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  • Question 1 - Regarding the lung roots, which of the following statements is CORRECT: ...

    Correct

    • Regarding the lung roots, which of the following statements is CORRECT:

      Your Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.

      Explanation:

      Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      12.1
      Seconds

  • Question 2 - Following a phone call from the microbiology consultant, you evaluate a patient who...

    Correct

    • Following a phone call from the microbiology consultant, you evaluate a patient who has been diagnosed with urinary sepsis. Following the results of the blood cultures, he recommends that you add gentamicin to the patient's antibiotic treatment.

      Gentamicin produces its pharmacological effect by binding to which of the following?

      Your Answer: The 30S subunit of the bacterial ribosome

      Explanation:

      Antibiotics with aminoglycosides, such as gentamicin, bind to the 30S subunit of the bacterial ribosome and prevent aminoacyl-tRNA from binding, preventing protein synthesis.

      They also cause mRNA misreading, resulting in the production of non-functional proteins. This last mechanism is unique to aminoglycosides, and it may explain why they are bactericidal rather than bacteriostatic, as other protein synthesis inhibitors are.

      Patients with myasthenia gravis should avoid aminoglycosides since they can disrupt neuromuscular transmission. They cross the placenta and are linked to poisoning of the 8th cranial nerve in the foetus, as well as permanent bilateral deafness.

      It is possible that they will cause deafness, although this is not a contraindication. In individuals with renal impairment, serum aminoglycoside concentrations should be closely monitored, but this is still not considered a contraindication.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      39.2
      Seconds

  • Question 3 - A 24-year-old patient is suspected to have a possible acute hepatitis B infection...

    Correct

    • A 24-year-old patient is suspected to have a possible acute hepatitis B infection and is currently under investigation.

      Which of the following markers is considered the earliest indicator of acute infection in acute Hepatitis B?

      Your Answer: Hepatitis B surface Ag

      Explanation:

      HBsAg is the serological hallmark of HBV infection. After an acute exposure to HBV, HBsAg appears in serum within 1 to 10 weeks. Persistence of this marker for more than 6 months implies chronic HBV infection.

      Anti-HBs is known as a neutralizing antibody, and confers long-term immunity. In patients with acquired immunity through vaccination, anti-HBs is the only serological marker detected in serum.

      HBcAg is an intracellular presence in infected hepatocyte, thus it is not identified in the serum. During acute infection, anti-HBc IgM and IgG emerges 1–2 weeks after the presence of HBsAg along with raised serum aminotransferase and symptoms. After 6 months of acute infection, anti-HBc IgM wears off. Anti-HBc IgG continues to detect in both patients with resolved HBV infection and chronic hepatitis B.

      Hepatitis D virus, also known as the delta hepatitis virus, is a defective ssRNA virus that requires HBV for replication. The infection can occur in one of two clinical forms, co-infection or superinfection. In a co-infection, the patient is simultaneously infected with HBV and HDV. In a superinfection, an HDV infection develops in a patient with a chronic HBV infection.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      36
      Seconds

  • Question 4 - At which vertebral level does the spinal cord normally end in adults? ...

    Correct

    • At which vertebral level does the spinal cord normally end in adults?

      Your Answer: L1/L2

      Explanation:

      The spinal cord starts at the foramen magnum, where it is continuous with the medulla oblongata, which is the most caudal portion of the brainstem.

      It then extends inferiorly through the vertebral canal. In adults, it usually ends at the level of the first or second lumbar vertebra.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      6.7
      Seconds

  • Question 5 - You are attending to a patient that has presented with a severe headache...

    Correct

    • You are attending to a patient that has presented with a severe headache in the Emergency Department. The patient has signs of cerebral oedema and raised intracranial pressure.

      You discuss the case with the on-call neurology registrar and decide to prescribe Mannitol. The nurse assisting you asks you to reconsider this management plan as she suspects the patient has a contraindication to Mannitol.

      Out of the following, what is a contraindication to mannitol?

      Your Answer: Severe cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.

      Mannitol has several contraindications and some of them are listed below:
      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      55.9
      Seconds

  • Question 6 - Regarding atracurium, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding atracurium, which of the following statements is CORRECT:

      Your Answer: Atracurium should be avoided in renal impairment.

      Correct Answer: Effects such as flushing, tachycardia and hypotension can occur due to significant histamine release.

