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Question 1
Correct
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A tumour compresses the jugular foramen of a 50-year-old patient. Compression of several nerves in the jugular foramen will result in which of the following complications?
Your Answer: Loss of gag reflex
Explanation:The glossopharyngeal nerve, which is responsible for the afferent pathway of the gag reflex, the vagus nerve, which is responsible for the efferent pathway of the gag reflex, and the spinal accessory nerve all exit the skull through the jugular foramen. These nerves are most frequently affected if the jugular foramen is compressed. As a result, the patient’s gag reflex is impaired.
The vestibulocochlear nerve is primarily responsible for hearing. The trigeminal nerve provides sensation in the face. The facial nerve innervates the muscles of face expression (including those responsible for closing the eye). Tongue motions are controlled mostly by the hypoglossal nerve.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 2
Correct
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A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?
Your Answer: Cranial diabetes insipidus
Explanation:Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes.
The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus.
By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone.
Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output.
Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 3
Correct
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A 34-year-old male is brought into the Emergency Department by the paramedics after a road traffic accident. After a quick triage, you establish that he will need to be intubated, and you ask for some ketamine to be prepared.
Which one of the following options regarding this drug is true?Your Answer: It is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties
Explanation:Ketamine is a dissociative anaesthetic with analgesic, amnesic, and hypnotic effects. It is the only anaesthetic agent which causes all three of these effects.
Ketamine exerts its action by non-competitive antagonism at the NMDA (N-methyl-D-aspartate) receptor. Due to its analgesic property, Ketamine is given so that patients do not retain memories of short term procedures. Ketamine is used for the induction and maintenance of anaesthesia in general surgery and for treating burn wounds, battlefield injuries, and children who cannot tolerate other anaesthetic or analgesic agents.
It can be given by both intravenous and intramuscular routes. Ketamine causes cardiac stimulation by increasing the sympathetic tone. The major side effect is increased intracranial pressure as an increase in the sympathetic tone causes vasoconstriction and an increase in the MAP.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 4
Correct
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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: 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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 5
Correct
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Which of the following clinical features is a feature of a chronic extravascular haemolytic anaemia:
Your Answer: Gallstones
Explanation:Clinical features of haemolytic anaemia include:
Anaemia
Jaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)
Pigment gallstones
Splenomegaly
Ankle ulcers
Expansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia major
Aplastic crisis caused by parvovirus -
This question is part of the following fields:
- Haematology
- Pathology
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Question 6
Incorrect
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A study investigating the risk of suffering a stroke in patients with atrial fibrillation taking the new antiplatelet drug ticagrelor, compared with standard treatment with warfarin is done over a 2-year time period. 30 of the 300 patients taking ticagrelor and 20 of the 500 patients taking warfarin suffered a stroke over the 2-year period.
One of these statements is true regarding the outcomes of this study.
Your Answer: The absolute risk in the warfarin group is 0.1
Correct Answer: Ticagrelor increases the risk of stroke
Explanation:Absolute risk and relative risk are used to assess the strength of a relationship between a disease and a factor that may affect it.
Absolute risk (AR) is the risk of developing a disease over a time period:
AR = the number of events that occur in a group / number of people in that groupThe absolute risk reduction (ARR) is the difference between the absolute risk in the control group (ARC) and the absolute risk in the treated group (ART).
ARR = ARC – ART
The control group is the warfarin group, therefore the ARC is 20/500 (0.04).
Treatment group is the ticagrelor group and ART = 30/300 (0.1).ARR = 0.04 – 0.1 = -0.06. This shows that treatment with ticagrelor increases risk of developing stroke. This is also termed a relative risk increase.
Relative risk, or risk ratio, (RR) is used to compare the risk in the two different groups. It is the ratio of the absolute risks of the disease in the treatment group (ART) to the absolute risk of the disease in the control group (ARC):
RR=ART /ARCTherefore RR = 0.1 / 0.04 = 2.5
RR < 1 means the intervention reduces the risk of the outcome being studied
RR = 1 means the treatment has no effect on the outcome being studied
RR > 1 means the intervention increased the risk of the outcome being studied
Since RR is 2.5, ticagrelor increases the risk of stroke.SUMMARY
Absolute risk reduction is -0.06
Absolute risk in warfarin group = 0.04
Relative risk = 2.5
Ticagrelor has no effect on stroke is incorrect because RR is not =1 -
This question is part of the following fields:
- Evidence Based Medicine
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Question 7
Correct
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Amoxicillin is used first line for all of the following infections EXCEPT for:
Your Answer: Cellulitis
Explanation:Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI). Flucloxacillin is used first line for acute cellulitis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 8
Correct
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Which of the following globin chains makes up normal adult haemoglobin (HbA)?
