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  • Question 1 - Osteoclasts are a type of bone cell that are critical in the maintenance,...

    Incorrect

    • Osteoclasts are a type of bone cell that are critical in the maintenance, repair and remodelling of bones.
      Which of the following inhibits osteoclast activity? Select ONE answer only.

      Your Answer: Parathyroid hormone

      Correct Answer: Calcitonin

      Explanation:

      Osteoclasts are a type of bone cell that breaks down bone tissue. This is a critical function in the maintenance, repair and remodelling of bones. The osteoclast disassembles and digests the composite of hydrated protein and minerals at a molecular level by secreting acid and collagenase. This process is known as bone resorption and also helps to regulate the plasma calcium concentration.
      Osteoclastic activity is controlled by a number of hormones:
      1,25-dihydroxycholecalciferol increases osteoclastic activity
      Parathyroid hormone increases osteoclastic activity
      Calcitonin inhibits osteoclastic activity
      Bisphosphonates are a class of drug that slow down and prevent bone damage. They are osteoclast inhibitors.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      13.5
      Seconds

  • Question 2 - A 14-year-old female is brought to the Emergency Room by her mother after...

    Incorrect

    • A 14-year-old female is brought to the Emergency Room by her mother after a fall from a tree in which she injured her elbow. An elbow fracture is suspected based on the examination findings, and she is given Entonox for analgesia as her elbow is set in a cast.

      Which one of the following statements regarding this drug is true?

      Your Answer:

      Correct Answer: It can cause inhibition of vitamin B12 synthesis

      Explanation:

      Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor.

      It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour.

      Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 3 - Which of the following immunoglobulin molecules is the most abundant in secretions (such...

    Incorrect

    • Which of the following immunoglobulin molecules is the most abundant in secretions (such as saliva and breast milk):

      Your Answer:

      Correct Answer: IgA

      Explanation:

      IgA is the predominant antibody class in secretions and tremendous quantities are secreted into various body spaces and onto mucosal surfaces (the gut lumen, the pharynx and sinuses, the larger airways, although not the alveoli).
      Because of its size, the majority of IgM is found in the circulation.

      Along with IgM, IgD is predominant among the surface receptors of mature B cells, where it plays a key role in B cells activation.

      IgE has the lowest concentration in normal human serum. It plays a prominent role in immune responses to helminth parasites, and in allergic reactions.
      IgG is the most abundant immunoglobulin and constitutes 75 percent of serum immunoglobulin in an adult human

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 4 - Which of the following best describes a natural killer cell: ...

    Incorrect

    • Which of the following best describes a natural killer cell:

      Your Answer:

      Correct Answer: A large granular lymphocyte that kills by inducing target cell apoptosis.

      Explanation:

      Natural killer (NK) cells are cytotoxic CD8 positive cells that lack the T-cell receptor. They are large cells with cytoplasmic granules. NK cells are designed to kill target cells that have a low level of expression of HLA class I molecules, such as may occur during viral infection or on a malignant cell. NK cells do this by displaying several receptors for HLA molecules on their surface. When HLA is expressed on the target cell these deliver an inhibitory signal into the NK cell. When HLA molecules are absent on the target cell this inhibitory signal is lost and the NK cell can then kill its target. In addition, NK cells display antibody-dependent cell-mediated cytotoxicity. In this, antibody binds to antigen on the surface of the target cell and then NK cells bind to the Fc portion of the bound antibody and kill the target cell.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 5 - An elderly man presents with bilateral lower facial swelling around the mandible and...

    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.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

  • Question 6 - The patient is a 61-year-old man with severe central chest pain. An acute...

    Incorrect

    • The patient is a 61-year-old man with severe central chest pain. An acute myocardial infarction is revealed by his ECG. Clopidogrel is one of the medications he takes as part of his treatment.

      Clopidogrel's direct mechanism of action is which of the following?

