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  • Question 1 - Clostridium difficile primarily causes which of the following infectious diseases: ...

    Correct

    • Clostridium difficile primarily causes which of the following infectious diseases:

      Your Answer: Pseudomembranous colitis

      Explanation:

      Clostridium difficile causes pseudomembranous colitis, an acute inflammatory diarrhoeal disease and an important cause of morbidity and mortality in hospitals. Gas gangrene is primarily caused by Clostridium perfringens. Tetanus is caused by Clostridium tetani. Toxic shock syndrome may be caused by Staphylococcus aureus or Streptococcus pyogenes. Necrotising fasciitis is most commonly caused by Streptococcus pyogenes but has a multitude of causes.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      21.6
      Seconds

  • Question 2 - A patient presents complaining of visual loss. On examination you note a contralateral...

    Incorrect

    • A patient presents complaining of visual loss. On examination you note a contralateral homonymous hemianopia. Where is the most likely site of the lesion:

      Your Answer:

      Correct Answer: Optic tract

      Explanation:

      At the optic chiasm, fibres from the medial (nasal) half of each retina crossover, forming the right and left optic tracts.
      The left optic tract contains fibres from the left lateral (temporal) retina and the right medial retina.
      The right optic tract contains fibres from the right lateral retina and the left medial retina.
      Each optic tract travels to its corresponding cerebral hemisphere to reach its lateral geniculate nucleus (LGN) located in the thalamus where the fibres synapse.
      A lesion of the optic tract will cause a contralateral homonymous hemianopia.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 3 - About what percentage of patients with hepatitis A develop chronic infection: ...

    Incorrect

    • About what percentage of patients with hepatitis A develop chronic infection:

      Your Answer:

      Correct Answer: None

      Explanation:

      Chronic hepatitis and carrier state does not occur in hepatitis A infection and complete immunity is attained after infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 4 - A patient presents with epistaxis. She tells you that she has a rare...

    Incorrect

    • A patient presents with epistaxis. She tells you that she has a rare platelet disorder and gives you her haematology outpatient letter that contains information about it. You learn that her disorder is caused by low levels of glycoprotein IIb/IIIa.
      What is the SINGLE most likely diagnosis?

      Your Answer:

      Correct Answer: Glanzamann’s thromboasthenia

      Explanation:

      Glanzmann’s thromboasthenia is a rare platelet disorder in which platelets contain defective or low levels of glycoprotein IIb/IIIa.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 5 - Which of the following best describes an intention to treat analysis: ...

    Incorrect

    • Which of the following best describes an intention to treat analysis:

      Your Answer:

      Correct Answer: All patients are included in the analysis according to the group into which they were randomised even if they are withdrawn from the study.

      Explanation:

      An intention to treat (ITT) analysis is one in which all patients are included in the analysis, classified according to the group into which they were randomised, even if they were withdrawn from the study and did not actually receive the treatment, did not comply with treatment or drop-out. Intention to treat analysis is a more reliable estimate of true treatment effectiveness by replicating what happens in the ‘real world’ (e.g. noncompliance and protocol violations commonly affect therapies).

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      0
      Seconds

  • Question 6 - In ventricular myocytes, the plateau phase of the action potential comes about through which...

    Incorrect

    • In ventricular myocytes, the plateau phase of the action potential comes about through which of the following:

      Your Answer:

      Correct Answer: Opening of voltage-gated Ca 2+ channels

      Explanation:

      After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 7 - Which of the following is an example of a vaccine produced by recombinant...

    Incorrect

    • Which of the following is an example of a vaccine produced by recombinant DNA technology:

      Your Answer:

      Correct Answer: Hepatitis B

      Explanation:

