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Question 1
Correct
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A 4-year old boy is taken to the emergency room after a sudden onset of coughing and wheezing. Further investigation reveals that he was drawing quietly in his room, when suddenly, he became anxious and started coughing. The parents also noted that the eraser on top of the pencil was missing.
A plain radiographic chest imaging is conducted, and confirmed foreign body aspiration.
Which of the following areas in the tracheobronchial tree is the most probable location of the aspirated eraser?Your Answer: Right main bronchus
Explanation:In foreign body aspiration, the foreign body is more likely to enter the right main bronchus because it is shorter, wider and more vertical than the left main bronchus. In a patient who is standing or sitting, the foreign body tends to become lodged in the posterobasal segment of the inferior lobe of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 2
Incorrect
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Which of these statements about experimental studies is true?
Your Answer: They must be blinded
Correct Answer: Randomisation serves to remove potential bias
Explanation:In experimental studies, the researcher introduces an intervention and studies the effect. The study subjects are allocated into different groups by the investigator through the use of randomisation. Randomisation serves to remove any potential bias.
A cohort study is a form of longitudinal, observational study that follows a group of patients (the cohort) over a period of time to monitor the effects of exposure to a proposed aetiological factor upon them.
A case-control study is a type observational study. Here, patients who have developed a disease are identified and compared on the basis of proposed causative factors that occurred in the past, to a control group.
Clinical trials are experimental studies. Examples include: double blind, single blind, and unblinded studies(both patient and researcher are aware of the treatment they receive)
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This question is part of the following fields:
- Evidence Based Medicine
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Question 3
Correct
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You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?
Your Answer: Potentiates effect of GABA
Explanation:Lorazepam is a type of benzodiazepine.
Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 4
Correct
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Which of the following is the most abundant immunoglobulin in plasma:
Your Answer: IgG
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 5
Incorrect
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A 19-year-old with a longstanding history of asthma presents to the ED with worsening symptoms of cough and wheeze and a peak expiratory flow rate (PEFR) measurement is taken.
Which statement concerning PEFR is true?Your Answer: PEFR is a useful measure in restrictive airways disease
Correct Answer: PEFR is dependent upon the patient's height
Explanation:The maximum flow rate generated during a forceful exhalation, after maximal inspiration is the peak expiratory flow rate (PEFR).
PEFR is dependent upon initial lung volume. It is, therefore, dependant on patient’s age, sex and height.
PEFR is dependent on voluntary effort and muscular strength of the patient.
PEFR is decreased with increasing airway resistance, e.g. in asthma, and it correlates well with the forced expiratory volume in one second (FEV1) value measured in spirometry. This correlation decreases in patients with asthma as airflow decreases.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 6
Incorrect
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Renin is produced by which of the following:
Your Answer: The macula densa
Correct Answer: Granular cells in the wall of the afferent arteriole
Explanation:Juxtaglomerular cells are specialised smooth muscle cells mainly in the walls of the afferent arterioles (and some in the efferent arterioles) which synthesise renin.
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This question is part of the following fields:
- Physiology
- Renal
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Question 7
Incorrect
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Which anatomical structure is divided following an emergency department anterolateral thoracotomy?
Your Answer: Teres minor
Correct Answer: Latissimus dorsi
Explanation:Thoracotomy describes an incision made in the chest wall to access the contents of the thoracic cavity. Thoracotomies typically can be divided into two categories; anterolateral thoracotomies and posterolateral thoracotomies. These can be further subdivided into supra-mammary and infra-mammary and, of course, further divided into the right or left chest. Each type of incision has its utility given certain circumstances.
