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Question 1
Correct
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A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.
Which of the following nerves has been damaged in this case? Select ONE answer only.Your Answer: The median nerve
Explanation:Flexor carpi radialis is innervated by the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 2
Incorrect
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Regarding the penis, which of the following statements is CORRECT:
Your Answer: Sensation to the penis is supplied by the genital branch of the genitofemoral nerve.
Correct Answer: The corpus spongiosum is ventral in the erect penis.
Explanation:Because the anatomical position of the penis is erect, the paired corpora cavernosa are defined as dorsal in the body of the penis and the single corpus spongiosum as ventral. The nerves and vessels lie superficial to the corpus cavernosum. The urethra lies within the corpus spongiosum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 3
Incorrect
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A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.
Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?Your Answer:
Correct Answer: ORT is sugar-free
Explanation:One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status.
Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries.
Some characteristics of Oral rehydration solutions are:
– slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.
– contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia.
– also contains essential mineral saltsCurrent NICE guidance recommends that 50 ml/kg is given over 4 hours to treat mild dehydration.
Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool. -
This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 4
Incorrect
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A 34-year-old man presented to the emergency room after being involved in a road traffic accident. Upon observation and examination, it was noted that he was hypotensive and has muffled heart sounds. It was suspected that he has pericardial effusion, so an emergency pericardiocentesis was to be performed.
In performing pericardiocentesis for suspected pericardial effusion, which of the following anatomical sites are at risk of being punctured?Your Answer:
Correct Answer: 1 cm below the left xiphocostal angle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.
In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle.
The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 5
Incorrect
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A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.
Which of the following muscles is most likely to be involved? Select ONE answer only.Your Answer:
Correct Answer: Sternothyroid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
Contents:
Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 6
Incorrect
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Where on the body is the radial artery pulsation best palpated?
Your Answer:
Correct Answer: At the wrist just lateral to the flexor carpi radialis tendon
Explanation:The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 7
Incorrect
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Regarding gas exchange at the alveolar-capillary membrane, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Transfer of oxygen is usually perfusion-limited.
Explanation:Gas exchange between alveolar air and blood in the pulmonary capillaries takes place by diffusion across the alveolar-capillary membrane. Diffusion occurs from an area of high partial pressure to an area of low partial pressure, thus the driving force for diffusion is the alveolar-capillary partial pressure gradient. Diffusion occurs until equilibrium is reached, but random movement of particles continues to occur and this is known as dynamic equilibrium. The diffusing capacity for oxygen (DLO2) cannot be measured directly but the rate of diffusion in the lungs can be estimated by measuring the diffusing capacity of the lungs for carbon monoxide (DLCO), not by measuring total lung capacity. The rate of transfer of a gas may be diffusion or perfusion limited; carbon monoxide transfer is diffusion-limited, oxygen transfer is usually perfusion-limited.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 8
Incorrect
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Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:
Your Answer:
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.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 9
Incorrect
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Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Anti-D antibodies are usually IgG.
Explanation:Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 10
Incorrect
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Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?
Your Answer:
Correct Answer: The lateral spinothalamic tract
Explanation:The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 11
Incorrect
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Which of the following neurotransmitter and receptor combinations is present at the neuromuscular junction:
Your Answer:
Correct Answer: Acetylcholine acting at nicotinic receptors
Explanation:At the neuromuscular junction, acetylcholine is released from the prejunctional membrane which acts on cholinergic nicotinic receptors on the postjunctional membrane.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 12
Incorrect
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Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?
Your Answer:
Correct 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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 13
Incorrect
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A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a course of antibiotics
Which of the antibiotics listed below is MOST likely to be the cause?Your Answer:
Correct Answer: Ciprofloxacin
Explanation:Tendinopathy and spontaneous tendon rupture are caused by fluoroquinolones, which are an uncommon but well-known cause. Tendon problems caused by fluoroquinolones are expected to affect 15 to 20 people per 100,000. Patients over the age of 60 are most likely to develop them.
It usually affects the Achilles tendon, but it has also been described in cases involving the quadriceps, peroneus brevis, extensor pollicis longus, long head of biceps brachii, and rotator cuff tendons. The exact aetiology is uncertain, although the fluoroquinolone medication is thought to obstruct collagen activity and/or cut off blood supply to the tendon.
Other factors linked to tendon rupture spontaneously include:
Gout
Treatment with corticosteroids
Hypercholesterolaemia
Long-term dialysis
Kidney transplant
Rheumatoid arthritis -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 14
Incorrect
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Liquefactive necrosis is most commonly seen in which of the following conditions:
Your Answer:
Correct Answer: Ischaemic stroke
Explanation:Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 15
Incorrect
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What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer:
Correct 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 16
Incorrect
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A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that she has a full, plethoric aspect to her face, as well as significant supraclavicular fat pads, when you examine her. She has previously been diagnosed with Cushing's syndrome.
Cushing's syndrome is most commonly caused by which of the following?Your Answer:
Correct Answer: Iatrogenic administration of corticosteroids
Explanation:Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.
Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome. Cushing’s illness is the second most prevalent cause of Cushing’s syndrome. Cushing’s disease is distinct from Cushing’s syndrome in that it refers to a single cause of the illness, a pituitary adenoma that secretes high quantities of ACTH, which raises cortisol levels.
Cushing’s syndrome has several endogenous sources, including:
Cushing’s disease is caused by a pituitary adenoma.
Adrenal adenoma Ectopic corticotropin syndrome, e.g. small cell cancer of the lung
Adrenal carcinoma is a cancer of the adrenal gland.
Hyperplasia of the adrenal glands -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 17
Incorrect
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A 30-year old male is taken to the emergency room after suffering a blunt trauma to the abdomen. He is complaining of severe abdominal pain, however all his other vital signs remain stable. A FAST scan is performed to assess for hemoperitoneum.
If hemoperitoneum is present, it is most likely to be observed in which of the following areas?Your Answer:
Correct Answer: Liver
Explanation:The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%.
The FAST exam evaluates four regions for pathologic fluid: (1) the right upper quadrant, (2) the subxiphoid (or subcostal) view, (3) the left upper quadrant, and (4) the suprapubic region.
The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The probe is positioned in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The hand is placed against the bed to ensure visualization of the retroperitoneal kidney. The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Recent retrospective evidence suggests the area along the caudal edge of the left lobe of the liver has the highest sensitivity, exceeding 93%.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 18
Incorrect
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The hypothalamus produces antidiuretic hormone (ADH), also known as vasopressin, which is a peptide hormone. It is important for maintaining water and electrolyte balance, as well helping control arterial pressure.
To have an effect on blood arteries, ADH binds to which of the following receptors?Your Answer:
Correct Answer: V 1 receptor
Explanation:ADH, or antidiuretic hormone, is a hormone that regulates water and electrolyte balance. It is released in response to a variety of events, the most important of which are higher plasma osmolality or lower blood pressure. ADH increases plasma volume and blood pressure via acting on the kidneys and peripheral vasculature.
It causes vasoconstriction by binding to peripheral V1 Receptors on vascular smooth muscle via the IP3 signal transduction and Rho-kinase pathways. The systemic vascular resistance and arterial pressure rise as a result. High levels of ADH appear to be required for this to have a major impact on arterial pressure, such as in hypovolaemic shock.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 19
Incorrect
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Which of the following muscles laterally rotates the hip?
Your Answer:
Correct Answer: Gluteus maximus
Explanation:External (lateral) rotation at the hip joint is produced by the gluteus maximus together with a group of 6 small muscles (lateral rotators): piriformis, obturator internus, superior and inferior gemelli, quadratus femoris and obturator externus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 20
Incorrect
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Digoxin is predominantly used for which of the following:
Your Answer:
Correct Answer: Rate control in persistent and permanent atrial fibrillation
Explanation:Digoxin is most useful for controlling the ventricular response in persistent and permanent atrial fibrillation and atrial flutter. Digoxin is usually only effective for controlling the ventricular rate at rest, and should therefore only be used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation. It is now rarely used for rapid control of heart rate, as even with intravenous administration, response may take many hours. Digoxin is reserved for patients with worsening or severe heart failure due to left ventricular systolic dysfunction refractory to combination therapy with first-line agents. Digoxin is contraindicated in supraventricular arrhythmias 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 21
Incorrect
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Which of the following organelles form lysosomes?
Your Answer:
Correct Answer: The Golgi apparatus
Explanation:Lysosomes are formed by the Golgi apparatus or the endoplasmic reticulum. Lysosome releases its enzymes and digests the cell when the cell dies.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 22
Incorrect
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An arterial blood gas test is performed to a 25-year-old students who presents with confusion, headache, nausea and malaise. The results show that carbon monoxide levels are significantly high. Which of the following carbon monoxide poisoning assertions is true?
Your Answer:
Correct Answer: The PO 2 of the blood in CO poisoning can be normal
Explanation:By combining with haemoglobin to form carboxyhaemoglobin, carbon monoxide (CO) disrupts the blood’s oxygen transport function. CO binds to haemoglobin with a 240-fold higher affinity than oxygen. As a result, even small amounts of CO can bind a large portion of the blood’s haemoglobin, making it unavailable for oxygen transport.
During a suspected carbon monoxide poisoning, the blood PO2 and haemoglobin concentrations will be normal, but the oxygen concentration will be drastically reduced. The oxygen dissociation curve will also shift to the left in the presence of Carboxyhaemoglobin ( haemoglobin and carbon monoxide combination), interfering with oxygen unloading.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 23
Incorrect
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What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer:
Correct Answer: Beta1-receptor agonist
Explanation:Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 24
Incorrect
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A patient suffers a stab wound to the neck. The entry point of the blade is situated within the posterior triangle of the neck.
Which of the following muscles is most likely to be involved? Select ONE answer only.Your Answer:
Correct Answer: Anterior scalene
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
Contents:
Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus
Of the muscles listed in the options, only the anterior scalene is situated within the posterior triangle of the neck. -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 25
Incorrect
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A 30-year-old male presents with easy bruising and bleeding gums, feeling very tired lately, and recurrent chest infections over the past few months. He had glandular fever approximately 6 months ago and feels that his symptoms started after that.
