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Question 1
Correct
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A 20-year-old male who is a known patient of sickle cell disease presents to the Emergency Room with a sustained erection that is extremely painful.
Out of the following clinical syndromes, which one does this patient most likely have?Your Answer: Priapism
Explanation:Sickling of red blood cells can lead to several different clinical syndromes. If the sickling occurs in the corpora cavernosa, it can lead to a sustained, painful erection of the penis, referred to as priapism. One of the complications is long-term impotence. It is important to seek a urological opinion immediately in this case, but in the interim, treat with perineal ice packs and walk up and down the stairs.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Correct
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For which of the following infections is phenoxymethylpenicillin (penicillin V) primarily used?
Your Answer: Streptococcal tonsillitis
Explanation:Phenoxymethylpenicillin (penicillin V) is less active than benzylpenicillin but both have similar antibacterial spectrum. Because penicillin V is gastric-acid stable, it is suitable for oral administration, but should not be used for serious infections as absorption can be unpredictable and plasma concentrations can be variable.
Its uses are:
1. mainly for respiratory tract infections in children
2. for streptococcal tonsillitis
3. for continuing treatment after one or more injections of benzylpenicillin when clinical response has begun.
4. for prophylaxis against streptococcal infections following rheumatic fever and against pneumococcal infections following splenectomy or in sickle-cell disease.It should not be used for meningococcal or gonococcal infections.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 3
Correct
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Glucagon is secreted by which of the following pancreatic cell types:
Your Answer: α cells
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 4
Incorrect
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Innate, or non-specific, immunity is the immune system we are born with.
Which of the following is NOT an example of innate immunity? Select ONE answer only.Your Answer: Macrophages
Correct Answer: T-lymphocytes
Explanation:Innate, or non-specific, immunity is the immune system we are born with.
There are three aspects of innate immunity:
1. Anatomical barriers, such as:
The cough reflex
Enzymes in tears and skin oils
Mucus – which traps bacteria and small particles
Skin
Stomach acid
2. Humoral barriers, such as:
The complement system
Interleukin-1
3. Cellular barriers, such as:
Neutrophils
Macrophages
Dendritic cells
Natural killer cells
Antibody production is part of the specific, or inducible immune response. T-lymphocytesare responsible for the cell mediated immune response which is part of specific, or inducible immunity. -
This question is part of the following fields:
- General Pathology
- Pathology
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Question 5
Correct
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Question 6
Incorrect
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You see a patient in the ED with photophobia, petechial rash, headache and neck stiffness, and suspect a diagnosis of meningococcal meningitis.
What is the most appropriate initial management?
Your Answer: Perform an LP and await results of Gram-staining
Correct Answer: Give ceftriaxone 2 g IV
Explanation:Treatment should be commenced with antibiotics immediately before laboratory confirmation due to the potentially life-threatening nature of the disease.
In a hospital setting, 2g of IV ceftriaxone (80 mg/kg for a child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the drugs of choice.
In the prehospital setting, IM benzylpenicillin can be given as an alternative. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Correct
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Which of these cell types in the stomach releases pepsinogen?
Your Answer: Chief cells
Explanation:The gastric chief cells in the stomach wall releases pepsinogen. Pepsinogen is a proenzyme. It mixes with hydrochloric acid in the stomach and is converted to pepsin. Pepsin breaks down proteins into peptides aiding protein digestion.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 8
Incorrect
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A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.
Which of these antibiotics is most likely to have been used?Your Answer: Nitrofurantoin
Correct Answer: Gentamicin
Explanation:Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.
Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear).
Both side effects are dose-related and occur commonly in the elderly.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 9
Correct
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A 26-year-old male presents to your clinic with the complaint of recurrent fevers over the past three months. On documentation of the fever, it is noted that the fever increases and decreases in a cyclical pattern over a 1-2 week period. After the appropriate investigations, a diagnosis of Pel-Ebstein fever is made.
Which ONE of the following conditions is most likely to cause this patient's fever?Your Answer: Hodgkin lymphoma
Explanation:The release of cytokines from Reed-Sternberg cells can cause fever in patients with Hodgkin lymphoma, which increases and decreases in a cyclical pattern of 1 to 2 weeks. This is called Pel-Ebstein or Ebstein-Cardarelli fever, specifically seen in Hodgkin lymphoma. The fever is always high grade and can reach 40 degrees or higher.
