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Question 1
Correct
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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: 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 2
Incorrect
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A 25-year-old girl just got back from a trip to Northern India. She complains of headaches and intermittent fever. The fever starts with intense chills, then feels very hot, followed by profuse sweating. She is drowsy and is running a fever of 39.0°C. On examination, there are no palpable lymph nodes or rash seen. She has hepatosplenomegaly.
Which one of the following is the most likely diagnosis?Your Answer: Chagas disease
Correct Answer: Malaria
Explanation:Malaria is a protozoal infection of red blood cells and the liver. It is caused by the parasite belonging to the genus Plasmodium. It is transmitted by the female mosquito Anopheles.
Several species with distinct features:
P. vivax/P. ovale
P. malariae
P. falciparumThe common symptoms of malaria are:
Paroxysms of fever – a cyclical occurrence of:
1) a cold phase – the patient experiences intense chills
2) a hot stage – the patient feels extremely hot
3) a sweating stage – the fever declines and the patient sweats profusely
– Fever recurs at regular intervals (48hrs, 72hrs): Variable by species of PlasmodiumAnaemia (RBC infection)
– Severity varies by species of Plasmodium
– Haemolytic: sometimes jaundiceSplenomegaly
Also nonspecific symptoms:
– Sweating
– fatigue
– malaise
– arthralgias
– headache
– Sometimes cough, vomiting, diarrhoea -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 3
Correct
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Which of the following data types does a pain-scoring system represent?
Your Answer: Ordinal
Explanation:Pain scoring systems are processes for assessing pain and the severity of illnesses that have been scientifically designed and tested. An example of ordinal categorical data is a pain scoring system.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 4
Incorrect
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Which of the following statements regarding the pituitary gland is CORRECT:
Your Answer: Hypothalamic hormones are transported to the posterior pituitary by hypophyseal portal vessels.
Correct Answer: Cortisol inhibits release of adrenocorticotropic hormone (ACTH) from the anterior pituitary.
Explanation:Anterior pituitary hormones are released under the control of hypothalamic releasing or inhibiting hormones originating from small neurons with their cell bodies in the hypothalamus and released into the blood at the median eminence. These hypothalamic hormones are transported directly to the anterior pituitary via hypophyseal portal vessels. The anterior pituitary hormones (and the hormones released by their target organs) inhibit further release of hypothalamic and anterior pituitary hormones by negative feedback mechanisms e.g. cortisol inhibits the release of ACTH. Prolactin release from the anterior pituitary is inhibited by dopamine.The posterior pituitary is really a direct extension of the hypothalamus. Oxytocin and ADH are manufactured in the cell bodies of large neurons in the hypothalamus and are transported down the axons of these cells to their terminals on capillaries originating from the inferior hypophyseal artery within the posterior pituitary gland. ADH release is controlled by negative feedback mechanisms based on plasma osmolality and blood volume, oxytocin however is involved in positive feedback mechanisms.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 5
Correct
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What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Explanation:A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 6
Correct
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Pancreatic acinar digestive enzyme secretion is mainly stimulated by which of the following hormones:
Your Answer: Cholecystokinin
Explanation:Exocrine pancreatic secretion is controlled by:
Parasympathetic stimulation which enhances secretion of both the enzyme and aqueous components
Sympathetic stimulation which inhibits pancreatic secretion
Secretin which stimulates secretion of the alkaline-rich fluid from ductal cells
Cholecystokinin which stimulates secretion of the enzyme-rich fluid from acinar cells
Somatostatin which inhibits secretion from both acinar and ductal cells
Gastrin which stimulates pancreatic acinar cells to secrete digestive enzymes -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 7
Incorrect
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Which of the following terms describes the proportion of individuals with a negative test result who actually do not have a disease:
Your Answer: Specificity
Correct Answer: Negative predictive value
Explanation:Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.
NPV = d/(c+d) -
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 8
Correct
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You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.
What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.Your Answer: 25 mg
Explanation:Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.
The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:
Corticosteroid
Potency relative to hydrocortisone
Prednisolone
4 times more potent
Triamcinolone
5 times more potent
Methylprednisolone
5 times more potent
Dexamethasone
25 times more potent -
This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 9
Incorrect
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A 28-year-old patient who has been in a car accident needs to be intubated using a rapid sequence induction. As an induction agent, you intend to use etomidate.
Etomidate works by interacting with which type of receptor?Your Answer: N-methyl-D-aspartate (NMDA)
Correct Answer: Gamma-aminobutyric acid (GABA)
Explanation:Etomidate is a carboxylated imidazole derivative with a short half-life that is primarily used to induce anaesthesia.