Your Answer: Two alpha and two beta chains
Explanation:Total adult haemoglobin comprises about 96 – 98 % of normal adult haemoglobin (HbA). It consists of two alpha (α) and two beta (β) globin chains.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 9
Correct
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A 28 year old man presents with abdominal pain and constipation, and bloods show hypocalcaemia. Which of the following hormones is increased as a result of hypocalcaemia?
Your Answer: Parathyroid hormone
Explanation:Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone that is secreted by the parathyroid glands, which lie immediately behind the thyroid gland. In particular, this hormone is made by chief cells. It regulates the serum calcium concentration through its effects on bone, kidney, and intestine. This hormone is primarily released in response to decreasing plasma Ca2+ concentration and it serves to increase plasma calcium levels and decrease plasma phosphate levels.
PTH activates Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane and as a result, increases calcium reabsorption in the distal tubule of the nephron. It inhibits reabsorption of phosphate and this increases its excretion by in the proximal tubule of the nephron. -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 10
Correct
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You're taking a history of a 59-year-old banker who has had heartburn in the past.
Which of the following information about antacids is correct?Your Answer: Magnesium carbonate can reduce the absorption of drugs taken at the same time
Explanation:Antacids such as aluminium hydroxide and magnesium carbonate are commonly used. They’re both water-insoluble and can reduce the absorption of drugs taken together. Allow at least 1-2 hours between taking these antacids and any other medications.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium carbonate has a laxative effect, whereas aluminium hydroxide has a constipating effect.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 11
Incorrect
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Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:
Your Answer: Insulin
Correct Answer: Calcium gluconate
Explanation:Calcium gluconate is given to antagonise cardiac cell membrane excitability to reduce the risk of arrhythmias. It has no effect on serum potassium levels unlike the alternative drugs listed above.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 12
Incorrect
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Gastrin release from antral G-cells is stimulated by all but which one of the following:
Your Answer: Raised gastric pH
Correct Answer: Secretin
Explanation:Gastrin secretion is stimulated by:
The presence of small peptides and amino acids in chyme
Gastric distension
Vagal stimulation directly via acetylcholine and indirectly via gastrin-releasing peptide (GRP)
Raised gastric pH -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 13
Incorrect
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The pelvic bone is formed by which of the following:
Your Answer: Ilium and pubis
Correct Answer: Ilium, ischium and pubis
Explanation:Each pelvic bone is formed by three elements: the ilium (superiorly), the pubis (anteroinferiorly) and the ischium (posteroinferiorly).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Correct
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How does dipyridamole mediate its antiplatelet effect:
Your Answer: It is a phosphodiesterase inhibitor.
Explanation:Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Correct
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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: 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 16
Incorrect
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All of the following statements are considered true regarding randomized control trials, except:
Your Answer: They can increase the power to study the effects of interest
Correct Answer: They can eliminate the need for further studies
Explanation:Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis. The examination of variability or heterogeneity in study results is also a critical outcome.
The benefits of meta-analysis include a consolidated and quantitative review of a large, and often complex, sometimes apparently conflicting, body of literature. The specification of the outcome and hypotheses that are tested is critical to the conduct of meta-analyses, as is a sensitive literature search.Important medical questions are typically studied more than once, often by different research teams in different locations. In many instances, the results of these multiple small studies of an issue are diverse and conflicting, which makes the clinical decision-making difficult. The need to arrive at decisions affecting clinical practise fostered the momentum toward evidence-based medicine. Evidence-based medicine may be defined as the systematic, quantitative, preferentially experimental approach to obtaining and using medical information. Therefore, meta-analysis, a statistical procedure that integrates the results of several independent studies, plays a central role in evidence-based medicine.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 17
Incorrect
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Question 18
Incorrect
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Regarding the cardiac cycle, which of the following statements is INCORRECT:
Your Answer: Diastole is usually twice the length of systole.
Correct Answer: The second heart sound occurs in late diastole caused by closure of the atrioventricular valves.
