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  • Question 1 - A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis....

    Correct

    • A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.

      Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?

      Your Answer: ORT is sugar-free

      Explanation:

      One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status.

      Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries.

      Some characteristics of Oral rehydration solutions are:
      – slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.
      – contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia.
      – also contains essential mineral salts

      Current NICE guidance recommends that 50 ml/kg is given over 4 hours to treat mild dehydration.
      Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pharmacology
      42.6
      Seconds

  • Question 2 - A 26-year-old female cuts her hand on a knife while preparing dinner but...

    Incorrect

    • A 26-year-old female cuts her hand on a knife while preparing dinner but the bleeding stops within a few minutes.

      Which one of the following cells will be among the first to be present at the wound site to be involved in haemostasis?

      Your Answer: Macrophages

      Correct Answer: Platelets

      Explanation:

      Platelets are the first cells to be attracted to the wound site due to the release of the Von Willebrand factor from the damaged endothelium. Platelets, in turn, release cytokines such as platelet-derived growth factor, which will attract other inflammatory cells to the wound site.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      106.1
      Seconds

  • Question 3 - Regarding haemophilia A, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding haemophilia A, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: In haemophilia both the APTT and PT are prolonged.

      Explanation:

      Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives.

      The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 4 - A 66-year-old female presents to the Emergency Department with a nose bleed. She...

    Incorrect

    • A 66-year-old female presents to the Emergency Department with a nose bleed. She says that she has been having frequent episodes of nose bleeds over the past four months, along with increasing fatigue and some weight loss. On examination, she has a diffuse petechial rash and hypertrophy of the gingiva.

      Which one of the following conditions is this patient most likely to have?

      Your Answer:

      Correct Answer: Acute myeloid leukaemia (AML)

      Explanation:

      The history of nosebleeds and fatigue, and gingival hyperplasia presents a typical picture of acute myeloid leukaemia. Leukemic infiltrates within the gingiva cause hypertrophy and distinguish this condition from other types of leukaemia. The fatigue is secondary to anaemia, while the nosebleeds are caused by thrombocytopenia secondary to leukemic infiltration of bone marrow. Patients may also report frequent infections secondary to neutropenia and hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 5 - Antidiuretic hormone (ADH) is synthesised by which of the following: ...

    Incorrect

    • Antidiuretic hormone (ADH) is synthesised by which of the following:

      Your Answer:

      Correct Answer: Hypothalamus

      Explanation:

      Antidiuretic hormone is synthesised in the hypothalamus and transported to the posterior pituitary within nerve fibres where it is stored in secretory granules. ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, raising cAMP levels and causing intracellular vesicles to fuse with the apical membrane. In their membrane these vesicles have water channels called aquaporins, which increase the water permeability allowing greater water reabsorption and concentration of urine. Excess levels of ADH results in syndrome of inappropriate ADH secretion (SIADH) characterised by hyponatremia with concomitant hypo-osmolality and high urine osmolality.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
      Seconds

  • Question 6 - You've been summoned to a young man in the resus area who has...

    Incorrect

    • You've been summoned to a young man in the resus area who has an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.

      The use of adenosine is not contraindicated in which of the following situations?

      Your Answer:

      Correct Answer: Concurrent use of a beta-blocker

      Explanation:

      The use of a beta-blocker at the same time increases the risk of myocardial depression, but it is not a contraindication.
      The use of adenosine is contraindicated in the following situations:
      Asthma
      COPD (chronic obstructive pulmonary disease)
      Decompensated heart failure 
      Long QT syndrome
      AV block in the second or third degree
      Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
      Hypotension that is severe

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 7 - A 7-year-old presented to a GP with a history of headache, neck stiffness...

    Incorrect

    • A 7-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent non-blanching rash on legs and arms. The GP administered a dose of antibiotics before transferring child to the Emergency Department.

      Which of these is the most appropriate antibiotic to administer in this scenario from the choices available?

      Your Answer:

      Correct Answer: Give IM benzylpenicillin 600 mg

      Explanation:

      Meningococcal septicaemia should be suspected in a child with a non-blanching rash especially in the presence of:
      An ill-looking child
      Neck stiffness
      Lesions larger than 2 mm in diameter (purpura)
      Capillary refill time of>3 seconds

      The index child is very sick and shows signs of septic shock. In the prehospital setting, a single dose of benzylpenicillin should be given immediately. The correct dose for this childs age is IM benzylpenicillin 600 mg.