His full blood count today is as follows:
Hb 6.3 g/dl (11.5-14 g/dl)
MCV 90 fl (80-100 fl)
WCC 2.0 x 10 9 /l (4-11 x 10 9 /l)
Platelets 15 x 10 9 /l (150-450 x 10 9 /l)
The SINGLE most likely diagnosis is?Your Answer:
Correct Answer: Aplastic anaemia
Explanation:Aplastic anaemia is a life-threatening failure of haemopoiesis characterised by pancytopenia and hypocellular bone marrow. It is rare and patients present with features of recurrent infections secondary to (leukocytopenia), increased bleeding tendency (secondary to thrombocytopenia) and anaemia. In aplastic anaemia, there is damage to the bone marrow and the haematopoietic stems cells leading to pancytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 26
Incorrect
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Naloxone is a reversal agent for which of the following groups of drugs:
Your Answer:
Correct Answer: Opioids
Explanation:Naloxone is a specific antagonist of mu(μ)-opioid receptors, the specific antidote for opioid overdose and will reverse respiratory depression and coma if given at sufficient dosage. The initial dose is usually 0.8 mg (2 mL) intravenously (the dose range suggested by BNF is 0.4-2 mg). It can also be given by intramuscular injection if the intravenous route is not feasible.
As naloxone has a shorter duration of action than most opioids, close monitoring and repeated injections are necessary according to the respiratory rate and depth of coma. The dose is generally repeated every 2-3 minutes to a maximum of 10 mg. When repeated doses are needed, naloxone may be given by a continuous infusion adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
In opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 27
Incorrect
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Which of the following increases the tendency for oedema to occur?
Your Answer:
Correct Answer: Increased venous pressure
Explanation:When more fluid is filtered out of the capillaries than can be returned to the circulation by the lymphatics, oedema occurs. Changes that increase capillary hydrostatic pressure or decrease plasma oncotic pressure will increase filtration.
Arteriolar constriction reduces hydrostatic capillary pressure and transiently increase absorption of fluid.
Dehydration increases plasma protein concentration and therefore increases plasma oncotic pressure and absorption. Capillary hydrostatic pressure and filtration are increased when there is increased venous pressure. -
This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 28
Incorrect
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Regarding platelets, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Platelets are produced in the bone marrow by fragmentation of the cytoplasm of megakaryocytes.
Explanation:Platelets are produced in the bone marrow by fragmentation of the cytoplasm of megakaryocytes, derived from the common myeloid progenitor cell. The time interval from differentiation of the human stem cell to the production of platelets averages 10 days. Thrombopoietin is the major regulator of platelet formation and 95% of this is produced by the liver. The normal platelet count is approximately 150 – 450 x 109/L and the normal platelet lifespan is 10 days. Under normal circumstances, about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 29
Incorrect
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Regarding shingles, which of the following statements is CORRECT:
Your Answer:
Correct Answer: You can catch chickenpox from a patient with shingles.
Explanation:After primary infection, VZV remains latent in sensory ganglia and in about 20% of patients will reactivate resulting in shingles, a painful vesicular rash in the related dermatome. Shingles usually affects older people and the immunocompromised. Shingles lesions are infectious to non-immune individuals who are at risk of developing chickenpox. Shingles can not be contracted directly from chickenpox, or from other cases of shingles. Shingles is treated with systemic antiviral treatment to reduce the severity and duration of pain, reduce complications, and reduce viral shedding.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 30
Incorrect
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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:
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
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Question 31
Incorrect
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Achlorhydria is diagnosed in a 37-year-old individual who has had recurring episodes of gastroenteritis. This is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production.
Damage to stomach parietal cells will alter the secretion of which other substance?Your Answer:
Correct Answer: Intrinsic factor
Explanation:Achlorhydria is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production. The parietal cells that have been injured are unable to create the necessary amount of stomach acid. As a result, the pH of the stomach rises, food digestion suffers, and the risk of gastroenteritis rises.
The secretion of hydrochloric acid and intrinsic factor is controlled by the gastric parietal cells, which are epithelial cells in the stomach. These cells can be found in the gastric glands, the fundus lining, and the stomach body.
In response to the following three stimuli, the stomach parietal cells release hydrochloric acid:
H2 Histamine receptors are stimulated by histamine (most significant contribution)
Acetylcholine stimulates M3 Receptors via parasympathetic action.
CCK2 receptors are stimulated by Gastrin.Intrinsic factor, which is essential for vitamin B12 absorption, is also produced by stomach parietal cells.
Omeprazole is a proton pump inhibitor that is both selective and irreversible. It inhibits the H+/K+-ATPase system present on the secretory membrane of gastric parietal cells, which lowers stomach acid secretion.
Ranitidine inhibits histamine H2-receptors in a competitive manner. The reversible inhibition of H2-receptors in gastric parietal cells reduces both the volume and concentration of gastric acid. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 32
Incorrect
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Which of the following statements about neutrophils is TRUE:
Your Answer:
Correct Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.
Explanation:Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.
The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 33
Incorrect
-
Regarding propofol, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: A lower induction dose of propofol is required in children.
Explanation:Elderly patients have a reduced volume of distribution and slower clearance of the drug. They are therefore more sensitive to the effects of propofol and the drug wears off more slowly. They need less of the drug, which should be injected slowly, monitoring its effect on the patient. The opposite is true in children, who need larger doses of propofol. This is particularly so in children under three years of age. Propofol is not recommended for induction of anaesthesia in children under one month of age or for maintenance of anaesthesia in children under three years old.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 34
Incorrect
-
Which of the following is NOT an adverse effect of amitriptyline:
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Adverse effects include:
Antimuscarinic effects: Dry mouth, Blurred vision, Constipation, Urinary retention, Sedation, Confusion
Cardiovascular effects: Heart block, Arrhythmias, Tachycardia, Postural hypotension, QT-interval prolongation, Hepatic impairment, Narrow-angle glaucoma -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 35
Incorrect
-
A patient suffers from an injury to his hip and thigh. As a consequence of his injury, the nerve that was damaged innervates the obturator externus muscle.
In which of the following nerves is the obturator externus muscle innervated by?Your Answer:
Correct Answer: Posterior branch of the obturator nerve
Explanation:The obturator externus is innervated by the posterior branch of the obturator nerve, L2-L4.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 36
Incorrect
-
Regarding benzodiazepines, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Diazepam is a short-acting benzodiazepine.
Explanation:Diazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration. Midazolam is a water-soluble benzodiazepine that is often used in preference to intravenous diazepam; recovery is faster than from diazepam, but may be significantly longer in the elderly, in patients with a low cardiac output, or after repeated dosing. Midazolam is associated with profound sedation when high doses are given intravenously or when it is used with certain other drugs.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 37
Incorrect
-
A mother has serious concerns about vaccinating her child. She has read about many contraindications and risks in the papers and would like to discuss them with you.
One of these is a valid contraindication to vaccination.
Your Answer:
Correct Answer: None of the other options
Explanation:The options listed in this question are not true contraindications to vaccination. Therefore, the correct answer is ‘none of the other options’.
The contraindications to vaccination are:
Confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.
A confirmed anaphylactic reaction to another component in the vaccine. -
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 38
Incorrect
-
Mannitol is primarily indicated for which of the following:
Your Answer:
Correct Answer: Cerebral oedema
Explanation:Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. Mannitol is a low molecular weight compound and is, therefore, freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain-barrier (BBB).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 39
Incorrect
-
Which of the following laboratory findings are suggestive of functional hyposplenism:
Your Answer:
Correct Answer: Howell-Jolly bodies
Explanation:Functional hyposplenism is characterised by the blood film findings of Howell-Jolly bodies or siderotic granules on iron staining. The most frequent cause is surgical removal of the spleen e.g. after traumatic rupture, but hyposplenism can also occur in sickle cell anaemia, gluten-induced enteropathy, amyloidosis and other conditions.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 40
Incorrect
-
Which one of the listed cells are typically found in a granuloma?
Your Answer:
Correct Answer: Epithelioid cells
Explanation:Typically, a granuloma has Langhan’s cells (large multinucleated cells) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.
Antigen presenting monocytic cells are found in the skin are known as Langerhan’s cells.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 41
Incorrect
-
The following all cause a right shift in the oxygen dissociation curve EXCEPT for:
Your Answer:
Correct Answer: Foetal haemoglobin
Explanation:A decreased affinity of haemoglobin for oxygen (and hence increased ease of dissociation), shown by a right shift in the oxygen dissociation curve, is caused by a fall in pH, a rise in PCO2(the Bohr effect) and an increase in temperature. These changes occur in metabolically active tissues such as in exercise, and encourage oxygen release. The metabolic by-product 2,3-diphosphoglycerate (2,3 -DPG) also causes a right shift; 2, 3 -DPG may also be raised in chronic anaemia, chronic lung disease, or at high altitude. Foetal haemoglobin (HbF) binds 2, 3 -DPG less strongly than does adult haemoglobin (HbA), and so the HbF dissociation curve lies to the left of that for HbA, reflecting its higher oxygen affinity. This helps transfer oxygen from mother to foetus.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 42
Incorrect
-
Which of the following is NOT a typical clinical feature of beta-thalassaemia major:
Your Answer:
Correct Answer: Increased bleeding tendency
Explanation:Features include:
– severe anaemia (becoming apparent at 3 – 6 months when the switch from gamma-chain to beta-chain production takes place)
– failure to thrive
– hepatosplenomegaly (due to excessive red cell destruction, extramedullary haemopoiesis and later due to transfusion related iron overload)
– expansion of bones (due to marrow hyperplasia, resulting in bossing of the skull and cortical thinning with tendency to fracture)
– increased susceptibility to infections (due to anaemia, iron overload, transfusion and splenectomy)
– osteoporosis
– hyperbilirubinaemia and gallstones
– hyperuricaemia and gout
– other features of haemolytic anaemia
– liver damage and other features of iron overload -
This question is part of the following fields:
- Haematology
- Pathology
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Question 43
Incorrect
-
Which of the following clinical features would you NOT expect to see in a tibial nerve palsy:
Your Answer:
Correct Answer: Weakened eversion of the foot
Explanation:Damage to the tibial nerve results in loss of plantarflexion of the ankle and weakness of inversion of the foot resulting in a shuffling gait, clawing of the toes and loss of sensation in its cutaneous distribution.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 44
Incorrect
-
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:
Correct 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 45
Incorrect
-
This anatomic part lies at the heart of the tooth.