      Hepatitis B vaccines are prepared from the viral surface antigen. The recombinant vaccine is now the most widely used vaccine and induces a sufficient antibody response in 90% of individuals.
      Indications for hepatitis B vaccination include:
      All health care professional’s
      Other professions with occupational risks (foster carers, staff of custodial institutions, morticians etc)
      Babies of mothers with hepatitis B during pregnancy
      Close family contacts of a case or carrier
      IV drug abusers
      Individuals with haemophilia
      Individuals with chronic renal failure
      Sex workers and individuals with frequently changing sexual partners
      The vaccine should be stored between 2 and 8 degrees C as freezing destroys its efficacy. The vaccine is administered intramuscularly, either into the deltoid region (preferred) or anterolateral thigh. The buttock should be avoided as it reduces the efficacy of the vaccine.
      The standard regime is to give 3 doses of the vaccine, the 1stand 2ndone month apart and the 2ndand 3rdsix months apart. Antibody titres should be tested 2 to 4 months after the primary course.
      A peak titre above 100 mIU/ml is regarded as a good response and implies long-term immunity. A peak titre between 10-100 mIU/ml is regarded as a low response and a peak titre of less than 10mIU/ml is regarded as a poor response.
      There is no substantiated association between hepatitis B vaccination and Guillain-Barre syndrome.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      0
      Seconds

  • Question 8 - The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 9 - Regarding bile acids, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding bile acids, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: The main primary bile acids are deoxycholic acid and lithocholic acid.

      Explanation:

      Bile acids have a hydrophobic and a hydrophilic end and in aqueous solution, bile salts orient themselves around droplets of lipid forming micelles to keep the lipid droplets dispersed. The principal primary bile acids are cholic acid and chenodeoxycholic acid. They are made more soluble by conjugation with taurine or glycine in the liver. Of the bile acids excreted into the intestine, about 95% are reabsorbed into the portal circulation by active transport mechanisms in the distal ileum and recycled by the liver.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
      Seconds

  • Question 10 - Which of the following is NOT an advantage of a cohort study used...

    Incorrect

    • Which of the following is NOT an advantage of a cohort study used to investigate the relationship between exposure to a risk factor and a future outcome:

      Your Answer:

      Correct Answer: Particularly suitable for rare diseases

      Explanation:

      Advantages: ideal for studying associations between an exposure and an outcome when the exposure is uncommon, the time sequence of events can be assessed, they can provide information on a wide range of disease outcomes, the absolute and relative risk of disease can be measured directly, they can give a direct estimation of disease incidence rates
      Disadvantages: costly and can take long periods of time if the outcome is delayed, subject to subject-selection and loss to follow-up bias, large sample size required for rare outcome of interest so it is not useful for rare diseases, prone to confounding

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      0
      Seconds

  • Question 11 - Regarding cellular respiration, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cellular respiration, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: When fats are used as the primary energy source, an excess of acetyl-CoA is produced.

      Explanation:

      Cellular respiration is the process by which cells obtain energy in the form of adenosine triphosphate (ATP). ATP transfers chemical energy from the energy rich substances in the cell to the cell’s energy requiring reactions e.g. active transport, DNA replication and muscle contraction.Cellular respiration is essentially a three step process: 1) Glycolysis, 2)The Krebs cycle, 3)The electron transfer system.The main respiratory substrate used by cells is 6-carbon glucose. Fats and proteins can also be used as respiratory substrates. When fats are being used as the primary energy source, in the absence of glucose, an excess amount of acetyl-CoA is produced, and is converted into acetone and ketone bodies. This can occur in starvation, fasting or in diabetic ketoacidosis. Proteins are used as an energy source only if protein intake is very high, or if glucose and fat sources are depleted.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 12 - A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been...

    Incorrect

    • A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been going on for 3 days.

      Among the following microorganisms, which is considered to be a cause of infectious bloody diarrhoea?

      Your Answer:

      Correct Answer: Entamoeba histolytica

      Explanation:

      The following are organisms that are capable of producing acute, bloody diarrhoea:
      – Campylobacter jejuni
      – Escherichia coli O157:H7
      – Salmonella species
      – Shigella species
      – Yersinia species
      – Entamoeba histolytica

      Other E. coli strains, Giardia, Vibrio, and other parasites are associated with watery, but not bloody, diarrhoea.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 13 - Coagulative necrosis is typically seen in which of the following: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Myocardial infarction

      Explanation:

      Coagulative necrosis is the most common form of necrosis characterised by the loss of cell nuclei, but with general preservation of the underlying architecture. Dead tissue is macroscopically pale and firm. This is the classic pattern seen in myocardial infarction.Liquefactive necrosis leads to complete loss of cellular structure and conversion into a soft, semi-solid mass. This is typically seen in the brain following cerebral infarction.Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.Gangrenous necrosis is necrosis with putrefaction of tissues due to exposure to air (dry gangrene) or infection (wet gangrene).

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      0
      Seconds

  • Question 14 - Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?...