      The recommended doses of benzylpenicillin according to age are:
      Infants <1 year of age: IM or IV benzylpenicillin 300 mg
      Children 1 to 9 years of age: IM or IV benzylpenicillin 600mg
      Children and adults 10 years or older: IM or IV benzylpenicillin 1.2g

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 8 - A patient with profuse watery diarrhoea was found to have C. difficile cytotoxin....

    Incorrect

    • A patient with profuse watery diarrhoea was found to have C. difficile cytotoxin. Which of the following complications is NOT a typical complication of pseudomembranous colitis:

      Your Answer:

      Correct Answer: Volvulus

      Explanation:

      Dehydration, electrolyte imbalance, acute kidney injury secondary to diarrhoea, toxic megacolon, bowel perforation, and sepsis secondary to intestinal infection are all possible complications of pseudomembranous colitis.

      When the intestine twists around itself and the mesentery that supports it, an obstruction is created. This condition is known as a volvulus. Volvulus is caused by malrotation and other anatomical factors, as well as postoperative abdominal adhesions, and not by Clostridium difficile infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 9 - Which of the following is a contraindication to using nitrous oxide: ...

    Incorrect

    • Which of the following is a contraindication to using nitrous oxide:

      Your Answer:

      Correct Answer: Raised intracranial pressure

      Explanation:

      Nitrous oxide should not be utilized in patients with an air-containing confined area because it diffuses into these spaces, causing a rise in pressure. This includes circumstances like pneumothorax, intracranial air after a head injury, imprisoned air from a recent undersea dive, a recent intraocular gas injection, or intestinal blockage. Nitrous oxide increases cerebral blood flow and should be avoided in individuals who have or are at risk of having high intracranial pressure.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 10 - Where is angiotensin I primarily converted to angiotensin II: ...

    Incorrect

    • Where is angiotensin I primarily converted to angiotensin II:

      Your Answer:

      Correct Answer: Lungs

      Explanation:

      Angiotensin I is converted to angiotensin II by the removal of two C-terminal residues by the enzyme angiotensin-converting enzyme (ACE). This primarily occurs in the lungs, although it does also occur to a lesser degree in endothelial cells and renal epithelial cells.
      The main actions of angiotensin II are:
      Vasoconstriction of vascular smooth muscle (resulting in increased blood pressure)
      Vasoconstriction of the efferent arteriole of the glomerulus (resulting in an increased filtration fraction and preserved glomerular filtration rate)
      Stimulation of aldosterone release from the zona glomerulosa of the adrenal cortex
      Stimulation of anti-diuretic hormone (vasopressin) release from the posterior pituitary
      Stimulation of thirst via the hypothalamus
      Acts on the Na+/H+ exchanger in the proximal tubule of the kidney to stimulate Na+reabsorption and H+excretion

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

  • Question 11 - Which of the following is NOT an advantage of a case-control study used...

    Incorrect

    • Which of the following is NOT an advantage of a case-control study used to identify past exposure to a risk factor in patients with a disease:

      Your Answer:

      Correct Answer: Can directly measure absolute and relative risk of a disease

      Explanation:

      Advantages:relatively quickrelatively cheap and easy to performparticularly suitable for studying associations between an exposure and an outcome when the outcome is uncommon or if the outcome occurs decades after exposurea wide range of risk factors can be investigated in each studyDisadvantages:subject to recall biasunlike in a whole population study, absolute risk cannot be quantifiedtemporal relationship between exposure and outcome can be difficult to establishunsuitable for rare risk factorsprone to confounding

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      0
      Seconds

  • Question 12 - The proximal convoluted tubule (PCT) is the first part of the renal tubule...

    Incorrect

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

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

      Your Answer:

      Correct Answer: Secondary active transport

      Explanation:

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

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      0
      Seconds

  • Question 13 - 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
      0
      Seconds

  • Question 14 - You assess a patient that has suffered a nerve injury that has paralysed...