Your Answer:
Correct Answer: The pulp cavity
Explanation:Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 46
Incorrect
-
Regarding hepatitis A, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Anti-HAV IgM antibodies are diagnostic.
Explanation:Anti-HAV IgM antibodies are diagnostic. Disease in children is more commonly asymptomatic, risk of symptomatic disease increases with age. Transmission is by the faecal-oral route. Faecal shedding has been demonstrated for 2 – 3 weeks before and about a week after, the onset of jaundice. Infection confers lifelong immunity.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 47
Incorrect
-
A 38-year-old woman is investigated for Addison's disease. She had low blood pressure, weakness, weight loss, and skin discoloration. An adrenocorticotropic hormone (ACTH) stimulation test is scheduled as part of her treatment.
Which of the following statements about ACTH is correct?Your Answer:
Correct Answer: It is released in response to the release of CRH
Explanation:The anterior pituitary gland produces and secretes a peptide hormone called adrenocorticotropic hormone (ACTH) (adenohypophysis). It is secreted in response to the hypothalamus’s secretion of the hormone corticotropin-releasing hormone (CRH).
ACTH promotes cortisol secretion via binding to cell surface ACTH receptors in the zona fasciculata of the adrenal cortex.
ACTH also promotes the production of beta-endorphin, which is a precursor to melanocyte-releasing hormone (MRH).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 48
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.
At the moment, he is completely symptom-free. When it comes to this type of overdose, how long does it usually take for symptoms to appear?Your Answer:
Correct Answer: 1-2 hours
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.
>10 tablets of verapamil (160 mg or 240 mg immediate or sustained-release capsules) or diltiazem can cause serious toxicity (180 mg, 240 mg or 360 mg immediate or sustained-release capsules)
In children, 1-2 tablets of verapamil or diltiazem (immediate or sustained-release)
Symptoms usually appear within 1-2 hours of ingestion with standard preparations. However, with slow-release preparations, significant toxicity may take 12-16 hours to manifest, with peak effects occurring after 24 hours.
The following are the main clinical features of calcium-channel blocker overdose:
Nausea and vomiting
Hypotension
Bradycardia and first-degree heart block
Myocardial ischaemia and stroke
Renal failure
Pulmonary oedema
HyperglycaemiaThe following are some of the most important bedside investigations to conduct:
Blood glucose
ECG
Arterial blood gas
Other investigations that can be helpful include
Urea & electrolytes
Chest X-ray (pulmonary oedema)
Echocardiography -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 49
Incorrect
-
Which of the following movements is controlled by the pectoralis major muscle?
Your Answer:
Correct Answer: Flexion, adduction and medial rotation of the humerus
Explanation:The pectoralis major is a muscle that runs across the top of the chest and connects to a ridge on the back of the humerus (the bone of the upper arm).
Adduction, or lowering, of the arm (opposed to the deltoideus muscle) and rotation of the arm forward around the axis of the body are two of its main functions.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 50
Incorrect
-
Which of the following muscles acts as an extensor of the shoulder joint?
Your Answer:
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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 51
Incorrect
-
Dexamethasone would be most useful for which of the following conditions:
Your Answer:
Correct Answer: Raised intracranial pressure secondary to malignancy
Explanation:Dexamethasone has a very high glucocorticoid activity in conjunction with insignificant mineralocorticoid activity. This makes it particularly suitable for high-dose therapy in conditions where fluid retention would be a disadvantage such as in the management of raised intracranial pressure or cerebral oedema secondary to malignancy. Dexamethasone also has a long duration of action and this, coupled with its lack of mineralocorticoid action makes it particularly suitable for suppression of corticotropin secretion in congenital adrenal hyperplasia. In most individuals a single dose of dexamethasone at night, is sufficient to inhibit corticotropin secretion for 24 hours. This is the basis of the ‘overnight dexamethasone suppression test’ for diagnosing Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 52
Incorrect
-
A patient is complaining of painless jaundice. His bilirubin levels are abnormally high.
Which of the following statements about bile is correct?Your Answer:
Correct Answer: Bile acids are amphipathic
Explanation:The liver produces bile on a constant basis, which is then stored and concentrated in the gallbladder. In a 24-hour period, around 400 to 800 mL of bile is generated.
Bile is involved in the following processes:
Fats are broken down into fatty acids.
Waste products are eliminated.
Cholesterol homeostasis is the balance of cholesterol in the body.The enteric hormones cholecystokinin and secretin are primarily responsible for bile secretion. When chyme from an unprocessed meal enters the small intestine, they are released, and they play the following function in bile secretion and flow:
Cholecystokinin promotes gallbladder and common bile duct contractions, allowing bile to reach the intestine.
Secretin enhances the secretion of bicarbonate and water by biliary duct cells, increasing the amount of bile and its flow into the gut.Bile acids have a hydrophobic and hydrophilic area, making them amphipathic. Bile acids’ amphipathic nature allows them to perform the following crucial functions:
Emulsification of lipid aggregates increases the surface area of fat and makes it easier for lipases to digest it.
Lipid solubilization and transport: solubilizes lipids by creating micelles, which are lipid clumps that float in water. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 53
Incorrect
-
Contraction of the diaphragm results in which of the following effects:
Your Answer:
Correct Answer: Increased vertical dimension of the thorax
Explanation:Contraction of the diaphragm (as in inspiration) results in flattening (depression) of the diaphragm with an increase in vertical dimension of the thorax. This results in decreased intrathoracic pressure and increased intra-abdominal pressure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 54
Incorrect
-
Which of the following statements is correct with regards to immunoglobulin?
Your Answer:
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 55
Incorrect
-
The primary mechanism of action of ketamine is:
Your Answer:
Correct Answer: N-methyl-D-aspartate (NMDA)-receptor antagonist
Explanation:Ketamine is a non-competitive antagonist of the calcium-ion channel in the NMDA (N-methyl-D-aspartate) receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
Overdose may lead to panic attacks and aggressive behaviour; rarely seizures, increased ICP, and cardiac arrest
Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 56
Incorrect
-
For which of the following is micelle formation necessary to facilitate intestinal absorption?
Your Answer:
Correct Answer: Vitamin D
Explanation:The arrangement of micelles is such that hydrophobic lipid molecules lie in the centre, surrounded by hydrophilic bile acids that are arranged in the outer region. This arrangement allows the entry of micelles into the aqueous layers surrounding the microvilli. As a result, the products of fat digestion (fatty acids and monoglycerides), cholesterol and fat-soluble vitamins (such as vitamin D) can then diffuse passively into the enterocytes. The bile salts are left within the lumen of the gut where they are reabsorbed from the ileum or excreted in faeces.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 57
Incorrect
-
A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.
Which of the following statements about antipsychotic drug side effects is correct?Your Answer:
Correct Answer: Haloperidol is the most common causative antipsychotic drug
Explanation:Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.
Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.
Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.
An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.
Renal impairment causes increased cerebral sensitivity, so lower doses should be used.
In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.
The following are some of the antipsychotic drugs’ contraindications:
Reduced level of consciousness/coma
Depression of the central nervous system
Phaeochromocytoma -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 58
Incorrect
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Question 59
Incorrect
-
A 42-year-old woman with a history of hyposplenism arrives at the Emergency Department sick and feverish. A complete set of bloods, including a peripheral blood film, is organised.
On a hyposplenic blood film, which of the following features is LEAST likely to be seen?Your Answer:
Correct Answer: Teardrop cells
Explanation:The collection of abnormalities found in these patients is referred to as a hyposplenic film.
The following features can be seen on hyposplenic blood films:
Howell-Jolly bodies
Heinz’s bodies
Target cells
RBCs with nuclei on occasion
Lymphocytosis
Macrocytosis
Acanthocytes
Teardrop cells, also known as dacrocytes, are named for their teardrop-shaped shape.Dacrocytosis is a condition in which a large number of these cells are present. Myelofibrosis and beta thalassemia major both have dacrocytes, but hyposplenism does not.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 60
Incorrect
-
Regarding iron handling, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).
Explanation:Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 61
Incorrect
-
Normal human immunoglobulin is mostly used to protect against which of the following infectious diseases?
Your Answer:
Correct Answer: Measles and hepatitis A
Explanation:Immune globulin IM is indicated for prophylaxis following exposure
to hepatitis A, to prevent or modify measles (rubeola) in a
susceptible person exposed fewer than 6 days previously,
for susceptible household contacts of measles patients,
particularly contacts <1 year and pregnant women without
evidence of immunity, and to modify rubella in exposed pregnant
women who will not consider a therapeutic abortion. -
This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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Question 62
Incorrect
-
A 64-year-old man presents with an acute episode of gout. He has a history of chronic heart failure and hypertension. His current medications include ramipril and furosemide.
Which of the following statements regarding the treatment of gout is true? Select ONE answer only.Your Answer:
Correct Answer: Colchicine has a role in prophylactic treatment
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs. -
This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 63
Incorrect
-
A patient presents with a history of renal problems, generalised weakness and palpitations. Her serum potassium levels are measured and come back at 6.2 mmol/L. An ECG is performed, and it shows some changes that are consistent with hyperkalaemia.