Cyclical fever in other conditions is common but is not termed as Pel-Ebstein fever. This term is reserved only with Hodgkin lymphoma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 10
Incorrect
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Superficial fibular nerve palsy results in which of the following clinical features:
Your Answer: Loss of dorsiflexion of the foot
Correct Answer: Loss of eversion of the foot
Explanation:Damage to the superficial fibular nerve results in loss of eversion of the foot and loss of sensation over the lower anterolateral leg and the dorsum of the foot.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 11
Incorrect
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In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic disrupts cell membrane function.
Which of the following antimicrobial drugs is prescribed to this patient?Your Answer: Flucloxacillin
Correct Answer: Nystatin
Explanation:Nystatin binds ergosterol (unique to the fungi cell membrane) and forms membrane pores that allow K+ leakage, acidification, and subsequent death of the fungus.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Flucloxacillin inhibits the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria.
Trimethoprim inhibits bacterial dihydrofolate reductase.
Isoniazid decreases the synthesis of mycolic acids in mycobacteria.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 12
Correct
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Which of the following is the most abundant immunoglobulin in plasma:
Your Answer: IgG
Explanation:IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 13
Correct
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A 54-year-old man returns from a recently holiday on a cruise ship with a dry cough and a fever. Today he has also had several episodes of diarrhoea and has developed bilateral pleuritic chest pain. He states that he is short of breath, most notably on exertion. He had been prescribed amoxicillin by the cruise ship doctor a few days earlier but has not seen any improvement.
Which of the following is the most likely causative organism? Select ONE answer only.Your Answer: Legionella pneumophila
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.
The clinical features of the pneumonic form of Legionnaires’ disease include:
Mild flu-like prodrome for 1-3 days
Cough (usually non-productive and occurs in approximately 90%)
Pleuritic chest pain
Haemoptysis
Headache
Nausea, vomiting and diarrhoea
Anorexia
Legionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 14
Incorrect
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A 69-year-old woman with new-onset back pain was diagnosed with osteopenia, osteolytic lesions, and vertebral collapse after undergoing a radiographic examination. Her laboratory results revealed anaemia and hypercalcemia. These findings most likely indicate what condition?
Your Answer: Chronic myeloid leukaemia
Correct Answer: Myeloma
Explanation:Bone pain, pathologic fractures, weakness, anaemia, infection, hypercalcemia, spinal cord compression, and renal failure are all signs and symptoms of multiple myeloma (MM). The patient’s condition matched the signs and symptoms of myeloma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Correct
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Which of the following is a contraindication for aspirin?
Your Answer: Children under 16 years
Explanation:Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.
There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 16
Incorrect
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A young 20-year-old boy is a known case of type I diabetes mellitus. Today, he presents with polyuria, polydipsia, and abdominal pain in the emergency department. His blood sugar is drawn, which is markedly elevated to 7 mmol/L. Quick ABGs are drawn, which show metabolic acidosis. You diagnose the patient to be suffering from diabetic ketoacidosis (DKA) and immediately commence its treatment protocol in which insulin is also administered.
Out of the following, which parameter is MOST likely to change due to initiating insulin?Your Answer: Sodium
Correct Answer: Potassium
Explanation:Diabetes ketoacidosis is an acute complication of diabetes mellitus. Insulin is administered to achieve euglycemia, and crystalloids or colloidal solution is administered to achieve euvolemia and euelectrolytaemia.
Potassium levels severely fluctuate during the treatment of DKA, hypokalaemia being more common. Insulin promotes the cell to take up potassium from the extracellular space via increased sodium-potassium pump activity.
It is important to monitor potassium levels during the treatment of DKA regularly. It is widely suggested that the normal saline shall be used for initial resuscitation, and once the potassium level is retrieved, the patient can be started on potassium replacement should the serum potassium level be between 3.3 and 4.5 mmol/L
If potassium levels fall below 3.3 mmol/l, insulin administration may need to be interrupted to correct the hypokalaemia. -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 17
Incorrect
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Which of the following statements accurately describes the flexor digitorum superficialis muscle?
