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  • Question 1 - Which of the following is NOT a typical clinical feature of diabetic ketoacidosis:...

    Correct

    • Which of the following is NOT a typical clinical feature of diabetic ketoacidosis:

      Your Answer: Cheyne–Stokes respiration

      Explanation:

      Clinical features of DKA:
      Symptoms: Polyuria, polydipsia, thirst, lethargy, weight loss, nausea, vomiting, anorexia, abdominal pain, dehydration, headache, altered mental state
      Signs: Dry mucous membranes, ketotic breath, tachycardia, hypotension, Kussmaul breathing, focal signs of precipitant e.g. infection

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      7.3
      Seconds

  • Question 2 - C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:...

    Correct

    • C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:

      Your Answer: IL-6

      Explanation:

      Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      2.8
      Seconds

  • Question 3 - Which of the following is required for vitamin B12 absorption: ...

    Correct

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

      Your Answer: Intrinsic factor

      Explanation:

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

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      3.2
      Seconds

  • Question 4 - A 25-year-old man suffers from a shoulder injury that damaged the nerve that...

    Correct

    • A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.

      Which of the following nerves may most likely be affected?

      Your Answer: The suprascapular nerve

      Explanation:

      The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      25.3
      Seconds

  • Question 5 - Cardiac muscle and skeletal muscle are alike, but there are a few key variations.
    Which...

    Correct

    • Cardiac muscle and skeletal muscle are alike, but there are a few key variations.
      Which of the following is NOT a characteristic of skeletal muscle but is a characteristic of cardiac muscle? 

      Your Answer: The presence of intercalated discs

      Explanation:

      Cardiac muscle is striated, and the sarcomere is the contractile unit, similar to skeletal muscle. Contracture is mediated by the interaction of calcium, troponins, and myofilaments, much as it occurs in skeletal muscle. Cardiac muscle, on the other hand, differs from skeletal muscle in a number of ways.

      In contrast to skeletal muscle cells, cardiac myocytes have a nucleus in the middle of the cell and sometimes two nuclei. The cells are striated because the thick and thin filaments are arranged in an orderly fashion, although the arrangement is less well-organized than in skeletal muscle.

      Intercalated discs, which work similarly to the Z band in skeletal muscle in defining where one cardiac muscle cell joins the next, are a very significant component of cardiac muscle.

      Adherens junctions and desmosomes, which are specialized structures that hold the cardiac myocytes together, are formed by the transverse sections. The lateral sections produce gap junctions, which join the cytoplasm of two cells directly, allowing for rapid action potential conduction. These critical properties allow the heart to contract in a coordinated manner, allowing for more efficient blood pumping.

      Cardiac myocytes have the ability to create their own action potentials, which is referred to as myogenic’. They can depolarize spontaneously to initiate a cardiac action potential. Pacemaker cells, as well as the sino-atrial (SA) and atrioventricular (AV) nodes, control this.

      The Purkinje cells and the cells of the bundle of His are likewise capable of spontaneous depolarization. While the bundle of His is made up of specialized myocytes, it’s vital to remember that Purkinje cells are not myocytes and have distinct characteristics. They are larger than myocytes, with fewer filaments and more gap junctions than myocytes. They conduct action potentials more quickly, allowing the ventricles to contract synchronously.
      Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.

      An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      8.8
      Seconds

  • Question 6 - About case-control studies, one of the following is true. ...

    Correct

    • About case-control studies, one of the following is true.

      Your Answer: They are suitable to be used in the study of rare diseases

      Explanation:

      Case-control studies are suitable when investigating a rare disease or in cases where little is known about the disease and the proposed aetiological factor, as a preliminary study. They have the ability to look at multiple risk-factors (exposures) but can only look at a single outcome.

      In a case-control study, two groups of patients, one with the disease and one without, are compared on the basis of a proposed causative factor that occurred in the past. They are therefore a retrospective study and useful in hypothesis generation.