Which of the following ECG changes is usually the earliest sign of hyperkalaemia? Select ONE answer only.Your Answer:
Correct Answer: Peaked T waves
Explanation:Hyperkalaemia causes a rapid reduction in resting membrane potential leading to increased cardiac depolarisation and muscle excitability. This in turn results in ECG changes which can rapidly progress to ventricular fibrillation or asystole. Very distinctive ECG changes that progressively change as the K+level increases:
K+>5.5 mmol/l – peaked T waves (usually earliest sign of hyperkalaemia), repolarisation abnormalities
K+>6.5 mmol/l – P waves widen and flatten, PR segment lengthens, P waves eventually disappear
K+>7.0 mmol/l – Prolonged QRS interval and bizarre QRS morphology, conduction blocks (bundle branch blocks, fascicular blocks), sinus bradycardia or slow AF, development of a sine wave appearance (a pre-terminal rhythm)
K+>9.0 mmol/l – Cardiac arrest due to asystole, VF or PEA with a bizarre, wide complex rhythm. -
This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 64
Incorrect
-
Which of the following is NOT a common side effect of antihistamines:
Your Answer:
Correct Answer: Tremor
Explanation:Common side effects of antihistamines may include:
Anticholinergic effects (blurred vision, dry mouth, urinary retention)
Headache
Gastrointestinal disturbances
Psychomotor impairment (sedation, dizziness and loss of appetite)
These side effects are significantly reduced with second-generation agents. -
This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 65
Incorrect
-
Which of these is NOT a naturally occurring anticoagulant:
Your Answer:
Correct Answer: Factor V Leiden
Explanation:It’s crucial that thrombin’s impact is restricted to the injured site. Tissue factor pathway inhibitor (TFPI), which is produced by endothelial cells and found in plasma and platelets, is the first inhibitor to function. It accumulates near the site of harm induced by local platelet activation. Xa and VIIa, as well as tissue factor, are inhibited by TFPI. Other circulating inhibitors, the most potent of which is antithrombin, can also inactivate thrombin and other protease factors directly. Coagulation cofactors V and VIII are inhibited by protein C and protein S. Tissue plasminogen activator (TPA) from endothelial cells facilitates fibrinolysis by promoting the conversion of plasminogen to plasmin.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 66
Incorrect
-
A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.
Which of these anatomic structures is the most superficial structure injured in the case above?Your Answer:
Correct Answer: Camper’s fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:
Skin
Fatty layer of the superficial fascia (Camper’s fascia)
Membranous layer of the superficial fascia (Scarpa’s fascia)
Aponeurosis of the external and internal oblique muscles
Rectus abdominis muscle
Aponeurosis of the internal oblique and transversus abdominis
Fascia transversalis
Extraperitoneal fat
Parietal peritoneum -
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 67
Incorrect
-
Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer:
Correct Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 68
Incorrect
-
By the third day of wound healing, which sort of inflammatory cell has predominated:
Your Answer:
Correct Answer: Macrophages
Explanation:The inflammatory phase of healing is sometimes called the lag phase because wound strength does not begin to return immediately. The inflammatory phase is completed within three days except in the presence of infection or other factors associated with impaired wound healing. Mononuclear leukocytes accumulate and are transformed into macrophages. The maturation of blood-derived monocytes into macrophages is heralded by several events, including secretion of vimentin, which is a structural filament protein involved in wound healing.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 69
Incorrect
-
In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic is a protein synthesis inhibitor.
Which of the following antimicrobial drugs is prescribed to this patient?Your Answer:
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 preventing initiation of protein synthesis.
Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.
Penicillins and cephalosporins are the major antibiotics that inhibit bacterial cell wall synthesis. They inactivate transpeptidases that help cross-link peptidoglycans in cell walls.
Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.
Ciprofloxacin inhibits prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 70
Incorrect
-
A young farmer who is caught under farm machinery and suffering from a major crush injury is taken to the emergency department and requires a quick induction sequence. In this type of injury, which of the following anaesthetic medicines should be avoided?
Your Answer:
Correct Answer: Suxamethonium
Explanation:Suxamethonium is a neuromuscular blocker. It is contraindicated in patients who have experienced massive trauma, hyperkalemic, or burn injuries.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 71
Incorrect
-
During swallowing, which of the following structures primarily closes the tracheal opening:
Your Answer:
Correct Answer: Epiglottis
Explanation:The vocal cords of the larynx are strongly
approximated, and the larynx is pulled upward
and anteriorly by the neck muscles. These actions,
combined with the presence of ligaments that
prevent upward movement of the epiglottis, cause
the epiglottis to swing back over the opening
of the larynx. All these effects acting together
prevent the passage of food into the nose and
trachea. Most essential is the tight approximation
of the vocal cords, but the epiglottis helps to
prevent food from ever getting as far as the vocal
cords. Destruction of the vocal cords or of the
muscles that approximate them can cause
strangulation. -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 72
Incorrect
-
You are giving a teaching session to a group of final year medical students regarding lower limb neurology. Which of the following clinical features would be expected in an obturator nerve palsy:
Your Answer:
Correct Answer: Weakness of hip adduction
Explanation:Damage to the obturator nerve results in weak adduction of the hip with lateral swinging of the limb during walking due to unopposed abduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 73
Incorrect
-
Myocardial contractility is best correlated with the intracellular concentration of:
Your Answer:
Correct Answer: Ca2+
Explanation:Contractility of myocardial cells depends on the intracellular [Ca2+], which is regulated by Ca2+entry across the cell membrane during the plateau of the action potential and by Ca2+uptake into and release from the sarcoplasmic reticulum (SR).
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 74
Incorrect
-
The sensory innervation of the oropharynx is provided by which of the following nerves:
Your Answer:
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.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 75
Incorrect
-
Cardiac muscle and skeletal muscle are alike, but there are a few key variations.
Which of the following is NOT a characteristic of skeletal muscle but is a characteristic of cardiac muscle?Your Answer:
Correct Answer: The presence of intercalated discs
Explanation:Cardiac muscle is striated, and the sarcomere is the contractile unit, similar to skeletal muscle. Contracture is mediated by the interaction of calcium, troponins, and myofilaments, much as it occurs in skeletal muscle. Cardiac muscle, on the other hand, differs from skeletal muscle in a number of ways.
In contrast to skeletal muscle cells, cardiac myocytes have a nucleus in the middle of the cell and sometimes two nuclei. The cells are striated because the thick and thin filaments are arranged in an orderly fashion, although the arrangement is less well-organized than in skeletal muscle.
Intercalated discs, which work similarly to the Z band in skeletal muscle in defining where one cardiac muscle cell joins the next, are a very significant component of cardiac muscle.
Adherens junctions and desmosomes, which are specialized structures that hold the cardiac myocytes together, are formed by the transverse sections. The lateral sections produce gap junctions, which join the cytoplasm of two cells directly, allowing for rapid action potential conduction. These critical properties allow the heart to contract in a coordinated manner, allowing for more efficient blood pumping.
Cardiac myocytes have the ability to create their own action potentials, which is referred to as myogenic’. They can depolarize spontaneously to initiate a cardiac action potential. Pacemaker cells, as well as the sino-atrial (SA) and atrioventricular (AV) nodes, control this.
The Purkinje cells and the cells of the bundle of His are likewise capable of spontaneous depolarization. While the bundle of His is made up of specialized myocytes, it’s vital to remember that Purkinje cells are not myocytes and have distinct characteristics. They are larger than myocytes, with fewer filaments and more gap junctions than myocytes. They conduct action potentials more quickly, allowing the ventricles to contract synchronously.
Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 76
Incorrect
-
Since the fluid that enters the loop of Henle is isotonic, what is its estimated osmolality?
Your Answer:
Correct Answer: 300 mOsm
Explanation:The loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It is consists of three major segments, the thin descending limb, the thin ascending limb, and the thick ascending limb.
The segments are differentiated based on structure, anatomic location, and function. The main action of the loop of Henle is to recover water and sodium chloride from urine. The liquid entering the loop of Henle is a solution of salt, urea, and other substances traversed along by the proximal convoluted tubule, from which most of the dissolved components are needed by the body, particularly glucose, amino acids, and sodium bicarbonate that have been reabsorbed into the blood.
This fluid is isotonic. Isotonic fluids generally have an osmolality ranging from 270 to 310 mOsm/L. With the fluid that enters the loop of Henle, it is estimated to be 300 mOsm/L. However, after passing the loop, fluid entering the distal tubule is hypotonic to plasma since it has been diluted during its passage.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 77
Incorrect
-
Question 78
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:
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.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 79
Incorrect
-
Clostridium difficile primarily causes which of the following infectious diseases:
Your Answer:
Correct Answer: Pseudomembranous colitis
Explanation:Clostridium difficile causes pseudomembranous colitis, an acute inflammatory diarrhoeal disease and an important cause of morbidity and mortality in hospitals. Gas gangrene is primarily caused by Clostridium perfringens. Tetanus is caused by Clostridium tetani. Toxic shock syndrome may be caused by Staphylococcus aureus or Streptococcus pyogenes. Necrotising fasciitis is most commonly caused by Streptococcus pyogenes but has a multitude of causes.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 80
Incorrect
-
A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?
Your Answer:
Correct Answer: Atenolol
Explanation:Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels.
This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific.
They have a lower effect on airway resistance, although they are not without this adverse effect.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 81
Incorrect
-
A 20-year-old patient had sustained a supracondylar fracture due to falling from a skateboard. The frequency of acute nerve injuries accompanying supracondylar humeral fractures ranges from 10 to 20%. The most common complication is injury to which nerve?
Your Answer:
Correct Answer: Median nerve
Explanation:According to various studies, the frequency of acute nerve damage associated with supracondylar humeral fractures in children ranges from 10% to 20%.
Median nerve injury and anterior interosseous nerve injury are the most common consequences.
Damage to this nerve indicated weakening or abnormal extension of the index finger’s distal interphalangeal joint and the thumb’s interphalangeal joint. The absence of sensibility is a distinguishing attribute.
A surgical neck humerus fracture may cause injury to the axillary nerve. A midshaft humerus fracture might cause injury to the radial nerve. A medial epicondylar fracture might cause injury to the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 82
Incorrect
-
A patient presents to your clinic with fever of unknown origin. His blood results shows a markedly elevated C-Reactive Protein (CRP) level.
Which of these is responsible for mediating the release of CRP?
Your Answer:
Correct Answer: IL-6
Explanation:C-reactive protein (CRP) is an acute phase protein produced by the liver hepatocytes. Its production is regulated by cytokines, particularly interleukin 6 (IL-6) and it can be measured in the serum as a nonspecific marker of inflammation.
Although a high CRP suggest an acute infection or inflammation, it does not identify the cause or location of infection.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 83
Incorrect
-
A patient presents with haemoptysis, weight loss, and night sweats. You suspect he may have tuberculosis. He works at an asylum seeker hostel, and has not received a BCG vaccination. In which of the following patient groups would the BCG vaccine be safe to administer?
Your Answer:
Correct Answer: The patient is asplenic
Explanation:Persons with chronic diseases. Persons with chronic renal disease or undergoing dialysis, and those with hyposplenism or asplenia, may receive BCG vaccine if indicated.