Explanation:Diastole is usually twice the length of systole at rest, but decreases with increased heart rate. During systole, contraction of the ventricles compresses the coronary arteries and suppresses blood flow. This is particularly evident in the left ventricle, where during systole the ventricular pressure is the same as or greater than that in the arteries and as a result more than 85% of left ventricular perfusion occurs during diastole. This becomes a problem if the heart rate is increased as the diastolic interval is shorter and can result in ischaemia. The second heart sound, caused by closure of the semilunar valves, marks the end of systole.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 19
Incorrect
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Regarding the flexor digitorum profundus muscle, which of the following is true?
Your Answer: The entire muscle is innervated by the median nerve
Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve
Explanation:Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.
Flexor digitorum profundus has a dual innervation:
(1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);
(2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Correct
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Regarding the resting membrane potential, which of the following statements is CORRECT:
Your Answer: The resting cell membrane is more permeable to K + ions than to Na + ions.
Explanation:A membrane potential is a property of all cell membranes, but the ability to generate an action potential is only a property of excitable tissues. The resting membrane is more permeable to K+and Cl-than to other ions (and relatively impermeable to Na+); therefore the resting membrane potential is primarily determined by the K+equilibrium potential. At rest the inside of the cell is negative relative to the outside. In most neurones the resting potential has a value of approximately -70 mV.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 21
Incorrect
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Which of the following is NOT an indication for a H1 receptor antihistamine:
Your Answer: Allergic rhinitis
Correct Answer: Gastroesophageal reflux disease
Explanation:Antihistamines are competitive inhibitors at the H1-receptor (in contrast to H2 receptor antagonists used to decrease gastric acid secretion in gastroesophageal reflux disease).
Indications:
Allergic rhinitis and conjunctivitis
Urticarial rashes, pruritus, insect bites and stings
Angioedema
Anaphylaxis (second line adjunct to adrenaline)
Nausea/vomiting and prevention of motion sickness
Insomnia -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 22
Incorrect
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After a work-related accident, a 33-year old male is taken to the emergency room with difficulty in adduction and flexion of his left arm at the glenohumeral joint. The attending physician is suspects involvement of the coracobrachialis muscle.
The nerve injured in the case above is?Your Answer: The suprascapular nerve
Correct Answer: The musculocutaneous nerve
Explanation:The coracobrachialis muscle is innervated by the musculocutaneous nerve (C5-C7) a branch of the lateral cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 23
Incorrect
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A 52-year old male comes to the out-patient department for a groin mass that protrudes when standing. The patient notes that it is reducible when lying down. On physical examination, there is presence of a cough impulse. The initial assessment is hernia. Further investigation reveals that the mass lies lateral to the epigastric vessels.
Among the types of hernia, which is the most likely diagnosis of the case above?Your Answer: Direct inguinal hernia
Correct Answer: Indirect inguinal hernia
Explanation:Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.
Groin hernias are categorized into 2 main categories: inguinal and femoral.
Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.
A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 24
Incorrect
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Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given:
Your Answer: At a concentration of 1 unit/mL at a fixed rate of 0.2 units/kg/hour
Correct Answer: At a concentration of 1 unit/mL at a fixed rate of 0.1 units/kg/hour
Explanation:An intravenous insulin infusion should be started at a concentration of 1 unit/mL, at a fixed rate of 0.1 units/kg/hour. Established subcutaneous long-acting insulin therapy should be continued concomitantly. Blood ketone and blood glucose concentrations should be checked hourly and the insulin infusion rate adjusted accordingly. Blood ketone concentration should fall by at least 0.5 mmol/litre/hour and blood glucose concentration should fall by at least 3 mmol/litre/hour.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 25
Incorrect
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Arterial baroreceptors are located primarily in which of the following:
Your Answer: Ascending aorta
Correct Answer: Carotid sinus and aortic arch
Explanation:Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 26
Incorrect
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Which of the following causes increased aldosterone secretion:
Your Answer: Hyperosmolarity
Correct Answer: Decreased blood volume
Explanation:Decreased blood volume stimulates the secretion of renin (because of decreased renal perfusion pressure) and initiates the renin-angiotensin-aldosterone cascade. Angiotensin-converting enzyme (ACE) inhibitors block the cascade by decreasing the production of angiotensin. Hyperosmolarity stimulates antidiuretic hormone (ADH) [not aldosterone] secretion. Hyperkalaemia, not hypokalaemia, directly stimulates aldosterone secretion by the adrenal cortex. ANPÂ inhibits renin secretion, thereby inhibiting the production of angiotensin and aldosterone.