      Your Answer:

      Correct Answer: Inhibition of platelet ADP receptors

      Explanation:

      Clopidogrel, a thienopyridine derivative, prevents platelet aggregation and cross-linking by the protein fibrin by inhibiting the ADP receptor on platelet cell membranes (inhibits binding of ADP to its platelet receptor (P2Y12 ADP-receptor).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 7 - A patient suffers a lower limb fracture that causes damage to the nerve...

    Incorrect

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

      Your Answer:

      Correct Answer: Superficial peroneal nerve

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 8 - A 72 year old man is brought to ED by ambulance with sudden...

    Incorrect

    • A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:

      Your Answer:

      Correct Answer: Synchronised DC cardioversion

      Explanation:

      All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 9 - An 18-year-old student presents with a 1-week history of sore throat, low grade...

    Incorrect

    • An 18-year-old student presents with a 1-week history of sore throat, low grade fever, and malaise. Upon history taking, she noted that she had a fine rash over her body a week ago that quickly fades. Further examination and observation was done and the presence of mild splenomegaly was noted. Her test shows positive for heterophile antibody test, suspecting a diagnosis of infectious mononucleosis.

      Which of the following characteristics is mostly associated with the diagnosis of infectious mononucleosis?

      Your Answer:

      Correct Answer: Atypical lymphocytes

      Explanation:

      Epstein-Barr virus causes infectious mononucleosis which is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue and fever.

      It is accompanied by atypical large peripheral blood lymphocytes. These atypical lymphocytes, also known as Downey cells, are actually activated CD8 T lymphocytes, most of which are responding to EBV-infected cells.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 10 - A blood culture was performed from a sample taken from a patient. It...

    Incorrect

    • A blood culture was performed from a sample taken from a patient. It was noted that a Gram-positive coccus organism was grown.

      Among the following microorganisms, which is considered an example of a Gram-positive coccus?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Bacillus cereus = Gram-positive bacillus
      Neisseria meningitidis = Gram-negative coccus
      Salmonella enterica & Escherichia coli = Gram-negative bacilli

      In Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative.
      The Staphylococci that are associated with infections in humans are colonizers of various skin and mucosal surfaces. Because the carrier state is common among the human population, infections are frequently acquired when the colonizing strain gains entrance to a normally sterile site as a result of trauma or abrasion to the skin or mucosal surface.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      0
      Seconds

  • Question 11 - Fatigue, dizziness upon standing, muscle weakness, weight loss, nausea, and sweating are all symptoms...

    Incorrect

    • Fatigue, dizziness upon standing, muscle weakness, weight loss, nausea, and sweating are all symptoms that a patient may experience in Addison's disease.

      Which of the following claims about Addison's disease is correct?

      Your Answer:

      Correct Answer: ACTH levels are elevated in primary insufficiency

      Explanation:

      The adrenal glands produce too little steroid hormones, which causes Addison’s disease. The production of glucocorticoids, mineralocorticoids, and sex steroids are all altered. The most prevalent cause is autoimmune adrenalitis, which accounts for 70-80 percent of cases.

      It affects more women than males and occurs most frequently between the ages of 30 and 50.

      The following are some of the clinical signs and symptoms of Addison’s disease:

      Weakness and sluggishness
      Hypotension is a condition in which the blood pressure (notably orthostatic hypotension)
      Vomiting and nausea
      Loss of weight
      Axillary and pubic hair loss
      Depression
      Hyperpigmentation is a condition in which a person’s (palmar creases, buccal mucosa and exposed areas more commonly affected)
      The following are the classic biochemical hallmarks of Addison’s disease:
      Hyponatraemia
      Hyperkalaemia
      Hypercalcaemia
      Hypoglycaemia
      Acidosis metabolica
      When ACTH levels are combined with cortisol levels, it is possible to distinguish between primary and secondary adrenal insufficiency:
      In primary insufficiency, levels rise.
      In secondary insufficiency, levels are low or low normal.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      0
      Seconds

  • Question 12 - A young male has presented to you with respiratory depression and small pupils...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 13 - By what mechanism does Vibrio cholerae causes diarrhoea? ...