      Cohort studies are better at identifying rare exposures. One group with an exposure is compared to a control group without that exposure.

      Case-control studies are usually less expensive to run and also shorter in duration compared with prospective cohort studies.

    • This question is part of the following fields:

      • Evidence Based Medicine
      20.7
      Seconds

  • Question 7 - A 30-year old male is brought to the emergency room after a terrible...

    Incorrect

    • A 30-year old male is brought to the emergency room after a terrible fall during a photoshoot. The patient reported falling on his right forearm. There is evident swelling and tenderness on the affected area, with notable weakness of the flexor pollicis longus muscle. Radiographic imaging showed a fracture on the midshaft of the right radius.

      Which of the following nerves is most likely injured in the case above?

      Your Answer: The radial nerve

      Correct Answer: The anterior interosseous nerve

      Explanation:

      Flexor pollicis longus receives nervous supply from the anterior interosseous branch of median nerve, derived from spinal roots C7 and C8.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      55.8
      Seconds

  • Question 8 - You are calculating the anion gap on a patient with an acid-base disturbance...

    Correct

    • You are calculating the anion gap on a patient with an acid-base disturbance and you find the anion gap to be low. Which of the following is the most likely cause for the low anion gap:

      Your Answer: Hypoalbuminaemia

      Explanation:

      A low anion gap is frequently caused by hypoalbuminemia. Albumin is a negatively charged protein and its loss from the serum results in the retention of other negatively charged ions such as chloride and bicarbonate. As bicarbonate and chloride anions are used to calculate the anion gap, there is a subsequent decrease in the gap. The anion gap is sometimes reduced in multiple myeloma, where there is an increase in plasma IgG (paraproteinaemia).

    • This question is part of the following fields:

      • Physiology
      • Renal
      6.7
      Seconds

  • Question 9 - Which of these cell types in the stomach releases pepsinogen? ...

    Correct

    • Which of these cell types in the stomach releases pepsinogen?

      Your Answer: Chief cells

      Explanation:

      The gastric chief cells in the stomach wall releases pepsinogen. Pepsinogen is a proenzyme. It mixes with hydrochloric acid in the stomach and is converted to pepsin. Pepsin breaks down proteins into peptides aiding protein digestion.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      486.6
      Seconds

  • Question 10 - A patient suffered from a chest injury while working out in the gym....

    Incorrect

    • A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.

      Which of the following statements regarding the pectoralis minor muscle is considered correct?

      Your Answer: It flexes the humerus

      Correct Answer: It stabilises the scapula

      Explanation:

      The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.

      Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      32
      Seconds

  • Question 11 - All of the following statements are incorrect about insulin except: ...

    Correct

    • All of the following statements are incorrect about insulin except:

      Your Answer: Proinsulin is cleaved into insulin and C peptide.

      Explanation:

      Proinsulin is synthesised as a single-chain peptide. A connecting peptide (C peptide) within storage granules is removed by proteases to yield insulin.

      Insulin:
      1. is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds.
      2. is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas.
      3. release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin. However, most output is driven by the rise in plasma glucose concentration that occurs after a meal.
      4. effects are mediated by the receptor tyrosine kinase.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      15.1
      Seconds

  • Question 12 - A 5 day old, full term neonate is with a unilateral purulent...

    Incorrect

    • 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: Neisseria gonorrhoea

      Correct 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.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      16.7
      Seconds

  • Question 13 - A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis...

    Correct

    • A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis on indwelling metal work and no known drug allergies. He has had a recent skin swab that has cultured MRSA and MRSA infection is suspected.
      Which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.