    Incorrect

    • Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?

      Your Answer:

      Correct Answer: Posterior

      Explanation:

      The periurethral portion of the prostate gland increases in size during puberty and after the age of 55 years due to the growth of non-malignant cells in the transition zone of the prostate that surrounds the urethra. Most cancers develop in the posterior lobe, and cancers in this location may be palpated during a digital rectal examination (DRE).

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      0
      Seconds

  • Question 15 - A patient suffers an injury to the nerve that innervates piriformis.
    The piriformis muscle...

    Incorrect

    • A patient suffers an injury to the nerve that innervates piriformis.
      The piriformis muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Nerve to piriformis

      Explanation:

      Piriformis is innervated by the nerve to piriformis, which is a direct branch from the sacral plexus (S1 and S2).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 16 - Regarding skeletal muscle, which of the following best describes the Z-line: ...

    Incorrect

    • Regarding skeletal muscle, which of the following best describes the Z-line:

      Your Answer:

      Correct Answer: A line dividing muscle fibres into sarcomeres

      Explanation:

      Each muscle fibre is divided at regular intervals along its length into sarcomeres separated by Z-lines. The sarcomere is the functional unit of the muscle.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 17 - Regarding bronchiolitis, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Chest x-ray may show hyperinflation and increased peribronchial markings.

      Explanation:

      Acute bronchiolitis is caused most commonly by respiratory syncytial virus, occurring mostly in children aged 6 months to 2 years. Children with bronchiolitis are febrile and tachypnoeic with a dry cough and difficulty feeding. Examination may reveal chest hyperinflation, respiratory distress, wheezing and fine end-inspiratory crepitations. Chest x-ray may show hyperinflation and increased peribronchial markings (although CXR should only performed if there is diagnostic uncertainty or an atypical course). Treatment is usually supportive, aerosolized ribavirin is reserved for severely ill or immunocompromised patients.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 18 - Eosinophils comprise what percentage of circulating white cells: ...

    Incorrect

    • Eosinophils comprise what percentage of circulating white cells:

      Your Answer:

      Correct Answer: 1 - 3%

      Explanation:

      Eosinophils comprise 1 – 3% of circulating white cells. Eosinophils are similar to neutrophils, except that the cytoplasmic granules are coarser and more deeply red staining, and there are rarely more than three nuclear lobes. They are less motile, but longer lived. They enter inflammatory exudates and have a special role in allergic responses, defence against parasites and removal of fibrin formed during inflammation. Thus they play a role in local immunity and tissue repair.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 19 - After reviewing a child with respiratory distress who presented to the clinic, you...

    Incorrect

    • 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

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 20 - You are attending to a patient that has presented with a severe headache...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 21 - Regarding the resting membrane potential, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the resting membrane potential, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: The resting cell membrane is more permeable to K + ions than to Na + ions.

      Explanation:

      A membrane potential is a property of all cell membranes, but the ability to generate an action potential is only a property of excitable tissues. The resting membrane is more permeable to K+and Cl-than to other ions (and relatively impermeable to Na+); therefore the resting membrane potential is primarily determined by the K+equilibrium potential. At rest the inside of the cell is negative relative to the outside. In most neurones the resting potential has a value of approximately -70 mV.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 22 - Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and...

    Incorrect

    • Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.

      What is cyclizine's main mechanism of action?

      Your Answer:

      Correct Answer: Antihistamine action

      Explanation:

      Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 23 - What is the mechanism of action of cetirizine: ...

    Incorrect

    • What is the mechanism of action of cetirizine:

      Your Answer:

      Correct Answer: H1-receptor antagonist

      Explanation:

      Cetirizine is a competitive inhibitor at the H1-receptor (an antihistamine).

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
      Seconds

  • Question 24 - A 29-year-old female with a swollen red finger presents to your clinic and...

    Incorrect

    • 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

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 25 - Which of the following is NOT a typical effect caused by adrenaline: ...