Only 2 absolute contraindications apply to all vaccines:
- anaphylaxis following a previous dose of the relevant vaccine
- anaphylaxis following any component of the relevant vaccine
2 further contraindications apply to live vaccines (both parenteral and oral):
- People who are significantly immunocompromised should not receive live vaccines. This is regardless of whether the immunocompromising condition is caused by disease or treatment.
- Pregnant women should not receive live vaccines, in general. Women should be advised not to become pregnant within 28 days of receiving a live vaccine.
Use of live vaccines in people who are immunocompromised:
People who are immunocomprised are at risk of adverse events or vaccine-related disease if they receive a live vaccine.Live vaccines include:
BCG (bacille Calmette–Guérin) vaccine
oral cholera vaccine (Vaxchora)
Some Japanese encephalitis virus vaccines
MMR (measles-mumps-rubella) vaccine
rotavirus vaccine
oral typhoid vaccine
varicella vaccine
yellow fever vaccine
zoster vaccine (Zostavax) -
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 84
Incorrect
-
Which of the following infections is vancomycin most likely prescribed for?
Your Answer:
Correct Answer: Clostridium difficile colitis
Explanation:125 mg PO q6hr for 10 days is indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhoea
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 85
Incorrect
-
Regarding the foetal oxygen-haemoglobin dissociation curve, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The HbF dissociation curve lies to the left of that for HbA.
Explanation:Foetal haemoglobin (HbF) has a higher affinity for oxygen than adult haemoglobin (HbA) because it’s gamma chains bind 2,3-DPG less avidly than beta chains of HbA. The HbF dissociation curve lies to the left of that for HbA. In the placenta PCO2moves from the foetal to the maternal circulation, shifting the maternal curve further right and the foetal curve further left (the double Bohr effect). The higher affinity of HbF relative to HbA helps transfer oxygen from mother to foetus. Therefore even through blood returning from the placenta to the foetus in the umbilical vein has a PO2of only about 4 kPa, its saturation is 70%. Oxygen transport in the foetus is also helped by a high Hb of about 170 – 180 g/L.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 86
Incorrect
-
A 21-year-old student presents to the minors area of your Emergency Department with a laceration on his external nose that occurred during sparring in a kickboxing class. The area is bleeding profusely and will require suturing. Pressure is being applied. The laceration extends through some of the nasal muscles.
Motor innervation of the nasal muscles of facial expression is provided by which of the following ? Select ONE answer only.Your Answer:
Correct Answer: Facial nerve
Explanation:The facial nerve (the labyrinthine segment) is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.
Motor innervation of the nasal muscles of facial expression is provided by the facial nerve (CN VII). -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 87
Incorrect
-
Regarding NSAIDs, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Diclofenac is contraindicated in people with ischaemic heart disease.
Explanation:Due to their increased risk of cardiovascular adverse events, coxibs and diclofenac are contraindicated in people with ischaemic heart disease, cerebrovascular disease, peripheral arterial disease and mild, moderate, or severe heart failure. Other NSAIDs are only contraindicated in people with severe heart failure. Selective inhibition of COX-2 is associated with less gastrointestinal intolerance. In single doses NSAIDs have analgesic activity comparable to that of paracetamol, therefore given their side effect profile, paracetamol is preferred, particularly in the elderly. Pain relief starts soon after taking the first dose and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to 3 weeks. Mefenamic acid has only very mild anti-inflammatory properties.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 88
Incorrect
-
Which of the following statements is correct with regards to natural killer cells?
Your Answer:
Correct Answer: They are part of the innate immune system.
Explanation:Natural Killer (NK) Cells are lymphocytes in the same family as T and B cells, which come from a common progenitor. They are cytotoxic CD8 positive cells that do not have the T-cell receptor. They are very big cells with cytoplasmic granules and are designed to kill target cells with a low level of expression of HLA class I molecules.
Examples include during a viral infection or on a malignant cell. NK cells display several receptors for HLA molecules on their surface, and when HLA is expressed on the target cell, these deliver an inhibitory signal into the NK cell. Absent HLA molecules on the target cell cause this inhibitory signal to get lost and as a result, the NK cell can then kill its target. Also, NK cells display antibody-dependent cell-mediated cytotoxicity, where antibody binds to antigen on the surface of the target cell. The NK cells then bind to the Fc portion of the bound antibody and kill the target cell. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 89
Incorrect
-
On review of a patient's serum and urine osmolality test result, you note that both osmolarities are decreased. There urine osmolality does not increase with fluid ingestion.
What is the most likely cause?Your Answer:
Correct Answer: Hyponatraemia
Explanation:As part of the investigation of hyponatraemia, serum osmolality is commonly requested in combination with urine osmolality to aid diagnosis.
When:
Serum osmolality is decreased and urine osmolality is decreased with no intake of fluid, the causes are
Hyponatraemia
Overhydration
Adrenocortical insufficiency
Sodium loss (diuretic or a low-salt diet)Serum osmolality is normal or increased and urine osmolality is increased the causes include:
Dehydration
Hyperkalaemia
Hyperglycaemia
Hyponatremia
Mannitol therapy
Diabetes mellitus
Alcohol ingestion
Congestive heart failure
Renal disease and uraemiaSerum osmolality is normal or increased and urine osmolality is decreased the usual cause is diabetes insipidus
Serum osmolality is decreased and urine osmolality is increased the usual cause is syndrome of inappropriate antidiuresis (SIAD)
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 90
Incorrect
-
Regarding Clostridium species, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: They are facultative anaerobes.
Explanation:Clostridium spp. are obligatory anaerobic spore-forming Gram-positive bacilli. Toxin production is the main pathogenicity mechanism.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 91
Incorrect
-
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:
Correct 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 92
Incorrect
-
You're a member of the cardiac arrest team, and you're helping to resuscitate an elderly gentleman who had collapsed at home. The team leader requests that you administer an adrenaline shot.
Which of the following statements about adrenaline is FALSE?Your Answer:
Correct Answer: The IM dose in anaphylaxis is 1 ml of 1:1000
Explanation:Adrenaline (epinephrine) is a sympathomimetic amine that binds to alpha- and beta-adrenergic receptors and acts as an agonist. It is active at both alpha and beta receptors in roughly equal amounts.
When taken orally, it becomes inactive. Subcutaneous absorption is slower than intramuscular absorption. In cardiac arrest, it is well absorbed from the tracheal mucosa and can be given through an endotracheal tube.
At the adrenergic synapse, catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) metabolise it primarily. The inactive products are then passed through the kidneys and excreted in the urine.
In adult cardiac arrest, the IV dose is 1 mg, which is equal to 10 ml of 1:10000 or 1 ml of 1:1000. In anaphylaxis, the IM dose is 0.5 ml of 1:1000. (500 mcg).
In open-angle glaucoma, adrenaline causes mydriasis and lowers pressure.
Adrenaline is used in cardiopulmonary resuscitation, the treatment of severe croup, and the emergency management of acute allergic and anaphylactic reactions (as a nebuliser solution).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 93
Incorrect
-
The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.
Which of the following patients has had adequate tetanus protection?Your Answer:
Correct Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin
Explanation:25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.
Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.
8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:
The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:
A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:
In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:
Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations. -
This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 94
Incorrect
-
A 36 year old man who is overweight with a history of gout, presents to emergency room with an acutely painful big toe which is red, hot and swollen. However, he is apyrexic and otherwise systemically well. He has been diagnosed with acute gout. The most appropriate first line treatment for him is which of the following?
Your Answer:
Correct Answer: NSAIDs
Explanation:The first line treatment for acute gout includes NSAIDs like diclofenac, indomethacin or naproxen. In patients in whom NSAIDs are contraindicated, not tolerated or ineffective, colchicine is an alternative. In those who cannot tolerate or who are resistant to NSAIDs and colchicine, oral or parenteral corticosteroids are an effective alternative. In acute monoarticular gout, intra-articular injection of a corticosteroid can be used occasionally. In acute gout. allopurinol is not used in the actual treatment, but its use should be continued during an acute attack if the patient is already established on long term therapy.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 95
Incorrect
-
For an action potential to occur, which of the following must be true:
Your Answer:
Correct Answer: Depolarisation of the membrane must reach threshold potential
Explanation:For an action potential to occur, the membrane must become more permeable to Na+and the Na+influx must be greater than the K+efflux. An action potential occurs when depolarisation of the membrane reaches threshold potential. The membrane must be out of the absolute refractory period, however an action potential can still occur in a relative refractory period but only in response to a larger than normal stimulus.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 96
Incorrect
-
All of the following statements are considered true regarding likelihood ratios, except:
Your Answer:
Correct Answer: If less than one, indicates that the information increases the likelihood of the suspected diagnosis
Explanation:The Likelihood Ratio (LR) is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.
The LR is used to assess how good a diagnostic test is and to help in selecting an appropriate diagnostic tests or sequence of tests. They have advantages over sensitivity and specificity because they are less likely to change with the prevalence of the disorder, they can be calculated for several levels of the symptom/sign or test, they can be used to combine the results of multiple diagnostic test and they can be used to calculate post-test probability for a target disorder.
A LR greater than 1 produces a post-test probability which is higher than the pre-test probability. An LR less than 1 produces a post-test probability which is lower than the pre-test probability. When the pre-test probability lies between 30 and 70 per cent, test results with a very high LR (say, above 10) rule in disease. An LR below 1 produces a post-test probability les than the pre-test probability. A very low LR (say, below 0.1) virtually rules out the chance that the patient has the disease.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 97
Incorrect
-
An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.
Which of the following valve disorders is an absolute contraindication to the use of GTN?Your Answer:
Correct Answer: Mitral stenosis
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.
Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
1. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension
2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)
3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)The nitrate drugs cause vasodilation via the action of nitric oxide.
The contraindications to the use of nitrate are the following:
1. Allergy to nitrates
2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil
3. Right ventricular infarction
4. Hypertrophic cardiomyopathy
5. Cardiac tamponade
6. Constrictive pericarditis
7. Hypotensive conditions
8. Hypovolaemia
9. Marked anaemia
10. Mitral stenosis
11. Raised intracranial pressure due to cerebral haemorrhage or head trauma
12. Toxic pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 98
Incorrect
-
Which of the following is NOT a typical electrolyte disturbance caused by furosemide:
Your Answer:
Correct Answer: Hypercalcaemia
Explanation:Adverse effects of loop diuretics include:
Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathy
Hyperglycaemia
Acute urinary retention
Water and electrolyte imbalance
Hyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolism
Metabolic alkalosis
Hyperuricaemia
Blood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)
Visual disturbance, tinnitus and deafness
Hypersensitivity reactions -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 99
Incorrect
-
A 30-year-old man suffers from an open fracture of his forearm. As a consequence of his injury, the nerve that innervates the pronator quadratus muscle was severed.