      Explanation:

      Cardiovascular effects such as flushing, tachycardia, hypotension and bronchospasm are associated with significant histamine release; histamine release can be minimised by administering slowly or in divided doses over at least 1 minute. Atracurium undergoes non-enzymatic metabolism which is independent of liver and kidney function, thus allowing its use in patients with hepatic or renal impairment. Atracurium has no sedative or analgesic effects. All non-depolarising drugs should be used with care in patients suspected to be suffering with myasthenia gravis or myasthenic syndrome, as patients with these conditions are extremely sensitive to their effects and may require a reduction in dose.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      78.5
      Seconds

  • Question 7 - A 70-year old male is taken to the Emergency Room after suffering a...

    Incorrect

    • A 70-year old male is taken to the Emergency Room after suffering a traumatic fall while showering. Upon physical examination, the attending physician noted a hyperextended neck, 1/5 muscle strength in both upper extremities, 4/5 muscle strength in both lower extremities, and variable loss in sensation. The patient is placed in the wards for monitoring. For the next 24 hours, anuria is noted.

      Which of the following spinal cord injuries is the most likely diagnosis?

      Your Answer: Brown-Séquard syndrome

      Correct Answer: Central cord syndrome

      Explanation:

      Central cord syndrome is the most common type of incomplete cord injury and almost always occurs due to a traumatic injury. It results in motor deficits that are worse in the upper extremities as compared to the lower extremities. It may also cause bladder dysfunction (retention) and variable sensory deficits below the level of injury.

      The majority of these patients will be older and present with symptoms after a fall with hyperextension of their neck. On examination, patients will have more significant strength impairments in the upper extremities (especially the hands) compared to the lower extremities. Patients often complain of sensory deficits below the level of injury, but this is variable. Pain and temperature sensations are typically affected, but the sensation of light touch can also be impaired. The most common sensory deficits are in a cape-like distribution across their upper back and down their posterior upper extremities. They will often have neck pain at the site of spinal cord impingement.

      Bladder dysfunction (most commonly urinary retention) and priapism can also be signs of upper motor neuron dysfunction. The sacral sensation is usually preserved, but the clinician should assess the rectal tone to evaluate the severity of the compression.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      103.3
      Seconds

  • Question 8 - A 6 year old boy is brought into the ED by his mom...

    Correct

    • A 6 year old boy is brought into the ED by his mom with a rash that is associated with Koplik's spots and a diagnosis of measles is made. What advice should be given about returning to school?

      Your Answer: 4 days from the onset of the rash

      Explanation:

      Prevention of spread of measles is extremely important and infected patients should be isolated. The infectious stage is from 3 days before the rash emerges and patients are advised to stay away from school/nursery/work for 4 days from onset of the rash.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      29.7
      Seconds

  • Question 9 - Which of the following nerves innervates the gastrocnemius muscle? ...

    Correct

    • Which of the following nerves innervates the gastrocnemius muscle?

      Your Answer: Tibial nerve

      Explanation:

      The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      36.4
      Seconds

  • Question 10 - Regarding fibrinolytics, which of the following statements is INCORRECT: ...

    Correct

    • Regarding fibrinolytics, which of the following statements is INCORRECT:

      Your Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.

      Explanation:

      Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      106.9
      Seconds

  • Question 11 - Fusidic acid is primarily indicated for infections caused by which of the following...

    Incorrect

    • Fusidic acid is primarily indicated for infections caused by which of the following microorganisms:

      Your Answer: Gonococcal infections

      Correct Answer: Staphylococcal infections

      Explanation:

      Fusidic acid is a narrow spectrum antibiotic used for staphylococcal infections, primarily topically for minor staphylococcal skin (impetigo) or eye infection. It is sometimes used orally for penicillin-resistant staphylococcal infection, including osteomyelitis or endocarditis, in combination with other antibacterials.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      27.4
      Seconds

  • Question 12 - A 36-year-old man presented to the emergency room after an incident of slipping...

    Correct

    • A 36-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip extension, but normal hip abduction.

      Which of the following muscles was most likely injured in this case?

      Your Answer: Gluteus maximus

      Explanation:

      The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.

      The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.
      The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      65.2
      Seconds

  • Question 13 - When an elderly dehydrated patient is moved from a supine to a standing...

    Correct

    • When an elderly dehydrated patient is moved from a supine to a standing position, her heart rate increases. Which of the following accounts for the increase in heart rate upon standing:

      Your Answer: Decreased venous return

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      120.1
      Seconds

  • Question 14 - Dehydration causes a significant increase in the amount of this hormone? ...

