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Question 1
Correct
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What is the effect of a positive inotrope on the Starling curve:
Your Answer: Shifts the curve upwards
Explanation:Contractility (inotropy) is the intrinsic ability of cardiac muscle to develop force at a given muscle length. It is determined by the intracellular [Ca2+] and can be estimated by the ejection fraction. Increases in contractility cause an increase in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume, and hence shift the Starling curve upwards. Decreases in contractility cause a decrease in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume and hence shift the Starling curve downwards.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 2
Correct
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A patient allergic to penicillin and with marked cellulitis presents and you decide to start him on erythromycin.
Which statement about macrolide antibiotics is true?
Your Answer: They are actively concentrated within leukocytes
Explanation:Macrolide antibiotics are bacteriostatic.
They act by binding to the 50S subunit of the bacterial ribosome inhibit protein synthesis.
Macrolide antibiotics are actively concentrated within leukocytes, because of this, they are transported into the site of infection.
Macrolide antibiotics are not effective in meningitis as they do not penetrate the central nervous system well.
They are mainly against Gram-positive organisms and can be used as an alternative in patients with penicillin allergy.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 3
Correct
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Which of the following does not increase renal phosphate excretion?
Your Answer: Vitamin D
Explanation:PO43-renal excretion is regulated several mechanisms. These include:
-parathyroid hormone – increases excretion by inhibiting reabsorption in the proximal tubule
-acidosis – increases excretion
-glucocorticoids – increases excretion
-calcitonin – increases excretion
-activated vitamin D – decreases excretion by increasing reabsorption in the distal tubule -
This question is part of the following fields:
- Physiology
- Renal
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Question 4
Correct
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A young pregnant woman is in the late stages of her pregnancy. She is administered a drug that results in her newborn being born with respiratory depression. The baby also suffers from neonatal withdrawal syndrome.
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer: Diazepam
Explanation:Benzodiazepines are used as a first-line treatment in breaking seizures and in status epilepticus as they are rapid-acting.
Use of benzodiazepines in the late third-trimester or exposure during labour is associated with great risks to the foetus/neonate. Babies can exhibit either floppy infant syndrome, or marked neonatal withdrawal symptoms. Symptoms vary from mild sedation, hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. These symptoms have been reported to persist for periods from hours to months after birth.
They also cross into breast milk and should be used with caution in breastfeeding mothers
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 5
Correct
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The triage nurse asks if you will prescribe a dose of codeine phosphate for a patient who is in a lot of pain. You discover that you are unable to prescribe it due to a contra-indication after evaluating the patient.
The use of codeine phosphate is contraindicated in which of the following situations?Your Answer: Age under 12 years
Explanation:Codeine phosphate is a mild opiate that can be used to treat mild to moderate pain when other pain relievers like paracetamol or ibuprofen have failed. It can also be used to treat diarrhoea and coughs that are dry or painful.
The use of all opioids is contraindicated for the following reasons:
Respiratory depression (acute)
Patients who are comatose
Head injury (opioid analgesics impair pupillary responses, which are crucial for neurological evaluation)
Intracranial pressure has risen (opioid analgesics interfere with pupillary responses vital for neurological assessment)
There’s a chance you’ll get paralytic ileus.The use of codeine phosphate is contraindicated in the following situations:
Because of the significant risk of respiratory side effects in children under the age of 12, it is not recommended for children under the age of 12.Patients of any age who have been identified as ultra-rapid codeine metabolizers (CYP2D6 ultra-rapid metabolizers)
Because codeine can pass through breast milk to the baby and because mothers’ ability to metabolise codeine varies greatly, it is especially dangerous in breastfeeding mothers.
If other painkillers, such as paracetamol or ibuprofen, fail to relieve acute moderate pain in children over the age of 12, codeine should be used. In children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy, a significant risk of serious and life-threatening adverse reactions has been identified.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 6
Correct
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Which of the following describes the pulse pressure:
Your Answer: Systolic - diastolic pressure
Explanation:During systole, the pressure in the left ventricle increases and blood is ejected into the aorta. The rise in pressure stretches the elastic walls of the aorta and large arteries and drives blood flow. Systolic pressure is the maximum arterial pressure during systole. During diastole, arterial blood flow is partly maintained by elastic recoil of the walls of large arteries. The minimum pressure reached before the next systole is the diastolic pressure. The difference between the systolic and diastolic pressure is the pulse pressure.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 7
Correct
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You examine a patient who is experiencing a worsening of his chronic heart failure. You discuss his care with the on-call cardiology registrar, who recommends switching him from furosemide to bumetanide at an equivalent dose. He's on 80 mg of furosemide once a day right now.
What is the recommended dose of bumetanide?Your Answer: 2 mg
Explanation:Bumetanide is 40 times more powerful than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide. This patient is currently taking 80 mg of furosemide and should be switched to a 2 mg bumetanide once daily.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 8
Correct
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A 25-year-old female arrives at the emergency room with a severe case of asthma. When she doesn't seem to be improving after initial treatment, you decide to start an aminophylline infusion.
From the options below, which is Aminophylline's main mechanism of action?Your Answer: Phosphodiesterase inhibition
Explanation:Theophylline and Ethylenediamine are combined in a 2:1 ratio to form Aminophylline. Its solubility is improved by the addition of Ethylenediamine. It has a lower potency and a shorter duration of action than Theophylline.
It is used to treat the following conditions:
Heart failure
It is used to treat the following conditions:
COPD
BradycardiasAminophylline has the following properties:
Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.
Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.
It has slight positive inotropic and chronotropic effects, increasing cardiac output and decreasing systemic vascular resistance, lowering arterial blood pressure. It has been used historically in the treatment of refractory heart failure and is indicated by the current ALS guidelines as a substitute treatment for bradycardia.The daily oral dose for adults is 900 mg, divided into 2-3 doses. For severe asthma or COPD, a loading dosage of 5 mg/kg over 10-20 minutes is given, followed by a continuous infusion of 0.5 mg/kg/hour. The therapeutic range is small (10-20 microgram/ml), hence assessments of aminophylline plasma concentrations are useful during long-term treatment.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 9
Correct
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A patient with diplopia is found to have eye deviation downwards and outwards. The likely nerves that are affected are:
Your Answer: Oculomotor nerve
Explanation:The results of an oculomotor (CN III) nerve palsy are a depressed and abducted (down and out) eye, ptosis, diplopia, and a fixed and dilated pupil.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 10
Correct
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Normal human immunoglobulin is mostly used to protect against which of the following infectious diseases?
Your Answer: Measles and hepatitis A
Explanation:Immune globulin IM is indicated for prophylaxis following exposure
to hepatitis A, to prevent or modify measles (rubeola) in a
susceptible person exposed fewer than 6 days previously,
for susceptible household contacts of measles patients,
particularly contacts <1 year and pregnant women without
evidence of immunity, and to modify rubella in exposed pregnant
women who will not consider a therapeutic abortion. -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 11
Correct
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You are planning on starting antibiotic therapy for a patient with a diagnosis of gonorrhoea.
Which of these is the MOST appropriate antibiotic combination?Your Answer: Ceftriaxone and azithromycin
Explanation:Currently, ceftriaxone in combination with azithromycin or doxycycline is the combination of antibiotics used in the treatment of gonorrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 12
Correct
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Regarding hepatitis C, which of the following statements is INCORRECT:
Your Answer: Anti-HCV IgG antibodies are diagnostic of acute infection.
Explanation:Anti-HCV IgG antibodies indicate exposure to hepatitis C but this could be acute, chronic or resolved infection. If the antibody test is positive, HCV RNA should be tested for, which if positive indicates that a person has current infection with active hepatitis C.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 13
Correct
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A patient noticed ankle swelling and has passed very little urine over the past 24 hours. He also has nausea and vomiting, reduced urine output and his blood results reveal a sudden rise in his creatinine levels over the past 48 hours. You make a diagnosis of acute kidney injury (AKI).