Your Answer: It has a point of origin on the lateral epicondyle of the humerus
Correct Answer: It flexes the middle phalanges of the medial four fingers at the proximal interphalangeal joints
Explanation:Flexor digitorum superficialis is the largest muscle of the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, together with pronator teres, flexor carpi radialis, flexor carpi ulnaris and palmaris longus. Some sources alternatively classify this muscle as an independent middle/intermediate layer of the anterior forearm, found between the superficial and deep groups.
Flexor digitorum superficialis is innervated by muscular branches of the median nerve, derived from roots C8 and T1 that arises from the medial and lateral cords of the brachial plexus. The skin that overlies the muscle is supplied by roots C6-8 and T1.
The primary arterial blood supply to the flexor digitorum superficialis is derived from the ulnar artery and its anterior recurrent branch. In addition to branches of the ulnar artery, the anterior and lateral surfaces of the muscle are supplied by branches of the radial artery; and its posterior surface also receives branches from the median artery.
The main function of flexor digitorum superficialis is flexion of the digits 2-5 at the proximal interphalangeal and metacarpophalangeal joints. Unlike the flexor digitorum profundus, flexor digitorum superficialis has independent muscle slips for all four digits. This allows it to flex the digits individually at their proximal interphalangeal joints. In addition, flexor digitorum superficialis aids the aids flexion of the wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 18
Incorrect
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A 25 year old man has sustained a fracture to the surgical neck of the humerus after falling from his bike. Examination suggests an axillary nerve injury. The clinical features expected to be seen in this patient are:
Your Answer: Weakness of shoulder adduction
Correct Answer: Weakness of shoulder abduction
Explanation:Axillary nerve injury results in:
1. weakness of arm abduction (paralysis of deltoid),
2. weakness of lateral rotation of the arm (paralysis of teres minor)
3. loss of sensation over the regimental badge area. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Incorrect
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An analytical cohort study is done to compare the relationship between omega 3 intake and occurrence of myocardial infarction (MI) among males aged over 65 years. The following are the data from the study:
No. of subjects taking placebo: 100 men
No. of subjects taking placebo who suffered an MI: 15 men
No. of subjects taking omega 3: 100 men
No. of subjects taking omega 3 who suffered an MI: 5 men
Compute for the absolute risk in the treatment (omega 3) group.Your Answer: 0.2
Correct Answer: 0.05
Explanation:The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.
AR = 5/100 = 0.05
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This question is part of the following fields:
- Evidence Based Medicine
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Question 20
Incorrect
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All of the following statements regarding metronidazole are correct except:
Your Answer: Metronidazole has high activity against anaerobic bacteria and protozoa.
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.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 21
Incorrect
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As part of his angina treatment, a 68-year-old man is prescribed a beta blocker. He starts having nightmares and has trouble sleeping soon after starting the beta-blocker.
Which of the beta blockers listed below is the most likely to be in his system?Your Answer: Celiprolol
Correct Answer: Propranolol
Explanation:The beta-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas, and liver are blocked by beta-adrenoceptor blocking drugs (beta blockers).
Beta blockers come in a wide range of strengths, with the choice largely determined by the disease being treated and the patient’s unique circumstances. The intrinsic sympathomimetic activity, lipid solubility, duration of action, and cardioselectivity of beta blockers all differ.
Some beta blockers are lipid (lipophilic) soluble, while others are water soluble (hydrophilic). Drugs that are more lipid-soluble are absorbed faster from the gut, undergo more first-pass metabolism, and are eliminated faster. They’re also more likely to get into the brain and cause central effects like insomnia and nightmares. Propranolol, pindolol, labetalol, and metoprolol are examples of lipid-soluble beta blockers. Beta blockers that are water-soluble are less likely to enter the brain and are more resistant to first-pass metabolism. They are excreted by the kidneys, and in renal impairment, dosage reduction is frequently required. Atenolol, nadolol, celiprolol, and sotalol are examples of water-soluble beta blockers.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 22
Incorrect
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Following an injury sustained during a rugby match, a 16-year-old boy is brought to the Emergency Department by his mother. His forearm appears to be deformed, and you believe he has a distal radius fracture. A numerical rating scale is used to assess his pain, and the triage nurse informs you that he is in moderate pain.'