    Incorrect

    • You assess a patient that has suffered a nerve injury that has paralysed her left latissimus dorsi muscle.
      Latissimus dorsi receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Thoracodorsal nerve

      Explanation:

      Latissimus dorsi originates from the lower part of the back, where it covers a wide area. It lies underneath the inferior fibres of trapezius superiorly, and trapezius is the most superficial back muscle.
      Superficial muscles of the back showing latissimus dorsi (from Gray’s Anatomy)
      Latissimus dorsi has a broad origin, arising from the spinous processes of T6-T12, the thoracolumbar fascia, the iliac crest and the inferior 3 or 4 ribs. The fibres converge into a tendon that inserts into the intertubercular groove of the humerus.
      Latissimus dorsi is innervated by the thoracodorsal nerve.
      Latissimus dorsi acts to extend, adduct and medially rotate the humerus. It, therefore, raises the body towards the arm during climbing.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 15 - A 62-year-old man complains of chest pain and goes to the emergency room....

    Incorrect

    • A 62-year-old man complains of chest pain and goes to the emergency room. You diagnose him with an acute coronary syndrome and prescribe enoxaparin as part of his treatment plan.

      Enoxaparin inactivates which of the following?

      Your Answer:

      Correct Answer: Thrombin

      Explanation:

      Enoxaparin is a low molecular weight heparin (LMWH) that works in the same way as heparin by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin by forming a 1:1 complex with it. Factor Xa and a few other clotting proteases are also inhibited by the heparin-antithrombin III complex.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 16 - A 46-year-old male who is suffering from a chest infection. You decide to start giving...

    Incorrect

    • A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give.

      From the following choices, which is considered an example of bacteriostatic antibiotic?

      Your Answer:

      Correct Answer: Trimethoprim

      Explanation:

      Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:

      Bactericidal antibiotics
      Bacteriostatic antibiotics

      Vancomycin
      Metronidazole
      Fluoroquinolone, such as ciprofloxacin
      Penicillins, such as benzylpenicillin
      Cephalosporin, such as ceftriaxone
      Co-trimoxazole
      Tetracyclines, such as doxycycline
      Macrolides, such as erythromycin
      Sulphonamides, such as sulfamethoxazole
      Clindamycin
      Trimethoprim
      Chloramphenicol

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

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

    Incorrect

    • Regarding renal clearance, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: The MDRD equation uses plasma creatinine to estimate the GFR making an adjustment for age, sex and race.

      Explanation:

      Clearance is defined as the volume of plasma that is cleared of a substance per unit time. Inulin clearance is the gold standard for measurement of GFR but creatinine clearance is typically used instead. Creatinine is freely filtered and not reabsorbed, but there is a little creatinine tubular secretion. In practice, GFR is usually estimated from the plasma creatinine using a formula e.g. the MDRD equation making an adjustment for age, sex and race.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

  • Question 18 - Which of the following clinical features is a feature of a chronic extravascular...

    Incorrect

    • Which of the following clinical features is a feature of a chronic extravascular haemolytic anaemia:

      Your Answer:

      Correct Answer: Gallstones

      Explanation:

      Clinical features of haemolytic anaemia include:
      Anaemia
      Jaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)
      Pigment gallstones
      Splenomegaly
      Ankle ulcers
      Expansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia major
      Aplastic crisis caused by parvovirus

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 19 - The transport of oxygen from maternal to fetal circulation is made possible by...

    Incorrect

    • The transport of oxygen from maternal to fetal circulation is made possible by fetal haemoglobin. Which of the statements about fetal haemoglobin (HbF) is also correct?

      Your Answer:

      Correct Answer: The oxygen dissociation curve for foetal haemoglobin is shifted to the left of that of adult haemoglobin

      Explanation:

      Fetal haemoglobin is the most common type of haemoglobin found in the foetus during pregnancy. It transports oxygen from the maternal circulation to the fetal circulation. It can easily bind to oxygen from the maternal circulation because it has a high affinity for oxygen. From 10 to 12 weeks of pregnancy to the first six months after birth, the erythroid precursor cells produce fetal haemoglobin. In comparison to adult haemoglobin, fetal haemoglobin has two alpha and two gamma subunits, whereas adult haemoglobin has two alpha and two beta subunits in its major form.

      And, unlike adult haemoglobin, the oxygen dissociation curve of fetal haemoglobin is left-shifted. Myoglobin is an oxygen storage molecule with a very high affinity for oxygen. Only when the partial pressure of oxygen is exceeded does it release oxygen.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      0
      Seconds

  • Question 20 - The enzyme protein gastric lipase is responsible for the breakdown of lipids in...

    Incorrect

    • The enzyme protein gastric lipase is responsible for the breakdown of lipids in the stomach.