Which of the following statements regarding the pronator quadratus muscle is considered correct?Your Answer:
Correct Answer: Its deep fibres bind the radius and ulna together
Explanation:Pronator quadratus is a deep-seated, short, flat, and quadrilateral muscle with fibres running in a parallel direction.
It arises from the oblique ridge on the anterior surface of the distal fourth of the Ulna. It is inserted in lateral border and anterior surface of the distal fourth of the radius. It is innervated by the anterior interosseous nerve, a branch of the median nerve (C8-T1). It is vascularized by the anterior interosseous artery.
The action of the pronator quadratus muscle along with the pronator teres result in the pronation of the radioulnar joint. Contraction of this muscle pulls the distal end of the radius over the ulna, resulting in the pronation of the radioulnar joint
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 100
Incorrect
-
A 25-year-old guy who has had a knee-high plaster cast on his left leg for the past 5 weeks arrives at the emergency department complaining of numbness on the dorsum of his left foot and an inability to dorsiflex or evert his foot. You know that his symptoms are due to fibular nerve compression. Where is the fibular nerve located?
Your Answer:
Correct Answer: Neck of fibula
Explanation:Dorsiflexion and eversion of the foot are innervated by the deep fibular nerve and the superficial fibular nerve, respectively.
The common fibular nerve runs obliquely downward along the lateral border of the popliteal fossa (medial to the biceps femoris) before branching at the neck of the fibula.
Thus, it is prone to being affected during an impact injury or fracture to the bone or leg. Casts that are placed too high can also compress the fibular nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 101
Incorrect
-
You come across a 60-year-old woman with a history of chronic pancreatitis. Today she is complaining of epigastric pain. She has blood tests done especially to review her cholecystokinin levels.
Which of the following is a cholecystokinin (CCK) releasing site?Your Answer:
Correct Answer: I-cells in the upper small intestine
Explanation:The I-cells in the duodenum generate and release cholecystokinin (CCK), a peptide hormone. It has a crucial role in the digestion process as a hormonal regulator.
CCK cells are concentrated in the proximal small intestine, and when food is consumed, the hormone is produced into the bloodstream. The presence of partly digested lipids and proteins in the duodenum is one of the most powerful stimulus for CCK synthesis.
CCK’s key physiological effects include:
Encourages the pancreas to release digesting enzymes into the small intestine.
Stimulates gallbladder contraction and sphincter of Oddi relaxation, resulting in bile delivery into the duodenum.
Gastric emptying is inhibited, and gastric acid output is reduced.
Satiety induction is a process that involves inducing a feeling of fullness. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 102
Incorrect
-
A 1-year-old male is brought to the paediatrician by his mother due to swelling of the right knee after a minor fall. On examination, the right knee is swollen, fluctuant and tender. Ultrasound-guided aspiration reveals a massive hemarthrosis. Family history shows that his older brother also has a bleeding disorder.
Which one of the following conditions does the patient most likely have?Your Answer:
Correct Answer: Haemophilia A
Explanation:A diagnosis of Haemophilia is supported in this patient by the family history and the presence of hemarthrosis-both characteristics of Haemophilia. Haemophilia A is caused by Factor VIII deficiency, leading to impaired coagulation. This disease typically presents after six months when the child starts crawling.
Von Willebrand disease presents with nosebleeds and hematomas. Idiopathic thrombocytopenic purpura presents with bruises that resemble a rash.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency presents with haemolytic anaemia induced by specific drugs or foods.
Factor V Leiden mutation causes blood clotting rather than bleeding.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 103
Incorrect
-
Which of the following is most likely to cause a bitemporal hemianopia:
Your Answer:
Correct Answer: Pituitary adenoma
Explanation:A bitemporal hemianopia is most likely due to compression at the optic chiasm. This may be caused by pituitary tumour, craniopharyngioma, meningioma, optic glioma or aneurysm of the internal carotid artery. A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 104
Incorrect
-
Herpes simplex virus is transmitted most commonly through which of the following routes:
Your Answer:
Correct Answer: Direct contact spread
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.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 105
Incorrect
-
Regarding the varicella zoster virus, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Contracting chickenpox infection while pregnant is associated with a higher risk of developing varicella pneumonitis.
Explanation:Chickenpox infection in neonates, adults/adolescents and pregnant women is associated with more severe disease. Varicella zoster pneumonitis typically occurs in pregnant women or immunocompromised individuals and is associated with a high mortality. A live attenuated-virus vaccine is available and recommended for non-immune healthcare workers but is not part of the routine childhood immunisation schedule. Antiviral treatment is not typically recommended in childhood chickenpox but is indicated for shingles.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 106
Incorrect
-
The Auerbach's plexus is a set of ganglia that controls peristalsis and is located in the gut wall.
Auerbach's plexus is located in which layer of the gut wall?Your Answer:
Correct Answer: Muscular layer
Explanation:The Auerbach’s plexus, also known as the myenteric plexus, is a collection of ganglia that controls peristalsis and is located in the gut wall.
In the muscular layer of the wall, it is located between the circular and longitudinal muscle layers. It is a linear network of linked neurons that runs the length of the gastrointestinal system. The myenteric plexus generates an increase in gut wall tone and the strength of rhythmical contractions when stimulated.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 107
Incorrect
-
A 29-year-old woman presents with night sweats, fever, and haemoptysis. A diagnosis of tuberculosis was suspected.
Which of the following statements regarding the diagnosis of tuberculosis is considered correct?Your Answer:
Correct Answer: Mycobacteria tuberculosis can be typed using a RFLP method
Explanation:Although a variety of clinical specimens may be submitted to the
laboratory to recover MTB and NTM, respiratory secretions such
as sputum and bronchial aspirates are the most common. An
early-morning specimen should be collected on three consecutive
days, although recent studies have suggested that the addition of
a third specimen does not significantly increase the sensitivity
of detecting Mycobacteria.Mycobacterium tuberculosis appear red on acid-fast staining because they take up the primary stain, which is carbolfuchsin, and is not decolorized by the acid alcohol anymore.
Culture on Lowenstein-Jensen medium should be read within 5 to 7 days after inoculation and once a week thereafter for up to 8 weeks.
Nucleic acid amplification assays designed to detect M. tuberculosis complex
bacilli directly from patient specimens can be performed in as little as 6 to 8 hours on processed specimens. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 108
Incorrect
-
A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke.
Which of the following is considered the best diagnosis for the case presented above?Your Answer:
Correct Answer: Medial medullary syndrome
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.
It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 109
Incorrect
-
The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A CT head scan is performed, and the diagnosis of an ischaemic stroke is confirmed. Her blood pressure is currently very high, with the most recent measurement being 196/124 mmHg, according to the nurse in charge. While you wait for the stroke team to review her, she asks you to prescribe something to help lower the patient's blood pressure.
Which of the following is the best drug treatment for this patient's BP reduction?Your Answer:
Correct Answer: Labetalol
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.
In the setting of a stroke syndrome (i.e., in the presence of focal neurological deficits), hypertensive emergencies usually necessitate a slower and more controlled blood pressure reduction than in other situations. Rapid reduction of MAP in the presence of an ischaemic stroke can compromise blood flow, leading to further ischaemia and worsening of the neurological deficit. In this situation, intravenous labetalol is the drug of choice for lowering blood pressure.
Significantly elevated blood pressure (>185/110 mmHg) is a contraindication to thrombolysis, but there is some evidence for controlling blood pressure before thrombolysis in exceptional circumstances, when it is only slightly above this threshold.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 110
Incorrect
-
You see a 63-year-old man with a history of melaena and epigastric discomfort. For a few months, he's been taking aspirin.
Which of the following statements about aspirin's mechanism of action is correct?Your Answer:
Correct Answer: It inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day)
Explanation:Aspirin inhibits cyclo-oxygenase irreversibly by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2. The production of prostaglandin and thromboxane is reduced as a result. As a result, platelet activation and aggregation are reduced. A single dose of aspirin has a half-life of 7-10 days, which is the time it takes for the bone marrow to produce new platelets.
Aspirin only inhibits COX-1, the enzyme that produces thromboxane A2, at low doses (75 mg per day), and thus has a primarily anti-thrombotic effect.
Aspirin inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day). COX-2 is involved in the production of prostaglandins, so it has an anti-inflammatory effect at these concentrations.
Aspirin, when used as an antipyretic for a viral illness in children, can cause Reye’s syndrome. Reye’s syndrome is a potentially fatal liver disease that causes encephalopathy and liver failure.
The inability of aspirin to reduce platelet production of thromboxane A2, and thus platelet activation and aggregation, is known as aspirin resistance. Although the exact frequency and mechanism of aspirin resistance are unknown, it is thought to affect about 1% of users. Women are more likely than men to experience this phenomenon.
According to new research, taking aspirin on a regular basis lowers the risk of colorectal cancer. It may also protect against cancers of the breast, bladder, prostate, and lungs.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 111
Incorrect
-
A patient suffers an injury to the nerve that innervates piriformis.
The piriformis muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Nerve to piriformis
Explanation:Piriformis is innervated by the nerve to piriformis, which is a direct branch from the sacral plexus (S1 and S2).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 112
Incorrect
-
What is the interquartile range of the following data set: 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70
Your Answer:
Correct Answer: 30
Explanation:5, 10, 15 /20, 25, 30 /35, 40, 45 /50, 60, 70
Sample size (n) = 12
Median = [(n+1)/2]th value
= (12+1)/2 = 6.5
= halfway between 6th and 7th value
= (30 +35)/2 = 32.5
The lower (first) quartile = halfway between 15 and 20
= 17.5
The upper (third) quartile = halfway between 45 and 50
= 47.5
The interquartile range is the difference between the upper quartile and lower quartile
= 47.5 – 17.5 = 30 -
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 113
Incorrect
-
Which of the following is typically used in diabetes mellitus as the cut-off to define hypoglycaemia?