The RCEM guidance recommends which of the following analgesics for the treatment of moderate pain in a child of this age?Your Answer: Oral paracetamol 10 mg/kg
Correct Answer: Oral codeine phosphate 1 mg/kg
Explanation:According to a 2018 audit conducted by the Royal College of Emergency Medicine (RCEM), the standard of care for children presenting to EDs with fractured limbs has deteriorated, with most patients waiting longer than ever before for pain relief. More than one-tenth of the children who came in with significant pain from a limb fracture received no pain relief at all.
For all patients, including children, the Agency for Health Care Policy and Research (AHCPR) in the United States recommends using the ABCs of pain management:
A – Ask about pain regularly. Assess pain systematically.
B – Believe the patient and family in their reports of pain and what relieves it.
C – Choose pain control options appropriate for the patient, family, and setting.
D – Deliver interventions in a timely, logical, coordinated fashion.
E – Empower patients and their families. Enable patients to control their course to the greatest extent possible.The RCEM guidelines recommend assessing a child’s pain within 15 minutes of arrival. This is a fundamental requirement. For the assessment of pain in children, a variety of rating scales are available; which one is used depends on the child’s age and ability to use the scale. These are some of them:
Faces of Wong-Baker Scale for assessing pain
Scale of numerical evaluation
The behavioural scale is a scale that measures how people behave.The RCEM has provided the following visual guide:
The RCEM has established the following guidelines for when patients in severe pain should receive appropriate analgesia:
100% within 60 minutes of arrival or triage, whichever is earliest
75% within 30 minutes of arrival or triage, whichever is earliest
50% within 20 minutes of arrival or triage, whichever is earliest -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 23
Incorrect
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A 29 year old patient with known inflammatory bowel disease presents to ED with surgical complications following his recent ileocaecal resection. Removal of the terminal ileum may result in the malabsorption of which of the following:
Your Answer: Vitamin K
Correct Answer: Vitamin B12
Explanation:On ingestion, vitamin B12 is bound to R protein found in saliva and gastric secretions, which protects it from digestion in the stomach. Intrinsic factor is secreted by gastric parietal cells. Receptors for the IF-B12 complex are present in the membrane of epithelial cells of the terminal ileum, which bind the complex and allow uptake of vitamin B12 across the apical membrane by endocytosis. Vitamin B12 is then transported across the basal membrane into the portal blood where it is bound to transcobalamin II and processed by the liver. In pernicious anaemia, there are autoantibodies against gastric parietal cells and intrinsic factor, resulting in vitamin B12 deficiency anaemia.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 24
Incorrect
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A 26-year-old woman is currently 9 weeks pregnant. Upon interview and history taking, she mentioned that she visited a friend whose child had just been diagnosed with slapped cheek disease.
If the mother contracts an illness during pregnancy, which among the following is not known to cause fetal abnormalities?Your Answer: Rubella
Correct Answer: Hepatitis A
Explanation:Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.
When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.
TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)toxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.
Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 25
Incorrect
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A young man develops an infection spread via aerosol transmission.
Which of these organisms is commonly spread by aerosol transmission?Your Answer: Rotavirus
Correct Answer: Measles virus
Explanation:Aerosols are airborne particles less than 5 µm in size, containing infective organisms that usually cause infection of the upper or lower respiratory tract.
Examples of organisms commonly spread by aerosol transmission are:
Measles virus
Varicella zoster virus
Mycobacterium tuberculosisThe following table summarises the various routes of transmission with example organisms:
Route of transmission
Example organisms
Aerosol (airborne particle < 5 µm)
Mycobacterium tuberculosis
Varicella zoster virus
Measles virusHepatitis A and Rotavirus are spread by the faeco-oral route.
Neisseria gonorrhoea is spread by sexual route.
Staphylococcus aureus is spread by direct contact.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 26
Incorrect
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Regarding calcium channel blockers, which of the following statements is CORRECT:
Your Answer: In cases of refractory hypertension, verapamil can be used in combination with a beta-blocker.
Correct Answer: Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle causing vasodilation.
Explanation:Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle, causing relaxation and vasodilation (reduction in peripheral vascular resistance). They also block calcium channels within the myocardium and conducting tissues of the heart which produces a negative inotropic effect by reducing calcium influx during the plateau phase of the action potential.