    Incorrect

    • By what mechanism does Vibrio cholerae causes diarrhoea?

      Your Answer:

      Correct Answer: Increases Cl- secretory channels in crypt cells

      Explanation:

      Cholera is a severe diarrheal illness caused by the Vibrio cholerae bacteria infecting the bowel. Ingesting cholera-infected food or drink is the a way to contract the disease. In the intestinal crypt cells, the toxigenic bacterium Vibrio cholera activates adenylate cyclase and raises cyclic adenosine monophosphate (cAMP).

      cAMP stimulates the Cl-secretory channels in crypt cells, resulting in the secretion of chloride with sodium ions and water. The toxin it produces causes the body to secrete massive amounts of water, resulting in diarrhoea and significant fluid and electrolyte loss.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
      Seconds

  • Question 14 - A 23 year old student presents to ED with a widespread maculopapular rash....

    Incorrect

    • A 23 year old student presents to ED with a widespread maculopapular rash. She recently had a sore throat and was started on a course of antibiotics. The most likely antibiotic that she was prescribed is:

      Your Answer:

      Correct Answer: Amoxicillin

      Explanation:

      Maculopapular rashes are commonly seen with ampicillin and amoxicillin. However they are not usually related to true penicillin allergy. Very often, they occur in patients with glandular fever and so, broad-spectrum penicillins should not be used blindly, for management and treatment of a sore throat. There is also an increased risk of rash in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 15 - A 71-year-old patient has been diagnosed with a dopamine-secreting neuroendocrine tumour.

    Which of the...

    Incorrect

    • A 71-year-old patient has been diagnosed with a dopamine-secreting neuroendocrine tumour.

      Which of the following statements about dopamine is correct?

      Your Answer:

      Correct Answer: It inhibits prolactin release from the anterior pituitary

      Explanation:

      Dopamine is a neurotransmitter and amine hormone that is derived from the amino acid tyrosine. It is made in a number of places throughout the human body, both inside and outside the central nervous system. The adrenal medulla, dopamine neurons in the arcuate nucleus of the hypothalamus, the substantia nigra, and other areas of the brain produce dopamine.

      The tuberoinfundibular pathway refers to the dopamine neurons in the arcuate nucleus of the hypothalamus’ tubeal region. Dopamine is discharged into the hypothalamo-hypophyseal portal system from these neurons’ neurosecretory terminals at the median eminence.

      The major function of dopamine produced from the hypothalamus is to suppress prolactin production from the anterior pituitary, and it is released in reaction to excessive levels of prolactin secretion. Modulation of motor-control centres and activation of reward centres are two more crucial activities of the brain.
      Dopamine-secreting cells can also be found in other areas of the body, where they perform mostly paracrine functions (acting on nearby cells).

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      0
      Seconds

  • Question 16 - An 80-year-old patient with a history of chronic heart failure presents to you....

    Incorrect

    • An 80-year-old patient with a history of chronic heart failure presents to you. Examination reveals widespread oedema.

      Which statement about plasma oncotic pressure (Ï€ p ) is true?

      Your Answer:

      Correct Answer: The influence of π p on fluid movement is negligible if the capillary reflection co-efficient is 0.1

      Explanation:

      Plasma oncotic pressure (Ï€p) is typically 25-30 mmHg.

      70% of π p is generated by albumin so Hypoalbuminemia will decrease π p

      The osmotic power of albumin is enhanced by the Gibbs-Donnan effect.

      The influence of π p on fluid movement is negligible if the capillary reflection coefficient is 0.1. Another way of saying a vessel is highly permeable is saying the reflection coefficient is close to 0.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      0
      Seconds

  • Question 17 - A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy...