    Incorrect

    • Which of the following is NOT a typical effect caused by adrenaline:

      Your Answer:

      Correct Answer: Bronchoconstriction

      Explanation:

      Actions of adrenaline:
      Cardiovascular system
      – Increased rate and force of cardiac contraction
      – Vasoconstriction of vessels in skin, mucous membranes and splanchnic bed
      – Vasodilation of skeletal muscle vessels
      – Increased cardiac output and blood pressure
      Respiratory system
      – Bronchodilation
      – Increased ventilation rate
      Gastrointestinal system
      – Smooth muscle relaxation
      – Contraction of sphincters
      – Metabolism
      – Decreased insulin release
      – Increased glucagon release
      – Increased thermogenesis
      – Increased glycolysis
      – Increased lipolysis
      Eye
      – Pupillary dilation

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
      Seconds

  • Question 26 - If a lesion is observed in Broca's area, which function is expected to...

    Incorrect

    • If a lesion is observed in Broca's area, which function is expected to become affected?

      Your Answer:

      Correct Answer: Formation of words

      Explanation:

      The primary functions of the Broca area are both language production and comprehension. While the exact role in the production is still unclear, many believe that it directly impacts the motor movements to allow for speech. Although originally thought to only aid in speech production, lesions in the area can rarely be related to impairments in the comprehension of language. Different regions of the Broca area specialize in various aspects of comprehension. The anterior portion helps with semantics, or word meaning, while the posterior is associated with phonology, or how words sound. The Broca area is also necessary for language repetition, gesture production, sentence grammar and fluidity, and the interpretation of others’ actions.

      Broca’s aphasia is a non-fluent aphasia in which the output of spontaneous speech is markedly diminished and there is a loss of normal grammatical structure. Specifically, small linking words, conjunctions, such as and, or, and but, and the use of prepositions are lost. Patients may exhibit interjectional speech where there is a long latency, and the words that are expressed are produced as if under pressure. The ability to repeat phrases is also impaired in patients with Broca’s aphasia. Despite these impairments, the words that are produced are often intelligible and contextually correct. In pure Broca’s aphasia, comprehension is intact.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 27 - A 6-year-old female is brought to the Ophthalmology Clinic by her mother with...

    Incorrect

    • A 6-year-old female is brought to the Ophthalmology Clinic by her mother with the complaint of itching, redness, and a watery discharge of the right eye. Past medical history revealed an upper respiratory tract infection one week ago.

      On examination of the right eye, there is mild erythema of the palpebral conjunctiva and visible follicles seen on eversion of the eyelid, lid oedema, and subconjunctival petechial haemorrhages. The discharge is watery and not purulent.

      You diagnose her with viral conjunctivitis. According to the current NICE guidelines, which ONE of the following management options would NOT be included for this patient?

      Your Answer:

      Correct Answer: The child should be excluded from school until the infection has resolved

      Explanation:

      The NICE guidelines do NOT recommend isolating a patient with viral conjunctivitis from others or skipping school or work. The disease is contagious, but the spread of the disease can be controlled by maintaining good hygiene practices such as:
      1. frequent hand washing
      2. use of separate flannels and towels
      3. Avoid close contact with others

      Antibiotic prescriptions are not part of the NICE guidelines for viral conjunctivitis as they will not affect the course of the disease. Most cases of viral conjunctivitis are self-limiting and resolve within one to two weeks.

      The NICE guidelines recommend that symptoms may be eased with self-care measures such as:
      1. Bathing/cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge
      2. Cool compresses applied gently around the eye area
      3. Use of lubricating drops or artificial tears

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 28 - A patient suffers a lower limb fracture that causes damage to the nerve...

    Incorrect

    • A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.
      Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Superficial peroneal nerve

      Explanation:

      Peroneus brevis is innervated by the superficial peroneal nerve.
      Peroneus longus is innervated by the superficial peroneal nerve.
      Peroneus tertius is innervated by the deep peroneal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 29 - A 22-year-old man arrives at the emergency department with a sore throat, low-grade...

    Incorrect

    • A 22-year-old man arrives at the emergency department with a sore throat, low-grade fever, and malaise. His partner has infectious mononucleosis, which was recently diagnosed. In this situation, which of the following cells is the most proliferative:

      Your Answer:

      Correct Answer: Lymphocytes

      Explanation:

      Histologic findings in EBV infectious mononucleosis: Oropharyngeal epithelium demonstrates an intense lymphoproliferative response in the cells of the oropharynx. The lymph nodes and spleen show lymphocytic infiltration primarily in the periphery of a lymph node.
      Relative lymphocytosis (≥ 60%) plus atypical lymphocytosis (≥ 10%) are the characteristic findings of Epstein Barr virus (EBV) infectious mononucleosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 30 - A 72-year-old man presents with chest pain that is characteristic of angina. You...