      Your Answer: Vancomycin

      Explanation:

      In the majority of patients the commonest causative organism for osteomyelitis isStaphylococcus aureus.Salmonella spp. are the commonest cause in patients with sickle cell disease.
      Other bacteria that can cause osteomyelitis include:
      Enterobacter spp.
      Group A and B streptococcus
      Haemophilus influenzae
      The current recommendations by NICE and the BNF on the treatment of osteomyelitis are:
      Flucloxacillin first-line
      Consider adding fusidic acid or rifampicin for initial 2 weeks
      If penicillin allergic use clindamycin
      If MRSA is suspected use vancomycin
      Suggested duration of treatment is 6 weeks for acute infection

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      19.8
      Seconds

  • Question 14 - Which cervical interspace is most likely injured if a patient presents with difficulty...

    Incorrect

    • Which cervical interspace is most likely injured if a patient presents with difficulty of shoulder abduction and elbow flexion, pain in the right shoulder and lateral arm, and decreased sensation over the deltoid and lateral arm?

      Your Answer: C6-C7

      Correct Answer: C4-C5

      Explanation:

      In the setting of cervical radiculopathy, because the nerve root of a spinal nerve is compressed or otherwise impaired, the pain and symptomatology can spread far from the neck and radiates to arm, neck, chest, upper back and/or shoulders. Often muscle weakness and impaired deep tendon reflexes are noted along the course of the spinal nerve.

      Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging especially in cases of trauma. If there is nerve impingement, the affected side will be reduced relative to the unaffected side. Reduction in strength of muscles innervated by the affected nerve is also significant physical finding.

      For a C4-C5 injury, the following symptoms may present:

      Weakness in the deltoid muscle (front and side of the shoulder) and upper arm
      Shoulder pain
      Numbness along the outside of the upper arm

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      34.2
      Seconds

  • Question 15 - The most important Complement protein for antigen opsonization is: ...

    Correct

    • The most important Complement protein for antigen opsonization is:

      Your Answer: C3b

      Explanation:

      Phagocytosis is largely responsible for depletion of cells coated with antibodies. Cells opsonized by IgG antibodies are recognized by phagocyte Fc receptors, which are specific for the Fc portions of some IgG subclasses. In addition, when IgM or IgG antibodies are deposited on the surfaces of cells, they may activate the complement system by the classical pathway. Complement activation generates by-products, mainly C3b and C4b, which are deposited on the surfaces of the cells and recognized by phagocytes that express receptors for these proteins. The net result is phagocytosis of the opsonized cells and their destruction.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      12.3
      Seconds

  • Question 16 - All of the following statements are correct regarding penicillin antibiotics except: ...

    Incorrect

    • All of the following statements are correct regarding penicillin antibiotics except:

      Your Answer: Penicillins inhibit bacterial cell wall synthesis.

      Correct Answer: Penicillins are of no use in meningitis as they are unable to penetrate into the cerebrospinal fluid.

      Explanation:

      Penicillin penetration into the cerebrospinal fluid is generally poor. However, when the meninges are inflamed, as in meningitis, penetration of penicillin is increased. Benzylpenicillin should be given before transfer to hospital if meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, once this does not delay transfer.

      Benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      20.2
      Seconds

  • Question 17 - Innate, or non-specific, immunity is the immune system we are born with.
    Which of...

    Correct

    • Innate, or non-specific, immunity is the immune system we are born with.
      Which of the following is NOT an example of innate immunity? Select ONE answer only.

      Your Answer: T-lymphocytes

      Explanation:

      Innate, or non-specific, immunity is the immune system we are born with.
      There are three aspects of innate immunity:
      1. Anatomical barriers, such as:
      The cough reflex
      Enzymes in tears and skin oils
      Mucus – which traps bacteria and small particles
      Skin
      Stomach acid
      2. Humoral barriers, such as:
      The complement system
      Interleukin-1
      3. Cellular barriers, such as:
      Neutrophils
      Macrophages
      Dendritic cells
      Natural killer cells
      Antibody production is part of the specific, or inducible immune response. T-lymphocytesare responsible for the cell mediated immune response which is part of specific, or inducible immunity.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      11
      Seconds

  • Question 18 - Which of the following movements does the iliacus muscle produce? ...