A scalpel is used to sharply divide the skin along the inframammary crease overlying the fifth rib. Electrocautery is then used to divide the pectoralis major muscle and serratus anterior muscle. Visualization of the proper operative field can be achieved with the division and retraction of the latissimus dorsi. Either the fourth or fifth intercostal space is then entered after the division of intercostal muscles above the rib to ensure the preservation of the neurovascular bundle. Once the patient is properly secured to the operating table, the ipsilateral arm is raised and positioned anteriorly and cephalad to rest above the head. The incision is started along the inframammary crease and extended posterolaterally below the tip of the scapula. It is then extended superiorly between the spine and the edge of the scapula, a short distance. The trapezius muscle and the subcutaneous tissues are divided with electrocautery. The serratus anterior and latissimus dorsi muscles are identified and can be retracted. The intercostal muscles are then divided along the superior border of the ribs, and the thoracic cavity is accessed.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 8
Incorrect
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Regarding the brachioradialis muscle, which of the following statements is true?
Your Answer: It is innervated by the musculocutaneous nerve
Correct Answer: It assists with supination of the forearm at the radioulnar joints
Explanation:Brachioradialis is a fusiform muscle located in the lateral part of the posterior forearm. Along with extensor carpi radialis brevis and extensor carpi radialis longus, it comprises the radial group of forearm muscles, which belong to the superficial layer of posterior forearm muscles. Although anatomically part of the posterior forearm muscles, which are known to be forearm extensors, brachioradialis’ fibre orientation enables it to rather flex the forearm, and aids in supination of the forearm at the radioulnar joint.
The brachioradialis muscle originates from the upper two-thirds of the lateral supracondylar ridge of humerus and the anterior surface of the lateral intermuscular septum of the arm. It slides over the lateral surface of the elbow joint, entering the anterolateral cubital area. The muscle fibres course inferiorly down the radial part of the anterior forearm, forming a thick tendon in approximately the middle of the forearm. This tendon then traverses the remainder of the forearm, inserting near the wrist, just proximal to the styloid process of radius.
Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus. Blood supply to the brachioradialis muscle comes from branches of the radial artery, radial recurrent artery and the radial collateral branch of the deep brachial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 9
Correct
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Which of the following statements is correct regarding anti-D immunoglobulin?
Your Answer: It is administered as part of routine antenatal care for rhesus-negative mothers.
Explanation:In all non-sensitised pregnant women who are RhD-negative, it is recommended that routine antenatal anti-D prophylaxis is offered. Even if there is previous anti-D prophylaxis, use of routine antenatal anti-D prophylaxis should be given for a sensitising event early in the same pregnancy. Postpartum anti-D prophylaxis should also be given even if there has been previous routine antenatal anti-D prophylaxis or antenatal anti-D prophylaxis for a sensitising event in the same pregnancy.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 10
Correct
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A patent has weakness of humeral flexion and extension. A CT scan reveals that he has suffered damage to the nerve that innervates pectoralis major.
Pectoralis major receives its innervation from which of the following nerves? Select ONE answer only.Your Answer: Lateral and medial pectoral nerves
Explanation:Pectoralis major is a thick, fan-shaped muscle situated in the chest. It makes up the bulk of the chest musculature in the male and lies underneath the breast in the female. It overlies the thinner pectoralis minor muscle.
Superficial muscles of the chest and arm showing pectoralis major (from Gray’s Anatomy)
Pectoralis major has two heads; the clavicular head and the sternocostal head. The clavicular head originates from the anterior border and medial half of the clavicle. The sternocostal head originates from the anterior surface of the sternum, the superior six costal cartilages and the aponeurosis of the external oblique muscle. It inserts into the lateral lip of the bicipital groove of the humerus.
Pectoralis major receives dual innervation from the medial pectoral nerve and the lateral pectoral nerve.
Its main actions are as follows:
Flexes humerus (clavicular head)
Extends humerus (sternocostal head)
Adducts and medially rotates the humerus
Draws scapula anteriorly and inferiorly -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 11
Correct
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Which of the following statements is correct with regards to natural killer cells?
Your Answer: They are part of the innate immune system.
Explanation:Natural Killer (NK) Cells are lymphocytes in the same family as T and B cells, which come from a common progenitor. They are cytotoxic CD8 positive cells that do not have the T-cell receptor. They are very big cells with cytoplasmic granules and are designed to kill target cells with a low level of expression of HLA class I molecules.