      Which of the following cell types secretes gastric lipase?

      Your Answer:

      Correct Answer: Chief cells

      Explanation:

      Gastric lipase, commonly known as LIPF, is an acidic lipase released by gastric chief cells, which are found deep within the stomach lining’s mucosal layer. It’s an enzymatic protein that’s in charge of fat digestion in the stomach.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      0
      Seconds

  • Question 21 - Among the following infectious diseases, which is typically considered to have an incubation...

    Incorrect

    • Among the following infectious diseases, which is typically considered to have an incubation period of less than 3 weeks?

      Your Answer:

      Correct Answer: Diphtheria

      Explanation:

      C. diphtheriae, which is the causative agent of diphtheria, is carried in the upper respiratory tract and spread by droplet infection or hand-to-mouth contact. The incubation period averages 2 to 5 days.

      Infectious mononucleosis is caused by Epstein-Barr virus (EBV). The incubation period for EBV varies from 2 weeks to 2 months.

      The incubation for Hepatitis A virus is approximately 1 month.

      The incubation period for Hepatitis C ranges from 2 weeks to 6 months.

      The period from infection to development of anti-HIV antibodies is usually less than 1 month but may be up to 3 months.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 22 - Which of the following features of cell damage tends to be reversible: ...

    Incorrect

    • Which of the following features of cell damage tends to be reversible:

      Your Answer:

      Correct Answer: Swelling of endoplasmic reticulum and some mitochondria

      Explanation:

      Features of cell damage that tend to be reversible include: swelling of endoplasmic reticulum and some mitochondrialoss of ribosomescell stress response
      Features of cell damage that tend to be irreversible include: loss of nucleolus, no ribosomes, swelling of all mitochondria, nuclear condensation, membrane blebs and holes, lysosome rupture, fragmentation of all inner membranes, nuclear breakup

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      0
      Seconds

  • Question 23 - In a ward round, you come across a patient's treatment chart prescribed an...

    Incorrect

    • In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic is an inhibitor of cell wall synthesis.

      Which of the following antimicrobial drugs is prescribed to this patient?

      Your Answer:

      Correct Answer: Benzylpenicillin

      Explanation:

      Penicillins and cephalosporins are the major antibiotics that inhibit bacterial cell wall synthesis. They inactivate transpeptidases that help cross-link peptidoglycans in cell walls.

      Isoniazid decreases the synthesis of mycolic acids in mycobacterium.

      Clarithromycin binds to the 50S subunit of ribosomes and inhibits protein synthesis.

      Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.

      Tetracycline bind to 30S and prevent attachment of aminoacyl-tRNA.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

  • Question 24 - Which law describes the rate of diffusion in a solution? ...

    Incorrect

    • Which law describes the rate of diffusion in a solution?

      Your Answer:

      Correct Answer: Fick’s law

      Explanation:

      Fick’s law describes the rate of diffusion in a solution. Fick’s law states that:
      Jx = -D A (ΔC / Δx)
      Where:
      Jx = The amount of substance transferred per unit time
      D = Diffusion coefficient of that particular substance
      A = Surface area over which diffusion occurs
      ΔC = Concentration difference across the membrane
      Δx = Distance over which diffusion occurs
      The negative sign reflects movement down the concentration gradient

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      0
      Seconds

  • Question 25 - Which of the following is NOT a typical side effect of digoxin: ...

    Incorrect

    • Which of the following is NOT a typical side effect of digoxin:

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Digoxin does not cause hypokalaemia, but hypokalaemia does potentiate digoxin toxicity. The adverse effects of digoxin are frequently due to its narrow therapeutic window and include:
      Cardiac adverse effects – Sinoatrial and atrioventricular block, Premature ventricular contractions, PR prolongation and ST-segment depression
      Nausea, vomiting and diarrhoea
      Blurred or yellow vision
      CNS effects – weakness, dizziness, confusion, apathy, malaise, headache, depression, psychosis
      Thrombocytopenia and agranulocytosis (rare)
      Gynaecomastia in men in prolonged administration

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 26 - Which of the following drugs decreases plasma-theophylline levels: ...

