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  • Question 1 - A patient with history of weight loss and diarrhoea was found out to...

    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: Only cysts pass through the host digestive system

      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
      488.4
      Seconds

  • Question 2 - When calculating the ventilation over perfusion ratio of a male patient, you should...

    Incorrect

    • When calculating the ventilation over perfusion ratio of a male patient, you should remember the ideal V/Q ratio for this patient to compare with his results. What is the approximate ventilation value for a healthy male patient?

      Your Answer:

      Correct Answer: 5 L/min

      Explanation:

      The ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching ventilation and perfusion. The ideal V/Q ratio is 1. In an average healthy male, the ventilation value is approximately 5 L/min and the perfusion value is approximately 5 L/min.

      Any mismatch between ventilation and perfusion will be evident in the V/Q ratio. If perfusion is normal but ventilation is reduced, the V/Q ratio will be less than 1, whereas if ventilation is normal but perfusion is reduced, the V/Q ratio will be greater than 1. If the alveoli were ventilated but not perfused at all, then the V/Q ratio would be infinity.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      0
      Seconds

  • Question 3 - Which of the following nerves supplies the abductor pollicis brevis? ...

    Incorrect

    • Which of the following nerves supplies the abductor pollicis brevis?

      Your Answer:

      Correct Answer: The recurrent branch of the median nerve

      Explanation:

      Abductor pollicis brevis is innervated by the recurrent (thenar) branch of median nerve (root value C8 and T1).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 4 - Regarding endothelin-1, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding endothelin-1, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Endothelin-1 release is inhibited by noradrenaline.

      Explanation:

      Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 5 - One of these statements about cohort studies is true: ...

    Incorrect

    • One of these statements about cohort studies is true:

      Your Answer:

      Correct Answer: They are longitudinal in nature

      Explanation:

      A cohort study is a longitudinal, observational study. It follows a group of patients (the cohort) forward in time and monitors the effects of the aetiological factor under study upon them.

      Cohort studies are usually of longer duration and are more expensive than case-control studies. They, however, provide more useful and reliable information.

      Cohort studies follow a cohort of patients who don’t have a disease and evaluate the absolute and relative risk of contracting the disease after exposure to the aetiological agent.

      Cross-sectional studies are the best way to determine the prevalence of a disease. while Cohort studies are better at determining the incidence of a disease.

    • This question is part of the following fields:

      • Evidence Based Medicine
      0
      Seconds

  • Question 6 - Which of the following is an adverse effect of carbamazepine: ...

    Incorrect

    • Which of the following is an adverse effect of carbamazepine:

      Your Answer:

      Correct Answer: Aplastic anaemia

      Explanation:

      Common adverse effects include nausea and vomiting, sedation, dizziness, headache, blurred vision and ataxia. These adverse effects are dose related and are most common at the start of treatment.
      Other adverse effects include:
      Allergic skin reactions (and rarely, more serious dermatological conditions)
      Hyponatraemia (avoid concomitant use with diuretics)
      Leucopenia, thrombocytopenia and other blood disorders including aplastic anaemia
      Hepatic impairment

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 7 - The following are all important buffers of H+EXCEPT for: ...

    Incorrect

    • The following are all important buffers of H+EXCEPT for:

      Your Answer:

      Correct Answer: Calcium

      Explanation:

      Buffers are weak acids or bases that can donate or accept H+ions respectively and therefore resist changes in pH. Buffering does not alter the body’s overall H+load, ultimately the body must get rid of H+by renal excretion if the buffering capacity of the body is not to be exceeded and a dangerous pH reached. Bicarbonate and carbonic acid (formed by the combination of CO2 with water, potentiated by carbonic anhydrase) are the most important buffer pair in the body, although haemoglobin provides about 20% of buffering in the blood, and phosphate and proteins provide intracellular buffering. Buffers in urine, largely phosphate, allow the excretion of large quantities of H+.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

  • Question 8 - When an elderly dehydrated patient is moved from a supine to a standing...

    Incorrect

    • When an elderly dehydrated patient is moved from a supine to a standing position, her heart rate increases. Which of the following accounts for the increase in heart rate upon standing:

      Your Answer:

      Correct Answer: Decreased venous return

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 9 - Regarding penicillin antibiotics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding penicillin antibiotics, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Patients with a history of atopy are at higher risk of hypersensitivity reactions.