    Correct

    • Dehydration causes a significant increase in the amount of this hormone?

      Your Answer: Antidiuretic hormone

      Explanation:

      Antidiuretic hormone induces the kidneys to release less water, resulting in reduced urine production.

      In the case of dehydration, ADH levels rise, resulting in a considerable decrease in urine output as well as an increase in plasma protein, blood Hct, and serum osmolality.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      33.6
      Seconds

  • Question 15 - Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis...

    Incorrect

    • Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis following exposure to a known allergen:

      Your Answer: Hypotension alone

      Correct Answer: Generalised urticaria and angioedema alone

      Explanation:

      Anaphylaxis is characterised by sudden onset and rapidly developing, life-threatening airway, breathing and circulation problems associated with skin and/or mucosal changes. Reactions can vary greatly, from hypotension alone, to reactions with predominantly asthmatic features, to cardiac/respiratory arrest. Skin or mucosal changes may be absent or subtle in up to 20% of cases but skin or mucosal changes alone are not a sign of an anaphylactic reaction.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      96.2
      Seconds

  • Question 16 - All of the following are indications for beta-blockers EXCEPT for: ...

    Correct

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer: Raynaud's disease

      Explanation:

      Beta-blockers are contraindicated in Raynaud’s syndrome.
      Beta-blockers may be indicated in:
      Hypertension
      Pheochromocytoma (only with an alpha-blocker)
      Angina
      Secondary prevention after ACS
      Arrhythmias including atrial fibrillation
      Heart failure
      Thyrotoxicosis
      Anxiety
      Prophylaxis of migraine
      Essential tremor
      Glaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      20
      Seconds

  • Question 17 - A new chemotherapy drug is being tested. The intervention reduces the risk of...

    Correct

    • A new chemotherapy drug is being tested. The intervention reduces the risk of death from 10 in 1000 to 5 in 1000. What is the number needed to treat to prevent one death:

      Your Answer: 200

      Explanation:

      Absolute risk reduction (ARR) of treatment
      = risk of death in control group – risk of death in treatment group
      ARR = (10/1000) – (5/1000)
      = 5/1000 = 0.005
      Number needed to treat (NNT)
      = 1/ARR
      = 1/0.005
      = 200
      Therefore 200 people would need to be treated to prevent one extra death.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      147.1
      Seconds

  • Question 18 - The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This...

    Correct

    • The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.

      Which of the following medications is most likely to be the cause of this adverse reaction?

      Your Answer: Amlodipine

      Explanation:

      Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      20.6
      Seconds

  • Question 19 - An ambulance transports a 40-year-old man to the hospital. He ingested a significant...

    Incorrect

    • An ambulance transports a 40-year-old man to the hospital. He ingested a significant amount of aspirin.

      In the early stages of an aspirin overdose, which form of acid-base problem should you anticipate?

      Your Answer: Metabolic alkalosis

      Correct Answer: Respiratory alkalosis

      Explanation:

      When you take too much aspirin, you have a mix of respiratory alkalosis and metabolic acidosis. Respiratory centre stimulation produces hyperventilation and respiratory alkalosis in the early phases. The direct acid actions of aspirin tend to create a higher anion gap metabolic acidosis in the latter phases.
      Below summarizes some of the most common reasons of acid-base abnormalities:

      Respiratory alkalosis:
      – Hyperventilation (e.g. anxiety, pain, fever)
      – Pulmonary embolism
      – Pneumothorax
      – CNS disorders (e.g. CVA, SAH, encephalitis)
      – High altitude
      – Pregnancy
      – Early stages of aspirin overdose

      Respiratory acidosis:
      – COPD
      – Life-threatening asthma
      – Pulmonary oedema
      – Respiratory depression (e.g. opiates, benzodiazepines)
      РNeuromuscular disease (e.g. Guillain-Barr̩ syndrome, muscular dystrophy
      – Incorrect ventilator settings (hypoventilation)
      – Obesity

      Metabolic alkalosis:
      – Vomiting
      – Cardiac arrest
      – Multi-organ failure
      – Cystic fibrosis
      – Potassium depletion (e.g. diuretic usage)
      – Cushing’s syndrome
      – Conn’s syndrome

      Metabolic acidosis (with raised anion gap):
      – Lactic acidosis (e.g. hypoxaemia, shock, sepsis, infarction)
      – Ketoacidosis (e.g. diabetes, starvation, alcohol excess)
      – Renal failure
      – Poisoning (e.g. late stages of aspirin overdose, methanol, ethylene glycol)

      Metabolic acidosis (with normal anion gap):
      – Renal tubular acidosis
      – Diarrhoea
      – Ammonium chloride ingestion
      – Adrenal insufficiency

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      75.8
      Seconds

  • Question 20 - Regarding platelets, which of the following statements is CORRECT: ...