They have a variety of uses, including:
Hypertension
Angina
Atrial fibrillation
Migraine
Calcium channel blockers have been found to be moderately useful in the prevention of migraines. The best evidence is for this is with verapamil. This may be due to the prevention of the arteriolar constriction that is associated with migraine. They are commonly used for this elsewhere in the world but are not currently licensed for this use in the UK.
The following are common side effects of all calcium-channel blockers:
Abdominal pain
Dizziness
Drowsiness
Flushing
Headache
Nausea and vomiting
Palpitations
Peripheral oedema
Skin reactions
Tachycardia
Verapamil is highly negatively inotropic and reduces cardiac output, slows the heart rate and may impair atrioventricular conduction. It may precipitate heart failure, exacerbate conduction disorders, and cause hypotension at high doses and should not be used with beta-blockers. Nifedipine has less myocardial effects than verapamil and has no antiarrhythmic properties but has more influence on the vessels. Nimodipine is used solely for the prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage. -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 27
Incorrect
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A 19-year-old woman presents with dysuria and vaginal discharge. A swab was taken for culture. Culture results showed the presence of Neisseria gonorrhoeae infection. Treatment of azithromycin and doxycycline was started.
Which of the following statements is considered correct regarding Neisseria gonorrhoeae?Your Answer: Pelvic tenderness is usually present in women
Correct Answer: Throat swabs can be used for diagnosis
Explanation:Neisseria gonorrhoeae is a Gram-negative diplococcus that causes gonorrhoea. Gonorrhoea is an acute pyogenic infection of nonciliated columnar and transitional epithelium; infection can be established at any site where these cells are found. Gonococcal infections are primarily acquired by sexual contact and occur primarily in the urethra, endocervix, anal canal, pharynx, and conjunctiva.
In men, acute urethritis, usually resulting in purulent discharge and dysuria (painful urination), is the most common manifestation. The endocervix is the most common site of infection in women. Symptoms of infection, when present, include dysuria, cervical discharge, and lower abdominal pain. Some cases in women may be asymptomatic leading to complications such as pelvic inflammatory disease. Blood-borne dissemination occurs in less than 1% of all infections, resulting in purulent arthritis and rarely septicaemia. Fever and a rash on the extremities can also be present. Other conditions associated with N. gonorrhoeae include anorectal and oropharyngeal infections. Infections in these sites are more common in men who have sex with men but can also occur in women.
Pharyngitis is the chief complaint in symptomatic oropharyngeal infections, whereas discharge, rectal pain, or bloody stools may be seen in rectal gonorrhoea. Approximately 30% to 60% of women with genital gonorrhoea have concurrent rectal infection. Newborns can acquire ophthalmia neonatorum, a gonococcal eye infection, during vaginal delivery through an infected birth canal.
Specimens collected for the recovery of N. gonorrhoeae may come from genital sources or from other sites, such as the rectum, pharynx, and joint
fluid. According to the 2010 STD Treatment guidelines, cephalosporins (e.g., ceftriaxone, cefixime) are currently recommended treatments. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 28
Incorrect
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Gallstones are commonly found lodged in which of the following parts of the gallbladder?
Your Answer: Pylorus
Correct Answer: Neck
Explanation:There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 29
Incorrect
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A 18 year old student presents to ED with a headache, fever and photophobia. You suspect meningitis and agree to observe your junior performing a lumbar puncture. What is the highest safest vertebral level to perform lumbar puncture in adults:
Your Answer: T12/L1
Correct Answer: L3/L4
Explanation:In adults, the spinal cord typically ends between L1/L2 whereas the subarachnoid space extends to approximately the lower border of vertebra S2. Lumbar puncture is performed in the intervertebral space L4/L5 or L3/L4.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 30
Incorrect
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A 61-year-old woman returns to get the results of recent blood tests she had done for non-specific malaise, lethargy, and weight loss.
The only abnormality discovered during the blood tests was a 580 x 10 9 /l increase in platelets. Her platelets were also elevated on a blood test taken 6 months earlier, according to her previous results. You're aware of the recent emergence of elevated platelet levels as a cancer risk marker and decide to look into it.
