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Excessive gastric acid output is detected in a patient with a history of recurrent stomach ulcers. It's possible that the patient has Zollinger-Ellison syndrome.
Which of the following statements about stomach acid is correct?Your Answer: Secretion occurs via passive transport
Correct Answer: The proton pump located in the canalicular membrane is vital to its secretion
Explanation:The stomach produces gastric acid, which is a digesting fluid. The stomach secretes about 2-3 litres every day. It is involved in tissue breakdown, the conversion of pepsinogen to active pepsin, and the creation of soluble salts with calcium and iron, and has a pH range of 1.5-3.5. It also serves as an immune system by destroying microbes.
The following substances are found in gastric acid:
Water
Acid hydrochloride
Pepsinogen
mucous
Intrinsic factorThe parietal cells in the proximal 2/3 (body) of the stomach release gastric acid. The concentration of hydrogen ions in parietal cell secretions is 1-2 million times that of blood. Chloride is released against both a concentration and an electric gradient, and active transport is required for the parietal cell to produce acid.
The following is how stomach acid is secreted:
1. Gastric acid secretion is dependent on the H+/K+ ATPase (proton pump) situated in the canalicular membrane. The breakdown of water produces hydrogen ions within the parietal cell. The hydroxyl ions produced in this reaction mix quickly with carbon dioxide to generate bicarbonate ions. Carbonic anhydrase is the enzyme that catalyses this process.
2. In return for chloride, bicarbonate is carried out of the basolateral membrane. The ‘alkaline tide’ occurs when bicarbonate is released into the bloodstream, resulting in a modest rise in blood pH. The parietal cell’s intracellular pH is maintained by this procedure. Conductance channels carry chloride and potassium ions into the lumen of canaliculi.
3. Through the action of the proton pump, hydrogen ions are pushed out of the cell and into the lumen in exchange for potassium; potassium is thus efficiently recycled.
4. The canaliculi accumulate osmotically active hydrogen ions, which creates an osmotic gradient across the membrane, allowing water to diffuse outward.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 39
Correct
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Which of the following vitamins is not paired correctly with its deficiency syndrome:
Your Answer: Vitamin B12 - Wernicke-Korsakoff syndrome
Explanation:Clinical Effects of vitamin deficiency include:
Vitamin C – Scurvy
Thiamine (Vitamin B1) – Beriberi/Wernicke-Korsakoff syndrome
Vitamin B12 – Megaloblastic anaemia/Subacute combined degeneration of spinal cord
Folate – Megaloblastic anaemia
Vitamin D – Osteomalacia/Rickets
Vitamin K – Defective clotting
Vitamin A – Blindness -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 40
Correct
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The 'bucket handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The middles of the shafts of the ribs moving upwards and laterally
Explanation:Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 41
Incorrect
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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: Multiple Myeloma
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
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Question 42
Incorrect
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Pressure across the wall of a flexible tube (the transmural pressure) increases wall tension and extends it.
Which law best describes transmural pressure?
Your Answer: Fick’s law
Correct Answer: Laplace’s law
Explanation:The transmural pressure (pressure across the wall of a flexible tube) can be described by Laplace’s law which states that:
Transmural pressure = (Tw) / r
Where:
T = Wall tension
w = Wall thickness
r = The radius
A small bubble with the same wall tension as a larger bubble will contain higher pressure and will collapse into the larger bubble if the two meet and join.Fick’s law describes the rate of diffusion in a solution
Poiseuille’s law is used to calculate volume of flow rate in laminar flow
Darcy’s law describes the flow of a fluid through a porous medium.
Starling’s law describes cardiac haemodynamics as it relates to myocyte contractility and stretch.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 43
Incorrect
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A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.
Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.Your Answer: Deep peroneal nerve
Correct Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.
Peroneus longus is innervated by the superficial peroneal nerve.
