-
Question 1
Correct
-
Which of the following is NOT an effect of benzodiazepines:
Your Answer: Analgesic effect
Explanation:Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhance inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.
-
This question is part of the following fields:
- Anaesthesia
- Pharmacology
-
-
Question 2
Incorrect
-
You are calculating the anion gap on a patient with an acid-base disturbance and you find the anion gap to be low. Which of the following is the most likely cause for the low anion gap:
Your Answer: Uraemia
Correct Answer: Hypoalbuminaemia
Explanation:A low anion gap is frequently caused by hypoalbuminemia. Albumin is a negatively charged protein and its loss from the serum results in the retention of other negatively charged ions such as chloride and bicarbonate. As bicarbonate and chloride anions are used to calculate the anion gap, there is a subsequent decrease in the gap. The anion gap is sometimes reduced in multiple myeloma, where there is an increase in plasma IgG (paraproteinaemia).
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 3
Correct
-
Which of the following is NOT a function of the commensal intestinal bacterial flora:
Your Answer: Breakdown of haem into bilirubin
Explanation:Commensal intestinal bacterial flora have a role in:Keeping pathogenic bacteria at bay by competing for space and nutrientConverting conjugated bilirubin to urobilinogen (some of which is reabsorbed and excreted in urine) and stercobilinogen which is excreted in the faecesThe synthesis of vitamins K, B12, thiamine and riboflavinThe breakdown of primary bile acids to secondary bile acidsThe breakdown of cholesterol, some food additives and drugs
-
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 4
Incorrect
-
If a patient dislocated his right shoulder and has been referred to the orthopaedic outpatient department for a follow-up after a successful reduction, which of the following is the most important position for him to avoid holding his arm in until he is seen in the clinic?
Your Answer: Arm held flexed across abdomen palm down
Correct Answer: Arm at 90 degrees to side with palm up
Explanation:The arm should be placed in a poly-sling that should be worn for about two weeks. A physiotherapist may give gentle movements for the arm to help in reducing stiffness and in relieving the pain. It is important that the patient must avoid positions that could cause re-dislocation.
The most important position to avoid is the arm being held out at 90 degrees to the side with the palm facing upwards, especially if a force is being applied. -
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 5
Correct
-
A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.
Which of these statements describes the mechanism of action of corticosteroids in asthma?
Your Answer: Reduction of bronchial inflammation
Explanation:Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.
They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.
Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways. -
This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
-
-
Question 6
Incorrect
-
Which of the following statements is correct regarding the neuronal action potential?
Your Answer: Action potentials can have a graded response depending on the stimuli.
Correct Answer: Initial depolarisation occurs as a result of a Na + influx.
Explanation:The resting potential in most neurons has a value of approximately -70 mV.
The threshold potential is generally around -55 mV.
Initial depolarisation when there is Na+influx through ligand-gated Na+channels.
Action potential is an all or nothing response. The size of the action potential is constant and so, the intensity of the stimulus is coded by the frequency of firing of a neuron.
K+efflux is responsible for repolarisation. -
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 7
Correct
-
Regarding aciclovir, which of the following statements is INCORRECT:
Your Answer: Aciclovir eradicates herpes simplex virus from the body.
Explanation:Aciclovir is active against herpesviruses but does not eradicate latent virus.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 8
Incorrect
-
Regarding macrolide antibiotics, which of the following statements is CORRECT:
Your Answer: Macrolides interfere with bacterial DNA synthesis.
Correct Answer: Macrolides are first line for treatment of whooping cough.
Explanation:A macrolide antibiotic is recommended first line for whooping cough (if onset of cough is within the previous 21 days)
Prescribe clarithromycin for infants less than 1 month of age.
Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
Prescribe erythromycin for pregnant women.