Which one of these is a prerenal cause of AKI?
Your Answer: Cardiac failure
Explanation:The causes of AKI can be divided into pre-renal, intrinsic renal and post-renal causes. Majority of AKI developing in the community is due to a pre-renal causes (90% of cases).
Pre-renal causes: Haemorrhage, severe vomiting or diarrhoea, burns, cardiac failure, liver cirrhosis, nephrotic syndrome, hypotension, severe cardiac failure, NSAIDs, COX-2 inhibitors, ACE inhibitors or ARBs, Abdominal aortic aneurysm, renal artery stenosis, hepatorenal syndrome,
Intrinsic (renal) causes:
Eclampsia, glomerulonephritis, thrombosis, haemolytic-uraemic syndrome, acute tubular necrosis (ATN), acute interstitial nephritis, drugs ( NSAIDs), infection or autoimmune diseases, vasculitis, polyarteritis nodosa, thrombotic microangiopathy, cholesterol emboli, renal vein thrombosis, malignant hypertensionPost-renal causes: Renal stones, Blood clot, Papillary necrosis, Urethral stricture, Prostatic hypertrophy or malignancy, Bladder tumour, Radiation fibrosis, Pelvic malignancy, Retroperitoneal fibrosis
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 14
Correct
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Salbutamol should be used with caution in patients with which of the following:
Your Answer: Susceptibility to QT-interval prolongation
Explanation:Beta-2 agonists should be used with caution in people with:
Cardiovascular disease, including arrhythmias and hypertension (beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate)
Diabetes(risk of hyperglycaemia and ketoacidosis, especially with intravenous use)
Hyperthyroidism(beta-2 agonists may stimulate thyroid activity)
Hypokalaemia(potentially serious hypokalaemia may result from beta-2 agonist therapy; this effect may be potentiated in severe asthma by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia)
Susceptibility to QT-interval prolongation
Convulsive disorders -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 15
Correct
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The patient is a 66-year-old woman who has troublesome bilateral ankle swelling. This has been happening since she began taking a new antihypertensive medication a few weeks ago.
Which of the following medications is most likely to be the cause of this adverse reaction?Your Answer: Amlodipine
Explanation:Amlodipine is a calcium-channel blocker that is frequently used to treat hypertension. Ankle swelling is a very common side effect of calcium-channel blockers, and it occurs quite frequently.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Correct
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You are about to give an antimuscarinic agent to a 55 year-old male patient. Which of the following conditions will make you with stop the administration, since it is a contraindication to antimuscarinic agents?
Your Answer: Prostatic enlargement
Explanation:Antimuscarinic medications may impair the contractility of bladder smooth muscle, resulting in acute urine retention in men with BPH, and should be avoided or used with caution.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 17
Correct
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A 54-year-old woman has been visiting her GP with symptoms of tiredness, muscle weakness and headaches. She is known to be hypertensive and takes amlodipine to control this. Her blood results today show that her potassium level is low at 3.0 mmol/L, and her sodium level is slightly elevated at 146 mmol/L.
Which of the following is the SINGLE most appropriate INITIAL investigation?Your Answer: Plasma renin and aldosterone levels
Explanation:Primary hyperaldosteronism occurs when there are excessive levels of aldosterone independent of the renin-angiotensin axis. Secondary hyperaldosteronism occurs due to high renin levels.
The causes of primary hyperaldosteronism include:
Adrenal adenoma (Conn’s syndrome) – the most common cause of hyperaldosteronism (,80% of all cases). These are usually unilateral and solitary and are more common in women.
Adrenal hyperplasia – this accounts for ,15% of all cases. Usually, bilateral adrenal hyperplasia (BAH) but can be unilateral rarely. More common in men than women.
Adrenal cancer – a rare diagnosis but essential not to miss
Familial aldosteronism – a rare group of inherited conditions affecting the adrenal glands
The causes of secondary hyperaldosteronism include:
Drugs – diuretics
Obstructive renal artery disease – renal artery stenosis and atheroma
Renal vasoconstriction – occurs in accelerated hypertension
Oedematous disorders – heart failure, cirrhosis and nephrotic syndrome
Patients are often asymptomatic. When clinical features are present, the classically described presentation of hyperaldosteronism is with:
Hypertension
Hypokalaemia
Metabolic alkalosis
Sodium levels can be normal or slightly raised
Other, less common, clinical features include:
Lethargy
Headaches
Muscle weakness (from persistent hypokalaemia)
Polyuria and polydipsia
Intermittent paraesthesia
Tetany and paralysis (rare)
Often the earliest sign of hyperaldosteronism is from aberrant urea and electrolytes showing hypokalaemia and mild hypernatraemia. If the patient is taking diuretics, and the diagnosis is suspected, these should be repeated after the patient has taken off diuretics.
If the diagnosis is suspected, plasma renin and aldosterone levels should be checked. Low renin and high aldosterone levels (with a raised aldosterone: renin ratio) is suggestive of primary aldosteronism.
If the renin: aldosterone ratio is high, then the effect of posture on renin, aldosterone and cortisol can be investigated to provide further information about the underlying cause of primary hyperaldosteronism. Levels should be measured lying at 9 am and standing at noon:
If aldosterone and cortisol levels fall on standing, this is suggestive of an ACTH dependent cause, e.g. adrenal adenoma (Conn’s syndrome)
If aldosterone levels rise and cortisol levels fall on standing, this is suggestive of an angiotensin-II dependent cause, e.g. BAH
Other investigations that can help to distinguish between an adrenal adenoma and adrenal hyperplasia include:
CT scan
MRI scan
Selective adrenal venous sampling -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 18
Incorrect
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Which of the following is considered the best source of information if a research on the national hospital MRSA rates is being done?
Your Answer: National Census data
Correct Answer: Hospital Episode Statistics
Explanation:Hospital Episode Statistics (HES) is a data warehouse containing details of all admissions, outpatient appointments and A and E attendances at NHS hospitals in England.
Each HES record contains a wide range of information about an individual patient admitted to an NHS hospital, including:
– clinical information about diagnoses and operations
– patient information, such as age group, gender and ethnicity
– administrative information, such as dates and methods of admission and discharge
– geographical information such as where patients are treated and the area where they liveSome benefits of HES include:
– monitor trends and patterns in NHS hospital activity
– assess effective delivery of care
– support local service planning
– reveal health trends over time
– determine fair access to health care -
This question is part of the following fields:
- Evidence Based Medicine
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Question 19
Correct
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A 63-year-old man presents with severe abdominal pain and vomiting of blood. An endoscopy was performed and a peptic ulcer was found to have eroded into an artery nearby.
Which of the following most likely describes the location of the ulcer?Your Answer: The posterior duodenum
Explanation:The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, particularly gastric and duodenal ulcers. Duodenal ulcers are most commonly associated with bleeding compared with gastric ulcers. Posterior duodenal ulcers are considered to be the most likely to cause severe bleeding because of its proximity to the branches of the gastroduodenal artery (GDA).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 20
Correct
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The term cardiac output refers to the amount of blood pumped by the heart in one minute. The rate in women is around 5 L/min, whereas in men is somewhat higher, around 5.5 L/min.
Which of the equations below best describes cardiac output?
Your Answer: Stroke volume x heart rate
Explanation:Cardiac output (CO) is calculated by multiplying stroke volume (SV) by heart rate (HR):
CO = HR x SVAs a result, both stroke volume and heart rate are exactly proportional to cardiac output. There will be an increase in cardiac output if the stroke volume or heart rate increases, and a reduction in cardiac output if the stroke volume or heart rate lowers.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 21
Correct
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One of the following pathogens is a conditional pathogen:
Your Answer: Neisseria meningitidis
Explanation:Obligate pathogens include Mycobacterium TB, HIV, Treponema pallidum, and Neisseria gonorrhoeae. Neisseria meningitidis, on the other hand, is a conditional pathogen.