    Correct

    • Which of the following movements does the iliacus muscle produce?

      Your Answer: Flexion of the thigh at the hip joint

      Explanation:

      The iliacus flexes the thigh at the hip joint when the trunk is stabilised. It flexes the trunk against gravity when the body is supine.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      20.4
      Seconds

  • Question 19 - All of the following cause bronchoconstriction, EXCEPT for: ...

    Correct

    • All of the following cause bronchoconstriction, EXCEPT for:

      Your Answer: Adrenaline

      Explanation:

      Factors causing bronchoconstriction:

      • Via muscarinic receptors
      • Parasympathetic stimulation
      • Stimulation of irritant receptors
      • Inflammatory mediators e.g. histamine, prostaglandins, leukotrienes
      • Beta-blockers

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      16.2
      Seconds

  • Question 20 - From which of the following cell types are platelets derived? ...

    Correct

    • From which of the following cell types are platelets derived?

      Your Answer: Megakaryocytes

      Explanation:

      Synthesis of platelets occurs in the bone marrow by fragmentation of megakaryocytes cytoplasm, derived from the common myeloid progenitor cell. The average time for differentiation of the human stem cell to the production of platelets is about 10 days. The major regulator of platelet formation is thrombopoietin and 95% of this is produced by the liver. Normal platelet count is 150 – 450 x 109/L and the normal lifespan of a platelet is about 10 days. Usually about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      6.1
      Seconds

  • Question 21 - A 26-year old female comes to the Emergency Room with complaints of bloody...

    Incorrect

    • A 26-year old female comes to the Emergency Room with complaints of bloody stools. She reports that prior to the passage of bloody stools, she experienced a sharp pain during defecation. Medical history reveals that she has been experiencing constipation for the past 2 weeks. After completing her medical history and physical examination, the attending physician gives an initial diagnosis of an anal fissure.

      Which of the following nerves transmit painful sensation from the anus, resulting in the pain associated with anal fissure?

      Your Answer: Inferior hypogastric plexus

      Correct Answer: Inferior rectal nerve

      Explanation:

      A fissure in ano is a tear in the anoderm distal to the dentate line. The pathophysiology of anal fissure is thought to be related to trauma from either the passage of hard stool or prolonged diarrhoea. A tear in the anoderm causes spasm of the internal anal sphincter, which results in pain, increased tearing, and decreased blood supply to the anoderm. The site of the anal fissure in the sensitive lower half of the anal canal, which is innervated by the inferior rectal nerve, results in reflex spasm of the external anal sphincter, aggravating the condition. Because of the intense pain, anal fissures may have to be examined under local anaesthesia.

      The inferior rectal nerve is a branch of the pudendal nerve. This nerve runs medially across the ischiorectal fossa and supplies the external anal sphincter, the mucous membrane of the lower half of the anal canal, and the perianal skin.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      30.8
      Seconds

  • Question 22 - In the extrinsic pathway of the coagulation cascade, the tenase complex is: ...

    Correct

    • In the extrinsic pathway of the coagulation cascade, the tenase complex is:

      Your Answer: Factor VIIa-tissue factor complex

      Explanation:

      The extrinsic pathway for initiating the formation of prothrombin activator begins with a traumatized vascular wall or traumatized extravascular tissues that come in contact with the blood. Exposed and activated by vascular injury, with plasma factor VII. The extrinsic tenase complex, factor VIIa-tissue factor complex, activates factor X to factor Xa.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      10.9
      Seconds

  • Question 23 - A 30 year old man stabbed in the upper arm presents to the...

    Incorrect

    • A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination.

      The brachial pulse can be best palpated at ?

      Your Answer: In the anterior arm, medial to the brachialis muscle

      Correct Answer: In the antecubital fossa, medial to the tendon of the biceps brachii

      Explanation:

      The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      37.6
      Seconds

  • Question 24 - Gastrin release from antral G-cells is stimulated by all but which one of...