      Explanation:

      Allergic reactions to penicillins occur in 1 – 10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. Patients with a history of atopic allergy are at higher risk of anaphylactic reactions to penicillins. Patients with a history of anaphylaxis, urticaria, or rash immediately after penicillin use should not receive a penicillin or other beta-lactam antibiotics; about 0.5 – 6.5 % of penicillin-sensitive patients will also be allergic to the cephalosporins.

      Patients with a history of a more minor rash (i.e. non-confluent, non-pruritic rash restricted to a small area of the body) or delayed reaction (rash occurring more than 72 hours after penicillin administration), may not be truly allergic and may be considered for penicillin or beta-lactam treatment in severe infection (although possibility of allergy should be borne in mind). Other beta-lactam antibiotics (including cephalosporins) can be used in these patients.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 10 - The renin-angiotensin-aldosterone system (RAAS) controls blood pressure and fluid balance.

    Which of the following...

    Incorrect

    • The renin-angiotensin-aldosterone system (RAAS) controls blood pressure and fluid balance.

      Which of the following sites produces the most angiotensinogen?

      Your Answer:

      Correct Answer: The liver

      Explanation:

      Angiotensinogen is an alpha-2-globulin generated predominantly by the liver and released into the blood. Renin, which cleaves the peptide link between the leucine and valine residues on angiotensinogen, converts it to angiotensin I.

      Angiotensinogen levels in the blood are raised by:
      Corticosteroid levels have risen.
      Thyroid hormone levels have risen.
      Oestrogen levels have risen.
      Angiotensin II levels have risen.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      0
      Seconds

  • Question 11 - Salbutamol should be used with caution in patients with which of the following:...

    Incorrect

    • Salbutamol should be used with caution in patients with which of the following:

      Your Answer:

      Correct 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
      0
      Seconds

  • Question 12 - A 6-year-old girl is brought to the nephrology clinic by her mother due...

    Incorrect

    • A 6-year-old girl is brought to the nephrology clinic by her mother due to facial oedema. Her lab workup shows proteinuria of 7 g/24 hours and serum albumin levels of 15 g/L. A diagnosis of Nephrotic Syndrome is made, and corticosteroid therapy is initiated.

      Which one of the following is the most likely cause of nephrotic syndrome in this patient?

      Your Answer:

      Correct Answer: Minimal change disease

      Explanation:

      Minimal Change Disease is the most common cause of Nephrotic Syndrome in the paediatric population. It may be caused by NSAID use. Electron microscopy shows the fusion of foot processes while light microscopy will appear normal.

      Focal segmental glomerulosclerosis causes Nephrotic Syndrome in adults. It is associated with Heroin use and HIV infection. There is a limited response to steroids, and the disease progresses to end-stage renal failure in 5-10 years.

      Diabetic nephropathy occurs after a long period of diabetes due to the deposition of amyloid protein leading to a decrease in glomerular filtration.

      There is no history of Hepatitis B in this patient and no symptoms of liver disease such as jaundice.

      Membranous glomerulonephritis would present with features of Nephritic Syndrome. These would be oedema, haematuria; red blood cell casts in the urine and hypertension.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 13 - The following structures all lie anteriorly to the oesophagus EXCEPT for the: ...

    Incorrect

    • The following structures all lie anteriorly to the oesophagus EXCEPT for the:

      Your Answer:

      Correct Answer: Thoracic duct

      Explanation:

      Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 14 - A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how...

    Incorrect

    • A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how to deal with her symptoms. In the first instance, the pharmacist advises her to take an over-the-counter antacid. She buys an antacid that contains aluminium hydroxide, which relieves her symptoms but has a negative side effect.

      She's most likely to have developed which of the following side effects?

      Your Answer:

      Correct Answer: Constipation

      Explanation:

      Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.

      When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.

      Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.

      Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 15 - Which of the following is considered an example of an observational study? ...

    Incorrect

    • Which of the following is considered an example of an observational study?

      Your Answer:

      Correct Answer: Cohort study

      Explanation:

      The two most common types of observational studies are cohort studies and case-control studies; a third type is cross-sectional studies.

    • This question is part of the following fields:

      • Evidence Based Medicine
      0
      Seconds

  • Question 16 - All of the following statements regarding metronidazole are correct except: ...

    Incorrect

    • All of the following statements regarding metronidazole are correct except:

      Your Answer:

      Correct Answer: Metronidazole reduces the anticoagulant effect of warfarin.