It is thought to modulate fast inhibitory synaptic transmission in the central nervous system by acting on GABA type A receptors.
The dose for anaesthesia induction is 0.3 mg/kg. Etomidate takes 10-65 seconds to take effect after an intravenous injection, and it lasts 6-8 minutes. With repeated administration, the effects are non-cumulative.The relative cardiovascular stability of etomidate is noteworthy. During induction, it causes less hypotension than thiopental sodium and propofol. It’s also linked to a quick recovery without the hangover.
Etomidate is a strong steroidogenesis inhibitor. The drug inhibits the enzymes responsible for adrenal 11 beta-hydroxylase and cholesterol cleavage, resulting in a decrease in cortisol and aldosterone synthesis for up to 24 hours after administration. It should not be used to maintain anaesthesia because of the adrenocortical suppression.
Other side effects associated with etomidate use include:
Vomiting and nausea
The injection causes pain (in up to 50 percent )
Phlebitis and thrombosis of the veins
Heart block and arrhythmias
Hyperventilation
Apnoea and respiratory depression
It has the potential to cause both hypo- and hypertension.
Critically ill patients have a higher mortality rate. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 10
Correct
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A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement of her blood glucose level is done and found to be grossly elevated. She is diagnosed with diabetic ketoacidosis. A fixed rate insulin infusion is given as part of her treatment.
Which of these is an action of insulin?Your Answer: Stimulates lipogenesis
Explanation:Insulin is an anabolic hormone. Its actions can be broadly divided into:
Lipid metabolism
Protein metabolism and
Carbohydrate metabolismFor lipid metabolism, insulin:
Stimulates lipogenesis
Inhibits lipolysis by lipaseFor carbohydrate metabolism, insulin:
Decreases gluconeogenesis
Stimulates glycolysis
Promotes glucose uptake in muscle and adipose tissue
Promotes glycogen storage
Increases glycogenesis
Decreases glycogenolysisProtein metabolism:
Stimulates protein synthesis
Accelerates net formation of protein
Stimulates amino acid uptake
Inhibits protein degradation
Inhibits amino acid conversion to glucose -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 11
Correct
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Tiredness, night sweats, and easy bruising are symptoms of a 58-year-old woman. Splenomegaly is observed during the examination.
Which of the following diagnoses is the SINGLE MOST LIKELY?Your Answer: Chronic myeloid leukaemia (CML)
Explanation:CML is a myeloproliferative disorder characterised by an abnormal pluripotent haemopoietic stem cell. A cytogenetic abnormality known as the Philadelphia chromosome, which results from a reciprocal translocation between the long arms of chromosomes 9 and 22, causes more than 80% of cases of CML.
CML is a disease that develops slowly over several years. This is known as the ‘chronic stage.’ This stage is usually asymptomatic, and 90 percent of patients are diagnosed at this point, with the disease being discovered frequently as a result of a routine blood test. During this stage, the bone marrow contains less than 10% immature white cells (blasts).
When CML cells expand, symptoms typically begin to appear. The ‘accelerated stage’ is what it’s called. Approximately 10% of people are diagnosed at this point. During this stage, between 10% and 30% of blood cells in the bone marrow are blasts. During this stage, common clinical features include:
Fatigue and exhaustion
Night sweats and fever
Distension of the abdomen
Pain in the left upper quadrant (splenic infarction)
Splenomegaly (commonest examination finding)
Hepatomegaly
Bruising is simple.
Gout is a type of arthritis that affects (rapid cell turnover)
Hyperviscosity is a condition in which the viscosity of (CVA, priapism)
A small percentage of patients experience a ‘blast crisis’ (blast stage). More than 30% of the blood cells in the bone marrow are immature blast cells at this stage. Patients with severe constitutional symptoms (fever, weight loss, bone pain), infections, and bleeding diathesis typically present at this stage.In CML, laboratory findings include:
White cell count is abnormally high (often greater than 100 x 109/l).
Increased number of immature leukocytes causes a left shift.
Anaemia that is mild to moderately normochromic and normocytic.
Platelets can be low, normal, or elevated, and the Philadelphia chromosome can be found in > 80% of patients.
Serum uric acid and ALP levels are frequently elevated.
Tyrosine kinase inhibitors (TKIs), such as imatinib and dasatinib, are the current mainstay of CML treatment.