    Incorrect

    • Gastrin release from antral G-cells is stimulated by all but which one of the following:

      Your Answer: Vagal stimulation

      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
      12.5
      Seconds

  • Question 25 - Which of the following is NOT a function of antibodies: ...

    Incorrect

    • Which of the following is NOT a function of antibodies:

      Your Answer: Neutralise toxins

      Correct Answer: Act as antigen receptors on T lymphocytes

      Explanation:

      Antibodies:
      Neutralise toxins and prevent attachment of pathogens
      Target, opsonise or agglutinate (clump together) antigens for phagocytosis
      Activate the complement cascade (leading to lysis or opsonisation of the pathogen)
      Act as antigen receptors on B lymphocytes
      Activate antibody-dependent cell-mediated cytotoxicity by natural killer (NK) cells or T cytotoxic cells
      Provide mucosal immunity (IgA-mediated)
      Stimulate degranulation of mast cells (IgE and IgG mediated)
      Provide passive immunity to the newborn (through transplacental passage of IgG and secretion of IgA in breast milk)

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      71.9
      Seconds

  • Question 26 - A patient presents to ED with heartburn for which they already take regular...

    Correct

    • A patient presents to ED with heartburn for which they already take regular antacids. Which of the following drugs can be affected if taken with antacids:

      Your Answer: Digoxin

      Explanation:

      Antacids should preferably not be taken at the same time as other drugs since they may affect absorption. When antacids are taken with acidic drugs (e.g. digoxin, phenytoin, chlorpromazine, isoniazid) they cause the absorption of the acidic drugs to be decreased, which causes low blood concentrations of the drugs, which ultimately results in reduced effects of the drugs. Antacids taken with drugs such as pseudoephedrine and levodopa increase absorption of the drugs and can cause toxicity/adverse events due to increased blood levels of the drugs. Antacids that contain magnesium trisilicate and magnesium hydroxide when taken with some other medications (such as tetracycline) will bind to the drugs, and reduce their absorption and effects.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      23.1
      Seconds

  • Question 27 - Where does angiotensin II directly act on the renal nephron: ...

    Correct

    • Where does angiotensin II directly act on the renal nephron:

      Your Answer: Proximal tubule

      Explanation:

      Angiotensin II acts to directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters).

    • This question is part of the following fields:

      • Physiology
      • Renal
      39
      Seconds

  • Question 28 - A 68-year-old female has presented to the Emergency Department with chest pain, palpitations,...

    Correct

    • A 68-year-old female has presented to the Emergency Department with chest pain, palpitations, and breathlessness complaints. On ECG, she is diagnosed with ventricular arrhythmia and is administered lidocaine.

      Which of the following is the correct mechanism of action of lidocaine?

      Your Answer: Blocks Na+ channels in the heart

      Explanation:

      Lidocaine is a tertiary amide local anaesthetic and also a class IV antiarrhythmic.

      Like other local anaesthetics, lidocaine works on the voltage-gated sodium ion channel on the nerve cell membranes. It works in the following steps:
      1. diffuses through neural sheaths and the axonal membrane into the axoplasm
      2. binds fast voltage-gated Na+ channels in the neuronal cell membrane and inactivates them
      3. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals

      The same principle applies to Lidocaine’s actions in the heart as it blocks the sodium channels in the conduction system and the myocardium. This raises the threshold for depolarizing, making it less likely for the heart to initiate or conduct any action potential that can cause arrhythmia.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      14.1
      Seconds

  • Question 29 - A man suffered from a back injury due to a fall from a...

    Correct

    • A man suffered from a back injury due to a fall from a ladder. Significant bruising was found to be overlying his latissimus dorsi muscle.

      Which of the following statements regarding the latissimus dorsi muscle is considered correct?