    Correct

    • Regarding platelets, which of the following statements is CORRECT:

      Your Answer: Platelets are produced in the bone marrow by fragmentation of the cytoplasm of megakaryocytes.

      Explanation:

      Platelets are produced in the bone marrow by fragmentation of the cytoplasm of megakaryocytes, derived from the common myeloid progenitor cell. The time interval from differentiation of the human stem cell to the production of platelets averages 10 days. Thrombopoietin is the major regulator of platelet formation and 95% of this is produced by the liver. The normal platelet count is approximately 150 – 450 x 109/L and the normal platelet lifespan is 10 days. Under normal circumstances, 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
      36.2
      Seconds

  • Question 21 - Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS)...

    Incorrect

    • Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS) in a patient infected with HIV:

      Your Answer: CD4 count < 350 cells/uL

      Correct Answer: CD4 count < 200 cells/uL

      Explanation:

      A diagnosis of AIDS can be made in a patient infected with HIV if the patient has a CD4 count < 200 cells/uL, or an AIDS-defining illness. Antiretroviral treatment should be considered in patients with CD4 counts < 350 cells/uL.

      Oral candidiasis is not an AIDS defining illness – candidiasis of the bronchi, trachea, lungs or of the oesophagus is an AIDS defining illness.

      A positive p24 antigen test seen in early HIV infection and does not indicate the development of AIDS.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      27.9
      Seconds

  • Question 22 - Regarding gas gangrene, which of the following statements is CORRECT: ...

    Correct

    • Regarding gas gangrene, which of the following statements is CORRECT:

      Your Answer: Infection is characterised by rapidly spreading tissue myonecrosis with crepitus.

      Explanation:

      Gas gangrene usually occurs within 3 days of injury, and is characterised by pain, rapidly spreading oedema, myositis, necrosis, palpable crepitus and systemic toxicity. Diagnosis is clinical and laboratory confirmation should not delay urgent surgical intervention. Hyperbaric oxygen therapy can be considered in addition to surgery and antibiotic therapy, to stop toxin production and inhibit bacteria from replicating and spreading (as Clostridium spp. are obligate anaerobes).

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      16.8
      Seconds

  • Question 23 - Fibrinoid necrosis is typically seen in which of the following: ...

    Incorrect

    • Fibrinoid necrosis is typically seen in which of the following:

      Your Answer: Acute pancreatitis

      Correct Answer: Malignant hypertension

      Explanation:

      Fibrinoid necrosis occurs in malignant hypertension where increased arterial pressure results in necrosis of smooth muscle wall. Eosinophilic and fibrinous deposits are seen.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      63.8
      Seconds

  • Question 24 - Regarding hypertensive crises, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hypertensive crises, which of the following statements is CORRECT:

      Your Answer: Hypertensive urgency requires intravenous antihypertensive therapy.

      Correct Answer: In a hypertensive emergency, blood pressure should be reduced by 20 - 25% within 2 hours.

      Explanation:

      A hypertensive emergency is defined as severe hypertension (blood pressure ≥ 180/110 mmHg) with acute damage to the target organs. Prompt treatment with intravenous antihypertensive therapy is generally required; over the first few minutes or within 2 hours, blood pressure should be reduced by 20 – 25%. Severe hypertension without acute target organ damage is defined as hypertensive urgency.; blood pressure should be reduced gradually over 24 – 48 hours with oral antihypertensive therapy. If blood pressure is reduced too quickly in the management of hypertensive crises, there is a risk of reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, and myocardial ischaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      41.2
      Seconds

  • Question 25 - A 66-year-old female presents to the Emergency Department with a nose bleed. She...

    Correct

    • A 66-year-old female presents to the Emergency Department with a nose bleed. She says that she has been having frequent episodes of nose bleeds over the past four months, along with increasing fatigue and some weight loss. On examination, she has a diffuse petechial rash and hypertrophy of the gingiva.