      Explanation:

      The anticoagulant effect of warfarin is enhanced by metronidazole. If use of both cannot be avoided, one must consider appropriately reducing the warfarin dosage. With alcohol, metronidazole can cause a disulfiram-like reaction, with symptoms like flushing, headaches, dizziness, tachypnoea and tachycardia, nausea and vomiting. The common side effects of metronidazole include a metallic taste and gastrointestinal irritation, in particular nausea and vomiting. These side effects are more common at higher doses. This drug has high activity against anaerobic bacteria and protozoa, and is well absorbed orally. For severe infections, the intravenous route is normally reserved.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 17 - A 6 year old boy is brought into the ED by his mom...

    Incorrect

    • A 6 year old boy is brought into the ED by his mom with a rash that is associated with Koplik's spots and a diagnosis of measles is made. What advice should be given about returning to school?

      Your Answer:

      Correct Answer: 4 days from the onset of the rash

      Explanation:

      Prevention of spread of measles is extremely important and infected patients should be isolated. The infectious stage is from 3 days before the rash emerges and patients are advised to stay away from school/nursery/work for 4 days from onset of the rash.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 18 - Which of the following is true about the extensor carpi radialis longus? ...

    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.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 19 - Regarding the extensor carpi ulnaris muscle, which of the following statements is true?...

    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.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 20 - A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus...

    Incorrect

    • A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus minimus muscle.

      Which of the following nerves innervates the gluteus minimus muscle?

      Your Answer:

      Correct Answer: Superior gluteal nerve

      Explanation:

      Gluteus minimus is the smallest muscle of the glutei. It is located just beneath the gluteus medius muscle. Gluteus minimus predominantly acts as a hip stabilizer and abductor of the hip.
      The superior gluteal nerve innervates the gluteus minimus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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      Seconds

  • Question 21 - A patient with a recent diagnosis of Hepatitis B would like to find...

    Incorrect

    • A patient with a recent diagnosis of Hepatitis B would like to find out further information regarding his diagnosis and prognosis.

      Which among the following statements is considered true regarding Hepatitis B?

      Your Answer:

      Correct Answer: 60-65% of patients that contract hepatitis B show subclinical disease

      Explanation:

      As the immune response is activated, the virus is slowly cleared from the system, and most patients become non-infectious. In adults, about 50% of infections are asymptomatic; 20% to 30% of patients exhibit clinical jaundice but have a benign resolution of the infection. Therefore, about 80% of infections do not cause serious sequelae. The risk for chronic infection is inversely proportional to age at time of infection, with approximately 90% of infants and only 3% of adults developing a chronic infection.
      Individuals with a chronic infection have a higher risk of liver disease, such as cirrhosis or hepatic carcinoma.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 22 - When the breast cancer of a 60-year old patient metastasizes and compresses the...

    Incorrect

    • When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?

      Your Answer:

      Correct Answer: Fifth cervical and fourth thoracic nerves

      Explanation:

      The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

  • Question 23 - A known epileptic is transported in status epilepticus by ambulance. On the way...

    Incorrect

    • A known epileptic is transported in status epilepticus by ambulance. On the way to the hospital, she took some diazepam.

      Which of the following statements about diazepam is correct?

      Your Answer:

      Correct Answer: It crosses into breast milk

      Explanation:

      Diazepam boosts GABA’s effects, giving it sedative, hypnotic, anxiolytic, anticonvulsant, and muscle-relaxing properties. It can be administered orally, rectally, or intravenously.

      With a half-life of 20-100 hours, it is a long-acting benzodiazepine. Midazolam, oxazepam, and alprazolam are examples of short-acting benzodiazepines with a half-life of less than 12 hours (Xanax).

      If used in the presence of hepatic impairment, benzodiazepines can cause coma. If treatment is necessary, benzodiazepines with shorter half-lives should be used in lower doses. Diazepam is a sedative that crosses into breast milk and should be avoided by breastfeeding mothers.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 24 - Ipratropium bromide should be used with caution in patients with which of the...

    Incorrect

    • Ipratropium bromide should be used with caution in patients with which of the following conditions:

      Your Answer:

      Correct Answer: Prostatic hyperplasia

      Explanation:

      Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.

      The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
      The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).

      Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
      The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma)

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
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  • Question 25 - A 71-year-old man treated with antibiotics for a chest infection returns with a...