      Your Answer: It raises the body towards the arm during climbing

      Explanation:

      The latissimus dorsi muscle is a broad, flat muscle that occupies the majority of the lower posterior thorax. The muscle’s primary function is of the upper extremity but is also considered to be a respiratory accessory muscle.

      Latissimus dorsi is a climbing muscle. With the arms fixed above the head, it can raise the trunk upwards, together with the help of pectoralis major.

      Functionally, the latissimus dorsi muscle belongs to the muscles of the scapular motion. This muscle is able to pull the inferior angle of the scapula in various directions, producing movements on the shoulder joint (internal rotation, adduction and extension of the arm). It is innervated by the thoracodorsal nerve (C6 – C8) from the posterior cord of the brachial plexus, which enters the muscle on its deep surface.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      13.1
      Seconds

  • Question 30 - A 66-year-old male presents to his family physician with the complaint of increasing...

    Correct

    • A 66-year-old male presents to his family physician with the complaint of increasing fatigue and lethargy, along with itching, especially after a hot bath. He also complains of increased sweating and dizziness. On examination, he has a plethoric appearance. Abdominal examination shows the presence of splenomegaly. A basic panel of blood tests is ordered in which her Hb comes out to be 17 g/dL.

      Which one of the following treatment options will be most suitable in this case?

      Your Answer: Venesection

      Explanation:

      The clinical and laboratory findings, in this case, support a diagnosis of polycythaemia vera. A plethoric appearance, lethargy, splenomegaly and itching are common in this disease. Patients may also have gouty arthritis, Budd-Chiari syndrome, erythromelalgia, stroke, myocardial infarction or DVT. The average age for diagnosis of Polycythaemia Vera is 65-74 years. It is a haematological malignancy in which there is overproduction of all three cell lines. Venesection is the treatment of choice as it would cause a decrease in the number of red blood cells within the body.

      Erythropoietin is given in patients with chronic renal failure as they lack this hormone. Administration of erythropoietin in such patients causes stimulation of the bone marrow to produce red blood cells.

      Desferrioxamine is a chelating agent for iron and is given to patients with iron overload due to repeated blood transfusions, e.g. in thalassemia patients.

      Penicillamine is a chelating agent for Copper, given as treatment in Wilson’s disease.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      9.1
      Seconds

  • Question 31 - Regarding endothelin-1, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: Endothelin-1 production may be increased in hypoxia.

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

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      18.2
      Seconds

  • Question 32 - A 14-year-old female is brought to the Emergency Room by her mother after...

    Correct

    • A 14-year-old female is brought to the Emergency Room by her mother after a fall from a tree in which she injured her elbow. An elbow fracture is suspected based on the examination findings, and she is given Entonox for analgesia as her elbow is set in a cast.

      Which one of the following statements regarding this drug is true?

      Your Answer: It can cause inhibition of vitamin B12 synthesis

      Explanation:

      Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor.

      It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour.

      Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      19.4
      Seconds

  • Question 33 - You've been summoned to a young man in the resus area who is...

    Incorrect

    • You've been summoned to a young man in the resus area who is experiencing an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.

      Which of the following is the correct adenosine mechanism of action?

      Your Answer: Slows conduction through the sino-atrial node

      Correct Answer: Opens K + channels in the heart

      Explanation:

      The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.
      Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.

      Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.

      The use of adenosine is contraindicated in the following situations:
      Asthma
      COPD (chronic obstructive pulmonary disease)
      Decompensated heart failure 
      Long QT syndrome
      AV block in the second or third degree
      Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
      Hypotension that is severe

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      16.6
      Seconds

  • Question 34 - Which of the following statements accurately describes the extensor indicis muscle? ...

    Incorrect

    • Which of the following statements accurately describes the extensor indicis muscle?