Macrolides interfere with bacterial protein synthesis and are mainly active against Gram-positive organisms. They have a similar antibacterial spectrum to penicillin and are thus a useful alternative in penicillin-allergic patients. Erythromycin is commonly associated with gastrointestinal upset. -
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 9
Correct
-
Bordetella pertussis causes which of the following infectious diseases:
Your Answer: Whooping cough
Explanation:Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 10
Correct
-
Depolarisation of a neuron begins with which of the following:
Your Answer: Opening of ligand-gated Na + channels
Explanation:Action potentials are initiated in nerves by activation of ligand-gated Na+channels by neurotransmitters. Opening of these Na+channels results in a small influx of sodium and depolarisation of the negative resting membrane potential (-70 mV). If the stimulus is sufficiently strong, the resting membrane depolarises enough to reach threshold potential (generally around -55 mV), at which point an action potential can occur. Voltage-gated Na+channels open, causing further depolarisation and activating more voltage-gated Na+channels and there is a sudden and massive sodium influx, driving the cell membrane potential to about +40 mV.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 11
Correct
-
Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?
Your Answer: HIT typically develops 5-10 days after starting heparin.
Explanation:Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. HIT is frequently considered in the differential diagnosis of thrombocytopenia occurring in patients on heparin therapy. HIT is a challenging diagnosis because of routine heparin use in hospitalized patients, the common occurrence of thrombocytopenia. The process of heparin dependent IgG antibodies binding to heparin/platelet factor 4 complexes activates platelets and produces a hypercoagulable state. This syndrome typically develops 5-10 days (range 4-15 days) after heparin is commenced. It can occur with unfractionated heparin, low molecular weight heparin, or, rarely, fondaparinux. The diagnosis of HIT requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent platelet activating HIT antibodies. Discontinuation of heparin alone or initiation of a vitamin K antagonist alone like warfarin, is not sufficient to stop the development of thrombosis in patients with acute HIT. If there is moderate clinical suspicion for HIT, all sources of heparin must be discontinued and there must be consideration of anticoagulant treatment with a non-heparin drug.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 12
Incorrect
-
Regarding hepatitis C, which of the following statements is INCORRECT:
Your Answer: Primary infection is often asymptomatic.
Correct Answer: Anti-HCV IgG antibodies are diagnostic of acute infection.
Explanation:Anti-HCV IgG antibodies indicate exposure to hepatitis C but this could be acute, chronic or resolved infection. If the antibody test is positive, HCV RNA should be tested for, which if positive indicates that a person has current infection with active hepatitis C.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 13
Incorrect
-
Herpes simplex encephalitis has a predilection for which of the following sites:
Your Answer: Parietal lobe
Correct Answer: Temporal lobe
Explanation:Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.
-
This question is part of the following fields:
- Infections
- Microbiology
-
-
Question 14
Incorrect
-
All of the following cause bronchoconstriction, EXCEPT for:
Your Answer: Reflex activation of parasympathetic nerves
Correct Answer: Adrenaline
Explanation:Factors causing bronchoconstriction:
- Via muscarinic receptors
- Parasympathetic stimulation
- Stimulation of irritant receptors
- Inflammatory mediators e.g. histamine, prostaglandins, leukotrienes
- Beta-blockers
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 15
Correct
-
Detection of urinary Bence-Jones protein would be most suggestive of which of the following malignancies:
Your Answer: Multiple myeloma
Explanation:Bence Jones proteins are monoclonal immunoglobulin light chains found in urine (and plasma) of some patients with myeloma. Because of their relatively small size, light chains are readily excreted into the urine. The presence of significant amounts of Bence Jones proteins in urine is indicative of malignant B cell proliferation.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 16
Correct
-
The medial and lateral pterygoid muscles are innervated by which of the following nerves:
Your Answer: Mandibular division of the trigeminal nerve
Explanation:Both the medial and lateral pterygoids are innervated by the mandibular division of the trigeminal nerve.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 17
Correct
-
A 20-year-old female presents with painful wrist following a fall while skating. X-rays shows fracture of the ulna.
The initial phase of bone healing is?
Your Answer: Haematoma at the fracture site
Explanation:Haemorrhage occurs into the fracture site from the ruptured vessels in the bone marrow and those supplying the periosteum immediately after fracture. This hematoma formation is the first phase of bone healing.