      Which one of the following conditions is this patient most likely to have?

      Your Answer: Acute myeloid leukaemia (AML)

      Explanation:

      The history of nosebleeds and fatigue, and gingival hyperplasia presents a typical picture of acute myeloid leukaemia. Leukemic infiltrates within the gingiva cause hypertrophy and distinguish this condition from other types of leukaemia. The fatigue is secondary to anaemia, while the nosebleeds are caused by thrombocytopenia secondary to leukemic infiltration of bone marrow. Patients may also report frequent infections secondary to neutropenia and hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      26
      Seconds

  • Question 26 - The cutaneous circulation's principal role is thermoregulation. This process is aided by the...

    Incorrect

    • The cutaneous circulation's principal role is thermoregulation. This process is aided by the existence of arteriovenous anastomoses.

      Which of the following anatomical areas has the greatest number of arteriovenous anastomoses?

      Your Answer: Thoracic wall

      Correct Answer: Pinna of the ear

      Explanation:

      Short vessels called arteriovenous anastomoses (AVAs) link tiny arteries and veins. They have a large lumen diameter. The strong and muscular walls allow AVAs to completely clog the vascular lumen, preventing blood flow from artery to vein (acting like a sphincter). When the AVAs open, they create a low-resistance connection between arteries and veins, allowing blood to flow into the limbs’ superficial venous plexuses. There is no diffusion of solutes or fluid into the interstitium due to their strong muscle walls.

      AVAs are densely innervated by adrenergic fibres from the hypothalamic temperature-regulation centre. High sympathetic output occurs at normal core temperatures, inducing vasoconstriction of the AVAs and blood flow through the capillary networks and deep plexuses. When the temperature rises, sympathetic output decreases, producing AVA vasodilation and blood shunting from the artery to the superficial venous plexus. Heat is lost to the environment as hot blood rushes near to the skin’s surface.
      AVAs are a specialized anatomical adaptation that can only be found in large quantities in the fingers, palms, soles, lips, and pinna of the ear.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      37.5
      Seconds

  • Question 27 - A dermatological examination on a patient presenting with a lump shows a small...

    Incorrect

    • A dermatological examination on a patient presenting with a lump shows a small visible skin elevation containing an accumulation of pus.

      Which one of these best describes the lump you have found on examination?

      Your Answer: Furuncle

      Correct Answer: Pustule

      Explanation:

      A pustule is a small visible skin elevation containing an accumulation of pus.

      A carbuncle is a collection of individual boils clustered together.

      A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.

      A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.

      A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      92.6
      Seconds

  • Question 28 - Which of the following statements is incorrect regarding the electron transfer system? ...

    Incorrect

    • Which of the following statements is incorrect regarding the electron transfer system?

      Your Answer: The electron transfer system is located on the cristae of the mitochondrion.

      Correct Answer: The electron transfer system occurs in anaerobic respiration.

      Explanation:

      The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      22
      Seconds

  • Question 29 - Which patients are particularly susceptible to infection with herpes simplex, those with: ...

    Incorrect

    • Which patients are particularly susceptible to infection with herpes simplex, those with:

      Your Answer: Complement deficiency

      Correct Answer: T-cell deficiency

      Explanation:

      Cell-mediated immunity, especially the action of cytotoxic T-cells, is essential in the control of herpesvirus infections and patients with T-cell deficiency are at particular risk of reactivation and severe infection. T-cell deficiency may follow HIV infection, chemotherapy, corticosteroid therapy or organ transplantation.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      12
      Seconds

  • Question 30 - The most common cause of anaemia worldwide is which of the following? ...

    Incorrect

    • The most common cause of anaemia worldwide is which of the following?

      Your Answer: Vitamin B12 deficiency

      Correct Answer: Iron deficiency anaemia

      Explanation:

      The most common cause of microcytic anaemia and of any anaemia worldwide is iron deficiency anaemia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      68.2
      Seconds

  • Question 31 - A 36-year-old man who works in a farm presents with a deep laceration...

    Incorrect

    • A 36-year-old man who works in a farm presents with a deep laceration over the palm of his hand. A median nerve block was performed at his wrist to facilitate wound exploration and closure.

      Which of the following statements regarding median nerve blocks at the wrist is considered correct?

