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Question 1
Correct
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Typically, granulomatous inflammation is associated with one of the following infections:
Your Answer: Tuberculosis
Explanation:Granulomatous inflammation is typically seen when an infective agent with a digestion-resistance capsule (e.g. Mycobacterium tuberculosis) or a piece of inert foreign material (such as suture or glass) is introduced into the tissue. A transient acute inflammatory response occurs and when this is ineffective in eradicating the stimulus, chronic inflammation occurs.
Tuberculosis is the prototype of the granulomatous diseases, but sarcoidosis, cat-scratch disease, lymphogranuloma inguinale, leprosy, brucellosis, syphilis, some mycotic infections, berylliosis, reactions of irritant lipids, and some autoimmune diseases are also included
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 2
Correct
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A 58-year-old male has cellulitis of his left leg. Because he is allergic to penicillin, you start him on erythromycin.
What is erythromycin's mechanism of action?Your Answer: Inhibition of protein synthesis
Explanation:Bacteriostatic antibiotics include erythromycin and other macrolide antibiotics. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and thereby protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered to the infection site as a result.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 3
Incorrect
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Which of the following nerves supplies the abductor pollicis brevis?
Your Answer: The anterior interosseous nerve
Correct Answer: The recurrent branch of the median nerve
Explanation:Abductor pollicis brevis is innervated by the recurrent (thenar) branch of median nerve (root value C8 and T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Correct
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In the emergency room, a 28-year-old woman complains of wobbly and slurred speech, is unable to do the heel-shin test, and has nystagmus. The following signs are most likely related to damage to which of the following areas:
Your Answer: Cerebellum
Explanation:Cerebellar injury causes delayed and disorganized motions. When walking, people with cerebellar abnormalities sway and stagger.
Damage to the cerebellum can cause asynergia, the inability to judge distance and when to stop, dysmetria, the inability to perform rapid alternating movements or adiadochokinesia, movement tremors, staggering, wide-based walking or ataxic gait, a proclivity to fall, weak muscles or hypotonia, slurred speech or ataxic dysarthria, and abnormal eye movements or nystagmus.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 5
Incorrect
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Lidocaine's mechanism of action as a local aesthetic is as follows:
Your Answer: Blocks opening of ligand-gated Na+ channels
Correct Answer: Blocks influx of Na+ through voltage-gated Na+ channels
Explanation:Local anaesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 6
Correct
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A p value < 0.05 obtained from a study with a significance level (α) of 0.05, means all of the following, EXCEPT:
Your Answer: the result is clinically significant.
Explanation:A p value < 0.05:is statistically significantmeans that the probability of obtaining a given result by chance is less than 1 in 20means the null hypothesis is rejectedmeans there is evidence of an association between a variable and an outcomeNote that this does not tell us whether the result is clinically significant.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 7
Correct
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Antidiuretic hormone (ADH) is synthesised by which of the following:
Your Answer: Hypothalamus
Explanation:Antidiuretic hormone is synthesised in the hypothalamus and transported to the posterior pituitary within nerve fibres where it is stored in secretory granules. ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, raising cAMP levels and causing intracellular vesicles to fuse with the apical membrane. In their membrane these vesicles have water channels called aquaporins, which increase the water permeability allowing greater water reabsorption and concentration of urine. Excess levels of ADH results in syndrome of inappropriate ADH secretion (SIADH) characterised by hyponatremia with concomitant hypo-osmolality and high urine osmolality.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 8
Correct
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Question 9
Correct
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Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that can cause a catheter-related urinary tract infection (UTI)?
Your Answer: Pseudomonas aeruginosa
Explanation:Listeria monocytogenes is a gram-positive bacteria that does not produce spores.
Staphylococcus aureus is a gram-positive bacteria, while Candida albicans is a gram-positive yeast with a single bud.
Among the choices, gram-negative bacteria include only Klebsiella pneumoniae and Pseudomonas aeruginosa.
Pseudomonas aeruginosa is an oxidase-positive bacterium, while Klebsiella pneumoniae is an oxidase-negative bacterium.
P. aeruginosa can cause urinary tract infections (UTIs) and is spread through poor hygiene or contaminated medical equipment or devices, such as catheters that haven’t been fully sterilized.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 10
Correct
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Which of the following nerves is most likely associated with an anterior shoulder dislocation?