Which of the following cancers is most likely to cause isolated thrombocytosis?Your Answer: Melanoma skin cancer
Correct Answer: Colorectal cancer
Explanation:Raised platelet levels have emerged as a cancer risk marker, according to a large population-based study published in 2017(link is external). According to the study, 12 percent of men and 6% of women with thrombocytosis were diagnosed with cancer within a year. These figures increased to 18% in men and 10% in women if a second platelet count was taken within 6 months of the first and showed an increased or stable elevated platelet count.
The researchers discovered that thrombocytosis linked to cancer is most common in colorectal and lung cancers, and it is linked to a worse prognosis. Furthermore, one-third of the cancer patients in the study had no other symptoms that would have prompted an immediate cancer referral.
The exact mechanism by which these cancers cause thrombocytosis is unknown, but one theory proposes the existence of pathogenic feedback loops between malignant cells and platelets, with a reciprocal interaction between tumour growth and metastasis, as well as thrombocytosis and platelet activation. Another hypothesis is that thrombocytosis occurs independently of cancer but aids in its spread and progression.
The findings show that routinely testing for thrombocytosis could cut the time it takes to diagnose colorectal and lung cancer by at least two months. In the UK, this could result in around 5500 earlier cancer diagnoses per year.
Because the positive predictive value of thrombocytosis in middle age for cancer (10%) is higher than the positive predictive value for a woman in her 50s presenting with a new breast lump (8.5%), this is clearly an important research paper that should be used to adjust future clinical practise. The current NICE guidelines predate these new research findings, so we’ll have to wait and see how they affect cancer referral guidelines in the UK.
Because there are so many possible cancers associated with thrombocytosis, the treating clinician should take a thorough history and perform a thorough clinical examination if a patient is diagnosed with it. Further investigation and the most appropriate referral route should be aided by this information.
It’s worth noting that the patients in the study had their blood tests done for a medical reason rather than as a random screening test.
If there are no other symptoms to guide investigation and referral (one-third of the patients in the study had no other symptoms), keep in mind that the two most common cancers encountered were colorectal and lung cancer, so a chest X-ray and a faecal immunochemical test (FIT) for faecal blood may be reasonable initial investigations.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 31
Incorrect
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Which of the following statements concerning the facial nerve is INCORRECT?
Your Answer: The facial nerve leaves the brainstem at the cerebellopontine angle.
Correct Answer: Forehead sparing in facial nerve palsy is indicative of a lower motor neuron lesion.
Explanation:In facial nerve palsy, LMN damage will involve the forehead and there will be an inability to close the eyes due to paralysis of the orbicularis oculi or raise the eyebrows due to paralysis of the occipitofrontalis muscle.
UMN damage causes sparing of the forehead as the occipitofrontalis and orbicularis oculi muscles have bilateral cortical representation. -
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 32
Incorrect
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Regarding the heart sounds in the cardiac cycle, which of the following statements is INCORRECT:
Your Answer: The fourth heart sound is heard in late diastole.
Correct Answer: The third heart sound is caused by filling of an abnormally stiff ventricle in atrial systole.
Explanation:Heart Sound – Phase of Cardiac Cycle – Mechanical Event:
First heart sound – Start of systole – Caused by closure of the atrioventricular (mitral & tricuspid) valves
Second heart sound – End of systole – Caused by closure of the semilunar (aortic and pulmonary) valves
Third heart sound – Early diastole – Caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase
Fourth heart sound – Late diastole – Caused by filling of an abnormally stiff ventricle in atrial systole -
This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 33
Incorrect
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In the emergency room, a 28-year-old woman complains of wobbly and slurred speech, is unable to do the heel-shin test, and has nystagmus. The following signs are most likely related to damage to which of the following areas:
Your Answer: Occipital lobe
Correct Answer: Cerebellum
Explanation:Cerebellar injury causes delayed and disorganized motions. When walking, people with cerebellar abnormalities sway and stagger.
Damage to the cerebellum can cause asynergia, the inability to judge distance and when to stop, dysmetria, the inability to perform rapid alternating movements or adiadochokinesia, movement tremors, staggering, wide-based walking or ataxic gait, a proclivity to fall, weak muscles or hypotonia, slurred speech or ataxic dysarthria, and abnormal eye movements or nystagmus.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 34
Incorrect
-
In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer: 10 minutes
Correct Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.
Prolonged seizures last 5 minutes or more.