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This question is part of the following fields:
- Physiology
- Renal
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Question 27
Incorrect
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Regarding Clostridium difficile, which of the following statements is CORRECT:
Your Answer: It has endotoxin-mediated effects causing profuse watery diarrhoea.
Correct Answer: It is normally found in gut flora.
Explanation:C. difficile is normally found in the gut flora but its growth is normally suppressed by more dominant anaerobes. It has exotoxin-mediated effects causing profuse diarrhoea. Oral clindamycin (a broad spectrum antibiotic) is commonly implicated in precipitating C. difficile colitis; first line treatment is with oral metronidazole. Tetanolysin is a toxin produced by Clostridium tetani bacteria.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 28
Correct
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In adult advanced life support, which of the following best describes the correct administration of adrenaline for a non-shockable rhythm:
Your Answer: Give 1 mg of adrenaline as soon as intravenous access is achieved and every 3 - 5 minutes thereafter
Explanation:IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 29
Incorrect
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Regarding skeletal muscle contraction, which of the following statements is CORRECT:
Your Answer: Motor units can contract in a graded fashion.
Correct Answer: The force of contraction of a muscle can be controlled by increasing recruitment of motor units.
Explanation:Each motor unit contracts in an all or nothing fashion, i.e. if a motor unit is excited, it will stimulate all of its muscle fibres to contract. The force of contraction of a muscle is controlled by varying the motor unit recruitment (spatial summation), and by varying the firing rate of the motor units (temporal summation). During a gradual increase in contraction of a muscle, the first units start to discharge and increase their firing rate, and, as the force needs to increase, new units are recruited and, in turn, also increase their firing rate. For most motor units, the firing rate for a steady contraction is between 5 and 8 Hz. Because the unitary firing rates for each motor unit are different and not synchronised, the overall effect is a smooth force profile from the muscle. Increasing the firing rate of motor units is temporal summation where the tension developed by the first action potential has not completely decayed when the second action potential and twitch is grafted onto the first and so on. If the muscle fibres are stimulated repeatedly at a faster frequency, a sustained contraction results where it is not possible to detect individual twitches. This is called tetanus.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 30
Incorrect
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Which statement regarding skeletal muscle is true?
Your Answer: Thin filaments contain more tropomyosin than troponin
Correct Answer: Myosin is the major constituent of the thick filament
Explanation:Myosin is the major constituent of the thick filament.
Actin is the major constituent of the THIN filament.
Thin filaments consist of actin, tropomyosin and troponin in the ratio 7:1:1.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 31
Correct
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What kind of function loss do you anticipate in a 22-year-old guy who had a laceration to his arm, resulting in nerve damage in the antecubital fossa?
Your Answer: Opposition of thumb
Explanation:The symptoms of median nerve injury include tingling or numbness in the forearm, thumb, and three adjacent fingers, as well as gripping weakness and the inability to move the thumb across the palm.
Because the thenar muscles and the flexor pollicis longus are paralyzed, flexion, abduction, and opposition of the thumb at the MCPJ and IPJ are gone.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 32
Incorrect
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Regarding threadworms, which of the following statements is CORRECT:
Your Answer: Threadworms live in the anal canal.
Correct Answer: First line treatment of threadworms is with mebendazole.
Explanation:First line treatment of threadworms is with mebendazole, with treatment of the whole family, and a repeat treatment after 2 weeks. Threadworms live in the large bowel, but direct multiplication of worms does not occur here. Threadworms most commonly infect children, and may be symptomatic or cause pruritus ani.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 33
Incorrect
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The most common cause of anaemia worldwide is which of the following?
Your Answer: Megaloblastic anaemia
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of microcytic anaemia and of any anaemia worldwide is iron deficiency anaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 34
Incorrect
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You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her�with Cushing's syndrome.
When would her random cortisol level likely be abnormal?Your Answer: 1200 hrs
Correct Answer: 2400 hrs
Explanation:Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep.
The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 35
Incorrect
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A 6 year old boy is brought into the ED by his mom with a rash that is associated with Koplik's spots and a diagnosis of measles is made. What advice should be given about returning to school?