      Your Answer: It is innervated by the median nerve

      Correct Answer: It lacks the juncturae tendinum

      Explanation:

      Extensor indicis is a narrow, elongated muscle found in the posterior compartment of the forearm. It belongs to the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus, and extensor pollicis brevis muscles. It lacks the juncturae tendinum, which connects the extensor digitorum on the dorsal aspect of the hand.

      Extensor indicis can be palpated by applying deep pressure over the lower part of the ulna while the index finger is extended. The main function of extensor indicis involves the extension of the index finger at the metacarpophalangeal and interphalangeal joints. As the index finger is one of the few fingers that have their own separate extensor muscle, it is able to extend independently from other fingers. Additionally, extensor indicis muscle produces a weak extension of the wrist.

      Extensor indicis receives its nervous supply from posterior interosseous nerve, a branch of the radial nerve derived from spinal roots C7 and C8. The skin overlying the muscle is supplied by the same nerve, with fibres that stem from the spinal roots C6 and C7.

      The superficial surface of the extensor indicis receives arterial blood supply from posterior interosseous branch of the ulnar artery, whereas its deep surface receives blood from perforating branches of the anterior interosseous artery.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      38.8
      Seconds

  • Question 35 - Which of the following is the site of secretion of intrinsic factor: ...

    Correct

    • Which of the following is the site of secretion of intrinsic factor:

      Your Answer: Stomach

      Explanation:

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

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      28.3
      Seconds

  • Question 36 - Platelet alpha granules release which of the following? ...

    Correct

    • Platelet alpha granules release which of the following?

      Your Answer: Von Willebrand factor (VWF)

      Explanation:

      There are three types of storage granules contained in platelets. These are dense granules which contain the following:
      -ATP
      -ADP
      -serotonin and calcium alpha granules containing clotting factors
      -von Willebrand factor (VWF)
      -platelet-derived growth factor (PDGF)
      – other proteins lysosomes containing hydrolytic enzymes.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      5.8
      Seconds

  • Question 37 - You've been asked to visit a 20-year-old patient  who has been complaining of stomach pain,...

    Incorrect

    • 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: Ghrelin

      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
      46.9
      Seconds

  • Question 38 - A 34-year-old male is brought into the Emergency Department by the paramedics after...

    Correct

    • 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.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      84.9
      Seconds

  • Question 39 - Cryptococcus neoformans is primarily implicated in which of the following conditions: ...

    Correct

    • Cryptococcus neoformans is primarily implicated in which of the following conditions:

      Your Answer: Chronic lymphocytic meningitis

      Explanation:

      Cryptococcus neoformans typically causes a chronic lymphocytic meningitis in immunosuppressed patients or those with intense exposure e.g. pigeon fanciers.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      30
      Seconds

  • Question 40 - A patient suffers a stab wound to the neck. The entry point of...

    Incorrect

    • 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: Sternothyroid

      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 nerve

      The 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
      23.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrine (2/2) 100%
Physiology (12/15) 80%
Inflammatory Responses (1/1) 100%
Pathology (4/5) 80%
Gastrointestinal (3/4) 75%
Anatomy (3/10) 30%
Upper Limb (2/6) 33%
Basic Cellular Physiology (1/1) 100%
Evidence Based Medicine (1/1) 100%
Renal (2/2) 100%
Gastrointestinal Physiology (1/2) 50%
Microbiology (2/3) 67%
Pathogens (1/2) 50%
Specific Pathogen Groups (1/1) 100%
Head And Neck (0/2) 0%
Immune Responses (1/2) 50%
Infections (0/1) 0%
Pharmacology (4/6) 67%
General Pathology (1/1) 100%
Abdomen (1/1) 100%
Respiratory (1/1) 100%
Basic Cellular (3/3) 100%
Abdomen And Pelvis (0/1) 0%
Cardiovascular Pharmacology (1/2) 50%
Haematology (1/1) 100%
Cardiovascular (0/1) 0%
Anaesthesia (2/2) 100%
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