    Incorrect

    • A 72-year-old man presents with chest pain that is characteristic of angina. You administer a dose of glyceryl trinitrate (GTN), which rapidly resolved his symptoms. Unfortunately, he also develops an unpleasant side effect.
      Which of the following side effects is he most likely to have developed? Select ONE answer only.

      Your Answer:

      Correct Answer: Headache

      Explanation:

      Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.
      The following are common or very common side effects of nitrates
      Arrhythmias
      Asthenia
      Cerebral ischaemia
      Dizziness
      Drowsiness
      Flushing
      Headache
      Hypotension
      Nausea and vomiting
      Diarrhoea, syncope and cyanosis can occur, but these are rare side effects. Dry eyes, bradycardia and metabolic acidosis have not been reported.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 31 - Which of the following clinical features is most suggestive of a lesion of...

    Incorrect

    • Which of the following clinical features is most suggestive of a lesion of the frontal lobe:

      Your Answer:

      Correct Answer: Conjugate eye deviation towards the side of the lesion

      Explanation:

      Conjugate eye deviation towards the side of the lesion is seen in damage to the frontal eye field of the frontal lobe. Homonymous hemianopia is typically a result of damage to the occipital lobe (or of the optic radiation passing through the parietal and temporal lobes). Auditory agnosia may been seen in a lesion of the temporal lobe. Hemispatial neglect may be seen in a lesion of the parietal lobe. Receptive dysphasia is seen in damage to Wernicke’s area, in the temporal lobe.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 32 - Intrinsic factor is secreted by which of the following cell types in the...

    Incorrect

    • Intrinsic factor is secreted by which of the following cell types in the stomach:

      Your Answer:

      Correct Answer: Parietal cells

      Explanation:

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

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 33 - A 58-year-old man showing symptoms of increase in weight, proximal muscular weakening and...

    Incorrect

    • A 58-year-old man showing symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that he has a full, plethoric aspect to his face, as well as significant supraclavicular fat pads, when you examine him. His blood pressure is 158/942 mmHg, and his glucose tolerance has lately been impaired. His potassium level is 3.2 mmol/L.

      What is the MOST LIKELY diagnosis?

      Your Answer:

      Correct Answer: Cushing’s syndrome

      Explanation:

      Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.

      Cushing’s syndrome has a wide range of clinical manifestations that are dependent on the degree of cortisol overproduction. The appearance might be vague and the diagnosis difficult to detect when cortisol levels are just somewhat elevated. On the other hand, in long-term cases of severely increased cortisol levels, the presentation might be colourful and the diagnosis simple.

      Cushing’s syndrome has the following clinical features:
      Obesity and weight growth in the true sense
      Supraclavicular fat pads are fat pads that are located above the clavicle.
      Buffalo hump
      Fullness and plethora of the face (‘moon facies’)
      Muscle atrophy and weakening at the proximal level
      Diabetes mellitus, also known as impaired glucose tolerance
      Hypertension
      Skin thinning and bruising
      Depression
      Hirsutism
      Acne
      Osteoporosis
      Amenorrhoea or oligomenorrhoea

      Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep. The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater during the whole 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed. As a result, random cortisol testing is not an effective screening technique and is not advised.

      The following are the two most common first-line screening tests:
      Cortisol levels in the urine are measured every 24 hours.
      A diagnosis of Cushing’s syndrome can be made if more than two collections measure cortisol excretion more than three times the upper limit of normal.
      Physical stress (e.g., excessive exercise, trauma), mental stress (e.g., sadness), alcohol or drug misuse, complex diabetes, and pregnancy can all cause false positives.
      Renal dysfunction, inadequate collection, and cyclical Cushing’s disease can all cause false negatives.
      The overnight low-dose dexamethasone suppression test (LDDST) involves giving 1 mg of dexamethasone at 11 p.m. and measuring blood cortisol levels at 8 a.m. the next day.
      Cushing’s syndrome is diagnosed when cortisol is not suppressed to less than 50 nmol/L.
      It might be difficult to tell the difference between mild Cushing’s disease and normal cortisol production.
      False positives can occur as a result of depression, severe systemic sickness, renal failure, prolonged alcohol misuse, old age, and the use of hepatic enzyme-inducing medicines, among other things.
      False negatives are extremely uncommon in Cushing’s disease patients.

