-
Question 1
Incorrect
-
Among the following microorganisms, which is considered to be transmitted by invasion of intact skin?
Your Answer: Staphylococcus epidermidis
Correct Answer: Leptospira spp.
Explanation:Rodents and domestic animals are the primary reservoirs for the Leptospira spp, although other animals, including cows, horses, mongooses, and frogs, can also harbour the leptospires. Humans may be directly infected from animal urine or indirectly by contact with soil or water that is contaminated with urine from infected animals. Infected humans can shed leptospires in urine for up to 11 months, infected cows for 3.5 months, infected dogs for 4 years, and infected rodents possibly for their entire lifetime.
The organisms enter the host through mucous membranes or abraded skin. The incubation period ranges from 5 to 14 days.
-
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
-
-
Question 2
Incorrect
-
A 6 year old boy is brought into the ED by his mom with a rash that is associated with Koplik's spots and a diagnosis of measles is made. What advice should be given about returning to school?
Your Answer: 7 days after the rash has gone
Correct Answer: 4 days from the onset of the rash
Explanation:Prevention of spread of measles is extremely important and infected patients should be isolated. The infectious stage is from 3 days before the rash emerges and patients are advised to stay away from school/nursery/work for 4 days from onset of the rash.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 3
Incorrect
-
The most common complication of paracetamol overdose is:
Your Answer: Lactic acidosis
Correct Answer: Hepatic failure
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 4
Correct
-
A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
Which of the following is NOT an action of the gluteus maximus muscle? Select ONE answer only.Your Answer: Hip abduction
Explanation:Gluteus maximus is the main extensor muscle of the hip and assists with lateral rotation of the thigh at the hip joint. It also acts as a hip adductor, steadies the thigh, and assists in raising the trunk from a flexed position.
Gluteus maximus is innervated by the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 5
Incorrect
-
A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.
Which of the following is a verapamil toxicity?Your Answer: Increased afterload
Correct Answer: Negative inotropy
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium-channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.
The following summarises the toxicity of calcium-channel blockers:
Cardiac effects
Vascular smooth muscle tone affects
Metabolic effects
Excessive negative inotropy: myocardial depression
Negative chronotropy: sinus bradycardia
Negative dromotropy: atrioventricular node blockade
Decreased afterload
Systemic hypotension
Coronary vasodilation
Hypoinsulinaemia
Calcium channel blocker-induced insulin resistance -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 6
Incorrect
-
In adult basic life support, chest compressions should be performed at which of the following rates:
Your Answer: 90 - 100 per minute
Correct Answer: 100 - 120 per minute
Explanation:Chest compressions should be performed at a rate of 100 – 120 per minute.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 7
Correct
-
Question 8
Correct
-
Which of these is NOT a lithium side effect:
Your Answer: Peptic ulcer disease
Explanation:Adverse Effects of lithium Include
Leucocytosis (most patients)
Polyuria/polydipsia (30-50%)
Dry mouth (20-50%)
Hand tremor (45% initially, 10% after 1 year of treatment)
Confusion (40%)
Decreased memory (40%)
Headache (40%)
Muscle weakness (30% initially, 1% after 1 year of treatment)
Electrocardiographic (ECG) changes (20-30%)
Nausea, vomiting, diarrhoea (10-30% initially, 1-10% after 1-2 years of treatment)
Hyperreflexia (15%)
Muscle twitch (15%)
Vertigo (15%)
Extrapyramidal symptoms, goitre (5%)
Hypothyroidism (1-4%)
Acne (1%)
Hair thinning (1%) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 9
Correct
-
Molecules with a molecular weight of less than which of the following are filtered freely at the glomerular filtration barrier:
Your Answer: 7000 Da
Explanation:Molecular weight is the main factor in determining whether a substance is filtered or not – molecules < 7 kDa in molecular weight are filtered freely e.g. glucose, amino acids, urea, ions but larger molecules are increasingly restricted up to 70 kDa, above which filtration is insignificant. Negatively charged molecules are further restricted, as they are repelled by negative charges, particularly in the basement membrane. Albumin has a molecular weight of 69 kDa and is negatively charged, thus only very small amounts are filtered (and all of the filtered albumin is reabsorbed in the proximal tubule), whereas small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. This means that ultrafiltrate is virtually protein free, but otherwise has an identical composition of that of plasma. The epithelial lining of the Bowman's capsule consists of a single layer of cells called podocytes. The glomerular capillary endothelium is perforated by pores (fenestrations) which allow plasma components with a molecular weight of < 70 kDa to pass freely.