    Incorrect

    • A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy vaginal bleeding. She complains of feeling hot and cold during transfusion of the second unit and her temperature is 38.5ºC. Prior to the transfusion, her temperature was 37ºC. She has no other symptoms.

      Which of these transfusions reactions most likely occurred?

      Your Answer:

      Correct Answer: Febrile transfusion reaction

      Explanation:

      Febrile transfusion reactions presents with an unexpected temperature rise (≥ 38ºC or ≥ 1ºC above baseline, if baseline ≥ 37ºC) during or shortly after transfusion. It is usually an isolated finding and the fever is accompanied by chills and malaise occasionally.

      Allergic reaction is commonly caused by foreign plasma proteins but may be due to anti-IgA. Allergic type reactions usually present with urticaria, pruritus, hives. Associations include laryngeal oedema or bronchospasm.

      Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.

      Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.

      Transfusion-related lung injury (TRALI) is a form of acute respiratory distress caused by the donor plasma containing antibodies against the patient’s leukocytes. It is defined as hypoxia and bilateral pulmonary oedema that occurs within 6 hours of a transfusion in the absence of other causes of acute lung injury. Clinical features include Breathlessness, cough, frothy sputum, hypertension or hypotension, hypoxia and fever. Chest X-ray shows multiple perihilar nodules with infiltration of the lower lung fields.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 18 - A 55-year-old female is urgently rushed into the Emergency Department as she complains...

    Incorrect

    • A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.

      She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.

      Which of the following does heparin activate?

      Your Answer:

      Correct Answer: Antithrombin III

      Explanation:

      Heparin works by binding to and activating the enzyme inhibitor antithrombin III.

      Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.

      Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
      1. Unfractionated: widely varying polymer chain lengths
      2. Low molecular weight: Smaller polymers only

      Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.

      Heparin is used for:
      1. Prevention and treatment of venous thromboembolism
      2. Treatment of disseminated intravascular coagulation
      3. Treatment of fat embolism
      4. Priming of haemodialysis and cardiopulmonary bypass machines

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 19 - A 43-year old male is taken to the Emergency Room for a lacerated...

    Incorrect

    • A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.

      Which of these anatomic structures is the deepest structure injured in the case above?

      Your Answer:

      Correct Answer: Transversalis fascia

      Explanation:

      The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:

      Skin
      Fatty layer of the superficial fascia (Camper’s fascia)
      Membranous layer of the superficial fascia (Scarpa’s fascia)
      Aponeurosis of the external and internal oblique muscles
      Rectus abdominis muscle
      Aponeurosis of the internal oblique and transversus abdominis
      Fascia transversalis
      Extraperitoneal fat
      Parietal peritoneum

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      0
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  • Question 20 - A 32-old woman comes for a follow-up visit after being discharged on medications...

    Incorrect

    • A 32-old woman comes for a follow-up visit after being discharged on medications for her newly diagnosed epilepsy. She now complains of a tremor in her arm when she holds a tray in her hand. You examine the patient and notice she has developed postural tremors.

      Which of the following medications for epilepsy is most likely responsible for this tremor?

      Your Answer:

      Correct Answer: Sodium valproate

      Explanation:

      A postural tumour is observed when a person maintains a position against gravity, such as holding the arms outstretched. (The patient holding her tray against gravity)

      Sodium valproate is the most commonly prescribed medication for epilepsy. It is commonly associated with tremors as valproate-induced tremors occur in around 6-45% of patients. The tremors are commonly postural, but a resting tremor may also occur.

      Approximately 25% of patients taking sodium valproate are found to develop a tremor within 3-12 months of initiating therapy.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
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  • Question 21 - A somatostatinoma is diagnosed in a 74-year-old patient who has recently developed diabetes...

    Incorrect

    • A somatostatinoma is diagnosed in a 74-year-old patient who has recently developed diabetes mellitus, recurrent episodes of gallstones, and Steatorrhoea. She also  has a tumour in the head of her pancreas.