    Incorrect

    • A 71-year-old man treated with antibiotics for a chest infection returns with a profuse, offensive smelling diarrhoea. A diagnosis of Clostridium difficile diarrhoea is made after investigations.

      Which antibiotic is associated with the greatest risk of causing Clostridium Difficile diarrhoea?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile infection (CDI) occurs. About 80% of Clostridium Difficile infections are seen in people over the age of 65 and its main clinical features are:
      Abdominal cramps, severe bloody and/or watery diarrhoea, offensive smelling diarrhoea, and fever.

      CDI is the most severe consequence of antibiotic treatment and is a major cause of morbidity and mortality.
      Risk for CDI has been found to be greatest with clindamycin followed by fluoroquinolones Tetracyclines are not associated with risk for CDI.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 26 - At which vertebral level does the spinal cord normally end in adults? ...

    Incorrect

    • At which vertebral level does the spinal cord normally end in adults?

      Your Answer:

      Correct Answer: L1/L2

      Explanation:

      The spinal cord starts at the foramen magnum, where it is continuous with the medulla oblongata, which is the most caudal portion of the brainstem.

      It then extends inferiorly through the vertebral canal. In adults, it usually ends at the level of the first or second lumbar vertebra.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 27 - Regarding bronchiolitis, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 28 - A 60-year-old man diagnosed with chronic kidney disease has an elevated creatinine level...

    Incorrect

    • A 60-year-old man diagnosed with chronic kidney disease has an elevated creatinine level and a reduced glomerular filtration rate (GFR).

      Which statement concerning glomerular filtration is true?

      Your Answer:

      Correct Answer: Creatinine is freely filtered at the glomerulus

      Explanation:

      Glomerular filtration is a passive process. It depends on the net hydrostatic pressure across the glomerular capillaries, the oncotic pressure, and the intrinsic permeability of the glomerulus.

      The mean values for glomerular filtration rate (GFR) in young adults are 130 ml/min/1.73m2 in males and 120 ml/min/1.73m2in females.

      The GFR declines with age after the age of 40 at a rate of approximately 1 ml/min/year.

      The Cockcroft and Gault formula overestimates creatinine in obese patients. This is because their endogenous creatinine production is less than that predicted by overall body weight.

      Creatinine is used in the estimation of GFR because it is naturally produced by muscle breakdown, not toxic, not produced by the kidney, freely filtered at the glomerulus, not reabsorbed from the nephron, and does not alter GFR.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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      Seconds

  • Question 29 - Which of the following is NOT an effect of cytokine activity: ...

    Incorrect

    • Which of the following is NOT an effect of cytokine activity:

      Your Answer:

      Correct Answer: Opsonisation of bacteria for phagocytosis

      Explanation:

      Cytokines are a family of chemical messengers, secreted by leucocytes, that act over short distances by binding specific receptors on target cell surfaces. They include: interleukins (act between leucocytes), interferons (inhibit replication of viruses within cells and activate macrophages and natural killer cells), growth factors, and tumour necrosis factors (kill tumour cells). Effects include: induction of fever and acute phase response, stimulation of leucocyte differentiation and maturation, leucocyte recruitment and activation and increased antibody production.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
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  • Question 30 - A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve...

    Incorrect

    • A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve injury. Which of the following will confirm the presence of an ulnar nerve injury?

      Your Answer:

      Correct Answer: Claw hand appearance

      Explanation:

      An ulnar injury may result in abnormal sensations in the little finger and ring finger, usually on the palm side, weakness, and loss of coordination of the fingers.

      A claw like deformity of the hand and wrist is present. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve are also possible.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
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  • Question 31 - What is the earliest physiological effect that causes postural hypotension: ...

    Incorrect

    • What is the earliest physiological effect that causes postural hypotension:

      Your Answer:

      Correct Answer: A fall in central venous pressure

      Explanation:

      When autonomic reflexes are impaired or intravascular volume is markedly depleted, a significant reduction in blood pressure occurs upon standing, a phenomenon termed Postural Hypotension (orthostatic hypotension). Orthostatic hypotension can cause dizziness, syncope, and even angina or stroke. When autonomic reflexes are impaired, blood pressure falls progressively after standing because the gravitational pooling of blood in the legs cannot be compensated by sympathetic vasoconstriction.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 32 - A pheochromocytoma is diagnosed in a 38-year-old female who has had episodes of...