      Your Answer: Palmaris longus can always be used to locate the median nerve

      Correct Answer: The needle should be inserted approximately 2.5 cm proximal to flexor retinaculum

      Explanation:

      A median nerve block is a simple, safe, and effective method of obtaining anaesthesia to the palmar aspect of the thumb, index finger, middle finger, radial portion of the palm and ring finger. The median nerve lies deep to the flexor retinaculum and about one centimetre under the skin of the volar wrist.
      The palmaris longus tendon lies superficial to the retinaculum and is absent in up to 20% of patients.
      The median nerve is located slightly lateral (radial) to the palmaris longus tendon and medial (ulnar) to the flexor carpi radialis tendon.

      The procedure is as follows:
      – Check sensation and motor function of the median nerve. Wear gloves and use appropriate barrier precautions.
      – Locate the flexor carpi radialis and palmaris longus tendons, which become prominent when the patient flexes the wrist against resistance. The palmaris longus tendon is usually the more prominent of the two tendons.
      – Needle-entry site: The needle will be inserted adjacent to the radial (lateral) border of the palmaris longus tendon just proximal to the proximal wrist crease. If the palmaris longus tendon is absent, the needle-entry site is about 1 cm ulnar to the flexor carpi radialis tendon.
      – Cleanse the site with antiseptic solution. Place a skin wheal of anaesthetic, if one is being used, at the needle-entry site.
      – Insert the needle perpendicularly through the skin and advance it slowly until a slight pop is felt as the needle penetrates the flexor retinaculum. When paraesthesia in the distribution of the median nerve confirms proper needle placement, withdraw the needle 1 to 2 mm.
      – Aspirate to exclude intravascular placement and then slowly (i.e., over 30 to 60 seconds) inject about 3 mL of anaesthetic. If the patient does not feel paraesthesia, redirect the needle in an ulnar direction, under the palmaris longus tendon. If paraesthesia is still not felt, slowly inject 3 to 5 mL of anaesthetic in the proximity of the nerve 1 cm deep to the tendon.
      – Allow about 5 to 10 minutes for the anaesthetic to take effect.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      23.7
      Seconds

  • Question 32 - Co-amoxiclav is used first line for which of the following indications: ...

    Incorrect

    • Co-amoxiclav is used first line for which of the following indications:

      Your Answer: Tetanus

      Correct Answer: Animal bite

      Explanation:

      Co-amoxiclav is used first line for infected and prophylaxis of infection in animal and human bites.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      47.7
      Seconds

  • Question 33 - Regarding beta-thalassaemia, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding beta-thalassaemia, which of the following statements is CORRECT:

      Your Answer: Beta-thalassaemia is typically associated with a macrocytic anaemia.

      Correct Answer: Beta-thalassaemia trait is associated with a raised HbA2.

      Explanation:

      Beta-thalassaemia major is caused by a complete or almost complete failure of β-globin chain synthesis, severe imbalance of α:β-chains with deposition of α-chains in erythroblasts, ineffective erythropoiesis and extramedullary haemopoiesis. The severe anaemia becomes apparent at 3 – 6 months when the switch from γ-chain to β-chain synthesis normally occurs. Beta-thalassaemia minor is a variable syndrome, milder than thalassaemia major, with later onset and characterised by moderate hypochromic microcytic anaemia with raised haemoglobin A2. Beta-thalassaemia trait is characterised by mild hypochromic, microcytic anaemia with raised red cell count and raised haemoglobin A2.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      97.9
      Seconds

  • Question 34 - Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the...

    Incorrect

    • Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the other hand, calcium-induced calcium release (CICR) is a mechanism that is unique to Cardiac myocytes. The influx of calcium ions (Ca 2+) into the cell causes a 'calcium spark,' which causes more ions to be released into the cytoplasm.

      In CICR, which membrane protein in the sarcoplasmic reticulum is involved?

      Your Answer: Voltage-gated potassium channel

      Correct Answer: Ryanodine receptor

      Explanation:

      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.

      The release of Ca2+ from the sarcoplasmic reticulum is required for calcium-induced calcium release (CICR). This is mostly accomplished by ryanodine receptors (RyR) on the sarcoplasmic reticulum membrane; Ca2+ binds to RyR, causing additional Ca2+ to be released.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      22.1
      Seconds

  • Question 35 - Renin is produced by which of the following: ...

    Incorrect

    • Renin is produced by which of the following:

      Your Answer: The glomerular basement membrane

      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.