      A characteristic biochemical picture might also be helpful in confirming the diagnosis of Cushing’s syndrome. The following are the primary characteristics:
      Hypokalaemia
      Alkalosis metabolique

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 34 - A 61-year-old man complains of crushing chest pain that radiates to his left...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 35 - A 24-year-old man goes to the emergency department with a fever, headache, and...

    Incorrect

    • A 24-year-old man goes to the emergency department with a fever, headache, and swollen parotid glands that are excruciating. You have a suspicion that it is mumps. Which of the following nerves is causing the discomfort the patient is experiencing:

      Your Answer:

      Correct Answer: Auriculotemporal nerve

      Explanation:

      The auriculotemporal nerve is irritated by mumps, which results in significant discomfort due to inflammation and swelling of the parotid gland, as well as the stretching of its capsule. Compression caused by swallowing or chewing exacerbates pain.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 36 - The proximal convoluted tubule (PCT) is the first part of the renal tubule...

    Incorrect

    • The proximal convoluted tubule (PCT) is the first part of the renal tubule and lies in the renal cortex. The bulk of reabsorption of solute occurs is the PCT and 100% of glucose is reabsorbed here.

      Which of the following is the mechanism of glucose reabsorption in the PCT?

      Your Answer:

      Correct Answer: Secondary active transport

      Explanation:

      Glucose reabsorption occurs exclusively in the proximal convoluted tubule by secondary active transport through the Na.Glu co-transporters, driven by the electrochemical gradient for sodium.
      The co-transporters transport two sodium ions and one glucose molecule across the apical membrane, and the glucose subsequently crosses the basolateral membrane by facilitated diffusion.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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  • Question 37 - Which of the following is NOT a typical complication associated with mumps: ...

    Incorrect

    • Which of the following is NOT a typical complication associated with mumps:

      Your Answer:

      Correct Answer: Subacute sclerosing panencephalitis

      Explanation:

      Complications of mumps include meningitis, post meningitis deafness, encephalitis, pancreatitis, orchitis and oophoritis. Subacute sclerosing panencephalitis is a complication typically associated with measles infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 38 - Nifedipine commonly causes which of the following adverse effects? ...

    Incorrect

    • Nifedipine commonly causes which of the following adverse effects?

      Your Answer:

      Correct Answer: Ankle oedema

      Explanation:

      Most common adverse effects of Nifedipine include:
      Peripheral oedema (10-30%)
      Dizziness (23-27%)
      Flushing (23-27%)
      Headache (10-23%)
      Heartburn (11%)
      Nausea (11%)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 39 - Streptococcus pneumoniae is commonly implicated in all of the following infectious diseases EXCEPT...

    Incorrect

    • Streptococcus pneumoniae is commonly implicated in all of the following infectious diseases EXCEPT for:

      Your Answer:

      Correct Answer: Impetigo

      Explanation:

      Impetigo is a highly contagious infection of the superficial epidermis that most commonly affects young children but can occur in any age group. In children it is the most common bacterial skin infection and it is the third most common skin disease overall, behind dermatitis and viral warts.
      The commonest causative organism is Staphylococcus aureus. Streptococcus pyogenesis the second commonest and causes fewer cases, either alone or in combination withS. aureus.The streptococcal form tends to be commoner in warmer, more humid climates. (Hirschmann JV. Impetigo: etiology and therapy. Curr Clin Top Infect Dis. 2002;22:42–51.)
      Impetigo is most commonly spread by direct person-to-person contact, and can spread rapidly through families and school classes. It can also, less commonly, be spread by indirect contact.
      There are two main forms of impetigo:
      Non-bullous impetigo – lesions usually start as tiny pustules or vesicles that evolve rapidly into honey-crusted plaques that tend to be under 2 cm in diameter. These can be itchy but are rarely painful.
      Bullous impetigo – lesions have a thin roof and tend to rupture spontaneously. This type is more likely to be painful and may be associated with systemic upset.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 40 - You are reviewing a patient with hypocalcaemia secondary to hypoparathyroidism. Parathyroid hormone (PTH)...