Allogenic bone marrow transplantation is now only used in cases where TKIs have failed to work. -
This question is part of the following fields:
- Haematology
- Pathology
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Question 12
Incorrect
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A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.
Iliacus is innervated by which of the following nerves? Select ONE answer only.Your Answer: Anterior rami of lumbar nerves L1-L3
Correct Answer: Femoral nerve
Explanation:Iliacus is innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Correct
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A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:
Your Answer: Decreased bradykinin breakdown
Explanation:Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 14
Correct
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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: 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.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 15
Correct
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Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the following locations is most likely to be the organism's origin?
Your Answer: Oral cavity
Explanation:Streptococci that are alpha-haemolytic, such as Streptococcus viridans, are major components of the flora in the oral cavity.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 16
Correct
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One of your patients has been infected by an obligate pathogen and presents with features of this condition.
Which of these is an example of an obligate pathogen?
Your Answer: Trepenoma pallidum
Explanation:Treponema pallidum is an obligate pathogen. Obligate pathogens are almost always associated with disease and usually cannot survive outside of the body for long periods of time. Examples include and HIV.
Staphylococcus aureus and Bacteroides fragilis are conditional pathogens. These are pathogens that usually cause disease only if certain conditions are met.
Pneumocystis jiroveci and Pseudomonas aeruginosa, are opportunistic pathogens. These are pathogens that can only cause disease in an immunocompromised host or under unusual circumstances.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 17
Correct
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What is the primary mode of action of Enoxaparin?
Your Answer: Inhibits factor Xa
Explanation:Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 18
Incorrect
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Regarding the flexor digitorum profundus muscle, which of the following is true?
Your Answer: The medial aspect of the muscle is innervated by the median nerve
Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve
Explanation:Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.
Flexor digitorum profundus has a dual innervation:
(1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);
(2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Incorrect
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Which of the following muscles are primarily involved in passive inspiration:
Your Answer: Internal and innermost intercostal muscles
Correct Answer: Diaphragm and external intercostal muscles
Explanation:Passive inspiration is produced by contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, elevation of the sternal ends of the ribs (‘pump handle’ movement), elevation of the lateral shafts of the ribs (‘bucket handle’ movement) and depression of the diaphragm result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in an increased intrathoracic volume and decreased intrathoracic pressure and thus air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Incorrect
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An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:
No. of patients who took Ticagrelor: 300
No. of patients who took Ticagrelor and suffered a stroke: 30
No. of patients who took Warfarin: 500
No. of patients who took Warfarin and suffered a stroke: 20
Compute for the risk ratio of a stroke.Your Answer: 0.06
Correct Answer: 2.5
Explanation:Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.
RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).
RR = ART/ARC
RR = (30/300) / (20/500)
RR = 2.5Recall that:
If RR < 1, then the intervention reduces the risk of the outcome.
If RR = 1, then the treatment has no effect on the outcome.
If RR > 1, then the intervention increases the risk of the outcome. -
This question is part of the following fields:
- Evidence Based Medicine
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Question 21
Incorrect
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and inferior oblique
Correct Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 22
Correct
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Question 23
Incorrect
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A patient with a wound infection on his right leg has reddening and oedema of the surrounding muscles. His condition has worsened considerably over the past few hours with the area now appearing blackened. There is also palpable crepitus under the skin. You suspect gas gangrene.
Which statement about Clostridium perfringens is true?Your Answer: It is a Gram-positive coccus
Correct Answer: Gas gangrene is caused by the release of an alpha-toxin
Explanation:Clostridium perfringens, a Gram-positive, anaerobic, spore forming rod-shaped, pathogenic bacterium is the most commonly associated with gas gangrene (85-90% of cases), although other species can also be implicated.
Clostridium perfringens is capsulate and produces a range of toxins. Alpha-toxin is the most important and is the cause of gas gangrene.
Gas gangrene develops when a devitalized wound becomes infected with Clostridium perfringens spores from the environment. The spores germinate and multiplies in the ischaemic conditions, releasing toxins, which further damage tissues.
Usually, the clinical features of gas gangrene appear within 24 hours of injury.
Clostridium perfringens spores are not destroyed by cooking. During slow cooling and unrefrigerated storage, they germinate to form vegetative cells.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 24
Incorrect
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Which of the following statements is correct with regards to immunoglobulin?
Your Answer: Immunoglobulin molecules are composed of 4 identical light chains.
Correct Answer: The isotype of immunoglobulin is determined by the heavy chain.