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 10
Incorrect
-
A 57-year-old male presents to the orthopaedic clinic complaining of pain and swelling in the left knee joint. On examination, the left knee is swollen, tender and erythematous. The patient is booked for joint aspiration, and a diagnosis of pseudogout is made following the aspiration.
Which types of crystals would be seen in the joint aspirate to lead to this diagnosis?Your Answer: Amorphous crystals
Correct Answer: Positively birefringent brick-shaped crystals
Explanation:Gout and pseudogout are both characterised by crystal deposition in the affected joints. The deposition of urate crystals causes gout, while calcium pyrophosphate crystals cause pseudogout. The crystals can be distinguished microscopically because urate crystals are negatively birefringent needle-shaped crystals, whilst calcium pyrophosphate crystals are positively birefringent brick-shaped crystals.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 11
Correct
-
Mast cells play a significant part in which of the following?
Your Answer: Allergic disease
Explanation:Mast cells play a central role in the response to allergen challenges. The activation of mast cells results in both an early and a delayed phase of inflammation. Mast cells have been implicated in both physiologic and pathogenic processes. Mast cells are important in defence against some bacteria and viruses and contribute to defence against parasites. They are key effector cells in both innate and acquired immunity and are capable of inducing and amplifying both types of responses. Specifically, mast cells are capable of detecting microbial products through surface pattern recognition receptors, and they are involved in the recruitment of other leukocytes, containment of bacterial infections, and tissue repair.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 12
Incorrect
-
A 72-year-old man presents with chest pain that is characteristic of angina. You administer a dose of glyceryl trinitrate (GTN), which rapidly resolved his symptoms. Unfortunately, he also develops an unpleasant side effect.
Which of the following side effects is he most likely to have developed? Select ONE answer only.Your Answer: Syncope
Correct Answer: Headache
Explanation:Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.
The following are common or very common side effects of nitrates
Arrhythmias
Asthenia
Cerebral ischaemia
Dizziness
Drowsiness
Flushing
Headache
Hypotension
Nausea and vomiting
Diarrhoea, syncope and cyanosis can occur, but these are rare side effects. Dry eyes, bradycardia and metabolic acidosis have not been reported. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 13
Correct
-
A lung function test is being performed on a male patient. For this patient, which of the following volumes for functional residual capacity is considered a normal result?
Your Answer: 2.0 L
Explanation:The volume of air that remains in the lungs after a single breath is known as functional residual capacity (FRC). It is calculated by combining the expiratory reserve volume and residual volume. In a 70 kg, average-sized male, a normal functional residual capacity is approximately 2100 mL.
-
This question is part of the following fields:
- Physiology
- Respiratory Physiology
-
-
Question 14
Incorrect
-
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 colloid intravenous infusion over 10 - 15 minutes
Correct 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 15
Incorrect
-
Which of the following muscles acts as an extensor of the shoulder joint?
Your Answer: Short head of biceps brachii
Correct Answer: Teres major
Explanation:The glenohumeral joint possesses the capability of allowing an extreme range of motion in multiple planes.
Flexion – Defined as bringing the upper limb anterior in the sagittal plane. The usual range of motion is 180 degrees. The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.
Extension—Defined as bringing the upper limb posterior in a sagittal plane. The normal range of motion is 45 to 60 degrees. The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.
Internal rotation—Defined as rotation toward the midline along a vertical axis. The normal range of motion is 70 to 90 degrees. The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.
External rotation – Defined as rotation away from the midline along a vertical axis. The normal range of motion is 90 degrees. Primarily infraspinatus and teres minor are responsible for the motion.
Adduction – Defined as bringing the upper limb towards the midline in the coronal plane. Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.