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This question is part of the following fields:
- Microbiology
- Principles
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Question 22
Correct
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Which of these increases osteoclast activity?
Your Answer: Parathyroid hormone
Explanation:Osteoclasts are bone cell that break down bone tissue.
Parathyroid hormone increases osteoclastic activity.
1,25-dihydroxycholecalciferol increases osteoclastic activity
Calcitonin inhibits osteoclastic activity
Bisphosphonates are osteoclast inhibitors.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 23
Correct
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A diagnosis of acute osteomyelitis was made on a patient with a known history of sickle cell disease. He has no joint prosthesis on in-dwelling metal work and no known drug allergies.
Which of the following is most likely the causative agent of the case presented above?Your Answer: Salmonella spp .
Explanation:Patients with sickle cell disease are prone to infection of the bone and bone marrow in areas of infarction and necrosis. Although Staphylococcus aureus is the most common cause of osteomyelitis in the general population, studies have shown that in patients with sickle cell disease, the relative incidence of Salmonella osteomyelitis is twice that of staphylococcal infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 24
Correct
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Which of the following statements is correct with regards to Klebsiella spp?
Your Answer: They are typically associated with nosocomial infection.
Explanation:Klebsiella is a type of bacteria commonly found in nature. In humans, the bacteria are often present in parts of the digestive tract and respiratory flora, where they do not generally cause problems. They are anaerobic Gram-negative rods. They are usually opportunistic pathogens which cause nosocomial infections, the most common ones being pneumonia and UTI.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 25
Correct
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A 18-year-old man returns from a trip to Ibiza with a severely painful left eye. He has copious mucopurulent discharge, is febrile and has left-sided tender preauricular lymphadenopathy. He attends the local eye casualty and is diagnosed with hyperacute conjunctivitis.
What is the SINGLE most likely causatiave organism?Your Answer: Neisseria gonorrhoeae
Explanation:Hyperacute bacterial conjunctivitis is a severe, sight-threatening ocular infection that warrants immediate ophthalmic work-up and management. The infection has an abrupt onset and is characterized by a copious yellow-green purulent discharge that reaccumulates after being wiped away. Typically caused by infection with Neisseria gonorrhoeae.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 26
Correct
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Which of the following leukaemias is most common in children in the UK:
Your Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. There is a secondary rise after the age of 40 years. 85% of cases are of B-cell lineage and have an equal sex incidence; there is a male predominance for the 15% of T-cell lineage.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Correct
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A newborn baby girl is delivered vaginally to a 19-year old female, however with complications due to cephalopelvic disproportion. Upon examination by the attending paediatrician, there is a notable 'claw hand' deformity of the left, and sensory loss of the ulnar aspect of the left distal upper extremity.
What is the most probable diagnosis of the case above?Your Answer: Klumpke’s palsy
Explanation:Klumpke palsy, named after Augusta Dejerine-Klumpke, is a neuropathy involving the lower brachial plexus. In contrast, the more common Erb–Duchenne palsy involves the more cephalic portion of the brachial plexus C5 to C6. The brachial plexus is a bundle of individual nerves that exit between the anterior and middle scalene muscles in the anterior lateral and basal portion of the neck. Although the most common anatomical presentation of the brachial plexus is between the anterior and middle scalene, there are variations, with the most common being penetration of the anterior scalene. The main mechanism of injury to the lower brachial plexus is hyper-abduction traction, and depending on the intensity, it will lead to signs and symptoms consistent with a neurological insult.
The most common aetiology resulting in Klumpke palsy is a hyper-abduction trauma to the arm that has enough intensity to traction the lower brachial plexus. Trauma during birth can cause brachial plexus injuries, but again hyper-abduction and traction forces to the upper extremity are usually present.
The history presented by the patient usually depicts a long axis hyper-abduction traction injury with high amplitude and velocity. The typical patient presentation is a decrease of sensation along the medial aspect of the distal upper extremity along the C8 and T1 dermatome. The patient might also present myotome findings that can range from decreasing muscular strength to muscular atrophy and positional deformity. For example, if the neurological damage has led to muscular atrophy and tightening, the patient may present with a claw hand. This deformity presents a finger and wrist flexion. The patient may also describe the severe pain that starts at the neck and travels down the medial portion of the arm. One other sign of a lower brachial plexus injury is Horner syndrome; because of its approximation to the T1 nerve root, it may damage the cephalic sympathetic chain. If this happens, the patient will develop ipsilateral ptosis, anhidrosis, and miosis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 28
Correct
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Platelet alpha granules release which of the following?
Your Answer: Von Willebrand factor (VWF)
Explanation:There are three types of storage granules contained in platelets. These are dense granules which contain the following:
-ATP
-ADP
-serotonin and calcium alpha granules containing clotting factors
-von Willebrand factor (VWF)
-platelet-derived growth factor (PDGF)
– other proteins lysosomes containing hydrolytic enzymes. -
This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 29
Correct
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A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia.
Which one of the following disorders is this patient most likely to have?Your Answer: Paroxysmal nocturnal haemoglobinuria
Explanation:Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight.
Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.
Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections.
Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections.
Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 30
Correct
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Regarding the trachea, which of the following statements is INCORRECT:
Your Answer: A cricothyrotomy involves making an opening in the neck inferior to the cricoid cartilage.
Explanation:A cricothyrotomy involves making an opening in the median cricothyroid ligament (the medial part of the cricothyroid membrane), between the cricoid cartilage below and the thyroid cartilage above.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 31
Correct
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The juxtacapillary receptors, or J receptors, are sensory cells that play an important role in the control of respiration.
At which of the following anatomical sites are the J receptors located? Select ONE answer only.Your Answer: The alveolar walls
Explanation:Juxtacapillary receptors (J receptors) are sensory cells that are located within the alveolar walls in juxtaposition to the pulmonary capillaries of the lung.
The J receptors are innervated by the vagus nerve and are activated by physical engorgement of the pulmonary capillaries or increased pulmonary interstitial volume, for example, in the presence of pulmonary oedema, pulmonary embolus, pneumonia and barotraumas. They may also be stimulated by hyperinflation of the lung.
Stimulation of the J receptors causes a reflex increase in breathing rate and is also thought to be involved in the sensation of dyspnoea. The reflex response that is produced is apnoea, followed by rapid breathing, bradycardia, and hypotension. -
This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 32
Correct
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For which of the following is micelle formation necessary to facilitate intestinal absorption?
Your Answer: Vitamin D
Explanation:The arrangement of micelles is such that hydrophobic lipid molecules lie in the centre, surrounded by hydrophilic bile acids that are arranged in the outer region. This arrangement allows the entry of micelles into the aqueous layers surrounding the microvilli. As a result, the products of fat digestion (fatty acids and monoglycerides), cholesterol and fat-soluble vitamins (such as vitamin D) can then diffuse passively into the enterocytes. The bile salts are left within the lumen of the gut where they are reabsorbed from the ileum or excreted in faeces.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 33
Correct
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The most common site of ectopic pregnancy is?
Your Answer: Ampulla of Fallopian tube
Explanation:Nearly 95% of ectopic pregnancies are implanted in the various segments of the fallopian tube and give rise to fimbrial, ampullary, isthmic, or interstitial tubal pregnancies. The ampulla is the most frequent site, followed by the isthmus. The remaining 5% of non tubal ectopic pregnancies implant in the ovary, peritoneal cavity, cervix, or prior caesarean scar.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 34
Incorrect
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The following statements are not true of the extensor carpi radialis brevis muscle, except?
Your Answer: It is innervated by the posterior interosseous nerve
Correct Answer: It receives its blood supply from the radial artery
Explanation:Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.
The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.
Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.
The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).
Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 35
Correct
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Which of the following statements is correct regarding paracetamol?
Your Answer: Liver damage peaks 3 to 4 days after paracetamol ingestion.