Examples include during a viral infection or on a malignant cell. NK cells display several receptors for HLA molecules on their surface, and when HLA is expressed on the target cell, these deliver an inhibitory signal into the NK cell. Absent HLA molecules on the target cell cause this inhibitory signal to get lost and as a result, the NK cell can then kill its target. Also, NK cells display antibody-dependent cell-mediated cytotoxicity, where antibody binds to antigen on the surface of the target cell. The NK cells then bind to the Fc portion of the bound antibody and kill the target cell. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 12
Incorrect
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Antinuclear antibodies (ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus.
Which ONE of these statements about ANAs is true?Your Answer: Anti-Ro antibodies are associated with CREST syndrome
Correct Answer: They can be of any immunoglobulin class
Explanation:Anti-nuclear antibodies(ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus. They can be of any immunoglobulin class.
CREST syndrome is usually associated with anti-centromere antibodies.
ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most reliable.
Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.
Anti-dsDNA antibodies are found in 80 – 90% of patients with SLE
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 13
Correct
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What is the main mechanism of action of metoclopramide:
Your Answer: Dopamine antagonist
Explanation:Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 14
Incorrect
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A 50-year-old man from Russia presents with a history of cough with blood-stained sputum, fever, night sweats, and weight loss. Suspecting tuberculosis, you begin investigations.
All the following statements regarding tuberculosis (TB) are true EXCEPT?Your Answer: Mycobacterium tuberculosis fluoresces with auramine staining
Correct Answer: Corticosteroid use is not a risk factor for developing TB
Explanation:Immunosuppressants like corticosteroids may be an important risk factor for developing tuberculosis.
All of the other statements are true.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 15
Correct
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A clinical audit cycle comprises of 5 steps. Each of these processes are listed below:
Which is the correct order that these should occur?
1. Observation of practice and collection of data
2. Identification of the problem
3. Implementation of change
4. Definition of criteria and setting of standards
5. Analysis of data and comparison of performance with the criteria and standardsYour Answer: 2,4,1,5,3
Explanation:An audit assesses if a certain aspect of health care is attaining a recognized standard. This lets care providers and patients know where their service is doing well, and where there could be improvements. The aim is to achieve quality improvement and improve outcomes for patients.
Audits are a quality improvement measure and one of the 7 pillars of clinical governance. It allows organizations to continually work toward improving quality of care by showing them where they are falling short, allows them to implement improvements, and reaudit or close the audit cycle to see if beneficial change has taken place.
Clinical audits are a cycle with several steps:
1. Identification of the problem
2. Definition of criteria and setting of standards
3. Observation of practice and collection of data
4. Analysis of data and comparison of performance with the criteria and standards
5. Implementation of change -
This question is part of the following fields:
- Evidence Based Medicine
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Question 16
Correct
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A patient with abdominal pain, vomiting and bloody diarrhoea develops a low platelet count and deranged renal function. A diagnosis of haemolytic uraemic syndrome is made.
Which of the following organisms is a recognised cause of haemolytic uraemic syndrome? Select ONE answer only.Your Answer: Escherichia coli
Explanation:E.Colistrain 0157 causes enterohaemorrhagic diarrhoea and can be followed by haemolytic uraemic syndrome (renal failure, haemolytic anaemia and thrombocytopenia).
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 17
Incorrect
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Which family of receptors does the glucagon receptor belong?
Your Answer: Enzyme-linked receptors
Correct Answer: G-protein coupled receptors
Explanation:Glucagon binds to class B G-protein coupled receptors and activates adenylate cyclase, increasing cAMP intracellularly.
This activates protein kinase A. Protein kinase A phosphorylates and activates important enzymes in target cells.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 18
Incorrect
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You review a 34-year-old man with lower back pain and plan to prescribe him ibuprofen and codeine phosphate. His only past medical history of note is depression, for which he takes fluoxetine.
