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Question 1
Correct
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Question 2
Incorrect
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Which of the following is NOT typically associated with eosinophilia:
Your Answer: Hodgkin lymphoma
Correct Answer: Whooping cough
Explanation:An eosinophil leucocytosis is defined as an increase in blood eosinophils above 0.4 x 109/L.It is most frequently due to:
Allergic diseases (e.g. bronchial asthma, hay fever, atopic dermatitis, urticaria)
Parasites (e.g. hookworm, ascariasis, tapeworm, schistosomiasis)
Skin diseases (e.g. psoriasis, pemphigus, urticaria, angioedema)
Drug sensitivity -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 3
Incorrect
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The lymph drainage of the anal canal above the pectinate line is initially to the:
Your Answer: External iliac nodes
Correct Answer: Internal iliac nodes
Explanation:Above the pectinate line, the anal canal drains to the internal iliac lymph nodes which subsequently drain to the lumbar (para-aortic) nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 4
Incorrect
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A patient in the Emergency Department had a diagnosis of diabetic ketoacidosis (DKA) and you commence an insulin infusion. Which of these statements concerning endogenous insulin is true?
Your Answer: Parasympathetic stimulation inhibits insulin release
Correct Answer: Insulin has a short half-life of around 5-10 minutes
Explanation:Insulin, a peptide hormone, is produced in the pancreas by the beta-cells of the islets of Langerhans.
The beta-cells first synthesise an inactive precursor called preproinsulin which is converted to proinsulin by signal peptidases, which remove a signal peptide from the N-terminus.
Proinsulin is converted to insulin by the removal of the C-peptide.
Insulin has a short half-life in the circulation of about 5-10 minutes.
Glucagon and parasympathetic stimulation stimulates insulin release. -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 5
Incorrect
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Regarding benzylpenicillin, which of the following statements is CORRECT:
Your Answer: Benzylpenicillin is first line in treatment of tetanus.
Correct Answer: If meningococcal disease is suspected, benzylpenicillin should be given before transfer to hospital.
Explanation:Benzylpenicillin (although inactivated by bacterial beta-lactamases) is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas gangrene, leptospirosis, and treatment of Lyme disease. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin should be given before transfer to hospital, so long as this does not delay the transfer; benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis. Although benzylpenicillin is effective in the treatment of tetanus, metronidazole is preferred. Benzylpenicillin is inactivated by gastric acid and absorption from the gastrointestinal tract is poor and therefore it must be given by injection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 6
Incorrect
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Damage to this nerve affects the flexor digitorum longus.
Your Answer: Obturator nerve
Correct Answer: Tibial nerve
Explanation:Like all muscles in the deep posterior compartment of the leg, flexor digitorum longus muscle is innervated by branches of the tibial nerve (root value L5, S1 and S2) which is a branch of sciatic nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 7
Incorrect
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What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer: 300 mg IV over 5 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Correct Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Explanation:A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 8
Correct
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Low levels of which of the following arterial blood gas parameters stimulate the peripheral chemoreceptors?
Your Answer: Arterial pO 2
Explanation:Chemoreceptors are activated when the chemical composition of their immediate surroundings changes.
Peripheral chemoreceptors, together with central chemoreceptors, regulate respiratory functions. They detect changes in arterial blood oxygen levels. Decreased arterial Po2 (partial pressure of oxygen) reflexly stimulates peripheral chemoreceptors.
When peripheral chemoreceptors detect changes in arterial blood oxygen, they will trigger cardiorespiratory changes such as an increase in breathing and blood pressure. These reflexes are important for maintaining homeostasis during hypoxemia.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 9
Incorrect
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A young man develops an infection spread via aerosol transmission.
Which of these organisms is commonly spread by aerosol transmission?Your Answer: Rotavirus
Correct Answer: Measles virus
Explanation:Aerosols are airborne particles less than 5 µm in size, containing infective organisms that usually cause infection of the upper or lower respiratory tract.
Examples of organisms commonly spread by aerosol transmission are:
Measles virus
Varicella zoster virus
Mycobacterium tuberculosisThe following table summarises the various routes of transmission with example organisms:
Route of transmission
Example organisms
Aerosol (airborne particle < 5 µm)
Mycobacterium tuberculosis
Varicella zoster virus
Measles virusHepatitis A and Rotavirus are spread by the faeco-oral route.
Neisseria gonorrhoea is spread by sexual route.
Staphylococcus aureus is spread by direct contact.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 10
Incorrect
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A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.
Which of the following is the patient's preferred drug treatment?Your Answer: 10% of the systolic pressure over the first hour
Correct Answer: 25% of the mean arterial pressure over the first hour
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.
Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.
Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.
The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.
An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 11
Incorrect
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Which of the following statements is true regarding the extensor pollicis longus?
Your Answer: It arises from the lateral epicondyle of the elbow
Correct Answer: It is innervated by the posterior interosseous nerve
Explanation:Extensor pollicis longus is part of the deep extensors of the forearm together with extensor pollicis brevis, abductor pollicis longus, extensor indicis and supinator muscles. It is located on the posterior aspect of forearm, extending from the middle third of the ulna, and adjacent interosseous membrane, to the distal phalanx of the thumb.
Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor pollicis brevis receives its blood supply from the posterior interosseous artery and perforating branches of the anterior interosseous artery.
The main action of extensor pollicis longus is extension of the thumb at the metacarpophalangeal and interphalangeal joints. Extension at the metacarpophalangeal joint occurs in synergy with extensor pollicis brevis muscle. When the thumb reaches the full extension or abduction, extensor pollicis longus can also assist in adduction of the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Correct
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Which of the following nerves innervates the gastrocnemius muscle?
Your Answer: Tibial nerve
Explanation:The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Incorrect
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Naloxone is a reversal agent for which of the following groups of drugs:
Your Answer: Depolarising muscle relaxants.
Correct Answer: Opioids
Explanation:Naloxone is a specific antagonist of mu(μ)-opioid receptors, the specific antidote for opioid overdose and will reverse respiratory depression and coma if given at sufficient dosage. The initial dose is usually 0.8 mg (2 mL) intravenously (the dose range suggested by BNF is 0.4-2 mg). It can also be given by intramuscular injection if the intravenous route is not feasible.
As naloxone has a shorter duration of action than most opioids, close monitoring and repeated injections are necessary according to the respiratory rate and depth of coma. The dose is generally repeated every 2-3 minutes to a maximum of 10 mg. When repeated doses are needed, naloxone may be given by a continuous infusion adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
In opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 14
Correct
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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: 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 15
Incorrect
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Which of the following is the most potent stimulus of fibrinolysis:
Your Answer: Antithrombin
Correct Answer: Tissue plasminogen activator
Explanation:Fibrinolysis is a normal haemostatic response to vascular injury. Plasminogen, a proenzyme in blood and tissue fluid, is converted to plasmin by activators either from the vessel wall (intrinsic activation) or from the tissues (extrinsic activation). The most important route follows the release of tissue plasminogen activator (TPA) from endothelial cells.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 16
Correct
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What is the primary route of transmission of Norovirus?
Your Answer: Oral-faecal route
Explanation:Norovirus is spread primarily by faecal-oral contact, but it can also be spread through contact with an infected person, ingestion of contaminated food or water, or contact with contaminated surfaces or items.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 17
Incorrect
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Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.
What is cyclizine's main mechanism of action?Your Answer: Antimuscarinic action
Correct Answer: Antihistamine action
Explanation:Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 18
Incorrect
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You are attending to a patient that has presented with a severe headache in the Emergency Department. The patient has signs of cerebral oedema and raised intracranial pressure.
You discuss the case with the on-call neurology registrar and decide to prescribe Mannitol. The nurse assisting you asks you to reconsider this management plan as she suspects the patient has a contraindication to Mannitol.
Out of the following, what is a contraindication to mannitol?Your Answer: Polyuria
Correct Answer: Severe cardiac failure
Explanation:Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Mannitol has several contraindications and some of them are listed below:
1. Anuria due to renal disease
2. Acute intracranial bleeding (except during craniotomy)
3. Severe cardiac failure
4. Severe dehydration
5. Severe pulmonary oedema or congestion
6. Known hypersensitivity to mannitol -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 19
Incorrect
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A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.
Which of the following statements is TRUE regarding naloxone?Your Answer: It has a longer duration of action than most opioids
Correct Answer: It can be given by a continuous infusion if repeated doses are required
Explanation:Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.
It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.
An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.
If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 20
Incorrect
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All of the following predisposes to lithium toxicity in patients taking long-term therapy EXCEPT:
Your Answer: Infections
Correct Answer: Hypernatraemia
Explanation:A common complication of long term lithium therapy results in most cases of lithium intoxication. It is caused by reduced excretion of the drug which can be due to several factors including deterioration of renal function, dehydration, hyponatraemia, infections, and co-administration of diuretics or NSAIDs or other drugs that may interact.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 21
Incorrect
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Regarding apoptosis, which of the following statements is INCORRECT:
Your Answer: Apoptosis leads to the formation of membrane-bound apoptotic bodies.
Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.
Explanation:Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 22
Incorrect
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A 69-year-old man presents with a painful groin swelling on the right side. The suspected diagnosis is an inguinal hernia.
Which of the following examination features make it more likely to be an indirect inguinal hernia?Your Answer: The hernia appears ‘round’ in shape
Correct Answer: It can be controlled by pressure over the deep inguinal ring
Explanation:The reduced indirect inguinal hernia can be controlled by pressure over the internal ring; a direct inguinal hernia cannot.
An indirect inguinal hernia can be reduced superiorly then superolaterally, while a direct inguinal hernia can be reduced superiorly then posteriorly.
An indirect inguinal hernia takes time to reach full size, but a direct inguinal hernia appears immediately upon standing.
Indirect inguinal hernias are seen as elliptical swelling, while direct inguinal hernias appear as symmetric, circular swelling.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 23
Incorrect
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A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer: Selegiline
Correct Answer: Lithium
Explanation:In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.
Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.
If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.