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 36
Correct
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You are giving a teaching session to a group of final year medical students regarding lower limb neurology. Which of the following clinical features would be expected in an obturator nerve palsy:
Your Answer: Weakness of hip adduction
Explanation:Damage to the obturator nerve results in weak adduction of the hip with lateral swinging of the limb during walking due to unopposed abduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 37
Correct
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When a child has chickenpox, how long should he or she be off from school?
Your Answer: Until all vesicles have crusted over
Explanation:To avoid the spread of infection, infected patients should be isolated. All lesions should be crusted over before children return to nursery or school, even if the standard exclusion time is 5 days.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 38
Correct
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A 27 year old woman presents to ED having sustained a deep laceration to the dorsum of her ring finger whilst cooking. Her proximal interphalangeal joint is fixed in flexion and the distal interphalangeal joint is hyperextended. Which of the following structures in the digit has most likely been injured:
Your Answer: Insertion of the central slip of the extensor tendon
Explanation:Damage to the central slip of the extensor digitorum tendon would result in loss of extension at the proximal interphalangeal joint resulting in a fixed flexion deformity of this joint, and hyperextension of the distal interphalangeal joint due to a loss of balancing forces. This is called the Boutonniere deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 39
Correct
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When there is the presence of distended and engorged veins in the umbilical area, which of the following portosystemic anastomoses has most likely occurred?
Your Answer: Para-umbilical veins and inferior epigastric vein
Explanation:Caput medusae is a condition that consists of collateral veins radiating from the umbilicus and results from recanalization of the umbilical vein.
Under normal conditions, the portal venous blood traverses the liver and drains into the inferior vena cava of the systemic venous circulation by way of the hepatic veins. This is the direct route. However, other, smaller communications exist between the portal and systemic systems, and they become important when the direct route becomes blocked. These communications are as follows:
At the lower third of the oesophagus, the oesophageal branches of the left gastric vein (portal tributary) anastomose with the oesophageal veins draining the middle third of the oesophagus into the azygos veins (systemic tributary).
Halfway down the anal canal, the superior rectal veins (portal tributary) draining the upper half of the anal canal anastomosis with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.
The paraumbilical veins connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall (systemic tributaries). The paraumbilical veins travel in the falciform ligament and accompany the ligamentum teres.
The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 40
Correct
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An elderly female has a bacterial infection and you are asked to prescribe an antibiotic to her. This antibiotic is a nucleic acid synthesis inhibitor.
Which of the following antimicrobial drugs will be prescribed to this patient?Your Answer: Metronidazole
Explanation:Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Erythromycin inhibits protein synthesis and blocks translocation by binding to the 23S rRNA of the 50S ribosomal subunit.
Chloramphenicol blocks peptidyl transferase at 50S ribosomal subunit.
Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA and thus preventing initiation of protein synthesis.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
1. Inhibition of cell wall synthesis
– Penicillins
– Cephalosporins
– Vancomycin
2. Disruption of cell membrane function
– Polymyxins
– Nystatin
– Amphotericin B
3. Inhibition of protein synthesis
– Macrolides
– Aminoglycosides
– Tetracyclines
– Chloramphenicol
4. Inhibition of nucleic acid synthesis
– Quinolones
– Trimethoprim
– 5-nitroimidazoles
– Rifampicin
5. Anti-metabolic activity
– Sulphonamides
– Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 41
Correct
-
How does abciximab mediate its antiplatelet effect:
Your 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 42
Correct
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A 36 year old man who is overweight with a history of gout, presents to emergency room with an acutely painful big toe which is red, hot and swollen. However, he is apyrexic and otherwise systemically well. He has been diagnosed with acute gout. The most appropriate first line treatment for him is which of the following?
Your Answer: NSAIDs
Explanation:The first line treatment for acute gout includes NSAIDs like diclofenac, indomethacin or naproxen. In patients in whom NSAIDs are contraindicated, not tolerated or ineffective, colchicine is an alternative. In those who cannot tolerate or who are resistant to NSAIDs and colchicine, oral or parenteral corticosteroids are an effective alternative. In acute monoarticular gout, intra-articular injection of a corticosteroid can be used occasionally. In acute gout. allopurinol is not used in the actual treatment, but its use should be continued during an acute attack if the patient is already established on long term therapy.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 43
Correct
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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: 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 44
Incorrect
-
A 38-year-old woman is investigated for Addison's disease. She had low blood pressure, weakness, weight loss, and skin discoloration. An adrenocorticotropic hormone (ACTH) stimulation test is scheduled as part of her treatment.
Which of the following statements about ACTH is correct?Your Answer:
Correct Answer: It is released in response to the release of CRH
Explanation:The anterior pituitary gland produces and secretes a peptide hormone called adrenocorticotropic hormone (ACTH) (adenohypophysis). It is secreted in response to the hypothalamus’s secretion of the hormone corticotropin-releasing hormone (CRH).
ACTH promotes cortisol secretion via binding to cell surface ACTH receptors in the zona fasciculata of the adrenal cortex.
ACTH also promotes the production of beta-endorphin, which is a precursor to melanocyte-releasing hormone (MRH).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 45
Incorrect
-
The functional residual capacity (FRC) will be decreased in which of the following:
Your Answer:
Correct Answer: Pulmonary fibrosis
Explanation:Factors decreasing FRC:
Restrictive ventilatory defects e.g. pulmonary fibrosis
Posture – lying supine
Increased intra-abdominal pressure (e.g. obesity, pregnancy, ascites)
Reduced muscle tone of diaphragm e.g. muscle relaxants in anaesthesia, neuromuscular disease -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 46
Incorrect
-
The fluid in contact with a tube is dragged by frictional forces to the tube's sidewalls. This creates a velocity gradient in which the fluid flow is greatest in the tube's centre.
Which of the following terms most accurately characterizes this flow pattern?Your Answer:
Correct Answer: Laminar flow
Explanation:The fluid in contact with a tube is dragged by frictional forces at the tube’s sidewalls. This creates a velocity gradient in which the fluid flow is greatest in the tube’s centre.
This is known as laminar flow, and it characterizes the flow in most circulatory and respiratory systems when they are at rest.The velocity of the fluid flow can fluctuate erratically at high velocities, particularly within big arteries and airways, disrupting laminar flow. As a result, resistance increases significantly.
This is known as turbulent flow, and symptoms include heart murmurs and asthmatic wheeze. -
This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 47
Incorrect
-
A 30-year-old male with a known allergy to natural latex rubber presents with an allergic reaction to a food he has just eaten.
Which ONE of these foods is most likely to cause an associated hypersensitivity in him?Your Answer:
Correct Answer: Banana
Explanation:About one third of patients with allergy to natural latex rubber (NRL) have an associated allergy to some plant-derived foods. It is known as the latex-fruit syndrome and occurs commonly with consumption of fresh fruits. Banana and avocado are the most implicated fruits but it can also be seen with tomato, kiwi and chestnut.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 48
Incorrect
-
Regarding the accessory nerve, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Accessory nerve palsy results in the inability to nod the head
Explanation:Accessory nerve palsy results in inability to shrug the shoulders and to rotate the head to look at the opposite side to the lesion.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 49
Incorrect
-
Which of the following best describes the popliteal artery's course?
Your Answer:
Correct Answer: After exiting the popliteal fossa terminates at the lower border of the popliteus muscle
Explanation:The popliteal artery divides into the anterior and posterior tibial arteries at the lower border of the popliteus after exiting the popliteal fossa between the gastrocnemius and popliteus muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 50
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.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 51
Incorrect
-
Liquefactive necrosis is most commonly seen in which of the following conditions:
Your Answer:
Correct Answer: Ischaemic stroke
Explanation:Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 52
Incorrect
-
What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer:
Correct Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 53
Incorrect
-
Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer:
Correct Answer: 75% of cases occur before the age of 6 years.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. There is great variation in the chance of individual patients achieving a long-term cure based on a number of biological variables. Approximately 25% of children relapse after first-line therapy and need further treatment but overall 90% of children can expect to be cured. The cure rate in adults drops significantly to less than 5% over the age of 70 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 54
Incorrect
-
A 35-year-old man suffered a severe road traffic accident and has been brought to the hospital. As part of his treatment, he requires a blood transfusion and experiences a transfusion reaction.