    Incorrect

    • Which of the following drugs decreases plasma-theophylline levels:

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      Examples of enzyme-inhibiting drugs (raise plasma theophylline level):
      Erythromycin
      Clarithromycin
      Ciprofloxacin
      Fluconazole
      Verapamil
      Allopurinol
      Cimetidine
      Examples of enzyme-inducing drugs (lower plasma theophylline level):
      Primidone
      Phenobarbital
      Carbamazepine
      Phenytoin
      Ritonavir
      Rifampicin
      St John’s Wort

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
      Seconds

  • Question 27 - Injury to which nerve can lead to weakness or paralysis of the brachialis...

    Incorrect

    • Injury to which nerve can lead to weakness or paralysis of the brachialis muscle?

      Your Answer:

      Correct Answer: The musculocutaneous nerve

      Explanation:

      The brachialis muscle is a prime flexor of the forearm at the elbow joint. It is fusiform in shape and located in the anterior (flexor) compartment of the arm, deep to the biceps brachii. The brachialis is a broad muscle, with its broadest part located in the middle rather than at either of its extremities. It is sometimes divided into two parts, and may fuse with the fibres of the biceps brachii, coracobrachialis, or pronator teres muscles. It also functions to form part of the floor of the cubital fossa.

      The brachialis is primarily supplied by the musculocutaneous nerve (C5, C6). In addition, a small lateral portion of the muscle is innervated by the radial nerve (C7).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 28 - Regarding alteplase, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding alteplase, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Alteplase is commonly associated with hypotensive effects.

      Explanation:

      Alteplase is a recombinant tissue-type plasminogen activator (tPA), a naturally occurring fibrin-specific enzyme that has selectivity for activation of fibrin-bound plasminogen. It has a short half-life of 3 – 4  minutes and must be given by continuous intravenous infusion but is not associated with antigenic or hypotensive effects, and can be used in patients when recent streptococcal infections or recent use of streptokinase contraindicates the use of streptokinase.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 29 - Gastric emptying is inhibited by all of the following EXCEPT for: ...

    Incorrect

    • Gastric emptying is inhibited by all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Parasympathetic stimulation

      Explanation:

      Gastric emptying is decreased by:
      Enterogastric inhibitory reflexes stimulated by – Distension of the duodenum, The presence of fats in the duodenum (by stimulating release of cholecystokinin), A fall in the pH of chyme in the duodenum, An increase in the osmolality of chyme in the duodenum, Irritation of the mucosal lining of the duodenum, Hormones: Cholecystokinin, Secretin

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
      Seconds

  • Question 30 - Which of the following is most likely to cause a homonymous hemianopia: ...

    Incorrect

    • Which of the following is most likely to cause a homonymous hemianopia:

      Your Answer:

      Correct Answer: Posterior cerebral artery stroke

      Explanation:

      A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 31 - Which of the following is an example of discrete data: ...

    Incorrect

    • Which of the following is an example of discrete data:

      Your Answer:

      Correct Answer: Number of children

      Explanation:

      Discrete data is quantitative data that can only take whole numerical values e.g. number of children, number of days missed from work.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      0
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  • Question 32 - Which of the following muscles is least likely to be involved in forceful expiration:...

    Incorrect

    • Which of the following muscles is least likely to be involved in forceful expiration:

      Your Answer:

      Correct Answer: External intercostal muscles

      Explanation:

      Forceful expiration is primarily produced by the deeper thoracic muscles (internal and innermost intercostal muscles, subcostals and transversus thoracis) aided by contraction of the abdominal wall muscles which increase intra-abdominal pressure thus further reducing the volume of the thorax.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
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  • Question 33 - The cutaneous circulation's principal role is thermoregulation. This process is aided by the...

    Incorrect

    • The cutaneous circulation's principal role is thermoregulation. This process is aided by the existence of arteriovenous anastomoses.

      Which of the following anatomical areas has the greatest number of arteriovenous anastomoses?

      Your Answer:

      Correct Answer: Pinna of the ear

      Explanation:

      Short vessels called arteriovenous anastomoses (AVAs) link tiny arteries and veins. They have a large lumen diameter. The strong and muscular walls allow AVAs to completely clog the vascular lumen, preventing blood flow from artery to vein (acting like a sphincter). When the AVAs open, they create a low-resistance connection between arteries and veins, allowing blood to flow into the limbs’ superficial venous plexuses. There is no diffusion of solutes or fluid into the interstitium due to their strong muscle walls.