Which of the following scenarios would prompt you to consider the co-prescription of a PPI for gastro-protection? Select ONE answer only.Your Answer: Ibuprofen dose of 400 mg TDS
Correct Answer: Co-prescription of fluoxetine
Explanation:Patients at risk of gastro-intestinal ulceration (including the elderly) who need NSAID treatment should receive gastroprotective treatment. The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:
Using maximum recommended dose of an NSAID
Aged 65 or older
History of peptic ulcer or GI bleeding
Concomitant use of medications that increase risk:
Low dose aspirin
Anticoagulants
Corticosteroids
Anti-depressants including SSRIs and SNRIs
Requirements for prolonged NSAID usage:
Patients with OA or RA at any age
Long-term back pain if older than 45
It is suggested that if required, either omeprazole 20 mg daily or lansoprazole 15-30 mg daily should be the PPIs of choice.
This patient is on 400 mg of ibuprofen TDS, but the maximum recommended dose of ibuprofen is 2.4 g daily. Co-prescription of codeine, raised BMI, and a family history of peptic ulceration would also not prompt gastro-protection. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 19
Incorrect
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Detection of urinary Bence-Jones protein would be most suggestive of which of the following malignancies:
Your Answer: Chronic myeloid leukaemia
Correct Answer: Multiple myeloma
Explanation:Bence Jones proteins are monoclonal immunoglobulin light chains found in urine (and plasma) of some patients with myeloma. Because of their relatively small size, light chains are readily excreted into the urine. The presence of significant amounts of Bence Jones proteins in urine is indicative of malignant B cell proliferation.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 20
Correct
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Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 21
Correct
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What is the effect of activated vitamin D on the renal handling of calcium:
Your Answer: Increases calcium reabsorption in the distal tubule
Explanation:Activated vitamin D acts to:
GUT:increase calcium and phosphate absorption in the small intestine (the main action)
KIDNEYS:increase renal calcium reabsorption (in the distal tubule via activation of a basolateral Ca2+ATPase pump), increase renal phosphate reabsorption, inhibit 1-alpha-hydroxylase activity in the kidneys (negative feedback)
PARATHYROID GLANDS:inhibit PTH secretion from the parathyroid glands -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 22
Incorrect
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You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
Which SINGLE statement regarding mannitol is true?Your Answer: It crosses the blood-brain-barrier
Correct Answer: It is irritant to veins and causes phlebitis
Explanation:Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
Decreasing the rate of CSF formation,and;
Withdrawing extracellular fluid from the brain across the BBB
Other uses of mannitol include:
Short-term management of glaucoma
Treatment of rhabdomyolysis
Preserve renal function in peri-operative jaundiced patients
To initiate diuresis in transplanted kidneys
Bowel preparation prior to colorectal procedures
The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
Anuria
Intracranial bleeding (except during craniotomy)
Severe cardiac failure
Severe dehydration
Severe pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 23
Incorrect
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Atrial natriuretic peptide (ANP) is primarily produced in response to:
Your Answer: A decrease in intravascular fluid volume
Correct Answer: An increase in intravascular fluid volume
Explanation:Atrial natriuretic peptide (ANP) is released from cardiac atrial muscle cells in response to atrial stretch caused by an increase in intravascular fluid volume and is also produced in collecting duct cells.
Atrial natriuretic peptide acts to inhibit sodium reabsorption in the distal nephron. -
This question is part of the following fields:
- Physiology
- Renal
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Question 24
Correct
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Which of the following is NOT an advantage of a case-control study used to identify past exposure to a risk factor in patients with a disease:
Your Answer: Can directly measure absolute and relative risk of a disease
Explanation:Advantages:relatively quickrelatively cheap and easy to performparticularly suitable for studying associations between an exposure and an outcome when the outcome is uncommon or if the outcome occurs decades after exposurea wide range of risk factors can be investigated in each studyDisadvantages:subject to recall biasunlike in a whole population study, absolute risk cannot be quantifiedtemporal relationship between exposure and outcome can be difficult to establishunsuitable for rare risk factorsprone to confounding
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 25
Correct
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During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate is born with bilateral deafness as a result of this.
From the  following antibiotics, which one is most likely to cause this side effect?Your Answer: Gentamicin
Explanation:Aminoglycosides cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 26
Correct
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A 6-year-old female is brought to the Ophthalmology Clinic by her mother with the complaint of itching, redness, and a watery discharge of the right eye. Past medical history revealed an upper respiratory tract infection one week ago.