Your Answer: Once mucosal involvement has resolved
Correct Answer: 4 days from the onset of the rash
Explanation:Prevention of spread of measles is extremely important and infected patients should be isolated. The infectious stage is from 3 days before the rash emerges and patients are advised to stay away from school/nursery/work for 4 days from onset of the rash.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 36
Incorrect
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Which of the following statements about lithium treatment is FALSE:
Your Answer: A serum-lithium concentration of 0.4 – 1 mmol/litre is therapeutic.
Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.
Explanation:Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.
Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 37
Incorrect
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You review an 18-months-old child who seems to be having a reaction following an immunisation she took earlier in the day.
Which statement concerning immunity and vaccination is true?Your Answer: Immunity is conferred approximately 1 week after injection of immunoglobulin
Correct Answer: The strongest immunological response is seen with natural immunity
Explanation:Vaccination induces ACTIVE adaptive immunity. Actively acquired immunity involves the development of an immune response either due to vaccination or natural exposure to a pathogen and leads to long-lasting resistance to infection.
Immediate protection is achieved with injection of immunoglobulin. The protection is transient lasting only a few weeks and is useful as post-exposure prophylaxis.
Passively acquired immunity usually leads to short-lasting resistance to infection because it does not involve a host immune response.
With inactivated bacteria, a series of primary vaccinations is usually required to induce an adequate immune response. In most cases, boosters are required to sustain adequate immunity.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 38
Incorrect
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A 32-year-old female is diagnosed case of bipolar disorder and is on medication. She presents to her psychiatric team with symptoms of severe depression. She is currently taking Lithium.
Out of the following, which is TRUE regarding lithium?Your Answer: Levels should be checked one month after starting therapy
Correct Answer: It commonly causes a tremor
Explanation:Lithium is the drug of choice for bipolar disorders but is commonly associated with side effects and toxicity.
Fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy with Lithium. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer. Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremors.
Option The normal therapeutic range is 2.0-2.5 mmol/l: Lithium should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l. Levels should be checked one week after starting therapy and one week after every change in dosage. (Option Levels should be checked one month after starting therapy)
Option It can induce hyperthyroidism: Lithium has a known effect on thyroid function. Lithium decreases the production of T4 and T3 and commonly causes hypothyroidism. More rarely, lithium causes hyperthyroidism due to thyroiditis.
Option It can induce diabetes mellitus: Lithium can induce nephrogenic diabetes insipidus but not diabetes mellitus.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 39
Incorrect
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A 20-year-old male receives a small cut over his hand while climbing a fence causing it to bleed. Upon applying pressure for a few minutes, the bleeding stops. Which one of the following physiological components of the blood is responsible for the primary haemostasis reaction, such as in this case?
Your Answer: Conversion of fibrinogen to fibrin
Correct Answer: Platelet plug formation
Explanation:Haemostasis is your body’s defence against an injury that causes bleeding. It stops bleeding in three main steps:
1) Primary haemostasis – formation of a weak platelet plug
– The primary reaction of the body is to cause local vasoconstriction at the site of injury and decrease blood flow to the affected area
– the release of cytokines and inflammatory markers lead to adhesion of platelets and aggregation at the site of injury forming a platelet plug
– the injured vessel wall has exposed subendothelial collagen that releases von Willebrand factorAny damage to the vessel wall causes the release of the Von Willebrand factor, which is necessary for platelet adhesion. Tissue Thromboplastin is also released, which activates the coagulation pathway, a component of secondary haemostasis. The coagulation cascade ultimately results in the conversion of fibrinogen to fibrin.
2) Secondary haemostasis
3) FibrinolysisFibrin (factor Ia) is a long, thin protein with branches produced at the end of the coagulation cascade when fibrinogen (factor I) is converted to fibrin, which stabilizes the blood clot.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 40
Incorrect
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Which of the following pathogens is most commonly implicated in croup:
Your Answer: Respiratory syncytial virus
Correct Answer: Parainfluenza
Explanation:Parainfluenza virus is the most commonly implicated infectious agent in croup.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 41
Incorrect
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Which of the following is NOT a feature characteristic of intravascular haemolysis:
Your Answer: Haemosiderinuria
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 42
Incorrect
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Regarding hepatitis B, which of the following statements is CORRECT:
Your Answer: Hepatitis B vaccination is not part of routine childhood immunisation.