The most common type of transfusion reaction is which of the following?Your Answer:
Correct Answer: Febrile transfusion reaction
Explanation:During or shortly after transfusion, febrile transfusion reactions, also known as non-haemolytic transfusion reactions, present with an unexpected temperature rise (38oC or 1oC above baseline, if baseline is 37oC). This is usually a one-off occurrence. The fever is sometimes accompanied by chills.
The most common type of transfusion reaction is febrile transfusion reactions, which occur in about 1 in every 8 transfusions.
The most common event leading to symptoms of febrile transfusion reactions is cytokine accumulation during storage of cellular components (especially platelet units). White cells secrete cytokines, and pre-storage leucodepletion has reduced this risk.
Recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leukocyte antigen (HLA) or other antigens can also cause febrile transfusion reactions. Donor lymphocytes, granulocytes, and platelets all contain these antigens.
Treatment is reassuring. Other causes should be ruled out, and antipyretics like paracetamol can help with fever relief. If another cause of fever is suspected, the transfusion should be stopped; however, if other causes of fever have been ruled out, it can be restarted at a slower rate.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 55
Incorrect
-
A 18 year old with known asthma presents himself to ED with acute breathlessness and wheeze for the past 20 minutes. On examination he is tachypneic and tachycardic. His oxygen saturations are 96% on air. What is the first line treatment for acute asthma:
Your Answer:
Correct Answer: Salbutamol
Explanation:High-dose inhaled short-acting beta2-agonists are the first line treatment for acute asthma(salbutamol or terbutaline). Oxygen should only been given to hypoxaemic patients (to maintain oxygen saturations of 94 – 98%). A pressurised metered dose inhaler with spacer device is preferred in patients with moderate to severe asthma (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). The oxygen-driven nebuliser route is recommended for patients with life-threatening features or poorly responsive severe asthma (salbutamol 5 mg at 15 – 30 minute intervals). Continuous nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose (salbutamol at 5 – 10 mg/hour) The intravenous route should be reserved for those in whom inhaled therapy cannot be used reliably.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 56
Incorrect
-
An elderly man presents with bilateral lower facial swelling around the mandible and upper neck. A CT scan of his neck was performed and the results were conclusive with Ludwig's angina.
Which of the following spaces is most likely affected based on the case presented?Your Answer:
Correct Answer: Submandibular space
Explanation:Ludwig’s angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. It involves three compartments of the floor of the mouth: the sublingual, submental, and submandibular.
Ludwig’s angina usually originates as a dental infection of the second or third mandibular molars. The infection begins in the subgingival pocket and spreads to the musculature of the floor of the mouth. It progresses below the mylohyoid line, indicating that it has moved to the sublingual space. As the roots of the second and third mandibular molars lie below this line, infection of these teeth will predispose to Ludwig’s angina. The infection spreads lingually rather than buccally because the lingual aspect of the tooth socket is thinner. It initially spreads to the sublingual space and progresses to the submandibular space.
The disease is usually polymicrobial, involving oral flora, both aerobes, and anaerobes. The most common organisms are Staphylococcus, Streptococcus, Peptostreptococcus, Fusobacterium, Bacteroides, and Actinomyces.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 57
Incorrect
-
Regarding protein digestion, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Oligopeptides are broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on the brush border.
Explanation:Digestion of dietary protein begins in the stomach where pepsin hydrolyses protein to polypeptides, and continues in the duodenum where pancreatic proteases (trypsin and chymotrypsin) continue the process of hydrolysis forming oligopeptides. These are further broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on luminal membrane epithelial cells. Free amino acids are absorbed across the apical membrane by secondary active transport coupled with Na+transport into the cell. Amino acids cross the basal membrane into the capillaries by facilitated diffusion.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 58
Incorrect
-
A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes.
The lymph from the testes will drain to which of the following nodes?Your Answer:
Correct Answer: Para-aortic lymph nodes
Explanation:Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.
The scrotum is the one which drains into the nearby superficial inguinal nodes.
The glans penis and clitoris drains into the deep inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 59
Incorrect
-
A patient suffers an injury to the nerve that innervates gluteus medius.​
The gluteus medius muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is innervated by the superior gluteal nerve.
Gluteus medius is innervated by the superior gluteal nerve.
Gluteus maximus is innervated by the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 60
Incorrect
-
A thyroid function test is done for a 55-year-old woman with non-specific symptoms, the results are shown below:
TSH = 5.2
Free T4 is normal
Free T3 is normal
The most likely diagnosis in this patient is?
Your Answer:
Correct Answer: Subclinical hypothyroidism
Explanation:Hypothyroidism is diagnosed using the results of thyroid function tests (TFTs).
In the early stages of the disease, the earliest biochemical change noticed is a rise in thyroid-stimulating hormone (TSH) levels. Free triiodothyronine (T3) and thyroxine (T4) levels are usually normal.
In primary hypothyroidism, the serum TSH level is usually greater than 10 mU/L, and free T4 levels are below the reference range.
Subclinical hypothyroidism is diagnosed when the serum TSH level is above the reference range, and the free T4 levels are within the reference range. The test should, however, be repeated after 3-6 months to exclude transient causes of raised TSH.
In summary, how to interpret TFTs in cases of suspected hypothyroidism is shown below:
Subclinical hypothyroidism
TSH is raised
Free T4 is normal
Free T3 is normalPrimary hypothyroidism
TSH is raised
Free T4 is lowered
Free T3 is lowered or normalSecondary hypothyroidism
TSH is lowered or normal
Free T4 is lowered
Free T3 is lowered or normal -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 61
Incorrect
-
You examine an elderly man who is experiencing chest pain. He doesn't recall all of his medications, but he does know that he takes a diuretic.
The enzyme carbonic anhydrase is inhibited by which of the following diuretics?Your Answer:
Correct Answer: Acetazolamide
Explanation:Acetazolamide is a non-competitive, reversible inhibitor of carbonic anhydrase found in the cytosol of cells and on the brush border of the proximal convoluted tubule. Bicarbonate and hydrogen ions are converted to carbonic acid by carbonic anhydrase, which then converts carbonic acid to carbon dioxide and water. As a result, acetazolamide reduces the availability of hydrogen ions, causing sodium and bicarbonate ions to accumulate in the renal tubule, resulting in diuresis.
The mechanism of action of the various types of diuretics is summarised below:1) Loop diuretics, e.g. furosemide, bumetanide
Act on the Na.K.2Cl co-transporters in the ascending loop of Henlé to inhibit sodium, chloride and potassium reabsorption.2) Thiazide diuretics, e.g. Bendroflumethiazide, hydrochlorothiazide
Act on the Na.Cl co-transporter in the distal convoluted tubule to inhibit sodium and chloride reabsorption.3) Osmotic diuretics, e.g. mannitol
Increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect.4) Aldosterone antagonists, e.g. spironolactone
Acts in the distal convoluted tubule as a competitive aldosterone antagonist resulting in inhibition of sodium reabsorption and increasing potassium reabsorption.5) Carbonic anhydrase inhibitors, e.g. acetazolamide
Inhibit the enzyme carbonic anhydrase preventing the conversion of bicarbonate and hydrogen ions into carbonic acid. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 62
Incorrect
-
Regarding the extensor carpi ulnaris muscle, which of the following statements is true?
Your Answer:
Correct Answer: It receives its blood supply from the ulnar artery
Explanation:Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.
Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.
Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.
Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 63
Incorrect
-
While on morning rounds in the medical ward, the attending physician asks a medical student about the differences between transudates and exudates and their causes. The student explains that a transudate is an excess fluid that leaks out of an intravascular compartment due to an imbalance between oncotic and hydrostatic pressures.
Which ONE of the following conditions will he mention as the cause of a transudate?Your Answer:
Correct Answer: Meig’s syndrome
Explanation:Transudative effusions are caused due to systemic causes leading to increased hydrostatic pressure or decreased oncotic pressure. These include:
1) Meig’s Syndrome (Ovarian tumour causing ascites and pleural effusion)
2) Congestive heart failure
3) Nephrotic Syndrome
4) Myxoedema
5) Cirrhosis
6) SarcoidosisAn exudate is caused by local inflammation and results from increased vascular permeability. Causes include:
1) Rheumatoid arthritis
2) Pneumonia leading to empyema
3) Malignancies
4) Pericarditis -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 64
Incorrect
-
A patient presents to your clinic with fever of unknown origin. His blood results shows a markedly elevated C-Reactive Protein (CRP) level.
Which of these is responsible for mediating the release of CRP?
Your Answer:
Correct Answer: IL-6
Explanation:C-reactive protein (CRP) is an acute phase protein produced by the liver hepatocytes. Its production is regulated by cytokines, particularly interleukin 6 (IL-6) and it can be measured in the serum as a nonspecific marker of inflammation.
Although a high CRP suggest an acute infection or inflammation, it does not identify the cause or location of infection.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 65
Incorrect
-
Which of the following is true about the extensor carpi radialis longus?
Your Answer:
Correct Answer: It assists with abduction of the hand at the wrist
Explanation:The majority of extensor carpi radialis longus originates from the lateral supracondylar ridge of humerus (distal third) and anterior aspect of the lateral intermuscular septum of the arm. A small portion of its fibres originate from the common extensor tendon attached to the lateral epicondyle of humerus. The fibres unite into a muscle belly which extends approximately to the middle of the forearm. The muscle belly is then replaced by a flat tendon that travels distally along the lateral surface of the radius, together with the tendon of extensor carpi radialis brevis. Both tendons course towards the radial styloid process, deep to the tendons of abductor pollicis longus and extensor pollicis brevis muscles. Proximal to the wrist, the tendons of extensor carpi radialis longus and brevis pass behind the radial styloid process within a common synovial sheath and continue along the radial groove deep to the extensor retinaculum of the wrist. At this level, the tendon of extensor carpi radialis longus is crossed by the tendon of extensor pollicis longus, after which it inserts on the posterior aspect of the base of the second metacarpal bone. Some tendon slips can insert into the first and third metacarpal bones.
Extensor carpi radialis longus receives innervation from the radial nerve, with contributions mainly from spinal nerves C5-C8. The radial nerve is a branch of the brachial plexus.
Extensor carpi radialis longus receives blood supply mainly from the radial artery. It directly supplies the distal part of the muscle, while the rest of the muscle receives blood from one of its radial recurrent branches. The brachial artery also supplies a small portion of the muscle via the radial collateral artery.
Extensor carpi radialis longus primarily acts on the wrist joint to produce two major actions: (1) wrist extension by working synergistically with extensor carpi radialis brevis and extensor carpi ulnaris, and (2) hand abduction (radial deviation), with the help of flexor carpi radialis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 66
Incorrect
-
How does aspirin mediate its antiplatelet effect:
Your Answer:
Correct Answer: It irreversibly inhibits cyclo-oxygenase
Explanation:Aspirin irreversibly inhibits cyclooxygenase and blocks the platelet production of thromboxane A2 (TXA2), thus inhibiting platelet aggregation.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 67
Incorrect
-
A patient in a high-dependency unit complains of severe and painful muscle cramps. His total corrected plasma calcium level is 1.90 mmol/L.
What is the most likely underlying cause?
Your Answer:
Correct Answer: Rhabdomyolysis
Explanation:Hypocalcaemia occurs when there is abnormally low level of serum calcium ( >2.2 mmol/l) after correction for the serum albumin concentration.
Rhabdomyolysis causes hyperphosphatemia, and this leads to a reduction in ionised calcium levels.
Patients with rhabdomyolysis are commonly cared for in a high dependency care setting.
Addison’s disease, hyperthyroidism, thiazide diuretics and lithium all cause hypercalcaemia.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 68
Incorrect
-
A 65-year-old man comes for a visit at the clinic with complaints of abdominal pain. On inquiring about drug history, you find out that he has been taking around 8-10 paracetamol to help relieve the pain.
Out of the following, which one is believed to be the main mechanism of action for paracetamol?Your Answer:
Correct Answer: Selective inhibition of COX-3 receptors
Explanation:The FDA categorizes Paracetamol as an NSAID (nonsteroidal anti-inflammatory drug) as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord.
COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.
Acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, therefore, has no peripheral anti-inflammatory effects.
The antipyretic actions of acetaminophen are likely attributed to direct action on heat-regulating centres in the brain, resulting in peripheral vasodilation, sweating, and loss of body heat. -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 69
Incorrect
-
Gastrin release from antral G-cells is stimulated by all but which one of the following:
Your Answer:
Correct Answer: Secretin
Explanation:Gastrin secretion is stimulated by:
The presence of small peptides and amino acids in chyme
Gastric distension
Vagal stimulation directly via acetylcholine and indirectly via gastrin-releasing peptide (GRP)
Raised gastric pH -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 70
Incorrect
-
A 60 -year-old man is tested to have low calcium levels . After additional questioning, it becomes clear that he has a calcium-deficient diet.
What is the daily calcium intake recommendation for a healthy adult?Your Answer:
Correct Answer: 1300 mg
Explanation:A daily calcium intake of 1,000 to 1,300 mg is advised for adults. Women have a slightly higher calcium need than men and are at a higher risk of developing osteoporosis as they age.
Calcium-rich foods include the following:
Milk, cheese, and butter as dairy products.
Broccoli, spinach, and green beans as green veggies.
Bread, rice, and cereals as whole grain foods.
Sardines, salmon, and other bony fish
Eggs
Nuts
The following foods have the least calcium:
Carrot
Fruits such as kiwis, raspberries, oranges, and papaya
Chicken and pork in meats. -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 71
Incorrect
-
A 40-year-old female presents to the orthopaedic clinic complaining of pain and limited range of motion in the right elbow for the past two days. On examination, the right elbow is extremely tender with erythema and warmth of the overlying skin due to acute inflammation.
Which ONE of the following statements is true with regards to acute inflammation?Your Answer:
Correct Answer: Neutrophils are activated and adhere to the endothelium as a result of interaction with endothelial cell adhesion molecules
Explanation:Acute inflammation is defined as inflammation occurring within minutes to hours in response to an injury lasting for less than two weeks.
Acute inflammation
Rapid onset (minutes to hours)
Quick resolution (usually days)Chronic inflammation
May last weeks, months, or yearsThere are five cardinal signs of inflammation:
1) Pain
2) Redness
3) Warmth
4) Oedema
5) Loss of functionDuring acute inflammation, neutrophils are activated and attracted to the site of inflammation in response to various interleukins and cytokines. This process takes place via the following mechanism:
1) Margination
Neutrophils flow nearer the vessel wall rather than in the axial stream, which is referred to as margination
2) Rolling along the surface of vascular endothelium
3) Adhesion to the endothelium by interaction with adhesion molecules (ICAMS and VCAMS)
4) Diapedesis is the movement of neutrophils from the endothelial cells into the interstitial space by squeezing through the gaps between adjacent endothelial cellsBradykinin and histamine are both responsible for vasodilation which causes oedema and decreases intravascular osmotic pressure.