On examination of the right eye, there is mild erythema of the palpebral conjunctiva and visible follicles seen on eversion of the eyelid, lid oedema, and subconjunctival petechial haemorrhages. The discharge is watery and not purulent.
You diagnose her with viral conjunctivitis. According to the current NICE guidelines, which ONE of the following management options would NOT be included for this patient?Your Answer: The child should be excluded from school until the infection has resolved
Explanation:The NICE guidelines do NOT recommend isolating a patient with viral conjunctivitis from others or skipping school or work. The disease is contagious, but the spread of the disease can be controlled by maintaining good hygiene practices such as:
1. frequent hand washing
2. use of separate flannels and towels
3. Avoid close contact with othersAntibiotic prescriptions are not part of the NICE guidelines for viral conjunctivitis as they will not affect the course of the disease. Most cases of viral conjunctivitis are self-limiting and resolve within one to two weeks.
The NICE guidelines recommend that symptoms may be eased with self-care measures such as:
1. Bathing/cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge
2. Cool compresses applied gently around the eye area
3. Use of lubricating drops or artificial tears -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 27
Incorrect
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After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?
Your Answer: 10 minutes
Correct Answer: 25 minutes
Explanation:If seizures recur or fail to respond after initial treatment with benzodiazepines within 25 minutes of onset, phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium should be used.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 28
Incorrect
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Regarding ampicillin, which of the following statements is CORRECT:
Your Answer: Ampicillin may be used for organisms resistant to amoxicillin.
Correct Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.
Explanation:Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections.
Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 29
Incorrect
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The pelvic bone is formed by which of the following:
Your Answer: Ilium, ischium and sacrum
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 30
Correct
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Which of the following organisms can penetrate intact skin:
Your Answer: Leptospira spp.
Explanation:Leptospirosis is a bacterial disease caused byLeptospira spp. It is the most common zoonotic infection worldwide.
It is usually contracted by exposure to water contaminated with the urine of infected animals (such as rodents, cattle, and dogs). The most important reservoirs are rodents, and rats are the most common source worldwide.
The bacteria enter the body through the skin or mucous membranes. This is more likely if the skin is broken by leptospirosis is somewhat unusual in that it can enter the body through intact skin. -
This question is part of the following fields:
- Microbiology
- Principles
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Question 31
Incorrect
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Identify the type of graph described below:
This graph has been used to create visual representations to communicate the risks and benefits of treatments using 4 face categories.Your Answer: Forest plot
Correct Answer: Cates plot
Explanation:Cates Plot, since 1999, has been used to create visual representations to communicate the risks and benefits of treatments. The essence of Cates Plot is the use of 4 face categories to visually indicate the following:
People not affected by a treatment (green faces for those with a good outcome and red for those with a bad outcome)
People for which treatment changes their category from a bad outcome to a good outcome (yellow faces)
People for which treatment causes an adverse event and changes their category from a good outcome to a bad outcome (crossed out green faces) -
This question is part of the following fields:
- Evidence Based Medicine
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Question 32
Incorrect
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A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been going on for 3 days.
Among the following microorganisms, which is considered to be a cause of infectious bloody diarrhoea?Your Answer: Enterotoxigenic Escherichia coli
Correct Answer: Entamoeba histolytica
Explanation:The following are organisms that are capable of producing acute, bloody diarrhoea:
– Campylobacter jejuni
– Escherichia coli O157:H7
– Salmonella species
– Shigella species
– Yersinia species
– Entamoeba histolyticaOther E. coli strains, Giardia, Vibrio, and other parasites are associated with watery, but not bloody, diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 33
Incorrect
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A 5 day old, full term neonate is with a unilateral purulent eye discharge noticed earlier that day is brought in. On gram stain of the exudate, no bacteria are seen.
What is the most likely causative pathogen?
Your Answer: Staphylococcus aureus
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.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 34
Incorrect
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Which of the following is most likely affected in De Quervain's tenosynovitis?