      AVAs are densely innervated by adrenergic fibres from the hypothalamic temperature-regulation centre. High sympathetic output occurs at normal core temperatures, inducing vasoconstriction of the AVAs and blood flow through the capillary networks and deep plexuses. When the temperature rises, sympathetic output decreases, producing AVA vasodilation and blood shunting from the artery to the superficial venous plexus. Heat is lost to the environment as hot blood rushes near to the skin’s surface.
      AVAs are a specialized anatomical adaptation that can only be found in large quantities in the fingers, palms, soles, lips, and pinna of the ear.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
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  • Question 34 - Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior...

    Incorrect

    • Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?

      Your Answer:

      Correct Answer: Auriculotemporal nerve

      Explanation:

      Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 35 - A 27-year-old man was sent to the emergency department by ambulance with suspected...

    Incorrect

    • A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?

      Your Answer:

      Correct Answer: 500 micrograms of adrenaline intramuscularly

      Explanation:

      Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils.

      If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution).

      In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh.

      Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 36 - Which of these drugs may reduce the efficacy of contraception? ...

    Incorrect

    • Which of these drugs may reduce the efficacy of contraception?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 37 - Which JVP waveform correlates to atrial systole? ...

    Incorrect

    • Which JVP waveform correlates to atrial systole?

      Your Answer:

      Correct Answer: The a wave

      Explanation:

      JVP Waveform in Cardiac Cycle Physiology: a wave Right atrial contraction causes atrial systole (end diastole). the c wave During right isovolumetric ventricular contraction, the tricuspid valve bulges into the right atrium, resulting in isovolumetric contraction (early systole). descent by x Rapid ventricular ejection (mid systole) is caused by a combination of right atrial relaxation, tricuspid valve downward movement during right ventricular contraction, and blood ejection from both ventricles. the v-wave Ventricular ejection and isovolumetric relaxation (late systole) occur as a result of venous return filling the right atrium. y lineage Ventricular filling occurs when the tricuspid valve opens, allowing blood to flow rapidly from the right atrium to the right ventricle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 38 - A 17-year-old patient with a headache, fever, and a non-blanching rash is brought...

    Incorrect

    • A 17-year-old patient with a headache, fever, and a non-blanching rash is brought to the emergency room. Meningococcal infection is confirmed by a lumbar puncture. Neisseria meningitidis uses one of the following immune evasion mechanisms:

      Your Answer:

      Correct Answer: Secretes IgA protease

      Explanation:

      Meningococci have 3 important virulence factors, as follows:

      Polysaccharide capsule – Individuals with immunity against meningococcal infections have bactericidal antibodies against cell wall antigens and capsular polysaccharides; a deficiency of circulating anti meningococcal antibodies is associated with the disease.
      Lipo-oligosaccharide endotoxin (LOS)
      Immunoglobulin A1 (IgA1)

    • This question is part of the following fields:

      • Microbiology
      • Principles
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  • Question 39 - Which of the following risk ratios indicates no difference in risk between two groups:...

    Incorrect

    • Which of the following risk ratios indicates no difference in risk between two groups:

      Your Answer:

      Correct Answer: 1

      Explanation:

      A risk ratio of 1 indicates no difference in risk between groups.If the risk ratio of an event is > 1, the rate of that event is increased in the exposed group compared to the control group.If the risk ratio is < 1, the rate of that event is reduced in the exposed group compared to the control group.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
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  • Question 40 - A 26 year old male presents to emergency room with a 2 day...

    Incorrect

    • A 26 year old male presents to emergency room with a 2 day history of burning pain when passing urine, accompanied by a green urethral discharge. Gonorrhoea is suspected. The first line antibiotic for this condition is which of the following?

      Your Answer:

      Correct Answer: Ceftriaxone

      Explanation:

      When there is a high suspicion of gonorrhoea from clinical features, empiric treatment should be commenced whilst waiting for laboratory confirmation.
      The first line treatment for uncomplicated anogenital and pharyngeal disease includes ceftriaxone 500 mg IM (single dose) + azithromycin 1 g orally as a single dose. This covers concomitant chlamydia infection. For all people who have been treated for gonorrhoea, a test of cure is recommended

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 41 - Regarding T helper cells, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding T helper cells, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: They form the vast majority (about 75%) of the total circulating T-cell population.

