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Question 1
Correct
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The blood test reports of a 56-year-old female are sent for your review. She seems acutely sick and has had multiple infections over the past few months. Her complete blood count report shows neutropenia.
Which one of the following options is true with regards to neutropenia?Your Answer: It can be caused by both radiotherapy and chemotherapy
Explanation:A total neutrophil count of less than 2 x 109/L is defined as neutropenia. It can be caused by the following:
1. viral infections
2. SLE
3. RA
4. hypersplenism
5. chemo- and radiotherapy
6. vitamin B12 and folate deficiency
7. drug reactions -
This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Incorrect
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Regarding gastric motility and emptying, which of the following statements is CORRECT:
Your Answer: A high pH in the duodenum inhibits gastric emptying.
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 3
Incorrect
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Which of the following is NOT a typical feature of an abducens nerve palsy:
Your Answer: Convergent squint at rest
Correct 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 4
Correct
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Bordetella pertussis causes which of the following infectious diseases:
Your Answer: Whooping cough
Explanation:Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
Correct
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Atrial natriuretic peptide (ANP) is primarily produced in response to:
Your 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 6
Correct
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Pre-oxygenation is done prior to intubation to extend the ‘safe apnoea time’.
Which lung volume or capacity is the most important store of oxygen in the body?
Your Answer: Functional residual capacity
Explanation:The administration of oxygen to a patient before intubation is called pre-oxygenation and it helps extend the ‘safe apnoea time’.
The Functional residual capacity (FRC) is the volume of gas that remains in the lungs after normal tidal expiration. It is the most important store of oxygen in the body. The aim of pre-oxygenation is to replace the nitrogen in the FRC with oxygen.
Apnoea can be tolerated for longer periods before critical hypoxia develops if the FRC is large. Patients with reduced FRC reach critical hypoxia more rapidly.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 7
Incorrect
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A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.
Which of the following nerves may most likely be affected?Your Answer: The lower subscapular nerve
Correct Answer: The suprascapular nerve
Explanation:The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 8
Incorrect
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A 35-year-old man is feeling unwell following his return from a business trip. He is diagnosed with a vector transmitted disease.
Which of these organisms is commonly spread by vector-borne transmission?Your Answer: Vibrio cholerae
Correct Answer: Borrelia burgdorferi
Explanation:Borrelia burgdorferiis, primarily spread by ticks and lice, is a zoonotic, vector-borne organism that causes Lyme disease.
Neisseria meningitidis and Bordetella pertussis are droplet borne infections (airborne particle > 5 µm)
Vibrio cholerae and Ascaris lumbricoides are spread by the faeco-oral route
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 9
Incorrect
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Regarding meningococcal meningitis, which of the following statements is CORRECT:
Your Answer: All healthcare workers should receive chemoprophylaxis if they have come into contact with an infected patient.
Correct Answer: Infection occurs most commonly below the age of 5 years.
Explanation:About half of meningococcal disease occurs in children aged less than five years, and babies are at the highest risk because their immune systems have not yet fully developed. There is a second, smaller increase in risk for older adolescents, mainly for social and behavioural reasons. Infection is most common in winter months. Antibiotics should be given as soon as the diagnosis is suspected (ideally cultures should be performed first but this should not delay treatment), and ceftriaxone/cefuroxime is the first line antibiotic. Only healthcare workers who have been directly exposed to large particle droplets/secretions from the respiratory tract of the index case should receive prophylaxis.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 10
Correct
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A 22-year-old man comes to the emergency department with a human bite injury to his hand received from a punch during a fight 3 hours earlier outside a bar. On closer inspection, you discover bite marks on his first and second knuckles. Which of the following is the best treatment option for this patient:
Your Answer: Oral co-amoxiclav for 7 days
Explanation:Even if there is no evidence of infection, prophylactic antibiotics should be administered for all human bite wounds that are less than 72 hours old. The first-line therapy is 7 days of co-amoxiclav. In penicillin-allergic people, metronidazole + doxycycline is an option. Streptococcus spp., Staphylococcus aureus, Haemophilus spp., Eikenella corrodens, Bacteroides spp., and other anaerobes are the most prevalent organisms found in human bites.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 11
Incorrect
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Which of the following pathogens causes tetanus:
Your Answer: Clostridium difficile
Correct Answer: Clostridium tetani
Explanation:Tetanus is caused by Clostridium tetani, a bacterium. Tetanus can cause mild spasms to severe whole-body contractions, suffocation, and heart attack.
Gas gangrene and food poisoning are both caused by Clostridium perfringens.
Pseudomembranous colitis is caused by Clostridium difficile.
Urinary tract infections, respiratory infections, dermatitis, soft tissue infections, bacteraemia, bone and joint infections, gastrointestinal infections, and a variety of systemic infections are all caused by Pseudomonas aeruginosa.
Pharyngitis, skin infections, acute rheumatic fever, scarlet fever, poststreptococcal glomerulonephritis, toxic shock–like syndrome, and necrotizing fasciitis can all be caused by Streptococcus pyogenes infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 12
Incorrect
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C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:
Your Answer: IL-4
Correct Answer: IL-6
Explanation:Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 13
Incorrect
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A 44 year old woman is brought to ED having fallen down the stairs and injured her right arm. On examination she is unable to abduct her arm normally, and has weakness of lateral rotation. She has sensory loss over the lateral aspect of her upper arm. Which of the following injuries is most likely to produce this pattern of injury:
Your Answer: Midshaft humerus fracture
Correct Answer: Surgical neck of humerus fracture
Explanation:Damage to the axillary nerve will result in loss of abduction past about 15 degrees and weakness of lateral rotation due to paralysis of the deltoid and teres minor and loss of sensation over the regimental badge area on the upper lateral arm. The axillary nerve is most likely injured in fracture of the surgical neck of the humerus due to its course where it winds around this region together with the posterior humeral circumflex vessels.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Incorrect
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What is the main mechanism of action of metoclopramide:
Your Answer: Serotonin-5HT3 antagonist
Correct 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 15
Incorrect
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How does abciximab mediate its antiplatelet effect:
Your Answer: It is a vitamin K antagonist.