    Incorrect

    • A pheochromocytoma is diagnosed in a 38-year-old female who has had episodes of acute sweating, palpitations, and paroxysmal hypertension.

      Which of the following is the MOST SUITABLE INITIAL TREATMENT?

      Your Answer:

      Correct Answer: Alpha-blocker

      Explanation:

      A phaeochromocytoma is a rare functional tumour that develops in the adrenal medulla from chromaffin cells. Extra-adrenal paragangliomas (extra-adrenal pheochromocytomas) are tumours that arise in the sympathetic nervous system’s ganglia and are closely connected to extra-adrenal paragangliomas (extra-adrenal pheochromocytomas). Catecholamines are secreted by these tumours, which generate a variety of symptoms and indications associated with sympathetic nervous system hyperactivity.
      Hypertension is the most prevalent presenting symptom, which can be continuous or intermittent.

      Symptoms are usually intermittent, occurring anywhere from many times a day to occasionally. The symptoms of the condition tend to grow more severe and frequent as the disease progresses.
      The ultimate therapy of choice is surgical resection, and if full resection is done without metastases, hypertension is typically cured.

      Preoperative medical treatment is critical because it lowers the risk of hypertensive crises during surgery. This is commonly accomplished by combining non-competitive alpha-blockers (such as phenoxybenzamine) with beta-blockers. To allow for blood volume expansion, alpha-blockade should be started at least 7-10 days before surgery. Beta-blockade, which helps to regulate tachycardia and some arrhythmias, can be started after this is accomplished. Hypertensive crises can be triggered if beta-blockade is started too soon.
      There should also be genetic counselling, as well as a search for and management of any linked illnesses.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 33 - A patient is currently taking is glyceryl trinitrate among other chronic medications. Which of...

    Incorrect

    • A patient is currently taking is glyceryl trinitrate among other chronic medications. Which of the following side effects is he LEAST likely to develop?

      Your Answer:

      Correct Answer: Syncope

      Explanation:

      Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.

      The following are common or very common side effects of nitrates:

      • Arrhythmias
      • Asthenia
      • Cerebral ischaemia
      • Dizziness
      • Drowsiness
      • Flushing
      • Headache
      • Hypotension
      • Nausea and vomiting
      • Diarrhoea, syncope and cyanosis can occur, but these are rare side effects.

      Dry eyes, bradycardia and metabolic acidosis have not been reported.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 34 - Which of the following is first-line for management of status epilepticus: ...

    Incorrect

    • Which of the following is first-line for management of status epilepticus:

      Your Answer:

      Correct Answer: Intravenous lorazepam

      Explanation:

      First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 35 - Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS)...

    Incorrect

    • Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS) in a patient infected with HIV:

      Your Answer:

      Correct Answer: CD4 count < 200 cells/uL

      Explanation:

      A diagnosis of AIDS can be made in a patient infected with HIV if the patient has a CD4 count < 200 cells/uL, or an AIDS-defining illness. Antiretroviral treatment should be considered in patients with CD4 counts < 350 cells/uL.

      Oral candidiasis is not an AIDS defining illness – candidiasis of the bronchi, trachea, lungs or of the oesophagus is an AIDS defining illness.

      A positive p24 antigen test seen in early HIV infection and does not indicate the development of AIDS.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 36 - Which of the following statements is INCORRECT. Fick's law tells us that the...

    Incorrect

    • Which of the following statements is INCORRECT. Fick's law tells us that the rate of diffusion of a gas across a membrane increases as:

      Your Answer:

      Correct Answer: the partial pressure gradient decreases.

      Explanation:

      Fick’s law tells us that the rate of diffusion of a gas increases:
      the larger the surface area involved in gas exchange
      the greater the partial pressure gradient across the membrane
      the thinner the membrane
      the more soluble the gas in the membrane
      the lower the molecular weight of the gas

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 37 - What is the main route of transmission of Mumps? ...

    Incorrect

    • What is the main route of transmission of Mumps?

      Your Answer:

      Correct Answer: Respiratory droplet route

      Explanation:

      Mumps is primarily transmitted person to person via respiratory droplets.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 38 - A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen...

    Incorrect

    • A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen on the way to hospital.

      What percentage of patients with anaphylactic reaction suffer a biphasic response?.

      Your Answer:

      Correct Answer: 20%

      Explanation:

      About 20% of patients that suffer an anaphylactic reaction suffer a biphasic response 4-6 hours after the initial response (sometimes up to 72 hours after).