Your Answer: Axillary nerve
Explanation:In an anterior dislocation, the arm is an abducted and externally rotated position. In the externally rotated position, the posterosuperior aspect of the humeral head abuts and drives through the anteroinferior aspect of the glenoid rim. This can damage the humeral head, glenoid labrum, or both. An associated humeral head compression fracture is described as a Hill Sach’s lesion. If large enough, it can lead to locked dislocations that may require open reduction. The glenoid labrum is a fibrocartilaginous structure that rings the circumference of the glenoid fossa. Bankart lesions are injuries to the anteroinferior glenoid labrum complex and the most common capsulolabral injury. A bony Bankart lesion refers to an associated fracture of the glenoid rim. These capsulolabral lesions are risk factors for recurrent dislocation.
Axillary nerve injury is identified in about 42% of acute anterior shoulder dislocations. Nerve transection is rare, and traction injuries are more common. Arterial injury has also been described. The subclavian artery becomes the axillary artery after passing the first rib. The distal portion of the axillary artery is anatomically fixed and, therefore, susceptible to injury in anterior dislocations. Ischemic injury, including pseudoaneurysm and arterial laceration, is rare but carries marked morbidity if not quickly identified.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 11
Incorrect
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Which of the following statements regarding forest plots is true? Select ONE answer only.
Which of the following statements regarding forest plots is true? Select ONE answer only.Your Answer: The length of the horizontal lines emerging from the squares represents the standard deviation
Correct Answer: Larger studies are associated with smaller horizontal lines
Explanation:Forest plots are graphical displays designed to illustrate the relative strength of treatment effects in multiple individual studies addressing the same question.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 12
Correct
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Which of the following is NOT a typical feature of an abducens nerve palsy:
Your Answer: Inability to look up
Explanation:CN VI palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 13
Correct
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A patient has a cardiac output of 4.8 L/min and a heart rate of 80 bpm, therefore their stroke volume is:
Your Answer: 60 mL
Explanation:Cardiac output (CO) = Stroke volume (SV) x Heart rate (HR).
Therefore SV = CO/HR
= 4.8/80
= 0.06 L = 60 mL. -
This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 14
Incorrect
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Regarding box and whisker plots, which of the following statements is true?
Your Answer: They are used to display qualitative variables
Correct Answer: 25% of the values lie below the lower quartile
Explanation:A box and whisker plot is defined as a graphical method of displaying variation in a set of data. In most cases, a histogram analysis provides a sufficient display, but a box and whisker plot can provide additional detail while allowing multiple sets of data to be displayed in the same graph.
The procedure to develop a box and whisker plot comes from the five statistics below:
(1) Minimum value: The smallest value in the data set
(2) Second quartile: The value below which the lower 25% of the data are contained
(3) Median value: The middle number in a range of numbers
(4) Third quartile: The value above which the upper 25% of the data are contained
(5) Maximum value: The largest value in the data set
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This question is part of the following fields:
- Evidence Based Medicine
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Question 15
Correct
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Which of the following statements is true regarding the extensor pollicis longus?
Your Answer: It is innervated by the posterior interosseous nerve
Explanation:Extensor pollicis longus is part of the deep extensors of the forearm together with extensor pollicis brevis, abductor pollicis longus, extensor indicis and supinator muscles. It is located on the posterior aspect of forearm, extending from the middle third of the ulna, and adjacent interosseous membrane, to the distal phalanx of the thumb.
Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor pollicis brevis receives its blood supply from the posterior interosseous artery and perforating branches of the anterior interosseous artery.
The main action of extensor pollicis longus is extension of the thumb at the metacarpophalangeal and interphalangeal joints. Extension at the metacarpophalangeal joint occurs in synergy with extensor pollicis brevis muscle. When the thumb reaches the full extension or abduction, extensor pollicis longus can also assist in adduction of the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
Correct
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A 61-year-old man complains of crushing chest pain that radiates to his left arm and jaw. An ECG is taken, and the lateral leads show extensive ST depression. His blood pressure is currently 190/123 mmHg, and as part of his treatment, you intend to begin drug therapy to lower it.
Which of the following is the INITIAL drug treatment for this patient's BP reduction?Your Answer: Glyceryl trinitrate
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.
In the presence of cardiac ischaemia, hypertensive emergencies require immediate treatment to prevent myocardial infarction.
Similarly, if myonecrosis occurs in the presence of an existing infarction, prompt treatment is required to prevent further myonecrosis. When thrombolysis is used as the primary reperfusion therapy for acute myocardial infarction, blood pressure control is especially important.
An intravenous nitrate is the drug of choice in this situation (e.g. GTN). These have a dual purpose in that they can help patients with ischaemic chest pain manage their symptoms. Because lowering blood pressure with nitrates isn’t always enough to achieve optimal results, intravenous beta-blockers are frequently used as a supplement. For this, intravenous atenolol and metoprolol are commonly used.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 17
Incorrect
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A 40-year-old woman presents with a red, scaly, itchy rash around her navel that occurred after contact with a nickel belt buckle. A diagnosis of allergic contact dermatitis is made. Which type of hypersensitivity reaction is this?