Repeated seizures refer to 3 or more seizures in an hour. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 35
Incorrect
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Regarding the resting membrane potential, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The resting cell membrane is more permeable to K + ions than to Na + ions.
Explanation:A membrane potential is a property of all cell membranes, but the ability to generate an action potential is only a property of excitable tissues. The resting membrane is more permeable to K+and Cl-than to other ions (and relatively impermeable to Na+); therefore the resting membrane potential is primarily determined by the K+equilibrium potential. At rest the inside of the cell is negative relative to the outside. In most neurones the resting potential has a value of approximately -70 mV.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 36
Incorrect
-
If the null hypothesis is wrongly rejected when it is actually true, this is an example of:
Your Answer:
Correct Answer: A test with a type I error
Explanation:A type I error occurs when the null hypothesis is wrongly rejected when it is actually true and we conclude that there is a difference of effect when in reality there is none (a false positive result).
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 37
Incorrect
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Adenosine is primarily indicated for which of the following:
Your Answer:
Correct Answer: Paroxysmal supraventricular tachycardia
Explanation:Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia including those associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 38
Incorrect
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A patient presents complaining of visual loss. On examination you note a contralateral homonymous hemianopia. Where is the most likely site of the lesion:
Your Answer:
Correct Answer: Optic tract
Explanation:At the optic chiasm, fibres from the medial (nasal) half of each retina crossover, forming the right and left optic tracts.
The left optic tract contains fibres from the left lateral (temporal) retina and the right medial retina.
The right optic tract contains fibres from the right lateral retina and the left medial retina.
Each optic tract travels to its corresponding cerebral hemisphere to reach its lateral geniculate nucleus (LGN) located in the thalamus where the fibres synapse.
A lesion of the optic tract will cause a contralateral homonymous hemianopia. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 39
Incorrect
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The causative organism for an infection in a patient you are reviewing is a facultative anaerobe.
Which of these is a facultative anaerobic organism?Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Facultative anaerobic bacteria make energy in the form of ATP by aerobic respiration in an oxygen rich environment and can switch to fermentation in an oxygen poor environment.
Examples of facultative anaerobes are:
Staphylococcus spp.
Listeria spp.
Streptococcus spp.
Escherichia coliMycobacterium tuberculosis, and Pseudomonas aeruginosa are obligate aerobe. They require oxygen to grow
Campylobacter jejuni and Clostridium spp are obligate anaerobes.
They live and grow in the absence of oxygen. -
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 40
Incorrect
-
Regarding haemophilia A, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: In haemophilia both the APTT and PT are prolonged.
Explanation:Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives.
The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 41
Incorrect
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Which of the following is a contraindication to the use of opioid analgesics:
Your Answer:
Correct Answer: Raised intracranial pressure
Explanation:Opioids should be avoided in people who have:
A risk of paralytic ileus (opioids reduce gastric motility)
Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)
Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 42
Incorrect
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A 36-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip extension, but normal hip abduction.
Which of the following muscles was most likely injured in this case?Your Answer:
Correct Answer: Gluteus maximus
Explanation:The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.
The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.
The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 43
Incorrect
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You are taking care of a 55-year-old male patient with a direct inguinal hernia. In explaining his hernia, which of the following layers was compromised and had resulted in his condition?
Your Answer:
Correct Answer: Transversalis fascia
Explanation:Direct inguinal hernias are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or heavy lifting.
A direct inguinal hernia protrudes through the Transversalis fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 44
Incorrect
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A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.
Which of the drugs listed below is the best fit for this strategy?Your Answer:
Correct Answer: Bisoprolol
Explanation:In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.
Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 45
Incorrect
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Regarding pressures and airflow during the normal breathing cycle, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Negative intrapleural pressure causes dynamic compression of the airways.
Explanation:Dynamic compression occurs during forced expiration, when as the expiratory muscles contract, all the structures within the lungs, including the airways, are compressed by the positive intrapleural pressure. Consequently the smaller airways collapse before the alveoli empty completely and some air remains within the lungs (the residual volume).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 46
Incorrect
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Regarding Cryptococcus neoformans, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Patients with complement deficiency are at particular risk of infection.
Explanation:Cryptococcus neoformans typically causes infection in patients with lymphoma, those taking steroid or cytotoxic therapy, those with T-cell deficiency e.g. AIDS and those with intense exposure, such as pigeon fanciers.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 47
Incorrect
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Which of the following antibiotics is the first line of treatment for a patient who has been diagnosed with chlamydia infection?