Your Answer: Extensor pollicis longus
Correct Answer: Extensor pollicis brevis
Explanation:De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. It is a condition which involves tendon entrapment affecting the first dorsal compartment of the wrist. With this condition thickening of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis develops where the tendons pass in through the fibro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial and ulnar deviation of the wrist.
The estimated prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties. It may be seen more commonly in individuals with a history of medial or lateral epicondylitis. Bilateral involvement is often reported in new mothers or child care providers in whom spontaneous resolution typically occurs once lifting of the child is less frequent.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 35
Correct
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Which of the following statements is correct with regards to immunoglobulin?
Your Answer: The isotype of immunoglobulin is determined by the heavy chain.
Explanation:The composition of immunoglobulin molecules is two identical heavy and two identical light chains. These chains are linked by disulphide bridges and are each have highly variable regions which give the immunoglobulin its specificity. In addition, they have constant regions and there is virtual complete correspondence in amino acid sequence in all antibodies of a given isotype.
Five isotypes of immunoglobulin exist – these are IgG, IgA, IgM, IgE and IgD. They are determined by the heavy chain (gamma, alpha, mu, epsilon or delta respectively). The light chains are either kappa or lambda. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 36
Incorrect
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A fracture on which of the following structures is associated with a posterior elbow dislocation?
Your Answer: Olecranon
Correct Answer: Radial head
Explanation:Fracture dislocations of the elbow appear extremely complex, and identification of the basic injury patterns can facilitate management. The simplest pattern of elbow fracture dislocation is posterior dislocation of the elbow with fracture of the radial head. Addition of a coronoid fracture, no matter how small, to elbow dislocation and radial head fracture is called the terrible triad of the elbow.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 37
Correct
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Flumazenil is a reversal agent for which of the following groups of drugs:
Your Answer: Benzodiazepines
Explanation:Flumazenil is a benzodiazepine antagonist used for the reversal of the sedative effects of benzodiazepines after anaesthesia, sedation and similar procedures.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 38
Correct
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Which one these is an example of a cause of an exudate?
Your Answer: Subphrenic abscess
Explanation:An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.
Some common causes of exudates are: pneumonia, empyema, lung cancer, breast cancer, cancer of the pleura, SLE, rheumatoid arthritis, pericarditis, subphrenic abscess, chylothorax.
Myxoedema, nephrotic syndrome, congestive cardiac failure, and liver cirrhosis all cause TRANSUDATE.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 39
Correct
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What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your Answer: 10 ml of 1 in 10,000 adrenaline solution
Explanation:Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.
IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.
For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then 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 40
Incorrect
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A 6-year-old child with a few itchy honey crusted sores on her left cheek is brought in by her mother. Following a thorough examination of the child, you diagnose impetigo and recommend a course of topical fusidic acid.
Fusidic acid's mode of action is which of the following?Your Answer: Inhibition of DNA gyrase
Correct Answer: Inhibition of protein synthesis
Explanation:By binding EF-G-GDP, fusidic acid prevents both peptide translocation and ribosome disassembly, which slows protein synthesis. Because it has a novel structure and mechanism of action, it is unlikely to cause cross-resistance with existing antibiotics.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 41
Correct
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Regarding skeletal muscle contraction, which of the following statements is CORRECT:
Your 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 42
Correct
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A 62 year old man has sustained a penetrating injury to the submandibular triangle. On examination, his tongue is weak and when protruded deviates to the left. Which of the following nerves has most likely been injured:
Your Answer: Left hypoglossal nerve
Explanation:Damage to the hypoglossal nerve results in weakness of the tongue, with deviation of the tongue towards the weak side on protrusion.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 43
Correct
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Your consultant requests that you do a lumbar puncture on a patient who is suspected of having meningitis. This patient, a 15-year-old female, presented to the emergency department with a fever, headache, and neck stiffness. Where should you aspirate a sample of CSF?
Your Answer: Subarachnoid space
Explanation:A lumbar puncture, also known as a spinal tap, is a procedure that involves inserting a needle into the lower back’s lumbar region.