    • This question is part of the following fields:

      • Physiology
      • Renal
      10.8
      Seconds

  • Question 36 - Glucagon may be used as an antidote for overdose with which of the...

    Correct

    • Glucagon may be used as an antidote for overdose with which of the following:

      Your Answer: Beta blockers

      Explanation:

      Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
      Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
      Glucagon then causes:
      Glycogenolysis
      Gluconeogenesis
      Lipolysis in adipose tissue
      The secretion of glucagon is also stimulated by:
      Adrenaline
      Cholecystokinin
      Arginine
      Alanine
      Acetylcholine
      The secretion of glucagon is inhibited by:
      Insulin
      Somatostatin
      Increased free fatty acids
      Increased urea production

      Glycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.

      Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      39.9
      Seconds

  • Question 37 - A patient sustains an injury to the proximal median nerve after falling through...

    Correct

    • A patient sustains an injury to the proximal median nerve after falling through a glass door. Which of the following muscles would you not expect to be affected:

      Your Answer: Flexor carpi ulnaris

      Explanation:

      All of the muscles in the anterior forearm are innervated by the median nerve, except for the flexor carpi ulnaris and the medial half of the flexor digitorum profundus which are innervated by the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      21.8
      Seconds

  • Question 38 - Which of the following hormones is dysfunctional in diabetes insipidus: ...

    Incorrect

    • Which of the following hormones is dysfunctional in diabetes insipidus:

      Your Answer: Renin

      Correct Answer: Antidiuretic hormone

      Explanation:

      Diabetes insipidus (DI) may result from a deficiency of ADH secretion (cranial DI) or from an inappropriate renal response to ADH (nephrogenic DI). As a result, fluid reabsorption at the kidneys is impaired, resulting in large amounts of hypotonic, dilute urine being passed with a profound unquenchable polydipsia.
      The biochemical hallmarks of DI are:
      High plasma osmolality (> 295 mOsm/kg)
      Low urine osmolality (< 300 mOsm/kg)
      Hypernatraemia (> 145 mmol/L)
      High urine volume

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      67
      Seconds

  • Question 39 - A 66-year-old patient attends the Emergency Department with chest pain. His ECG and...

    Incorrect

    • A 66-year-old patient attends the Emergency Department with chest pain. His ECG and troponin are suggestive of a new myocardial infarction. You have explained the condition and the prognosis. He asks you about how the damaged area of his heart will heal following this.
      Which answer best describes the process of myocardial healing following myocardial infarction? Select ONE answer only.

      Your Answer: The damaged cells will enter G1 from G0

      Correct Answer: The damaged myocardium will form non-contractile scar tissue

      Explanation:

      Myocardial cells are unable to regenerate, they are unable to divide in response to tissue injury. The remain permanently in G0 and cannot progress to G1. If a segment of muscle dies, for example in myocardial infarction, this tissue will be replaced by scar tissue if the patient recovers. This scar tissue is non-contractile and therefore the remaining myocardium must work harder to maintain cardiac output. As a consequence the remaining undamaged myocardium undergoes compensatory hypertrophy without cell division.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      28.1
      Seconds

  • Question 40 - You are calculating the anion gap on a patient with an acid-base disturbance...

    Incorrect

    • 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: Uraemia

      Correct 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
      21.7
      Seconds

  • Question 41 - Infection with Campylobacter jejuni is one of the most common risk factors for...

    Incorrect

    • Infection with Campylobacter jejuni is one of the most common risk factors for which of the following conditions?

      Your Answer: Glomerulonephritis

      Correct Answer: Guillain-Barre syndrome

      Explanation:

      One of the most common risk factors for GBS is infection with Campylobacter jejuni, which causes diarrhoea.

      Guillain-Barré syndrome (GBS) is a rare autoimmune disorder in which the body’s immune system attacks the nerves, resulting in muscle weakness and paralysis.

      Infection with Streptococcus pyogenes can cause acute glomerulonephritis and rheumatic fever.

      Haemolytic uraemic syndrome is commonly linked to E. coli infection.

      Following measles infection, subacute sclerosing panencephalitis develops.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      45.7
      Seconds

  • Question 42 - Regarding folate requirements, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding folate requirements, which of the following statements is CORRECT:

      Your Answer: Absorption of folate is primarily from the terminal ileum.

      Correct Answer: Dietary folate is found particularly in leafy green vegetables and liver.