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.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 16
Correct
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Which of the following statements regarding hookworm is FALSE:
Your Answer: Transmission of hookworm is via ingestion of contaminated food and water.
Explanation:The hookworm life cycle begins with the passage of eggs from an adult host into the stool. Hookworm eggs hatch in the soil to release larvae that mature into infective larvae. Infection is usually transmitted by larval penetration into human skin (duodenal infection may also be transmitted by the oral route). From the skin, larvae migrate into the blood vessels and are carried to the lungs, where they penetrate the pulmonary alveoli, ascend the bronchial tree to the pharynx, and are swallowed.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 17
Incorrect
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A 7-year old boy is referred to the Paediatrics Department due to slurred speech. Upon further examination, the attending physician noted the presence of dysdiadochokinesia, intention tremors, and nystagmus. An MRI is taken, which revealed a brain tumour.
Which of the following options is the most probable diagnosis given the clinical features of the patient?Your Answer: Astrocytoma of frontal lobe
Correct Answer: Astrocytoma of cerebellum
Explanation:Pilocytic astrocytoma (PCA), previously known as cystic cerebellar astrocytoma or juvenile pilocytic astrocytoma, was first described in 1931 by Harvey Cushing, based on a case series of cerebellar astrocytomas; though he never used these terms but rather described a spongioblastoma. They are low-grade, and usually well-circumscribed tumours, which tend to occur in young patients. By the World Health Organization (WHO) classification of central nervous system tumours, they are considered grade I gliomas and have a good prognosis.
PCA most commonly occurs in the cerebellum but can also occur in the optic pathway, hypothalamus, and brainstem. They can also occur in the cerebral hemispheres, although this tends to be the case in young adults. Presentation and treatment vary for PCA in other locations. Glial cells include astrocytes, oligodendrocytes, ependymal cells, and microglia. Astrocytic tumours arise from astrocytes and are the most common tumour of glial origin. The WHO 2016 categorized these tumours as either diffuse gliomas or other astrocytic tumours. Diffuse gliomas include grade II and III diffuse astrocytomas, grade IV glioblastoma, and diffuse gliomas of childhood. The other astrocytic tumours group include PCA, pleomorphic xanthoastrocytoma, subependymal giant cell astrocytoma, and anaplastic pleomorphic xanthoastrocytoma.
PCA can present with symptoms secondary to the posterior fossa mass effect. This may include obstructive hydrocephalus, with resultant headache, nausea and vomiting, and papilledema. If hydrocephalus occurs before the fusion of the cranial sutures (<18-months-of-age), then an increase in head circumference will likely occur. Lesions of the cerebellar hemisphere result in peripheral ataxia, dysmetria, intention tremor, nystagmus, and dysarthria. In contrast, lesions of the vermis cause a broad-based gait, truncal ataxia, and titubation. Posterior fossa lesions can also cause cranial nerve palsies. Diplopia may occur due to abducens palsy from the stretching of the nerve. They may also have blurred vision due to papilledema. Seizures are rare with posterior fossa lesions.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 18
Incorrect
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A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.
She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.
Out of the following, which antibiotic is most appropriate to be prescribed to this patient?Your Answer: Ciprofloxacin
Correct Answer: Fosfomycin
Explanation:The NICE guidelines for women with lower UTIs who are not pregnant are:
1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibioticThe first choice of antibiotics for non-pregnant women aged 16 years and over is:
1. Nitrofurantoin
100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
2. Trimethoprim
200 mg PO BD for three daysThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
1. Nitrofurantoin
100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
2. Pivmecillinam
400 mg PO initial dose, then 200 mg PO TDS for three days
3. Fosfomycin 3 g single sachet dose -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 19
Incorrect
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The following statements about cross-sectional studies are true EXCEPT?
Your Answer: They can be used to assess the prevalence of a condition
Correct Answer: They can be used to determine the relative risk of a condition
Explanation:The UK national census is an example of a cross-sectional study.
Cross-sectional studies can be used to assess the prevalence of a condition, and support or refute inferences of cause and effect.
Cross-sectional studies are observations of the frequency and characteristics of a disease in a given population at one particular point in time.
Cross-sectional studies do not differentiate between cause and effect and also do not establish the sequence of events.
Cross-sectional studies cannot be used to calculate the relative risk of a condition.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 20
Incorrect
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A 34-year-old man presents with loss of vision in his left eye due to an episode of optic neuritis. Upon history taking, it was noted that he has a history of multiple sclerosis.
Which of the following anatomical points in the visual pathway has the lesion occurred?Your Answer:
Correct Answer: Optic nerve
Explanation:A lesion in the optic nerve causes ipsilateral monocular visual loss.
Optic neuritis is an inflammatory demyelination of the optic nerve that is highly associated with multiple sclerosis. The two most common symptoms of optic neuritis are vision loss and eye pain. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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SESSION STATS - PERFORMANCE PER SPECIALTY