    Incorrect

    • You are reviewing a patient with hypocalcaemia secondary to hypoparathyroidism. Parathyroid hormone (PTH) acts to increased calcium reabsorption at which of the following sites in the nephron:

      Your Answer:

      Correct Answer: Distal convoluted tubule

      Explanation:

      Parathyroid hormone (PTH) is a peptide hormone synthesised by the chief cells of the parathyroid glands, located immediately behind the thyroid gland. PTH is primarily released in response to decreasing plasma [Ca2+] concentration. PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.
      Parathyroid hormone (PTH) acts to increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane) and increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 41 - Where:
    Capillary hydrostatic pressure is (P c)Hydrostatic pressure in the interstices is (P I...

    Incorrect

    • Where:
      Capillary hydrostatic pressure is (P c)Hydrostatic pressure in the interstices is (P I )
      Plasma oncotic pressure is (π p)Interstitial oncotic pressure is (π i)

      Which of the following formulas best represents fluid flow at the capillary bed?

      Your Answer:

      Correct Answer: Volume / min = (P c - P i ) - (π p - π i )

      Explanation:

      Starling’s equation for fluid filtration describes fluid flow at the capillary bed.
      Filtration forces (capillary hydrostatic pressure and interstitial oncotic pressure) stimulate fluid movement out of the capillary, while resorption forces promote fluid movement into the capillary (interstitial hydrostatic pressure and plasma oncotic pressure). Although the forces fluctuate along the length of the capillary bed, overall filtration is achieved.

      At the capillary bed, there is fluid movement.

      The reflection coefficient (σ), the surface area accessible (S), and the hydraulic conductance of the wall (Lp) are frequently used to account for the endothelium’s semi-permeability, yielding:
      Volume / min = LpS [(Pc- Pi) –  σ(πp– πi)]
      Volume /min = (Pc-Pi) – (πp–πi) describes the fluid circulation at the capillaries.
      Where:
      Pc= capillary hydrostatic pressure
      Pi= interstitial hydrostatic pressure
      πp= plasma oncotic pressure
      πi= interstitial oncotic pressure

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
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  • Question 42 - Regarding Clostridium tetani, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding Clostridium tetani, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Infection is predominantly derived from animal faeces and soil.

      Explanation:

      Clostridium tetaniis a Gram positive, rod shaped, obligate anaerobic bacterium.
      The incubation period is quoted as anywhere between 4-21 days and can occur after several months but symptoms usually occur within the first 7 days after exposure.
      Approximately 80% of patients develop generalised tetanus. The commonest presenting feature of generalised tetanus is trismus (lockjaw), occurring in approximately 75% of affected individuals. Other clinical features include:
      Facial spasms (risus sardonicus)
      Opisthotonus (characteristic body shape during spasms)
      Neck stiffness
      Dysphagia
      Calf and pectoral muscle rigidity
      Fever
      Hypertension
      Tachycardia
      Spasms can occur frequently and last for several minutes, they can continue to occur for up to 4 weeks. Current mortality rates are between 10 and 15%.
      Tetanic spasms are caused by the exotoxin tetanospasmin. The effects of tetanolysin are not fully understood but it is not believed to have clinical significance.
      Localised tetanus is a rare form of the disease, occurring in around 1% of affected individuals. Patients have persistent contraction of muscles in the same anatomic area as the injury. It may precede generalised tetanus.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 43 - The sensation produced by touching the arm with a vibrating tuning fork during...

    Incorrect

    • The sensation produced by touching the arm with a vibrating tuning fork during a neurological examination is mediated by which of the following spinal tracts:

      Your Answer:

      Correct Answer: Posterior column

      Explanation:

      Fine-touch, proprioception and vibration sensation are mediated by the posterior column-medial lemniscus pathway.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 44 - An 80-year-old female complains of chest pain characteristic of angina. A dose of...

    Incorrect

    • An 80-year-old female complains of chest pain characteristic of angina. A dose of glyceryl trinitrate (GTN) is administered that resolves the chest pain rapidly.

      Which ONE of the following is released on the initial metabolism of GTN?

      Your Answer:

      Correct Answer: Nitrite ions

      Explanation:

      Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.

      Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
      1. Glyceryl trinitrate
      2. Isosorbide dinitrate

      The nitrate drugs are metabolized in the following steps:
      1. Release Nitrite ions (NO2-), which are then converted to nitric oxide (NO) within cells.
      2. NO activates guanylyl cyclase, which causes an increase in the intracellular concentration of cyclic guanosine-monophosphate (cGMP) in vascular smooth muscle cells.
      3. Relaxation of vascular smooth muscle.