The 4 stages of bone healing are:
Haematoma at the fracture site (provides a framework for healing)
Callus formation
Lamellar bone formation
Remodelling -
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 18
Incorrect
-
A 40-year-old man with reduced urine output, nausea, and confusion also has a 150% rise of creatinine from baseline over the past 7 days. A diagnosis of acute kidney injury (AKI) is made after more tests are done.
His AKI stage is?Your Answer: Stage 3
Correct Answer: Stage 2
Explanation:This patient with a 150% rise of creatinine above baseline within 7 days has stage 2 Acute kidney injury (AKI).
AKI stages are as follows:
Stage 1
Creatinine rise of 26 micromole/L or more within 48 hours, or
Creatinine rise of 50-99% from baseline within 7 days (1.5-1.99 x baseline),or
Urine output <0.5 mL/kg/hour for more than 6 hours Stage 2
Creatinine rise of 100-199% from baseline within 7 days (2.0-2.99 x baseline),or
Urine output <0.5 mL/kg/hour for more than 12 hours Stage 3
Creatinine rise of 200% or more from baseline within 7 days (3.0 or more x baseline), or
Creatinine rise to 354 micromole/L or more with acute rise of 26 micromole/L or more within 48 hours or 50% or more rise within 7 days, or
Urine output <0.3 mL/kg/hour for 24 hours or anuria for 12 hours -
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 19
Correct
-
When treating diabetic ketoacidosis (DKA), which of the following should be given if the systolic blood pressure is initially less than 90 mmHg:
Your Answer: 500 mL sodium chloride 0.9% intravenous infusion over 10 - 15 minutes
Explanation:If SBP is less than 90 mmHg , 500 mL sodium chloride 0.9 percent should be administered intravenously over 10–15 minutes, and repeated if SBP remains less than 90 mmHg. When SBP is greater than 90 mmHg, sodium chloride infusion must be maintained at a rate that replaces the deficit.
-
This question is part of the following fields:
- Endocrine
- Pharmacology
-
-
Question 20
Correct
-
Which of the following is NOT a heritable risk factor for venous thrombosis:
Your Answer: Von Willebrand disease
Explanation:Approximately one-third of patients who suffer DVT or PE have an identifiable heritable risk factor, although additional risk factors are usually present when they develop the thrombosis. The history of a spontaneous DVT in a close relative increases an individual’s risk of DVT even if no known genetic predisposition can be identified.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 21
Correct
-
Question 22
Correct
-
Caseous necrosis is typically seen in which of the following:
Your Answer: Tuberculosis
Explanation:Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.
-
This question is part of the following fields:
- Inflammatory Responses
- Pathology
-
-
Question 23
Correct
-
Which of the following is NOT one of insulin's actions:
Your Answer: Increased gluconeogenesis
Explanation:Insulin has a number of effects on glucose metabolism, including:
Inhibition of glycogenolysis and gluconeogenesis
Increased glucose transport into fat and muscle
Increased glycolysis in fat and muscle
Stimulation of glycogen synthesis
By inhibiting gluconeogenesis, insulin maintains the availability of amino acids as substrates for protein synthesis. Thus, insulin supports protein synthesis through direct and indirect mechanisms. -
This question is part of the following fields:
- Endocrine
- Pharmacology
-
-
Question 24
Incorrect
-
A patient presents with a rash for dermatological examination. A large area of purplish discolouration of the skin that measures 2 cm in diameter and does not blanch when pressure is applied is seen .
What is the best description of this rash that you have found on examination?
Your Answer: Macule
Correct Answer: Ecchymoses
Explanation:Ecchymosis are discolouration of the skin or mucous membranes caused by extravasation of blood. They are usually red or purple in colour and measure greater than 1 cm in diameter and do not blanch on applying pressure.
A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.
Petechiae are discolouration of the skin measuring less than 3 mm in diameter
Purpura are discolouration of the skin measuring between 0.3 cm and 1 cm in diameter.