Correct Answer: Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months.
Explanation:Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months. Hepatitis B has a long incubation period of about 2 – 6 months. Hepatitis B vaccine has recently been introduced to the routine childhood immunisation schedule – given at 2, 3 and 4 months. It is also given to babies born to hepatitis B infected mothers at birth, four weeks and 12 months old. Treatment of acute hepatitis is supportive. Treatment with antivirals should be considered in chronic infection as responders have a reduced risk of liver damage and liver cancer in the long term.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 43
Incorrect
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A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate, nasal regurgitation of food, and nasal quality to the voice.
Which of the following cranial nerves is most likely responsible for the aforementioned features?Your Answer: Hypoglossal nerve
Correct Answer: Vagus nerve
Explanation:The vagus nerve, ‘the wanderer’, contains motor fibres (to the palate and vocal cords), sensory components (posterior and floor of external acoustic meatus) and visceral afferent and efferent fibres.
Palatal weakness can cause nasal speech and nasal regurgitation of food. The palate moves asymmetrically when the patient says ‘ahh’. Recurrent nerve palsy results in hoarseness, loss of volume and ‘bovine cough’.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 44
Incorrect
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Hepatitis A is transmitted by which of the following routes:
Your Answer: Direct skin contact
Correct Answer: Faecal-oral route
Explanation:Hepatitis A transmission is by the faecal-oral route; the virus is excreted in bile and shed in the faeces of infected people.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 45
Incorrect
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A 27 year old woman presents to ED having sustained a deep laceration to the dorsum of her ring finger whilst cooking. Her proximal interphalangeal joint is fixed in flexion and the distal interphalangeal joint is hyperextended. Which of the following structures in the digit has most likely been injured:
Your Answer: Insertion of the flexor digitorum superficialis
Correct Answer: Insertion of the central slip of the extensor tendon
Explanation:Damage to the central slip of the extensor digitorum tendon would result in loss of extension at the proximal interphalangeal joint resulting in a fixed flexion deformity of this joint, and hyperextension of the distal interphalangeal joint due to a loss of balancing forces. This is called the Boutonniere deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 46
Correct
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A 65-year-old man presents with a red, hot, swollen great toe. A diagnosis of acute gout is made. His past medical history includes heart failure and type 2 diabetes mellitus.
Which of the following is the most appropriate medication to use in the treatment of his gout? Select ONE answer only.Your Answer: Colchicine
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 47
Incorrect
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An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:
Your Answer: Descending limb
Correct Answer: Thick ascending limb
Explanation:Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 48
Incorrect
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Which of the following does NOT typically cause a neutrophil leucocytosis:
Your Answer: Myeloproliferative disorders
Correct Answer: Glandular fever
Explanation:Causes of neutrophil leucocytosis:
Bacterial infection
Inflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)
Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)
Pregnancy
Acute haemorrhage or haemolysis
Neoplasms of all types
Drugs (e.g. corticosteroid therapy, lithium, tetracyclines)
Asplenia
Myeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)
Rare inherited disorders -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 49
Incorrect
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A 29-year-old woman with a skin infection not responding to first-line antibiotics return for a review clinic appointment. The result of her culture shows growth of methicillin-resistant Staphylococcus aureus (MRSA).
Which among the following antibiotics is methicillin-resistant Staphylococcus aureus usually sensitive to?Your Answer: Imipenem
Correct Answer: Linezolid
Explanation:Historically, MRSA has been treated successfully with outpatient oral sulphonamides, clindamycin, rifampin, doxycycline, or a combination of these agents. With the development of increasing drug resistance of MRSA to these traditional antimicrobials, there has been a search for more effective antibiotics. One recent study demonstrated that vancomycin, linezolid, and quinupristin-dalfopristin were the most effective antibiotics against multiple strains of MRSA.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 50
Incorrect
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The resting membrane potential of a neurone is usually about:
Your Answer:
Correct Answer: -70 mV
Explanation:In most neurones the resting potential has a value of approximately -70 mV. The threshold potential is generally around -55 mV. Initial depolarisation occurs as a result of a Na+influx through ligand-gated Na+channels. Action potential is an all or nothing response; because the size of the action potential is constant, the intensity of the stimulus is coded by the frequency of firing of a neuron. Repolarisation occurs primarily due to K+efflux.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