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 39 - A 4-year-old girl is rushed to the Emergency Department by her grandparents after...

    Incorrect

    • A 4-year-old girl is rushed to the Emergency Department by her grandparents after swallowing some of her grandfather's Warfarin tablets. On further questioning, it turns out that she took 5 of his 3 mg tablets which he needs to take due to a history of atrial fibrillation. The child appears healthy well-oriented in time, place and person, and has normal vitals.

      What is the threshold dose of Warfarin that needs to be ingested for there to be a risk of anticoagulation?

      Your Answer:

      Correct Answer: 0.5 mg/kg

      Explanation:

      The clinical effects of Warfarin occur after a dose of greater than 0.5 mg/kg, and they will be observable 8-10 hours after consumption of the drug. The antidote used for Warfarin is Vitamin K.

      1. In low-risk cases with no apparent bleeding:
      an oral dose of 10 mg vitamin K

      2. If there is clinically significant bleeding
      an intravenous dose of 250-300 mcg/kg

      Activated charcoal:
      in cases of warfarin ingestion
      binds to it and reduces the absorption of warfarin
      the ingestion must have occurred within the last hour
      There is, however, rarely a need for the use of activated charcoal because vitamin K is such as safe and effective antidote.

      Clotting studies, including an INR, can be performed, but small children who have ingested warfarin do not require INRs or follow up if they have been treated with 10 mg vitamin K. This dose of vitamin will completely reverse the anticoagulative effects of warfarin.

      Perform INR if any of the following are present:
      1. Delayed presentation (>6 hours)
      2. Patients with symptoms or signs of anticoagulation
      3. Possible massive ingestion

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 40 - Which of the following comprises a negative feedback mechanism? ...

    Incorrect

    • Which of the following comprises a negative feedback mechanism?

      Your Answer:

      Correct Answer: Detectors, comparators, a variable set point and effectors

      Explanation:

      Negative feedback loops, also known as inhibitory loops, play a crucial role in controlling human health. It is a self-regulating mechanism of some sort.

      A negative feedback system is made up of three main components: a detector (often neural receptor cells) that measures the variable in question and provides input to the comparator; a comparator (usually a neural assembly in the central nervous system) that receives input from the detector, compares the variable to the variable set point, and determines whether or not a response is required.

      The comparator activates an effector (typically muscular or glandular tissue) to conduct the appropriate reaction to return the variable to its set point.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 41 - Which of the following statements is not true regarding ion channels? ...

    Incorrect

    • Which of the following statements is not true regarding ion channels?

      Your Answer:

      Correct Answer: Ion channels provide a charged, hydrophobic pore through which ions can diffuse across the lipid bilayer.

      Explanation:

      Ion channels are pore-forming protein complexes that facilitate the flow of ions across the hydrophobic core of cell membranes. They are present in the plasma membrane and membranes of intracellular organelles of all cells, and perform essential physiological functions. They provide a charged, hydrophilic pore through which ions can move across the lipid bilayer. They are selective for particular ions and their pores may be opened or closed. Because of this ability to open and close, ion channels allow the cell to have the ability to closely control the movement of ions across the membrane. Gating refers to the transition between an open and closed ion channel state, and is brought about by a conformationational change in the protein subunits that open or close the ion-permeable pore.
      Ion channels can be:
      1. voltage-gated these are regulated according to the potential difference across the cell membrane or
      2. ligand-gated – these are regulated by the presence of a specific signal molecule.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 42 - Mast cells play a significant part in which of the following? ...

    Incorrect

    • Mast cells play a significant part in which of the following?

      Your Answer:

      Correct Answer: Allergic disease

      Explanation:

      Mast cells play a central role in the response to allergen challenges. The activation of mast cells results in both an early and a delayed phase of inflammation. Mast cells have been implicated in both physiologic and pathogenic processes. Mast cells are important in defence against some bacteria and viruses and contribute to defence against parasites. They are key effector cells in both innate and acquired immunity and are capable of inducing and amplifying both types of responses. Specifically, mast cells are capable of detecting microbial products through surface pattern recognition receptors, and they are involved in the recruitment of other leukocytes, containment of bacterial infections, and tissue repair.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 43 - A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic...