If given in the 2nd and 3rd-trimesters, there is a risk of the following:
1. hypotonia
2. lethargy
3. feeding problems
4. hypothyroidism
5. goitre
6. nephrogenic diabetes insipidus in the neonate -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 24
Incorrect
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Where does angiotensin II directly act on the renal nephron:
Your Answer:
Correct Answer: Proximal tubule
Explanation:Angiotensin II acts to directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters).
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This question is part of the following fields:
- Physiology
- Renal
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Question 25
Incorrect
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All of the following typically occurs as part of normal passive expiration except:
Your Answer:
Correct Answer: Contraction of the internal intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs.
In expiration, several movements occur. There are:
1. depression of the sternal ends of the ribs (‘pump handle’ movement),
2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and
3. elevation of the diaphragm.
These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs. -
This question is part of the following fields:
- Anatomy
- Thorax
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Question 26
Incorrect
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Regarding ACE inhibitors, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Angiotensin-II receptor blockers are a useful alternative in patients who cannot tolerate ACE-inhibitors due a persistent cough.
Explanation:ACE inhibitors should be used with caution in patients of Afro-Caribbean descent who may respond less well; calcium channel blockers are first line for hypertension in these patients. ACE inhibitors have a role in the management of diabetic nephropathy. ACE inhibitors are contraindicated in pregnant women. ACE inhibitors inhibit the breakdown of bradykinin; this is the cause of the persistent dry cough. Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 27
Incorrect
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Which of the following statements is correct about the extensor digitorum muscle?
Your Answer:
Correct Answer: It extends the medial four digits at the metacarpophalangeal joints
Explanation:Extensor digitorum is a long muscle located in the posterior compartment of the forearm. Together with the extensor carpi ulnaris and extensor digiti minimi, extensor carpi radialis longus and brevis as well as the brachioradialis, it belongs to the group of superficial extensors of the forearm. These muscles can be easily palpated in the lateral aspect of the posterior forearm, especially during the extension of hand when they are contracted.
Extensor digitorum runs from the lateral epicondyle of humerus to the medial four phalanges of the hand. In this way, it generates the pull for the extension of the four medial fingers in their metacarpophalangeal and both interphalangeal joints. Extensor digitorum also participates in the extension of the wrist.
Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor digitorum is vascularized by the branches of three different arteries: (1) posterior interosseous artery, (2) radial recurrent artery, and (3) anterior interosseous artery. Anterior and posterior interosseous arteries are the branches of the common interosseous artery that arises from the ulnar artery. The radial recurrent artery is a branch of the radial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 28
Incorrect
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An 8-year-old boy was brought to the emergency room with complaints of a rash and fever that have been present for the past 3 days. Upon history taking and observation, it was noted that the rash started behind the ears and then spread to the face and body. The presence of coryzal symptoms, dry cough, and conjunctivitis was also observed.
What is most likely the diagnosis of the case presented above?Your Answer:
Correct Answer: Measles
Explanation:The measles virus is an enveloped virus classified in the genus
Morbillivirus.
Measles is highly contagious and spreads by aerosol. Initial replication takes place in the mucosal cells of the respiratory tract; measles virus then replicates in the local lymph nodes and spreads systemically. The virus circulates in the T and B cells and monocytes, until eventually the lungs, gut, bile duct, bladder, skin, and lymphatic organs are involved. After an incubation period of 7 to 10 days, there is an abrupt onset, with symptoms of sneezing, runny nose and cough, red eyes, and rapidly rising fever. About 2 to 3 days later, a maculopapular rash appears on the head and trunk. Koplik spots, lesions on the oral mucosa consisting of irregular red spots, with a bluish white speck in the centre, generally appear 2 to 3 days before the rash and are diagnostic.Measles is easily diagnosed clinically, so few requests for laboratory identification are made. The virus is fragile and must be handled carefully. The specimens of choice are from the nasopharynx and urine, but the virus can only be recovered from these sources in the early stages of infection. The virus grows on PMK cells, causing the formation of distinctive spindle-shaped or multinucleated cells.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 29
Incorrect
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A 53-year-old male has presented to your clinic with the complaint of a rash on his right forearm. On examination, you discover small reddish-purple spots on the skin measuring less than 2-3 mm. They do not blanch on applying pressure.
Which one of the following best fits the description given above?Your Answer:
Correct Answer: Petechiae
Explanation:Petechiae are small red or purple spots on the skin measuring less than 3 mm, caused by minor haemorrhages which do not blanch on applying pressure.
Purpura measures between 3mm and 1 cm in diameter, while ecchymoses are greater than 1 cm in diameter. Both are caused due to haemorrhage.Erythema is the generalised redness of the skin.
A macule is a flat, discoloured area of the skin measuring less than 1 cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 30
Incorrect
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Doxycycline is indicated first line for treatment of which of the following infections:
Your Answer:
Correct Answer: Chlamydia
Explanation:Doxycycline may be used first line for chlamydia, pelvic inflammatory disease (with metronidazole and ceftriaxone), acute bacterial sinusitis, exacerbation of chronic bronchitis, moderate-severity community acquired pneumonia and high-severity community acquired pneumonia (with benzylpenicillin).
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This question is part of the following fields:
- Infections
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