Erythema is redness of the skin or mucous membranes caused by hyperaemia of superficial capillaries caused by skin injury, infection or inflammation. Erythema blanches when pressure is applied whereas ecchymosis, purpura and petechiae do not.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 25
Incorrect
-
Which of the following is the most potent stimulus of fibrinolysis:
Your Answer: Protein S
Correct Answer: Tissue plasminogen activator
Explanation:Fibrinolysis is a normal haemostatic response to vascular injury. Plasminogen, a proenzyme in blood and tissue fluid, is converted to plasmin by activators either from the vessel wall (intrinsic activation) or from the tissues (extrinsic activation). The most important route follows the release of tissue plasminogen activator (TPA) from endothelial cells.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 26
Incorrect
-
A 35-year-old man presents with haemoptysis, night sweats, and weight loss. Further examinations were done and a diagnosis of tuberculosis is suspected.
Which of the following statements is considered correct regarding Mycobacterium tuberculosis?Your Answer: The Ghon focus typically appears at the base of the lower lobe of the lung
Correct Answer: It is impervious to decolourisation with acid
Explanation:Mycobacterium tuberculosis are part of the Mycobacteriaceae family. They are described to have the characteristics of a Gram-positive cell wall but they are not easily stained with Gram stain. This is because their cell wall contains a high lipid content, and this lipid allows the Mycobacteria to bind to alkaline stains with the application and help of heat. Once stained, they are able to resist decolorization even with the use of acid alcohol as the decolourizer, making them very difficult to decolorize, that is why they are known to be acid-fast.
The Ghon complex is a non-pathognomonic radiographic finding on a chest x-ray that is significant for pulmonary infection of tuberculosis. The location of the Ghon’s focus is usually subpleural and predominantly in the upper part of the lower lobe and lower part of the middle or upper lobe.
Skeletal tuberculosis of the spine is referred to as Pott disease.
The risk of reactivation TB is about 3.3% during the first year after a positive PPD skin test and a total of 5% to 15% thereafter in the person’s lifetime. Progression from infection to active disease varies with age and the intensity and duration of exposure. Reactivation TB occurs when there is an alteration or suppression of the cellular immune system in the infected host that favours
replication of the bacilli and progression to disease. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
-
-
Question 27
Incorrect
-
Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:
Your Answer: Oral steroid
Correct Answer: Local aminosalicylate
Explanation:Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 28
Incorrect
-
Parasympathetic preganglionic neurons originate in which of the following locations:
Your Answer: Lateral horn of spinal cord segments T1 - L2
Correct Answer: Brainstem and pelvic splanchnic nerves
Explanation:Parasympathetic preganglionic neurones originate in the brainstem from which they run in cranial nerves III, VII, IX and X and also from the second and third sacral segments of the spinal cord. Parasympathetic preganglionic neurones release acetylcholine into the synapse, which acts on cholinergic nicotinic receptors on the postganglionic fibre. Parasympathetic peripheral ganglia are generally found close to or within their target, whereas sympathetic peripheral ganglia are located largely in two sympathetic chains on either side of the vertebral column (paravertebral ganglia), or in diffuse prevertebral ganglia of the visceral plexuses of the abdomen and pelvis. Parasympathetic postganglionic neurones release acetylcholine, which acts on cholinergic muscarinic receptors.
-
This question is part of the following fields:
- Basic Cellular
- Physiology
-
-
Question 29
Incorrect
-
A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His GP had recently given him a new medication.
Which one of these is the most likely medication responsible for the drug-induced anaphylactic reaction?
Your Answer: Ramipril
Correct Answer: Penicillin
Explanation:The most common cause of drug-induced anaphylaxis is penicillin.
The second commonest cause are NSAIDs. Other drugs associated with anaphylaxis are ACE inhibitors and aspirin.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 30
Incorrect
-
A 34-year-old man presents with loss of vision in his left eye due to an episode of optic neuritis. Upon history taking, it was noted that he has a history of multiple sclerosis.
Which of the following anatomical points in the visual pathway has the lesion occurred?Your Answer:
Correct Answer: Optic nerve
Explanation:A lesion in the optic nerve causes ipsilateral monocular visual loss.
Optic neuritis is an inflammatory demyelination of the optic nerve that is highly associated with multiple sclerosis. The two most common symptoms of optic neuritis are vision loss and eye pain. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
SESSION STATS - PERFORMANCE PER SPECIALTY