      Explanation:

      CD4+ T-cells (Helper T cells)Recognise antigen only in association with HLA class II molecules (found on antigen presenting cells (APCs) e.g. dendritic cells, B-cells; present exogenous antigens that have been phagocytosed/endocytosed into intracellular vesicles)Form most of the circulating T-cell population (about 75%)Secrete cytokines (e.g. IFN-gamma) which are required for recruitment and activation of other immune cells such as macrophages, T cytotoxic cells and NK cells and for the activation of and production of immunoglobulin from B-cells

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 42 - Many of the chemical digestion and absorption takes place in the small intestine....

    Incorrect

    • Many of the chemical digestion and absorption takes place in the small intestine. Most digestive enzymes in the small intestine are secreted by the pancreas and enter the small intestine through the pancreatic duct.

      Which of these digestive enzymes is responsible for breaking down carbohydrates into monosaccharides?

      Your Answer:

      Correct Answer: Glucoamylase

      Explanation:

      Majority of carbohydrates are broken down into monosaccharides (glucose, fructose galactose) and are absorbed by the small intestine. Enzymes released from the brush border break down carbohydrate. Some carbohydrates, such as cellulose, are not digested at all, despite being made of multiple glucose units. This is because the cellulose is made out of beta-glucose that makes the inter-monosaccharide bindings different from the ones present in starch, which consists of alpha-glucose. Humans lack the enzyme for splitting the beta-glucose-bond.

      The principal brush border enzymes are dextranase and glucoamylase. Other brush border enzymes are maltase, sucrase, and lactase.

      Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Dextranase and glucoamylase, then further break down oligosaccharides.

      Trypsin aids in digestion of protein.

      Chymotrypsin is a proteolytic enzyme that digests protein

      Carboxypeptidase hydrolyses the first peptide or amide bond at the carboxyl or C-terminal end of proteins and peptides

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
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  • Question 43 - Vitamin D is a group of secosteroids that play a role in calcium...

    Incorrect

    • Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.

      Which enzyme hydroxylates 25-hydroxycholecalciferol to form 1,25-dihydroxycholecalciferol?

      Your Answer:

      Correct Answer: 1-alpha-hydroxylase

      Explanation:

      The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.

      In the presence of UVB light, 7-dehydrocholesterol is converted to cholecalciferol in the epidermal layer of the skin, resulting in 1,25-dihydroxycholecalciferol.

      Cholecalciferol is then converted to 25-hydroxycholecalciferol in the endoplasmic reticulum of liver hepatocytes by 25-hydroxylase (calcifediol).

      Finally, 1-alpha-hydroxylase converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol in the kidney. The key regulatory point in the formation of 1,25-dihydroxycholecalciferol is 1-alpha-hydroxylase, which is induced by parathyroid hormone or hypophosphatemia.

      The following are the primary effects of 1,25-dihydroxycholecalciferol:
      Calcium and phosphate absorption in the small intestine is increased.
      Calcium reabsorption in the kidneys is increased.
      Increases phosphate reabsorption in the kidneys.
      Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)
      Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 44 - The mechanism of action of abciximab is by: ...

    Incorrect

    • The mechanism of action of abciximab is by:

      Your Answer:

      Correct Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites

      Explanation:

      Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 45 - A 60-year-old female with a past history of rheumatic fever and a prosthetic...

    Incorrect

    • A 60-year-old female with a past history of rheumatic fever and a prosthetic mitral valve presents to you with fever and an episode of expressive dysphasia that lasted around 30 minutes. There is no history of known drug allergies On examination you note a systolic murmur and you suspect it is infective endocarditis.

      Which antibacterial agents would be the most appropriate to prescribe in this case?

      Your Answer:

      Correct Answer: Vancomycin, rifampicin and gentamicin

      Explanation:

      Endocarditis is infective or non infective inflammation (marantic endocarditis) of the inner layer of the heart and it often involves the heart valves.

      Risk factors include:
      Prosthetic heart valves
      Congenital heart defects
      Prior history of endocarditis
      Rheumatic fever
      Illicit intravenous drug use

      In the presentation of endocarditis, the following triad is often quoted:
      Persistent fever
      Embolic phenomena
      New or changing murmur

      A combination of vancomycin, rifampicin and gentamicin is advised if the patient has a cardiac prostheses, is penicillin allergic, or if methicillin-resistant Staphylococcus aureus (MRSA) is suspected. In this case the patient has a prosthetic valve making this the most appropriate initial treatment regimen.