Your Answer:
Correct Answer: Azithromycin
Explanation:The Centres for Disease Control and Prevention (CDC) recommends azithromycin, a single 1 g dose, and doxycycline, 100 mg bd for 7 days, as first-line medications for chlamydial infection treatment.
Second-line medications (such as erythromycin, penicillins, and sulfamethoxazole) are less effective and have more side effects
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 48
Incorrect
-
You examine a resuscitated patient who has been diagnosed with ventricular tachycardia. The patient's hemodynamics are normal. You intended to prescribe amiodarone to him, but you can't because he has a contraindication.
In these circumstances, which of the following is a contraindication to using amiodarone?Your Answer:
Correct Answer: Sinus node disease
Explanation:Amiodarone is an anti-arrhythmic medication that can be used to treat both ventricular and atrial arrhythmias.
The use of amiodarone is contraindicated in the following situations:
Conduction disturbances that are severe (unless pacemaker fitted)
Sinus node disease is a condition that affects the lymph nodes in (unless pacemaker fitted)
Sensitivity to iodine
Blockage of the Sino-atrial heart valve (except in cardiac arrest)
Bradycardia in the sinuses (except in cardiac arrest)
Thyroid disorders -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 49
Incorrect
-
A 6-year-old child presents with profuse watery diarrhoea and dehydration.
Which of the following statements is considered correct regarding infective diarrhoea?Your Answer:
Correct Answer: E.Coli can cause diarrhoea and renal failure
Explanation:E. coli may cause several different gastrointestinal syndromes. Based on virulence factors, clinical manifestation, epidemiology, and different O and H serotypes, there are five major categories of diarrheagenic E. coli, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroadherent, which includes diffusely adherent E. coli (DAEC) and enteroaggregative E. coli (EAEC). These five categories are sometimes
collectively referred to as enterovirulent E. coli or diarrheagenic E. coli.Norwalk virus is part of the Caliciviridae family of viruses which are single-stranded RNA viruses and are the most common cause of infectious gastroenteritis in the US.
Rotaviruses are the most common cause of viral gastroenteritis
in infants and children. With the introduction in 2006 of a human-bovine rotavirus vaccine (RV5; RotaTeq, Merck), a delay in the onset of rotavirus
season was seen. RotaTeq is a series of three oral vaccines beginning at 6 to 12 weeks of age. A second vaccine, Rotarix (RV1; GlaxoSmithKline, Middlesex, England), was approved in June 2008.Cryptosporidium causes an illness characterized by abdominal cramping, watery diarrhoea, vomiting, fever, and anorexia. This organism is resistant to chlorine, so public swimming pools can be the source of an outbreak.
G. lamblia has a worldwide distribution and has frequently been identified as the causative agent of outbreaks of gastroenteritis and traveller’s diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 50
Incorrect
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A 38-year-old man returns from an overseas business trip with a fever and a headache. Following investigations a diagnosis of Plasmodium falciparum malaria is made.
Which of the following statements regarding Plasmodium falciparum malaria is true? Select ONE answer only.Your Answer:
Correct Answer: There may be a continuous fever
Explanation:Plasmodium falciparum malaria is transmitted by female of the Anopheles genus of mosquito. The Aedes genus is responsible for transmitting diseases such as dengue fever and yellow fever.
Plasmodium falciparumis found globally but is mainly found in sub-Saharan Africa.
The incubation period of Plasmodium falciparum malaria is 7-14 days.
Sporozoites invade hepatocytes. Within the hepatocyte asexual reproduction occurs producing merozoites, which are released into the blood stream and invade the red blood cells of the host.
Artesunate is the drug treatment of choice for Plasmodium falciparum malaria. Quinine can still be used where artesunate is not available. Often combination therapy with drugs such as doxycycline or fansidar is also required.
The classic symptom of malaria is the malarial paroxysm, a cyclical occurrence of a cold phase, where the patient experiences intense chills, a hot stage, where the patient feels extremely hot and finally a sweating stage, where the fever declines and the patient sweats profusely. There may also, however, be a continuous fever. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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SESSION STATS - PERFORMANCE PER SPECIALTY