      Which of the following is the most likely effect of this tumour?

      Your Answer:

      Correct Answer: Inhibit gastric acid secretion

      Explanation:

      Somatostatin-producing cells present in the pyloric antrum, duodenum, and pancreatic islets are known as D-cells or delta-cells. Somatostatin inhibits gastric acid secretion by acting directly on acid-producing parietal cells in the stomach via a G-protein coupled receptor.

      Somatostatin affects hormones in the following ways:
      Inhibits the anterior pituitary’s secretion of growth hormone.
      Inhibits the anterior pituitary’s secretion of thyroid-stimulating hormone.

      The secretion of various gastrointestinal hormones is inhibited (including gastrin, CCK, secretin, motilin, VIP and GIP)

      Reduces the rate at which the stomach empties.
      Inhibits the release of insulin and glucagon from the pancreas.

      The pancreas’ exocrine secretory activity is inhibited.
      Somatostatin can also slow the digestive process by suppressing the production of hormones such gastrin, secretin, and histamine, which reduces gastric acid secretion.

      A somatostatinoma is a cancerous tumour of the endocrine pancreas’ D-cells, which make somatostatin. Somatostatin inhibits pancreatic and gastrointestinal hormones when levels are high. The following clinical characteristics are related with somatostatinomas:

      Insulin secretion blockage causes diabetes mellitus.
      Gallstones by inhibition of CCK and secretin Steatorrhoea via inhibition of CCK and secretin

      Hypochlorhydria is caused by the suppression of gastrin, a hormone that increases gastric acid output regularly.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
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  • Question 22 - An infection causes an Addisonian crisis in a male patient with a known history...

    Incorrect

    • An infection causes an Addisonian crisis in a male patient with a known history of Addison's disease.

      Which of the following is NOT a well-known symptom of an Addisonian crisis?

      Your Answer:

      Correct Answer: Hyperglycaemia

      Explanation:

      Although Addisonian crisis is a rare illness, it can be fatal if it is misdiagnosed. Hypoglycaemia and shock are the most common symptoms of an Addisonian crisis (tachycardia, peripheral vasoconstriction, hypotension, altered conscious level, and coma).

      Other clinical characteristics that may be present are:
      Fever
      Psychosis
      Leg and abdominal pain
      Dehydration and vomiting
      Convulsions 

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 23 - A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part...

    Incorrect

    • A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part in a powerlifting competition, he felt a painful snap at the front of his shoulder and chest. There is also the presence of bruising and swelling over the left side of his chest. A ruptured pectoralis major muscle was suspected upon examining the injured area.

      Which of the following statements regarding the surface markings of the pectoralis major muscle is considered correct?

      Your Answer:

      Correct Answer: It inserts into the lateral lip of the bicipital groove of the humerus

      Explanation:

      The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.

      Its origin lies anterior surface of the medial half of the clavicle, the anterior surface of the sternum, the first 7 costal cartilages, the sternal end of the sixth rib, and the aponeurosis of the external oblique of the anterior abdominal wall.
      The insertion of the pectoralis major is at the lateral lip of the intertubercular sulcus of the humerus. There are 2 heads of the pectoralis major, the clavicular and the sternocostal, which reference their area of origin.
      The function of the pectoralis major is 3-fold and dependent on which heads of muscles are involved:
      – Flexion, adduction and medial rotation of the arm at the glenohumeral joint
      – Clavicular head causes flexion of the extended arm
      – Sternoclavicular head causes extension of the flexed arm

      Arterial supply of the pectoralis major, the pectoral artery, arises from the second branch of the axillary artery, the thoracoacromial trunk.

      The 2 heads of the pectoralis major have different nervous supplies. The clavicular head derives its nerve supply from the lateral pectoral nerve. The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the medial pectoral nerve arises from the medial cord.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 24 - You suspected typhoid disease in a patient who had recently returned from South...