Neutrophils dominate early (<2 days)
– Many in the bloodstream
– Attach firmly to adhesion molecules
– Apoptosis after 24-48hrs
Monocytes/macrophages dominate late (>2 days)
– Live longer
– Replicate in tissues -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 72
Incorrect
-
A patient with history of weight loss and diarrhoea was found out to have Giardia lamblia in her stool since returning from a holiday to Nepal.
Which of the following statements is considered true regarding the life cycle of Giardia lamblia?Your Answer:
Correct Answer: Trophozoites attach to the intestinal wall via a specialised sucking disc
Explanation:Cysts are resistant forms and are responsible for transmission of giardiasis. Both cysts and trophozoites can be found in the faeces (diagnostic stages). The cysts are hardy and can survive several months in cold water. Infection occurs by the ingestion of cysts in contaminated water, food, or by the faecal-oral route (hands or fomites).
In the small intestine, excystation releases trophozoites (each cyst produces two trophozoites).
Trophozoites multiply by longitudinal binary fission, remaining in the lumen of the proximal small bowel where they can be free or attached to the mucosa by a ventral sucking disk.
Encystation occurs as the parasites transit toward the colon. The cyst is the stage found most commonly in non diarrheal faeces.
Because the cysts are infectious when passed in the stool or shortly afterward, person-to-person transmission is possible. While animals are infected with Giardia, their importance as a reservoir is unclear. -
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 73
Incorrect
-
You examine a 78-year-old man who has been diagnosed with chronic lymphocytic leukaemia (CLL).
What is the MAIN contributory factor in this condition's immunodeficiency?Your Answer:
Correct Answer: Hypogammaglobulinemia
Explanation:Immunodeficiency is present in all patients with chronic lymphocytic leukaemia (CLL), though it is often mild and not clinically significant. Infections are the leading cause of death in 25-50 percent of CLL patients, with respiratory tract, skin, and urinary tract infections being the most common.
Hypogammaglobulinemia is the most common cause of immunodeficiency in CLL patients, accounting for about 85 percent of all cases.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 74
Incorrect
-
You are reviewing a patient in the Emergency Department brought in by the ambulance team from a burning building. After examination, you decide to intubate the patient due to laryngeal oedema. The induction agent you are planning to use is propofol.
Which one of the following statements about this medicine is TRUE?Your Answer:
Correct Answer: It decreases cardiac output by approximately 20%
Explanation:Propofol is a short-acting anaesthetic that is thought to work by potentiating GABA and glycine. It induces anterograde amnesia and anaesthetic effects and is used to induce anaesthesia, outpatient surgeries and preoperative sedation. The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.
Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.
The main side effects of propofol are:
Pain on injection (in up to 30%)
Hypotension
Transient apnoea
Hyperventilation
Coughing and hiccough
Headache
Thrombosis and phlebitis -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 75
Incorrect
-
Glucagon is the main catabolic hormone of the body and raises the concentration of glucose and fat in the bloodstream.
Which pancreatic islet cells secretes glucagon?Your Answer:
Correct Answer: Alpha
Explanation:Glucagon, secreted from the pancreatic islet alpha cells, is considered to be the main catabolic hormone of the body. It raises the concentration of glucose and fat in the bloodstream
There are five different pancreatic islet cells:
Alpha cells (20%) – produce glucagon
Beta cells (70%) – produce insulin and amylin
Delta cells (<10%) – produce somatostatin
Gamma cells (<5%) – produce pancreatic polypeptide
Epsilon cells (<1%) – produce ghrelin -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 76
Incorrect
-
In the United Kingdom, which of the following is the most often used intravenous aesthetic:
Your Answer:
Correct Answer: Propofol
Explanation:In the United Kingdom, propofol is the most widely used intravenous anaesthetic. In adults and children, it can be used to induce or maintain anaesthesia, although it is not commonly used in newborns. It can also be used to sedate individuals in intensive care and for sedation during operations.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 77
Incorrect
-
Which of the following cell types in the stomach secretes histamine?
Your Answer:
Correct Answer: Enterochromaffin-like cells
Explanation:The parietal cells operate in close association with another type of cell called enterochromaffin-like cells (ECL cells), the primary function of which is to secrete histamine. The ECL cells lie in the deep recesses of the oxyntic glands and therefore release histamine indirect contact with the parietal cells of the glands.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 78
Incorrect
-
C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:
Your Answer:
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 79
Incorrect
-
Which of the following ligaments supports the head of the talus?
Your Answer:
Correct Answer: Spring ligament
Explanation:The spring-ligament complex is a significant medial arch stabilizer.
The two important functions of this ligament include promoting the stability of the talonavicular joint by acting as a support for the talus head and by acting as a static support to maintain the medial longitudinal arch.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 80
Incorrect
-
You are examining the lower limbs of a 54 year old man who presented after falling from a ladder at home. During your neurological assessment you note a weakness of hip flexion. Which of the following nerves is the most important for flexion of the thigh at the hip joint:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the thigh at the hip joint is produced by the sartorius, psoas major, iliacus and pectineus muscles, assisted by the rectus femoris muscle, all innervated by the femoral nerve (except for the psoas major, innervated by the anterior rami of L1 – 3).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 81
Incorrect
-
Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Infection usually requires antibiotic treatment.
Explanation:Campylobacter jejuni is the primary human pathogen, typically causing dysentery (bloody diarrhoea illness) following ingestion of contaminated meat, especially poultry. Infection is typically self-limiting and does not require antibiotic therapy. Campylobacter gastroenteritis is associated with the immune-mediated complications of Guillain-Barre syndrome, reactive arthritis and Reiter’s syndrome.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 82
Incorrect
-
Regarding renal clearance, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The MDRD equation uses plasma creatinine to estimate the GFR making an adjustment for age, sex and race.
Explanation:Clearance is defined as the volume of plasma that is cleared of a substance per unit time. Inulin clearance is the gold standard for measurement of GFR but creatinine clearance is typically used instead. Creatinine is freely filtered and not reabsorbed, but there is a little creatinine tubular secretion. In practice, GFR is usually estimated from the plasma creatinine using a formula e.g. the MDRD equation making an adjustment for age, sex and race.
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This question is part of the following fields:
- Physiology
- Renal
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Question 83
Incorrect
-
During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.
Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer:
Correct Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.
The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:
L– lateral two lumbricals
O– Opponens pollicis
A– Abductor pollicis
F– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.
Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 84
Incorrect
-
The most important nerve for plantar flexion of the foot at the ankle joint is:
Your Answer:
Correct Answer: Tibial nerve
Explanation:Muscles of the posterior compartment of the leg, innervated by the tibial nerve, perform plantar flexion of the foot at the ankle joint. The fibularis longus (innervated by the superficial fibular nerve) assists in plantar flexion but is not the most important.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 85
Incorrect
-
A 29-year-old male presents with a 3-day history of bloody diarrhoea and abdominal pain.
All the following are causes of infectious bloody diarrhoea EXCEPT?
Your Answer:
Correct Answer: Enterotoxigenic Escherichia coli
Explanation:Infective causes of bloody diarrhoea include:
Salmonella spp
Campylobacter spp
Schistosomiasis
Entamoeba histolytica (Amoebiasis )
Shigella spp
Clostridium difficile
Yersinia spp
Enteroinvasive Escherichia coliEnterotoxigenic Escherichia coli is non-invasive and does not cause inflammation of the gut and bloody diarrhoea. It presents with copious watery diarrhoea and usually are not associated with abdominal cramping.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 86
Incorrect
-
A 17-year-old patient with a headache, fever, and a non-blanching rash is brought to the emergency room. Meningococcal infection is confirmed by a lumbar puncture. Neisseria meningitidis uses one of the following immune evasion mechanisms:
Your Answer:
Correct Answer: Secretes IgA protease
Explanation:Meningococci have 3 important virulence factors, as follows:
Polysaccharide capsule – Individuals with immunity against meningococcal infections have bactericidal antibodies against cell wall antigens and capsular polysaccharides; a deficiency of circulating anti meningococcal antibodies is associated with the disease.