      Explanation:

      Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
      Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      28
      Seconds

  • Question 43 - Which of the following neurotransmitter and receptor combinations is present at the neuromuscular...

    Incorrect

    • Which of the following neurotransmitter and receptor combinations is present at the neuromuscular junction:

      Your Answer: Noradrenaline acting at beta receptors

      Correct Answer: Acetylcholine acting at nicotinic receptors

      Explanation:

      At the neuromuscular junction, acetylcholine is released from the prejunctional membrane which acts on cholinergic nicotinic receptors on the postjunctional membrane.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      21.7
      Seconds

  • Question 44 - How does abciximab mediate its antiplatelet effect: ...

    Incorrect

    • How does abciximab mediate its antiplatelet effect:

      Your Answer: It irreversibly inhibits cyclo-oxygenase.

      Correct Answer: It is a GPIIb/IIIa inhibitor.

      Explanation:

      Abciximab, eptifibatide and tirofiban are GPIIb/IIIa inhibitors, inhibiting platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor and other adhesive molecules.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      52.2
      Seconds

  • Question 45 - Regarding iron handling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding iron handling, which of the following statements is CORRECT:

      Your Answer: Most dietary iron is in the ferrous (Fe 2+ ) state.

      Correct Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).

      Explanation:

      Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      43.6
      Seconds

  • Question 46 - Which of the following terms describes the proportion of individuals with a negative...

    Incorrect

    • Which of the following terms describes the proportion of individuals with a negative test result who actually do not have a disease:

      Your Answer: Specificity

      Correct Answer: Negative predictive value

      Explanation:

      Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.
      NPV = d/(c+d)

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      39.6
      Seconds

  • Question 47 - A 62 year old man has sustained a penetrating injury to the submandibular...

    Incorrect

    • 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: Right glossopharyngeal nerve

      Correct 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.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      68.9
      Seconds

  • Question 48 - Regarding the cardiac cycle, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding the cardiac cycle, which of the following statements is INCORRECT:

      Your Answer: More than 85% of left ventricular perfusion occurs during diastole.

      Correct Answer: The second heart sound occurs in late diastole caused by closure of the atrioventricular valves.

      Explanation:

      Diastole is usually twice the length of systole at rest, but decreases with increased heart rate. During systole, contraction of the ventricles compresses the coronary arteries and suppresses blood flow. This is particularly evident in the left ventricle, where during systole the ventricular pressure is the same as or greater than that in the arteries and as a result more than 85% of left ventricular perfusion occurs during diastole. This becomes a problem if the heart rate is increased as the diastolic interval is shorter and can result in ischaemia. The second heart sound, caused by closure of the semilunar valves, marks the end of systole.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      31.1
      Seconds

  • Question 49 - Regarding the brachioradialis muscle, which of the following statements is true? ...

    Incorrect

    • Regarding the brachioradialis muscle, which of the following statements is true?

      Your Answer: It is a muscle of the anterior compartment of the forearm

      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.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      48.7
      Seconds

  • Question 50 - The following structures all lie anteriorly to the oesophagus EXCEPT for the: ...

    Incorrect

    • The following structures all lie anteriorly to the oesophagus EXCEPT for the:

      Your Answer:

      Correct Answer: Thoracic duct

      Explanation:

      Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (6/10) 60%
Thorax (1/2) 50%
Infections (2/3) 67%
Pharmacology (8/11) 73%
Microbiology (5/5) 100%
Specific Pathogen Groups (1/1) 100%
Head And Neck (1/1) 100%
Cardiovascular Pharmacology (2/2) 100%
Anaesthesia (0/1) 0%
Central Nervous System (0/1) 0%
Pathogens (4/4) 100%
Lower Limb (2/2) 100%
Cardiovascular (4/5) 80%
Physiology (8/12) 67%
Endocrine (3/3) 100%
Respiratory (0/1) 0%
Evidence Based Medicine (1/2) 50%
Statistics (1/2) 50%
Renal Physiology (0/1) 0%
Basic Cellular (2/3) 67%
Inflammatory Responses (0/1) 0%
Pathology (6/9) 67%
Haematology (4/6) 67%
Cardiovascular Physiology (1/1) 100%
General Pathology (2/2) 100%
Upper Limb (1/3) 33%
Basic Cellular Physiology (0/1) 0%
Renal (2/2) 100%
Cranial Nerve Lesions (1/1) 100%
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