Explanation:The composition of immunoglobulin molecules is two identical heavy and two identical light chains. These chains are linked by disulphide bridges and are each have highly variable regions which give the immunoglobulin its specificity. In addition, they have constant regions and there is virtual complete correspondence in amino acid sequence in all antibodies of a given isotype.
Five isotypes of immunoglobulin exist – these are IgG, IgA, IgM, IgE and IgD. They are determined by the heavy chain (gamma, alpha, mu, epsilon or delta respectively). The light chains are either kappa or lambda. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 25
Correct
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The following statements about leukotrienes as chemical mediators of the acute inflammatory response are all true EXCEPT?
Your Answer: They decrease vascular permeability
Explanation:Leukotrienes increases (not decrease) vascular permeability during acute inflammation.
All the other statements are correct
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 26
Incorrect
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After collapsing in his nursing home, a 70-year-old man is brought into the ER. He is a known case of diabetes mellitus and is on medication for it. An RBS of 2.5 mmol/L (3.9-5.5 mmol/L) is recorded in the ER.
Out of the following, which medication for diabetes mellitus is MOST likely responsible for his hypoglycaemic episode?Your Answer: Metformin
Correct Answer: Pioglitazone
Explanation:Pioglitazone is used to treat type 2 diabetes mellitus. It selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-γ) and to a lesser extent PPAR-α.
Of the medications mentioned in this question, only pioglitazone is a recognized cause of hypoglycaemia.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 27
Correct
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A 32-year-old woman diagnosed with hyperthyroidism has her T 4 levels grossly elevated and she is started on carbimazole.
A release of which of the following from the hypothalamus is inhibited by increase in T4 levels?Your Answer: Thyrotropin-releasing hormone
Explanation:A negative feedback mechanism involving the hypothalamic-pituitary-thyroid axis controls the release of T3 and T4 into the bloodstream.
When metabolic rate is low or serum T3 and/or T4 levels are decrease, this triggers the secretion of thyrotropin-releasing hormone (TRH) from the hypothalamus.
TRH goes to the anterior pituitary gland and stimulates secretion of thyroid-stimulating hormone (TSH).
An increased serum level of T3 and T4 inhibits the release of TRH.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 28
Incorrect
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A 27-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
In which of the following nerves is the gluteus maximus muscle innervated by?Your Answer: Superior gluteal nerve
Correct Answer: Inferior gluteal nerve
Explanation:The gluteal muscles are a group of muscles that make up the buttock area. These muscles include: gluteus maximus, gluteus medius. and gluteus minimus.
The gluteus maximus is the most superficial as well as largest of the three muscles and makes up most of the shape and form of the buttock and hip area. It is a thick, fleshy muscle with a quadrangular shape. It is a large muscle and plays a prominent role in the maintenance of keeping the upper body erect.
The innervation of the gluteus maximus muscle is from the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 29
Incorrect
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A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the resuscitation area of the Emergency Department. A loading dose of IV aminophylline is administered and her symptoms begin to improve. You are asked to check her theophylline levels after an appropriate time period.
How long should you wait before taking her blood sample be taken?
Your Answer: 48 hours
Correct Answer: 4-6 hours
Explanation:Plasma theophylline concentration is usually measured five days after starting oral treatment and three days after each dose adjustment.
A blood sample to check theophylline concentration should usually be taken after 4-6 hours if an IV dose of aminophylline was given.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 30
Incorrect
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Regarding water and electrolyte absorption in the small intestine, which of the following statements is INCORRECT:
Your Answer: Water follows osmotic gradients set up by the transport of ions, primarily mediated by the sodium pump.
Correct Answer: Na+ enters the cell across the apical membrane against its concentration gradient by both membrane channels and transporter protein mechanisms.
Explanation:As the contents of the intestine are isotonic with body fluids and mostly have the same concentration of the major electrolytes, their absorption is active. Water cannot be moved directly, but follows osmotic gradients set up by the transport of ions, primarily mediated by the sodium pump.Na+/K+ ATPase located on the basolateral membrane of the epithelial cells pumps three Na+ ions from the cell in exchange for two K+ ions, against their respective concentration gradients. This leads to a low intracellular concentration of Na+ and a high intracellular concentration of K+. The low intracellular concentration of Na+ ensures a movement of Na+ from the intestinal contents into the cell down its concentration gradient by both membrane channels and transporter protein mechanisms. Na+ is then rapidly pumped again by the basolateral sodium pump. K+ leaves the cell across the basolateral membrane down its concentration gradient linked to an outward movement of Cl- against its concentration gradient (Cl- having entered the cell across the luminal membrane down its concentration gradient).
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