Your Answer: Type II hypersensitivity reaction
Correct Answer: Type IV hypersensitivity reaction
Explanation:A type IV hypersensitivity reaction occurred in this patient. Allergic contact dermatitis is an inflammatory skin reaction occurring in response to an external stimulus, acting either as an allergen or an irritant, caused by a type IV or delayed hypersensitivity reaction. They usually take several days to develop.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 18
Correct
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A 77 year old lady presents to ED with her left leg shortened and externally rotated following slipping and falling on a wet bathroom floor. There is an intracapsular fracture of the neck of femur seen on imaging studies. She is at risk of avascular necrosis of the head of femur.
This is caused by lack of blood supply from which of these arteries?
Your Answer: Medial circumflex artery
Explanation:The primary blood supply to the head of the femur is from branches of the medial femoral circumflex artery.
The superior and inferior gluteal arteries supply the hip joint but not the head of femur.
The lateral circumflex artery anastomoses with the medial femoral circumflex artery and assists in supplying the head of femur.
The obturator artery is an important source of blood supply in children up to about 8 years. It gives rise to the artery of the head of femur which runs in the ligamentum teres and is insufficient to supply the head of femur in adults.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 19
Correct
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Which of the following is required for vitamin B12 absorption:
Your Answer: Intrinsic factor
Explanation:Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 20
Correct
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An 85-year-old woman is brought in from her nursing home. She arrives in the Emergency Department and appears confused. The staff member from the nursing home accompanying her informs you that she takes a water tablet.
From her past medical history and records, you deduce that the water tablet is a loop diuretic.
Which of the following parts of a nephron does a loop diuretic act on?Your Answer: Ascending loop of Henlé
Explanation:Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
Furosemide
Bumetanide
Torsemide
Ethacrynic AcidLoop diuretics act on the apical membrane of the thick ascending loop of Henle and inhibit the Na-K-Cl cotransporter. This blocks the reabsorption of sodium and chloride and results in salt-water excretion. This relieves congestion and reduces oedema.
Other diuretics act on the following part of the nephron:
1. Thiazide diuretics – Na/Cl co-transporter in the distal convoluted tubule
2. Osmotic diuretics – PCT and the loop of Henle
3. Aldosterone antagonists – distal convoluted tubule
4. Carbonic anhydrase inhibitors – inhibit the carbonic anhydrase and act on proximal tubular cells -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 21
Incorrect
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Question 22
Incorrect
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Which of the following is an ECG change typically associated with hyperkalaemia:
Your Answer:
Correct Answer: Wide QRS complex
Explanation:Hyperkalaemia causes a rapid reduction in resting membrane potential leading to increased cardiac depolarisation and muscle excitability. This in turn results in ECG changes which can rapidly progress to ventricular fibrillation or asystole. Very distinctive ECG changes that progressively change as the K+level increases:
K+>5.5 mmol/l – peaked T waves (usually earliest sign of hyperkalaemia), repolarisation abnormalities
K+>6.5 mmol/l – P waves widen and flatten, PR segment lengthens, P waves eventually disappear
K+>7.0 mmol/l – Prolonged QRS interval and bizarre QRS morphology, conduction blocks (bundle branch blocks, fascicular blocks), sinus bradycardia or slow AF, development of a sine wave appearance (a pre-terminal rhythm)
K+>9.0 mmol/l – Cardiac arrest due to asystole, VF or PEA with a bizarre, wide complex rhythm. -
This question is part of the following fields:
- Physiology
- Renal
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Question 23
Incorrect
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A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.
Which of these statements concerning indications and contraindications for vaccination is FALSE?
Your Answer:
Correct Answer: Premature infants should have the their immunisation schedule adjusted for gestational age
Explanation:All vaccines are contraindicated in individuals with:
A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.
A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycinLive attenuated vaccines are contraindicated in pregnancy except in cases where risk of infection is more than the risks of vaccination.
During times of acute febrile illness, vaccination should be avoided.
12 weeks should elapse after a dose of human immunoglobulin before a live vaccine is administered.
The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should NOT be implemented.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 24
Incorrect
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Which of the following is first-line for management of status epilepticus:
Your Answer:
Correct Answer: Intravenous lorazepam
Explanation:First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 25
Incorrect
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A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin. There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute. A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:URINARY TRACT INFECTIONS IN ADULT MEN
Symptomatic urinary tract infections are much less common in men than in women, and all UTIs
in men are considered complicated UTIs. Men with UTIs should be evaluated for predisposing or
causative factors.Uncomplicated cystitis
- Fosfomycin, oral, 3 g as a single dose.