Abduction – Defined as bringing the upper limb away from the midline in the coronal plane. The normal range of motion is 150 degrees. Due to the ability to differentiate several pathologies by the range of motion of the glenohumeral joint in this plane of motion, it is essential to understand how different muscles contribute to this action.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 16
Correct
-
Regarding folate requirements, which of the following statements is CORRECT:
Your Answer: Dietary folate is found particularly in leafy green vegetables and liver.
Explanation:Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time. -
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 17
Correct
-
Which of the following is the most common cause of hyperthyroidism:
Your Answer: Graves disease
Explanation:Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disease in which autoantibodies against TSH receptors are produced. These antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Therefore, the signs and symptoms of Graves disease are the same as those of hyperthyroidism, reflecting the actions of increased circulating levels of thyroid hormones: increased heat production, weight loss, increased 02 consumption and cardiac output and exophthalmos (bulging eyes, not drooping eyelids). TSH levels will be decreased (not increased) as a result of the negative feedback effect of increased T3 levels on the anterior pituitary.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 18
Incorrect
-
Which of the following statements regarding forest plots is true? Select ONE answer only.
Which of the following statements regarding forest plots is true? Select ONE answer only.Your Answer: The meta-analysed measure of effect is plotted as a square
Correct Answer: Larger studies are associated with smaller horizontal lines
Explanation:Forest plots are graphical displays designed to illustrate the relative strength of treatment effects in multiple individual studies addressing the same question.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 19
Incorrect
-
Which of the following is NOT a typical side effect of digoxin:
Your Answer: Gynaecomastia
Correct Answer: Hypokalaemia
Explanation:Digoxin does not cause hypokalaemia, but hypokalaemia does potentiate digoxin toxicity. The adverse effects of digoxin are frequently due to its narrow therapeutic window and include:
Cardiac adverse effects – Sinoatrial and atrioventricular block, Premature ventricular contractions, PR prolongation and ST-segment depression
Nausea, vomiting and diarrhoea
Blurred or yellow vision
CNS effects – weakness, dizziness, confusion, apathy, malaise, headache, depression, psychosis
Thrombocytopenia and agranulocytosis (rare)
Gynaecomastia in men in prolonged administration -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 20
Incorrect
-
A 40-year-old woman presents with a red, scaly, itchy rash around her navel that occurred after contact with a nickel belt buckle. A diagnosis of allergic contact dermatitis is made. Which type of hypersensitivity reaction is this?
Your Answer: Type II hypersensitivity reaction
Correct Answer: Type IV hypersensitivity reaction
Explanation:A type IV hypersensitivity reaction occurred in this patient. Allergic contact dermatitis is an inflammatory skin reaction occurring in response to an external stimulus, acting either as an allergen or an irritant, caused by a type IV or delayed hypersensitivity reaction. They usually take several days to develop.
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 21
Incorrect
-
The sensory innervation of the oropharynx is provided by which of the following nerves:
Your Answer: Vagus nerve
Correct Answer: Glossopharyngeal nerve
Explanation:Each subdivision of the pharynx has a different sensory innervation:the nasopharynx is innervated by the maxillary nervethe oropharynx is innervated by the glossopharyngeal nervethe laryngopharynx is innervated by the vagus nerve.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 22
Correct
-
A patient suffers an injury to the nerve that innervates gluteus medius.​
The gluteus medius muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer: Superior gluteal nerve
Explanation:Gluteus minimus is innervated by the superior gluteal nerve.
Gluteus medius is innervated by the superior gluteal nerve.
Gluteus maximus is innervated by the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 23
Incorrect
-
Which of the following ABO blood groups is the universal recipient:
Your Answer: None of the above
Correct Answer: AB
Explanation:Blood group AB has both A and B antigens but no antibodies and thus is the universal recipient.
-
This question is part of the following fields:
- Immune Responses
- Pathology
-
-
Question 24
Incorrect
-
Many of the chemical digestion and absorption takes place in the small intestine. Most digestive enzymes in the small intestine are secreted by the pancreas and enter the small intestine through the pancreatic duct.