      Although nitrates are potent coronary vasodilators, their principal benefit in the management of angina results from a predominant mechanism of venous dilation:
      – Bigger veins hold more blood
      – Takes blood away from the left ventricle
      – Lowers LVEDV (preload), LA pressure
      – Less pulmonary oedema → improved dyspnoea

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 45 - Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: They are contraindicated in paralytic ileus.

      Explanation:

      Antimuscarinics are contraindicated in paralytic ileus. Antimuscarinics reduce intestinal motility by blocking muscarinic acetylcholine receptors and relaxing smooth muscle. Hyoscine butylbromide is advocated as a gastrointestinal antispasmodic, but it is poorly absorbed and thus has limited clinical utility. Antimuscarinics cause a reduction in bronchial secretions (they can be used to this effect in palliative patients). Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
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  • Question 46 - Which of the following best describes digoxin: ...

    Incorrect

    • Which of the following best describes digoxin:

      Your Answer:

      Correct Answer: A positive inotrope and negative chronotrope

      Explanation:

      Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 47 - An analytical cohort study is done to compare the relationship between omega 3...

    Incorrect

    • An analytical cohort study is done to compare the relationship between omega 3 intake and occurrence of myocardial infarction (MI) among males aged over 65 years. The following are the data from the study:

      No. of subjects taking placebo: 100 men
      No. of subjects taking placebo who suffered an MI: 15 men

      No. of subjects taking omega 3: 100 men
      No. of subjects taking omega 3 who suffered an MI: 5 men

      Compute for the absolute risk in the treatment (omega 3) group.

      Your Answer:

      Correct Answer: 0.05

      Explanation:

      The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.

      AR = 5/100 = 0.05

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 48 - You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble...

    Incorrect

    • You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble breathing after eating peanuts. Which of the following diagnostic tests will confirm this?

      Your Answer:

      Correct Answer: Mast cell tryptase

      Explanation:

      The concentration of serum tryptase rises in anaphylaxis and anaphylactoid responses.

      Because tryptase is a significant component of mast cell granules, mast cell degranulation causes elevated tryptase levels in the blood.

      Although tryptase levels are not always high during anaphylaxis, it is considered a particular marker.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 49 - Identify the type of graph described below:

    This graph is a scatter plot of...

    Incorrect

    • Identify the type of graph described below:

      This graph is a scatter plot of the effect estimates from individual studies against some measure of each study's size or precision.

      Your Answer:

      Correct Answer: Funnel plot

      Explanation:

      A funnel plot is a scatter plot of the effect estimates from individual studies against some measure of each study’s size or precision. The standard error of the effect estimate is often chosen as the measure of study size and plotted on the vertical axis with a reversed scale that places the larger, most powerful studies towards the top. The effect estimates from smaller studies should scatter more widely at the bottom, with the spread narrowing among larger studies. In the absence of bias and between study heterogeneity, the scatter will be due to sampling variation alone and the plot will resemble a symmetrical inverted funnel. A triangle centred on a fixed effect summary estimate and extending 1.96 standard errors either side will include about 95% of studies if no bias is present and the fixed effect assumption (that the true treatment effect is the same in each study) is valid.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 50 - Which of these structures is the smallest and deepest component of...

    Incorrect

    • Which of these structures is the smallest and deepest component of muscle connective tissue?

      Your Answer:

      Correct Answer: Endomysium

      Explanation:

      There are three types of muscle:
      Skeletal muscle
      Cardiac muscle
      Smooth muscle

      Individual muscle is enveloped in a layer of dense irregular connective tissue called the epimysium. The epimysium protects the muscles from friction against bones and other muscles.

      Skeletal muscle is composed of muscle fibres, referred to as myofibers which is ensheathed by a wispy layer of areolar connective tissue called the endomysium. The endomysium is the smallest and deepest component of muscle connective tissue.

      Myofibers grouped together in bundles form fascicles, or fasciculi. These are surrounded by a type of connective tissue called the perimysium.

      Beneath the endomysium lies the sarcolemma, an elastic sheath with infoldings that invaginate the interior of the myofibers, particularly at the motor endplate of the neuromuscular junction.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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Pathogens (1/1) 100%
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