    Incorrect

    • A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic reaction after being stung by a bee. She responded well to initial treatment but developed anaphylactic symptoms after 6 hours. Her symptoms were resolved after a further dose of adrenaline. Her family threatened legal action as they thought she had not received adequate treatment but withdrew their accusation after the attending physician explained that the woman had suffered a biphasic reaction.

      What is the approximate percentage of people who suffer this type of reaction?

      Your Answer:

      Correct Answer: 20%

      Explanation:

      Anaphylactic reactions are Type 1 hypersensitivity reactions IgE-mediated and can be potentially life-threatening if not treated promptly. There are four well-recognized patterns of anaphylaxis:
      1) Uniphasic
      2) Biphasic
      3) Protracted
      4) Refractory

      Biphasic reactions occur in 20% of the population, although their mechanism is poorly understood. The symptoms of anaphylaxis recur within 4-6 hours, although they may also recur up to 72 hours later. All patients discharged from the hospital after an anaphylactic shock must:
      1) Be warned to return to the hospital immediately if symptoms recur
      2) Have a treatment plan in place
      3) Have a follow-up appointment
      4) Be considered for an adrenaline auto-injector
      5) Referred to an allergy clinic

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 44 - Regarding the lung roots, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the lung roots, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.

      Explanation:

      Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 45 - Following a decrease in extracellular volume, which of the following is a reaction...

    Incorrect

    • Following a decrease in extracellular volume, which of the following is a reaction to enhanced sympathetic innervation of the kidney:

      Your Answer:

      Correct Answer: Release of renin

      Explanation:

      The RAS pathway begins with renin cleaving its substrate, angiotensinogen (AGT), to produce the inactive peptide, angiotensin I, which is then converted to angiotensin II by endothelial angiotensin-converting enzyme (ACE). ACE activation of angiotensin II occurs most extensively in the lung. Angiotensin II mediates vasoconstriction as well as aldosterone release from the adrenal gland, resulting in sodium retention and increased blood pressure.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 46 - Which of the following is NOT a common effect of etomidate: ...

    Incorrect

    • Which of the following is NOT a common effect of etomidate:

      Your Answer:

      Correct Answer: Significant hypotension

      Explanation:

      Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 47 - A 30-year-old carpenter presented to the emergency room with a laceration of his...

    Incorrect

    • A 30-year-old carpenter presented to the emergency room with a laceration of his upper volar forearm. Upon further exploration and observation, it was revealed that the nerve that innervates the pronator teres muscle has been damaged.

      Which of the following nerves is most likely damaged in the case?

      Your Answer:

      Correct Answer: The median nerve

      Explanation:

      Pronator teres syndrome (PTS) is caused by a compression of the median nerve (MN) by the pronator teres (PT) muscle in the forearm.

      The median nerve, C6 and C7, innervates the pronator teres.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 48 - Which of the following statements is correct regarding the neuronal action potential? ...

    Incorrect

    • Which of the following statements is correct regarding the neuronal action potential?

      Your Answer:

      Correct Answer: Initial depolarisation occurs as a result of a Na + influx.

      Explanation:

      The resting potential in most neurons has a value of approximately -70 mV.
      The threshold potential is generally around -55 mV.
      Initial depolarisation when there is Na+influx through ligand-gated Na+channels.
      Action potential is an all or nothing response. The size of the action potential is constant and so, the intensity of the stimulus is coded by the frequency of firing of a neuron.
      K+efflux is responsible for repolarisation.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 49 - An analytical cohort study aimed to determine a relationship between intake of dietary...

    Incorrect

    • An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:

      No. of post-menopausal women who took Calcium: 500
      No. of post-menopausal women who took Calcium and suffered a hip fracture: 10

      No. of post-menopausal women who took placebo: 500
      No. of post-menopausal women who took placebo and suffered a hip fracture: 25

      Compute for the absolute risk reduction of a hip fracture.

      Your Answer:

      Correct Answer: 0.03

      Explanation:

      Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).

      ARR = ARC-ART
      ARR = (25/500) – (10/500)
      ARR = 0.03

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 50 - The following are all examples of type I hypersensitivity EXCEPT for: ...

    Incorrect

    • The following are all examples of type I hypersensitivity EXCEPT for:

      Your Answer:

      Correct Answer: Contact dermatitis

      Explanation:

      Examples of type I reactions include:
      Allergic rhinitis
      Allergic conjunctivitis
      Allergic asthma
      Systemic anaphylaxis
      Angioedema
      Urticaria
      Penicillin allergy

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

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