Which of these digestive enzymes is responsible for breaking down carbohydrates into monosaccharides?Your Answer: Carboxypeptidase
Correct Answer: Glucoamylase
Explanation:Majority of carbohydrates are broken down into monosaccharides (glucose, fructose galactose) and are absorbed by the small intestine. Enzymes released from the brush border break down carbohydrate. Some carbohydrates, such as cellulose, are not digested at all, despite being made of multiple glucose units. This is because the cellulose is made out of beta-glucose that makes the inter-monosaccharide bindings different from the ones present in starch, which consists of alpha-glucose. Humans lack the enzyme for splitting the beta-glucose-bond.
The principal brush border enzymes are dextranase and glucoamylase. Other brush border enzymes are maltase, sucrase, and lactase.
Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Dextranase and glucoamylase, then further break down oligosaccharides.
Trypsin aids in digestion of protein.
Chymotrypsin is a proteolytic enzyme that digests protein
Carboxypeptidase hydrolyses the first peptide or amide bond at the carboxyl or C-terminal end of proteins and peptides
-
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
-
-
Question 25
Incorrect
-
A 22 year old male has been stabbed and is brought to the ED with a stab wound to his upper limb. On examination, the patient is unable to flex the distal interphalangeal joints of the ring and little finger. However, the proximal interphalangeal joint is intact. The most likely affected nerve is which of the following, and at which level is this occurring?
Your Answer: Ulnar nerve at wrist
Correct Answer: Ulnar nerve at elbow
Explanation:The medial half of the flexor digitorum profundus is innervated by the ulnar nerve. Paralysis of this muscle results in loss of flexion at the distal interphalangeal joint of the ring and little finger.
Flexion at the proximal interphalangeal joint is preserved as this is a function of the flexor digitorum superficialis which is innervated by the median nerve.
The ulnar nerve is not correct as ulnar nerve injury at the wrist would not affect the long flexors, and the injury must have been more proximal. -
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 26
Incorrect
-
The following structures all lie anteriorly to the oesophagus EXCEPT for the:
Your Answer: Left recurrent laryngeal nerve
Correct Answer: Thoracic duct
Explanation:Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 27
Incorrect
-
Regarding probability distribution, which of the following statements is CORRECT:
Your Answer: In skewed data the mean is usually equal to the mode.
Correct Answer: In a negative skew, the mass of distribution is concentrated on the right.
Explanation:Distribution of data is usually unimodal (one peak) but may be bimodal (two peaks) or uniform (no peaks, each value equally likely). The normal distribution is a symmetrical bell-shaped curve. The mean, median, and mode of a normal distribution are equal. In a positive skew, the right tail is longer and the mass of distribution is concentrated on the left; mean > median > mode. In a negative skew, the left tail is longer and the mass of distribution is concentrated on the right; mean < median < mode.
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 28
Incorrect
-
A patient presents with a necrolytic migratory rash. Her blood serum glucagon concentration is 1246 pg/mL. Following further investigations, she is diagnosed with glucagonoma.
Which SINGLE statement regarding glucagon is true?Your Answer: It inhibits glycogenolysis
Correct Answer: It makes fatty acids available for oxidation
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.
-
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 29
Correct
-
Regarding Clostridium difficile, which of the following statements is CORRECT:
Your Answer: It is normally found in gut flora.
Explanation:C. difficile is normally found in the gut flora but its growth is normally suppressed by more dominant anaerobes. It has exotoxin-mediated effects causing profuse diarrhoea. Oral clindamycin (a broad spectrum antibiotic) is commonly implicated in precipitating C. difficile colitis; first line treatment is with oral metronidazole. Tetanolysin is a toxin produced by Clostridium tetani bacteria.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 30
Incorrect
-
A patient with diplopia is found to have eye deviation downwards and outwards. The likely nerves that are affected are:
Your Answer: Abducens nerve
Correct Answer: Oculomotor nerve
Explanation:The results of an oculomotor (CN III) nerve palsy are a depressed and abducted (down and out) eye, ptosis, diplopia, and a fixed and dilated pupil.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
SESSION STATS - PERFORMANCE PER SPECIALTY