    Incorrect

    • You suspected typhoid disease in a patient who had recently returned from South America and presented to the emergency department with fever, constipation, and a rose spot rash. Which of the following antibiotics will be administered to this patient?

      Your Answer:

      Correct Answer: Cefotaxime

      Explanation:

      Typhoid fever, often known as enteric fever, is a potentially fatal multi-systemic sickness caused predominantly by Salmonella enterica serotype typhi and, to a lesser extent, paratyphi A, B, and C.

      Cefotaxime is the first-line treatment for typhoid fever (or ceftriaxone). In cases of mild or moderate sickness caused by multiresistant pathogens, azithromycin is an option. If the bacterium is sensitive, ciprofloxacin is an option.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 25 - You are about to perform an emergency pericardiocentesis on a 26-year-old male who...

    Incorrect

    • You are about to perform an emergency pericardiocentesis on a 26-year-old male who was involved in a car accident and is suspected of having cardiac tamponade due to signs of hypotension, muffled heart sounds, and distended neck veins. Where should you insert the needle to relieve tamponade?

      Your Answer:

      Correct Answer: Inferior and to the left of the xiphochondral junction

      Explanation:

      Pericardiocentesis is a procedure that removes excess fluid from the pericardium. As a result, it’s used in cases of cardiac tamponade, which occurs when there’s too much fluid in the space around the heart.

      During the procedure, a needle and a small catheter are inserted 1 to 2 cm inferior and to the left of the xiphochondral junction into the pericardial cavity.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 26 - If the ejection fraction increases, there will be a decrease in: ...

    Incorrect

    • If the ejection fraction increases, there will be a decrease in:

      Your Answer:

      Correct Answer: End-systolic volume

      Explanation:

      An increase in ejection fraction means that a higher fraction of the end-diastolic volume is ejected in the stroke volume (e.g. because of the administration of a positive inotropic agent). When this situation occurs, the volume remaining in the ventricle after systole, the end-systolic volume, will be reduced. Cardiac output, stroke volume, and mean arterial pressure will be increased.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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      Seconds

  • Question 27 - Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:...

    Incorrect

    • Regarding linear relationships between two variables, what does a positive correlation coefficient indicate:

      Your Answer:

      Correct Answer: The two variables are directly proportional

      Explanation:

      A positive correlation coefficient means that the two variables are directly proportional e.g. height and weight in healthy growing children.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
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  • Question 28 - A 29-year-old female with a swollen red finger presents to your clinic and...

    Incorrect

    • A 29-year-old female with a swollen red finger presents to your clinic and you suspect that the underlying process is of acute inflammation. You request for some bloods investigations.

      Which statement about histamine as a chemical mediator of the acute inflammatory response is TRUE?

      Your Answer:

      Correct Answer: It increases vascular permeability

      Explanation:

      Histamine increases vascular permeability in the acute inflammatory response.

      Histamine causes vasodilation.

      It is released from Mast cells and basophils, eosinophils and platelets.

      Mast cells and basophils are its primary source

      Nitric oxide (not histamine) is a major factor in endotoxic shock

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 29 - Which of the following is the correct sequential order of the phases of...

    Incorrect

    • Which of the following is the correct sequential order of the phases of healing:

      Your Answer:

      Correct Answer: Haemostasis, inflammation, proliferation, remodelling

      Explanation:

      Acute wound healing has four main stages: haemostasis, inflammation, proliferation and remodelling.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
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      Seconds

  • Question 30 - You are seeing a child with known mitochondrial disease who has presented breathlessness...

    Incorrect

    • You are seeing a child with known mitochondrial disease who has presented breathlessness and cough. Which of the following best describes the function of mitochondria:

      Your Answer:

      Correct Answer: Energy production

      Explanation:

      Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.
      Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.
      Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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