A needle is inserted into the space between the arachnoid mater and the pia mater, also known as the subarachnoid space, to remove a sample of cerebrospinal fluid.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 44
Incorrect
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Regarding haemophilia A, which of the following statements is INCORRECT:
Your Answer: Haemophilia A is caused by a deficiency of factor VIII.
Correct Answer: In haemophilia both the APTT and PT are prolonged.
Explanation:Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives.
The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 45
Incorrect
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For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:
Your Answer: Adenosine
Correct Answer: Synchronised DC shock
Explanation:If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 46
Incorrect
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Regarding gastric motility and emptying, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Gastric emptying is inhibited by the presence of the products of fat digestion in the duodenum.
Explanation:Gastric emptying is decreased by the presence of fats in the duodenum (by stimulating release of cholecystokinin). Mixing of the food with gastric secretions takes place in the distal body and antrum of the stomach where the muscularis externa layer is thicker. The stomach has an additional inner oblique smooth muscle layer (in addition to the inner circular layer and outer longitudinal layer). Gastric emptying is increased by a low gastric pH and decreased by a low duodenal pH.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 47
Incorrect
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Regarding protein digestion, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Oligopeptides are broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on the brush border.
Explanation:Digestion of dietary protein begins in the stomach where pepsin hydrolyses protein to polypeptides, and continues in the duodenum where pancreatic proteases (trypsin and chymotrypsin) continue the process of hydrolysis forming oligopeptides. These are further broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on luminal membrane epithelial cells. Free amino acids are absorbed across the apical membrane by secondary active transport coupled with Na+transport into the cell. Amino acids cross the basal membrane into the capillaries by facilitated diffusion.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 48
Incorrect
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All of the following are actions of insulin except:
Your Answer:
Correct Answer: Increased gluconeogenesis
Explanation:Major Actions of Insulin:
↑ Glucose uptake into cells
↑ Glycogenesis
↓ Glycogenolysis
↓ Gluconeogenesis
↑ Protein synthesis
↓ Protein degradation
↑ Fat deposition
↓ Lipolysis
↓ Ketoacid production
↑ K+ uptake into cellsMajor Actions of Glucagon:
↓ Glycogenesis
↑ Glycogenolysis
↑ Gluconeogenesis
↓ Fatty acid synthesis
↑ Lipolysis
↑ Ketoacid production -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 49
Incorrect
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Which lobe of the prostate gland is most commonly affected in benign prostatic hypertrophy?
Your Answer:
Correct Answer: Median
Explanation:Benign enlargement of the prostate is common in men older than 50 years. The cause is possibly an imbalance in the hormonal control of the gland. The median lobe of the gland enlarges upward and encroaches within the sphincter vesicae, located at the neck of the bladder. The leakage of urine into the prostatic urethra causes an intense reflex desire to micturate. The enlargement of the median and lateral lobes of the gland produces elongation and lateral compression and distortion of the urethra so that the patient experiences difficulty in passing urine and the stream is weak. Back-pressure effects on the ureters and both kidneys are a common complication. The enlargement of the uvula vesicae (owing to the enlarged median lobe) results in the formation of a pouch of stagnant urine behind the urethral orifice within the bladder. The stagnant urine frequently becomes infected, and the inflamed bladder (cystitis) adds to the patient’s symptoms.
In all operations on the prostate, the surgeon regards the prostatic venous plexus with respect. The veins have thin walls, are valveless, and are drained by several large trunks directly into the internal iliac veins. Damage to these veins can result in a severe haemorrhage.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 50
Incorrect
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Which of the following microbes attaches to host cells by its haemagglutinin antigen:
Your Answer:
Correct Answer: Influenza virus
Explanation:Hemagglutinin (HA) or Haemagglutinin (BE) is an antigenic glycoprotein found on the surface of the influenza viruses. It is responsible for binding the virus to the cell that is being infected. The name hemagglutinin comes from the protein’s ability to cause red blood cells (erythrocytes) to clump together (agglutinate) in vitro.
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This question is part of the following fields:
- Microbiology
- Principles
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SESSION STATS - PERFORMANCE PER SPECIALTY