Peroneus tertius is innervated by the deep peroneal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 44
Incorrect
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Depolarisation of a neuron begins with which of the following:
Your Answer: Opening of voltage-gated Na + channels
Correct Answer: Opening of ligand-gated Na + channels
Explanation:Action potentials are initiated in nerves by activation of ligand-gated Na+channels by neurotransmitters. Opening of these Na+channels results in a small influx of sodium and depolarisation of the negative resting membrane potential (-70 mV). If the stimulus is sufficiently strong, the resting membrane depolarises enough to reach threshold potential (generally around -55 mV), at which point an action potential can occur. Voltage-gated Na+channels open, causing further depolarisation and activating more voltage-gated Na+channels and there is a sudden and massive sodium influx, driving the cell membrane potential to about +40 mV.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 45
Correct
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The primary mechanism of action of ketamine is:
Your Answer: N-methyl-D-aspartate (NMDA)-receptor antagonist
Explanation:Ketamine is a non-competitive antagonist of the calcium-ion channel in the NMDA (N-methyl-D-aspartate) receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
Overdose may lead to panic attacks and aggressive behaviour; rarely seizures, increased ICP, and cardiac arrest
Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 46
Correct
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Regarding flow through a tube, which of the following statements is CORRECT:
Your Answer: Polycythaemia will decrease the rate of blood flow through a vessel.
Explanation:Darcy’s law states that flow through a tube is dependent on the pressure differences across the ends of the tube (P1 – P2) and the resistance to flow provided by the tube (R). Resistance is due to frictional forces and is determined by the length of the tube (L), the radius of the tube (r) and the viscosity of the fluid flowing down that tube (V). The radius of the tube has the largest effect on resistance and therefore flow – this explains why smaller gauge cannulas with larger diameters have a faster rate of flow. Increased viscosity, as seen in polycythemia, will slow the rate of blood flow through a vessel.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 47
Incorrect
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A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke.
Which of the following is considered the best diagnosis for the case presented above?Your Answer: Weber’s syndrome
Correct Answer: Medial medullary syndrome
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.
It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 48
Incorrect
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Which of the following statements is correct regarding hyponatraemia?
Your Answer: Hyponatraemia is defined as a serum sodium concentration < 145 mmol/L
Correct Answer: Correction of serum sodium that is too rapid can precipitate central pontine myelinolysis.
Explanation:Hyponatraemia refers to a serum sodium concentration < 135 mmol/L.
It is safer to quickly correct acute hyponatremia than chronic hyponatremia but correction should not be too fast, especially in chronic hyponatraemia, because of the risk of central pontine myelinolysis. Hyponatraemia is usually associated with a low plasma osmolality.
Under normal circumstances, if serum osmolality is low, then urine osmolality should also be low because the kidneys should be trying to retain solute.
In SIADH, excess ADH causes water retention, but not the retention of solute. Therefore, urine that is concentrated and relatively high in sodium is produced, even though the serum sodium is low (urine osmolality > 100 mosmol/kg). -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 49
Incorrect
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The last two segments of the nephrons are the distal convoluted tubule (DCT) and collecting duct (CD).
Which cell reabsorbs sodium more in the late DCT and CD?Your Answer: Intercalated cells
Correct Answer: Principal cells
Explanation:The main Na+ reabsorbing cells in the late distal convoluted tubule and collecting duct are the principal cells. These make up the majority of the tubular cells.
The exchange is driven by the Na.K.ATPase pumps on the basolateral membrane.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 50
Incorrect
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A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is diagnosed with hyperaldosteronism.
Which of these is the commonest cause of hyperaldosteronism?
Your Answer: Renal artery stenosis
Correct Answer: Adrenal adenoma
Explanation:When there are excessive circulating levels of aldosterone, hyperaldosteronism occurs. There are two main types of hyperaldosteronism:
Primary hyperaldosteronism (,95% of cases)
Secondary hyperaldosteronism (,5% of cases)Primary causes of hyperaldosteronism include:
Adrenal adenoma (Conn’s syndrome)
Adrenal hyperplasia
Adrenal cancer
Familial aldosteronism
Secondary causes of hyperaldosteronism include:
Drugs
Obstructive renal artery disease
Renal vasoconstriction
Oedematous disorders syndromeAdrenal adenoma is the commonest cause of hyperaldosteronism (seen in ,80% of all cases).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