Your Answer:
Correct Answer: < 4.0 mmol/L
Explanation:Hypoglycaemia is defined as plasma glucose of less than 4 mmol/L.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 114
Incorrect
-
A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?
Your Answer:
Correct Answer: Cranial diabetes insipidus
Explanation:Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes.
The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus.
By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone.
Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output.
Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 115
Incorrect
-
Regarding cellular respiration, which of the following statements is CORRECT:
Your Answer:
Correct Answer: When fats are used as the primary energy source, an excess of acetyl-CoA is produced.
Explanation:Cellular respiration is the process by which cells obtain energy in the form of adenosine triphosphate (ATP). ATP transfers chemical energy from the energy rich substances in the cell to the cell’s energy requiring reactions e.g. active transport, DNA replication and muscle contraction.Cellular respiration is essentially a three step process: 1) Glycolysis, 2)The Krebs cycle, 3)The electron transfer system.The main respiratory substrate used by cells is 6-carbon glucose. Fats and proteins can also be used as respiratory substrates. When fats are being used as the primary energy source, in the absence of glucose, an excess amount of acetyl-CoA is produced, and is converted into acetone and ketone bodies. This can occur in starvation, fasting or in diabetic ketoacidosis. Proteins are used as an energy source only if protein intake is very high, or if glucose and fat sources are depleted.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 116
Incorrect
-
Which of these drugs may reduce the efficacy of contraception?
Your Answer:
Correct Answer: Carbamazepine
Explanation:Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 117
Incorrect
-
A 52-year-old man develops pneumonia 3 days following an admission for investigation of chest pain. He has coarse left basal crackles and evidence of consolidation in the left lower lobe of chest X-ray. He has no known drug allergies.
According to the latest NICE guidelines, which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.Your Answer:
Correct Answer: Co-amoxiclav
Explanation:Nosocomial infections are defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital. Annually, this results in 5000 deaths with a cost to the National Health Service of a billion pounds. On average, a patient with hospital acquired infection spent 2.5-times longer in hospital, incurring additional costs of £3000 more than an uninfected patient. Intensive care units (ICU) have the highest prevalence of hospital-acquired infections in the hospital setting.
The current recommendations by NICE and the BNF on the treatment of hospital acquired pneumonia are:
Early onset infection(less than 5 days after admission to hospital): co-amoxiclav or cefuroxime for 7 days
Late-onset infection(more than 5 days after admission to hospital): an antipseudomonal penicillin (e.g. piperacillin with tazobactam), a broad-spectrum cephalosporin (e.g. ceftazidime), or a quinolone (e.g. ciprofloxacin)
If the patient developed a hospital-acquired pneumonia within 5 days of admission – co-amoxiclav would be the most appropriate choice.
If the patient has developed a hospital-acquired pneumonia > 5 days after admission – ciprofloxacin would be the most appropriate choice from the list of options available. -
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 118
Incorrect
-
In adults in the United Kingdom, which of the following pathogens is the most likely cause of viral infectious gastroenteritis:
Your Answer:
Correct Answer: Norovirus
Explanation:Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhoea in community settings. In the United Kingdom, norovirus has become the most common cause of gastroenteritis in adults and children since the introduction of rotavirus vaccination.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 119
Incorrect
-
Which of the following statements is correct with regards to Klebsiella spp?
Your Answer:
Correct Answer: They are typically associated with nosocomial infection.
Explanation:Klebsiella is a type of bacteria commonly found in nature. In humans, the bacteria are often present in parts of the digestive tract and respiratory flora, where they do not generally cause problems. They are anaerobic Gram-negative rods. They are usually opportunistic pathogens which cause nosocomial infections, the most common ones being pneumonia and UTI.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 120
Incorrect
-
A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.
Which drug is NOT likely to cause cholestatic jaundice out of the following?Your Answer:
Correct Answer: Isoniazid
Explanation:Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.
The drugs that cause cholestatic jaundice are the following:
1. Nitrofurantoin
2. Erythromycin
3. Cephalosporins
4. Verapamil
5. NSAIDs
6. ACE inhibitors
7. Tricyclic antidepressants
8. Phenytoin
9. Azathioprine
10. Carbamazepine
11. Oral contraceptive pills
12. Diazepam
13. Ketoconazole
14. Tamoxifen -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 121
Incorrect
-
ACE inhibitors are indicated for all of the following EXCEPT for:
Your Answer:
Correct Answer: Angina
Explanation:ACE inhibitors have many uses and are generally well tolerated. They are indicated for:
- Heart failure
- Hypertension
- Diabetic nephropathy
- Secondary prevention of cardiovascular events
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 122
Incorrect
-
Regarding endothelin-1, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Endothelin-1 release is inhibited by noradrenaline.
Explanation:Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 123
Incorrect
-
A 55-year-old woman with a known history of bronchiectasis has lung function testing carried out and is found to have significant airways obstruction.
Which of the following lung volumes or capacities is LEAST likely to be decreased in this case? Select ONE answer only.Your Answer:
Correct Answer: Functional residual capacity
Explanation:Obstructive lung disorders are characterised by airway obstruction. Many obstructive diseases of the lung result from narrowing of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself.
In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to <0.7.
Types of obstructive lung disorders include:
Chronic obstructive pulmonary disease (COPD)
Asthma
Bronchiectasis
The following table outlines the effects of obstructive lung disease on the various lung volumes and capacities:
Increased by obstructive lung disease
Decreased in obstructive lung disease
Total lung capacity (TLC)
Residual volume (RV)
Functional residual capacity (FRC) Residual volume/total lung capacity (RV/TLC) ratio
Vital capacity (VC)
Inspiratory capacity (IC)
Inspiratory reserve volume (IRV) Expiratory reserve volume (ERV)
According to the latestNICE guidelines(link is external), airflow obstruction is defined as follows:
Mild airflow obstruction = an FEV1of >80% in the presence of symptoms
Moderate airflow obstruction = FEV1of 50-79%
Severe airflow obstruction = FEV1of 30-49%
Very severe airflow obstruction = FEV1<30%. -
This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 124
Incorrect
-
All of the following cause bronchodilation, EXCEPT for:
Your Answer:
Correct Answer: Stimulation of irritant receptors
Explanation:Factors causing bronchodilation: Via beta2-adrenoceptors
Sympathetic stimulation:
Adrenaline (epinephrine)
Beta2-adrenergic agonists e.g. salbutamol
Anticholinergic and muscarinic antagonists e.g. ipratropium -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 125
Incorrect
-
A 61-year-old man complains of crushing chest pain that radiates to his left arm and jaw. An ECG is taken, and the lateral leads show extensive ST depression. His blood pressure is currently 190/123 mmHg, and as part of his treatment, you intend to begin drug therapy to lower it.
Which of the following is the INITIAL drug treatment for this patient's BP reduction?Your Answer:
Correct Answer: Glyceryl trinitrate
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.
In the presence of cardiac ischaemia, hypertensive emergencies require immediate treatment to prevent myocardial infarction.
Similarly, if myonecrosis occurs in the presence of an existing infarction, prompt treatment is required to prevent further myonecrosis. When thrombolysis is used as the primary reperfusion therapy for acute myocardial infarction, blood pressure control is especially important.
An intravenous nitrate is the drug of choice in this situation (e.g. GTN). These have a dual purpose in that they can help patients with ischaemic chest pain manage their symptoms. Because lowering blood pressure with nitrates isn’t always enough to achieve optimal results, intravenous beta-blockers are frequently used as a supplement. For this, intravenous atenolol and metoprolol are commonly used.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 126
Incorrect
-
Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer:
Correct Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 127
Incorrect
-
Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.
What is cyclizine's main mechanism of action?Your Answer:
Correct Answer: Antihistamine action
Explanation:Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 128
Incorrect
-
Question 129
Incorrect
-
An ambulance transports a 40-year-old man to the hospital. He ingested a significant amount of aspirin.
In the early stages of an aspirin overdose, which form of acid-base problem should you anticipate?Your Answer:
Correct Answer: Respiratory alkalosis
Explanation:When you take too much aspirin, you have a mix of respiratory alkalosis and metabolic acidosis. Respiratory centre stimulation produces hyperventilation and respiratory alkalosis in the early phases. The direct acid actions of aspirin tend to create a higher anion gap metabolic acidosis in the latter phases.
Below summarizes some of the most common reasons of acid-base abnormalities:Respiratory alkalosis:
– Hyperventilation (e.g. anxiety, pain, fever)
– Pulmonary embolism
– Pneumothorax
– CNS disorders (e.g. CVA, SAH, encephalitis)
– High altitude
– Pregnancy
– Early stages of aspirin overdoseRespiratory acidosis:
– COPD
– Life-threatening asthma
– Pulmonary oedema
– Respiratory depression (e.g. opiates, benzodiazepines)
– Neuromuscular disease (e.g. Guillain-Barré syndrome, muscular dystrophy
– Incorrect ventilator settings (hypoventilation)
– ObesityMetabolic alkalosis:
– Vomiting
– Cardiac arrest
– Multi-organ failure
– Cystic fibrosis
– Potassium depletion (e.g. diuretic usage)
– Cushing’s syndrome
– Conn’s syndromeMetabolic acidosis (with raised anion gap):
– Lactic acidosis (e.g. hypoxaemia, shock, sepsis, infarction)
– Ketoacidosis (e.g. diabetes, starvation, alcohol excess)
– Renal failure
– Poisoning (e.g. late stages of aspirin overdose, methanol, ethylene glycol)Metabolic acidosis (with normal anion gap):
– Renal tubular acidosis
– Diarrhoea
– Ammonium chloride ingestion
– Adrenal insufficiency -
This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 130
Incorrect
-
A 32 year old man is brought to ED having been thrown off his motorbike. Following initial resuscitation and ruling out life-threatening injuries, you establish the patient has weakness of hip flexion. Which of the following nerves has most likely been injured:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the hip is produced by the iliacus, the psoas major, the sartorius, rectus femoris and the pectineus muscles. The femoral nerve innervates the iliacus, pectineus, sartorius and quadriceps femoris muscles, and supplies skin on the anterior thigh, anteromedial knee and medial leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 131
Incorrect
-
Regarding ampicillin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Ampicillin may cause a widespread maculopapular rash in a patient with glandular fever.