If fosfomycin is unavailable:
- Nitrofurantoin, oral, 100 mg 6 hourly for 5 days.
Do not use nitrofurantoin or fosfomycin if there is any suspicion of early pyelonephritis as they do
not achieve adequate renal tissue levels.
If there are any factors precluding the use of the above agents, then a beta-lactam should be used.
Options include:
Cefixime 200 mg PO 12 hourly for 7 days
OR
Cefpodoxime 100 mg PO 12 hourly for 7 daysComplicated cystitis
Adults- Ciprofloxacin 500 mg PO 12 hourly
OR - Levofloxacin 750 mg PO once daily
Empiric antibiotic therapy should be changed based upon the bacteria isolated and its
antimicrobial susceptibility.
Treat for a total of 7–14 days -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 26
Incorrect
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Which of the following diseases is caused by a build-up of lymphoblasts in the bone marrow?
Your Answer:
Correct Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is a clonal (malignant) bone marrow disorder in which early lymphoid precursors multiply and replace the marrow’s normal hematopoietic cells. ALL is most common between the ages of 3 and 7, with 75 percent of cases occurring before the age of 6.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Incorrect
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After reviewing a child with respiratory distress who presented to the clinic, you make a diagnosis of bronchiolitis.
What is the most common causative organism?
Your Answer:
Correct Answer: Respiratory syncitial virus
Explanation:Bronchiolitis is a common respiratory infection that occurs in infancy between the ages of 3-6 months and in the winter months. It is most commonly caused by the respiratory syncytial virus (70% of cases)
Although it can also be caused by parainfluenza virus, adenovirus, coronavirus, rhinovirus, and influenza virus, these are not the most common causes
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 28
Incorrect
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Which of the following conditions manifests hyperkalaemia as one of its symptoms?
Your Answer:
Correct Answer: Congenital adrenal hyperplasia
Explanation:Plasma potassium greater than 5.5 mmol/L is hyperkalaemia or elevated plasma potassium level. Among the causes of hyperkalaemia include congenital adrenal hyperplasia.
Congenital adrenal hyperplasia is a general term referring to autosomal recessive disorders involving a deficiency of an enzyme needed in cortisol and/or aldosterone synthesis. The level of cortisol and/or aldosterone deficiency affects the clinical manifestations of congenital adrenal hyperplasia. When it involves hypoaldosteronism, it can result in hyponatremia and hyperkalaemia. While hypercortisolism can cause hypoglycaemia.
The other causes of hyperkalaemia may include renal failure, excess potassium supplementation, Addison’s disease (adrenal insufficiency), renal tubular acidosis (type 4), rhabdomyolysis, burns, trauma, Tumour lysis syndrome, acidosis, and medications such as ACE inhibitors, angiotensin receptor blockers, NSAIDs, beta-blockers, digoxin, and suxamethonium.
Bartter’s syndrome is characterized by hypokalaemic alkalosis with normal to low blood pressure.
Type 1 and 2 renal tubular acidosis both cause hypokalaemia.
Gitelman’s syndrome is a defect of the distal convoluted tubule of the kidney. It causes metabolic alkalosis with hypokalaemia and hypomagnesemia.
And excessive liquorice ingestion causes hypermineralocorticoidism and hypokalaemia as well. Thus, among the choices, only congenital adrenal hyperplasia can cause hyperkalaemia
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 29
Incorrect
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The most common source of healthcare-associated bacteraemia is:
Your Answer:
Correct Answer: Intravenous cannula
Explanation:Healthcare-associated bacteraemia is most commonly caused by intravenous access. Any intravenous device that is left in place for a long time increases the risk of infection. It allows bacteria like Staphylococcus aureus and Staphylococcus epidermidis to enter the body.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 30
Incorrect
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A 29-year-old female with a swollen red finger presents to your clinic and you suspect that the underlying process is of acute inflammation. You request for some bloods investigations.
Which statement about histamine as a chemical mediator of the acute inflammatory response is TRUE?Your Answer:
Correct Answer: It increases vascular permeability
Explanation:Histamine increases vascular permeability in the acute inflammatory response.
Histamine causes vasodilation.
It is released from Mast cells and basophils, eosinophils and platelets.
Mast cells and basophils are its primary source
Nitric oxide (not histamine) is a major factor in endotoxic shock
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This question is part of the following fields:
- General Pathology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