      Flucloxacillin and gentamicin are current recommended by NICE and the BNF for the initial ‘blind’ therapy in endocarditis. This patient has prostheses and this is not the most appropriate initial treatment regimen.

      Other features that may be present include heart failure, splenomegaly, finger clubbing, renal features (haematuria, proteinuria, nephritis), and vasculitic features (splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth’s spots).

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 46 - One of the following statements about acute lymphoblastic leukaemia(ALL) is true. ...

    Incorrect

    • One of the following statements about acute lymphoblastic leukaemia(ALL) is true.

      Your Answer:

      Correct Answer: It is classified using the FAB classification

      Explanation:

      ALL affects children predominantly.

      The CNS is commonly involved in ALL.

      The Philadelphia chromosome is present in 25% of adult ALL and 5% of childhood ALL cases.

      The cure rate in children is approximately 80% in children and 50% in adults.

      ALL is classified into 3 groups using the French-American-British (FAB) classification:
      ALL-L1: small uniform cells
      ALL-L2: large varied cells
      ALL-L3: large varied cells with vacuoles.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 47 - A 22-year-old presents with acute severe asthma. He takes a drug prescribed by...

    Incorrect

    • A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.

      Which drug is least likely to have caused his hypokalaemia?

      Your Answer:

      Correct Answer: Spironolactone

      Explanation:

      Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.

      Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 48 - A 10-year-old girl presents with polyuria, polydipsia, and stomach pain. She has a...

    Incorrect

    • A 10-year-old girl presents with polyuria, polydipsia, and stomach pain. She has a history of type I diabetes mellitus. On blood gas analysis, she has metabolic acidosis. Diabetic ketoacidosis (DKA) is diagnosed, and therapy is initiated. She becomes increasingly confused when intravenous fluids and insulin are administered.

      Which electrolyte imbalance is the MOST likely reason of the increased confusion

      Your Answer:

      Correct Answer: Hyponatraemia

      Explanation:

      Because of the shift of water from the intracellular to the extracellular compartment as a result of hyperglycaemia and increased plasma osmolality, dilutional hyponatraemia is common in diabetic ketoacidosis (DKA).

      If intravenous fluids are not delivered with caution, hyponatraemia might worsen, which can lead to increased degrees of disorientation. Hyponatraemia has also been linked to an increased risk of cerebral oedema, especially if blood glucose levels drop too quickly following treatment.

      Headache, recurrence of vomiting, irritability, Glasgow Coma Scale score, inappropriate heart rate slowing, and rising blood pressure are the most common causes of death in paediatric DKA, and children should be monitored for the symptoms mentioned above. To prevent this from developing,  s low osmolarity normalization, attention to glucose and salt levels, as well as hydration over 48 hours, is necessary. 

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
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  • Question 49 - A 28 year old man presents with abdominal pain and constipation, and bloods...

    Incorrect

    • A 28 year old man presents with abdominal pain and constipation, and bloods show hypocalcaemia. Which of the following hormones is increased as a result of hypocalcaemia?

      Your Answer:

      Correct Answer: Parathyroid hormone

      Explanation:

      Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone that is secreted by the parathyroid glands, which lie immediately behind the thyroid gland. In particular, this hormone is made by chief cells. It regulates the serum calcium concentration through its effects on bone, kidney, and intestine. This hormone is primarily released in response to decreasing plasma Ca2+ concentration and it serves to increase plasma calcium levels and decrease plasma phosphate levels.
      PTH activates Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane and as a result, increases calcium reabsorption in the distal tubule of the nephron. It inhibits reabsorption of phosphate and this increases its excretion by in the proximal tubule of the nephron.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 50 - Swelling of the lips, tongue, and face is observed in a 59-year-old African-American...

    Incorrect

    • Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.

      Which of the following drugs is most likely to have caused her symptoms?

      Your Answer:

      Correct Answer: Ramipril

      Explanation:

      Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.

      Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.

      Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.

      The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.

      Other medications that are less frequently linked to angioedema include:
      Angiotensin-receptor blockers (ARBs)
      Nonsteroidal anti-inflammatory drugs (NSAIDs)
      Bupropion (e.g. Zyban and Wellbutrin)
      Beta-lactam antibiotics
      Statins
      Proton pump inhibitors

      The majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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Pharmacology (1/1) 100%
Haematology (0/1) 0%
Pathology (0/1) 0%
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