Lipo-oligosaccharide endotoxin (LOS)
Immunoglobulin A1 (IgA1) -
This question is part of the following fields:
- Microbiology
- Principles
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Question 87
Incorrect
-
Regarding hypertensive crises, which of the following statements is CORRECT:
Your Answer:
Correct Answer: In a hypertensive emergency, blood pressure should be reduced by 20 - 25% within 2 hours.
Explanation:A hypertensive emergency is defined as severe hypertension (blood pressure ≥ 180/110 mmHg) with acute damage to the target organs. Prompt treatment with intravenous antihypertensive therapy is generally required; over the first few minutes or within 2 hours, blood pressure should be reduced by 20 – 25%. Severe hypertension without acute target organ damage is defined as hypertensive urgency.; blood pressure should be reduced gradually over 24 – 48 hours with oral antihypertensive therapy. If blood pressure is reduced too quickly in the management of hypertensive crises, there is a risk of reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, and myocardial ischaemia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 88
Incorrect
-
A 26-year-old man is involved in a motorcycle accident that results in an open fracture of his tibia and fibula. The nerve that innervates peroneus tertius is damaged as a consequence of his injuries.
Peroneus tertius receives its innervation from which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Deep 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
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Question 89
Incorrect
-
A 2-day-old male is referred to a tertiary care hospital by the community midwife after a home visit due to jaundice and dyspnoea. After history and examination, the relevant blood work is performed, and the baby is found to have conjugated hyperbilirubinemia. The paediatric team suspects a hepatic origin for jaundice based on the findings.
Which one of the following aetiologies is the most likely cause of jaundice in this case?Your Answer:
Correct Answer: Alpha 1-antitrypsin deficiency
Explanation:The presence of dyspnoea makes alpha-1 antitrypsin deficiency the more likely diagnosis as biliary atresia does not cause respiratory symptoms. Deficiency of the enzyme alpha-1 antitrypsin causes uninhibited elastase activity and a decrease in elastic tissue. This causes liver cirrhosis leading to an elevation of conjugated bilirubin and emphysema in the lungs.
Rhesus disease, hereditary spherocytosis and breast milk jaundice cause an elevation of unconjugated bilirubin thus ruling it out in this case. Breast milk jaundice occurs due to an inability of the newborn to metabolize the proteins in breast milk.
Rhesus disease occurs when an Rh negative mother gives birth to an Rh positive baby. The jaundice would have been accompanied by anaemia and oedema.
Hereditary spherocytosis occurs due to extravascular haemolysis as defective RBCs are removed by the spleen. The patient would present with jaundice, splenomegaly and possibly an aplastic crisis (if Parvovirus B19 infection).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 90
Incorrect
-
A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke.
Which of the following is considered the best diagnosis for the case presented above?Your Answer:
Correct Answer: Medial medullary syndrome
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.
It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 91
Incorrect
-
Regarding bile, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Bile passes into the duodenum through the ampulla of Vater.
Explanation:Bile is synthesised in the liver. Bile functions to eliminate endogenous and exogenous substances from the liver, to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile is stored and concentrated in the gallbladder. Bile passes out of the gallbladder via the cystic duct. Bile passes into the duodenum through the ampulla of Vater regulated by the sphincter of Oddi.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 92
Incorrect
-
A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.
Which statement about ipratropium bromide is true?Your Answer:
Correct Answer: It can trigger acute closed-angle glaucoma
Explanation:Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD.
It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.
The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists.
It can trigger acute closed-angle glaucoma in patients that are susceptible.
First-line treatment for moderate asthma attacks is short-acting β2agonists.
The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.
Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 93
Incorrect
-
All of the following statements are considered true regarding likelihood ratios, except:
Your Answer:
Correct Answer: If less than one, indicates that the information increases the likelihood of the suspected diagnosis
Explanation:The Likelihood Ratio (LR) is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.
The LR is used to assess how good a diagnostic test is and to help in selecting an appropriate diagnostic tests or sequence of tests. They have advantages over sensitivity and specificity because they are less likely to change with the prevalence of the disorder, they can be calculated for several levels of the symptom/sign or test, they can be used to combine the results of multiple diagnostic test and they can be used to calculate post-test probability for a target disorder.
A LR greater than 1 produces a post-test probability which is higher than the pre-test probability. An LR less than 1 produces a post-test probability which is lower than the pre-test probability. When the pre-test probability lies between 30 and 70 per cent, test results with a very high LR (say, above 10) rule in disease. An LR below 1 produces a post-test probability les than the pre-test probability. A very low LR (say, below 0.1) virtually rules out the chance that the patient has the disease.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 94
Incorrect
-
A 7-days-old neonate is taken to the emergency department. She's pyretic, lethargic, and unresponsive, and her fontanelle has bulged. Antibiotics are started, and a lumbar puncture reveals Gram-negative rods. Which pathogen is most likely to be the cause:
Your Answer:
Correct Answer: Escherichia coli
Explanation:Among neonates, group B streptococci (GBS) are the most commonly identified causes of bacterial meningitis, implicated in roughly 50% of all cases. Escherichia coli(Gram-negative rods) accounts for another 20%. Thus, the identification and treatment of maternal genitourinary infections is an important prevention strategy.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 95
Incorrect
-
A patient presents with a lump for a dermatological examination. There is a circumscribed skin elevation measuring 0.3 cm in diameter seen on examination.
Which one of these best describes the lump you have found on examination?Your Answer:
Correct Answer: Papule
Explanation:A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.
A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.
A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.
A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.
A pustule is a small visible skin elevation containing an accumulation of pus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 96
Incorrect
-
Which of the following is NOT a typical feature of an abducens nerve palsy:
Your Answer:
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 97
Incorrect
-
A patient suffers from an injury to his hip and thigh. As a consequence of his injury, the nerve that was damaged innervates the obturator externus muscle.
In which of the following nerves is the obturator externus muscle innervated by?Your Answer:
Correct Answer: Posterior branch of the obturator nerve
Explanation:The obturator externus is innervated by the posterior branch of the obturator nerve, L2-L4.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 98
Incorrect
-
Regarding haemophilia A, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: In haemophilia both the APTT and PT are prolonged.
Explanation:Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives.
The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 99
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.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 100
Incorrect
-
At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts for around 50% of body weight. This can increase to nearly 80% of cardiac output during exercise. Skeletal muscle circulation is highly controlled and has a number of specialized adaptations as a result of this high degree of disparity during exercise, in combination with the diversity in the size of skeletal muscle around the body.
What is the primary mechanism for boosting skeletal muscle blood flow during exercise?
Your Answer:
Correct Answer: Metabolic hyperaemia
Explanation:In skeletal muscle, blood flow is closely related to metabolic rate. Due to the contraction of precapillary sphincters, most capillaries are blocked off from the rest of the circulation at rest and are not perfused. This causes an increase in vascular tone and vessel constriction. As metabolic activity rises, this develops redundancy in the system, allowing it to cope with greater demand. During exercise, metabolic hyperaemia, which is induced by the release of K+, CO2, and adenosine, recruits capillaries. Sympathetic vasoconstriction in the active muscles is overridden by this. Simultaneously, blood flow in non-working muscles is restricted, preserving cardiac output. During exercise, muscle contractions pump blood through the venous system, raising the pressure differential between arterioles and venules and boosting blood flow via capillaries.
Capillary angiogenesis is evident when muscles are used repeatedly (e.g. endurance training). It is a long-term effect, not a quick fix for increased blood flow.
The local partial pressure of alveolar oxygen is the primary intrinsic control of pulmonary blood flow (pAO2). Low pAO2 promotes arteriole vasoconstriction and vice versa. The hypoxic pulmonary vasoconstriction (HPV) reflex allows blood flow to be diverted away from poorly ventilated alveoli and towards well-ventilated alveoli in order to maximize gaseous exchange.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