Explanation:Ampicillin is a broad-spectrum antibiotic, active against certain Gram-positive and Gram-negative organisms but is inactivated by penicillinases (similar to amoxicillin in spectrum). Ampicillin is associated with high levels of resistance, therefore it is often not appropriate for blind treatment of infection. It is principally indicated for the treatment of exacerbations of chronic bronchitis and middle ear infections, both of which may be due to Streptococcus pneumoniae and H. influenzae, and for urinary tract infections.
Maculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; thus broad-spectrum penicillins should not be used for blind treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 132
Incorrect
-
Regarding the accessory nerve, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Accessory nerve palsy results in the inability to nod the head
Explanation:Accessory nerve palsy results in inability to shrug the shoulders and to rotate the head to look at the opposite side to the lesion.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 133
Incorrect
-
Which of the following clinical features is a feature of a chronic extravascular haemolytic anaemia:
Your Answer:
Correct Answer: Gallstones
Explanation:Clinical features of haemolytic anaemia include:
Anaemia
Jaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)
Pigment gallstones
Splenomegaly
Ankle ulcers
Expansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia major
Aplastic crisis caused by parvovirus -
This question is part of the following fields:
- Haematology
- Pathology
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Question 134
Incorrect
-
Identify the type of graph described below:
This graph is a scatter plot of the effect estimates from individual studies against some measure of each study's size or precision.
Your Answer:
Correct Answer: Funnel plot
Explanation:A funnel plot is a scatter plot of the effect estimates from individual studies against some measure of each study’s size or precision. The standard error of the effect estimate is often chosen as the measure of study size and plotted on the vertical axis with a reversed scale that places the larger, most powerful studies towards the top. The effect estimates from smaller studies should scatter more widely at the bottom, with the spread narrowing among larger studies. In the absence of bias and between study heterogeneity, the scatter will be due to sampling variation alone and the plot will resemble a symmetrical inverted funnel. A triangle centred on a fixed effect summary estimate and extending 1.96 standard errors either side will include about 95% of studies if no bias is present and the fixed effect assumption (that the true treatment effect is the same in each study) is valid.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 135
Incorrect
-
A 12-year-old boy presents to you with a history of fever. A rash began as small red dots on the face, scalp, torso, upper arms and legs shortly afterwards and has now progressed to small blisters and pustules. You make a diagnosis of chickenpox.
The following complications of chickenpox is the LEAST likely.
Your Answer:
Correct Answer: Bronchospasm
Explanation:Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.
Some recognized complications of chickenpox are:
Orchitis
Hepatitis
Pneumonia
Encephalitis
Infected spots
Otitis media
Myocarditis
Glomerulonephritis
Appendicitis
Pancreatitis -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 136
Incorrect
-
Regarding fluid balance, which of the following statements is CORRECT:
Your Answer:
Correct Answer: About three-quarters of extracellular fluid is interstitial.
Explanation:An ‘average’ person (70 kg male) contains about 40 litres of water in total, separated into different fluid compartments by biological semipermeable membranes; plasma cell membranes between extracellular and intracellular fluid, and capillary walls between interstitial and intravascular fluid. Around two-thirds of the total fluid (27 L) is intracellular fluid (ICF) and one-third of this (13 L) is extracellular fluid (ECF). The ECF can be further divided into intravascular fluid (3.5 L) and interstitial fluid (9.5 L).
Transcellular fluid refers to any fluid that does not contribute to any of the main compartments but which are derived from them e.g. gastrointestinal secretions and cerebrospinal fluid, and has a collective volume of approximately 2 L.
Osmosis is the passive movement of water across a semipermeable membrane from regions of low solute concentration to those of higher solute concentration. -
This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 137
Incorrect
-
Regarding antacids, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Antacids should not be taken at the same time as other drugs as they impair absorption.
Explanation:Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids act by neutralising stomach acid. They are used for symptomatic relief in dyspepsia, but are not first line for proven peptic ulcer disease where antisecretory drugs have a better healing effect. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are contraindicated in hypophosphataemia.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 138
Incorrect
-
Approximately how long is the duration of a lidocaine block (when given with adrenaline):
Your Answer:
Correct Answer: 90 minutes
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 139
Incorrect
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Question 140
Incorrect
-
Which of the following is NOT a function of bile:
Your Answer:
Correct Answer: Digestion of fats into monoglycerides and fatty acids.
Explanation:Bile functions to eliminate endogenous and exogenous substances from the liver (including bilirubin), to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile salts also act as bactericides, destroying many of the microbes that may be present in the food. Bile doesn’t contain digestive enzymes for digestion of lipids into monoglycerides and fatty acids; this is performed mainly by pancreatic lipase.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 141
Incorrect
-
Angiotensin II acts to cause all but which one of the following effects:
Your Answer:
Correct Answer: Inhibit release of ADH from the posterior pituitary gland
Explanation:Angiotensin II acts to:
Stimulate release of aldosterone from the zona glomerulosa of the adrenal cortex (which in turn acts to increase sodium reabsorption)
Cause systemic vasoconstriction
Cause vasoconstriction of the renal arterioles (predominant efferent effect thus intraglomerular pressure is stable or increased, thereby tending to maintain or even raise the GFR)
Directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters)
Stimulate synthesis and release of ADH from the hypothalamus and posterior pituitary respectively
Stimulate the sensation of thirst
Potentiate sympathetic activity (positive feedback)
Inhibit renin production by granular cells (negative feedback) -
This question is part of the following fields:
- Physiology
- Renal
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Question 142
Incorrect
-
Which of the following is NOT a typical clinical feature of hypoglycaemia:
Your Answer:
Correct Answer: Polyuria
Explanation:Clinical features of hypoglycaemia:
Autonomic symptoms: Sweating, feeling hot, anxiety/agitation, palpitations, shaking, paraesthesia, dizziness
Neuroglycopaenic symptoms: Weakness, blurred vision, difficulty speaking, poor concentration, poor coordination, drowsiness, confusion, seizures, coma
Other symptoms: Nausea, fatigue, hunger -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 143
Incorrect
-
You are about to perform a blood test on a patient suspected of having systemic lupus erythematosus. Which antibodies will indicate a positive result of systemic lupus erythematosus?
Your Answer:
Correct Answer: Anti-nuclear antibodies
Explanation:Antinuclear antibodies (ANA) are autoantibodies to the cells’ nucleus.
The ANA test is the most sensitive diagnostic test for verifying the disease’s diagnosis.
Other autoantibodies that may be found in SLE patients include rheumatoid factor, antiphospholipid antibodies, and antimitochondrial antibodies.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 144
Incorrect
-
The ECG of a patient presenting with a history of intermittent palpitations has a prolonged QT interval.
Which of these can cause prolongation of the QT interval on the ECG?Your Answer:
Correct Answer: Hypomagnesaemia
Explanation:The causes of a prolonged QT interval include:
Hypomagnesaemia
Hypothermia
Hypokalaemia
Hypocalcaemia
Hypothyroidism
Jervell-Lange-Nielsen syndrome (autosomal dominant)
Romano Ward syndrome (autosomal recessive)
Ischaemic heart disease
Mitral valve prolapse
Rheumatic carditis
Erythromycin
Amiodarone
Quinidine
Tricyclic antidepressants
Terfenadine
Methadone
Procainamide
Sotalol -
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 145
Incorrect
-
Which of the following is true about the extensor carpi radialis longus?
Your Answer:
Correct Answer: It assists with abduction of the hand at the wrist
Explanation:The majority of extensor carpi radialis longus originates from the lateral supracondylar ridge of humerus (distal third) and anterior aspect of the lateral intermuscular septum of the arm. A small portion of its fibres originate from the common extensor tendon attached to the lateral epicondyle of humerus. The fibres unite into a muscle belly which extends approximately to the middle of the forearm. The muscle belly is then replaced by a flat tendon that travels distally along the lateral surface of the radius, together with the tendon of extensor carpi radialis brevis. Both tendons course towards the radial styloid process, deep to the tendons of abductor pollicis longus and extensor pollicis brevis muscles. Proximal to the wrist, the tendons of extensor carpi radialis longus and brevis pass behind the radial styloid process within a common synovial sheath and continue along the radial groove deep to the extensor retinaculum of the wrist. At this level, the tendon of extensor carpi radialis longus is crossed by the tendon of extensor pollicis longus, after which it inserts on the posterior aspect of the base of the second metacarpal bone. Some tendon slips can insert into the first and third metacarpal bones.
Extensor carpi radialis longus receives innervation from the radial nerve, with contributions mainly from spinal nerves C5-C8. The radial nerve is a branch of the brachial plexus.
Extensor carpi radialis longus receives blood supply mainly from the radial artery. It directly supplies the distal part of the muscle, while the rest of the muscle receives blood from one of its radial recurrent branches. The brachial artery also supplies a small portion of the muscle via the radial collateral artery.
Extensor carpi radialis longus primarily acts on the wrist joint to produce two major actions: (1) wrist extension by working synergistically with extensor carpi radialis brevis and extensor carpi ulnaris, and (2) hand abduction (radial deviation), with the help of flexor carpi radialis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 146
Incorrect
-
Low levels of which of the following arterial blood gas parameters stimulate the peripheral chemoreceptors?
Your Answer:
Correct Answer: Arterial pO 2
Explanation:Chemoreceptors are activated when the chemical composition of their immediate surroundings changes.
Peripheral chemoreceptors, together with central chemoreceptors, regulate respiratory functions. They detect changes in arterial blood oxygen levels. Decreased arterial Po2 (partial pressure of oxygen) reflexly stimulates peripheral chemoreceptors.
When peripheral chemoreceptors detect changes in arterial blood oxygen, they will trigger cardiorespiratory changes such as an increase in breathing and blood pressure. These reflexes are important for maintaining homeostasis during hypoxemia.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 147
Incorrect
-
A 30-year-old woman was involved in a road traffic accident and had a class I haemorrhage.
Which physiological parameter is consistent with a diagnosis of class I haemorrhage?
Your Answer:
Correct Answer: Increased pulse pressure
Explanation:There are 4 classes of haemorrhage. Classification is based on clinical signs and physiological parameters.
In CLASS I:Blood loss (ml) is < or = 750
Blood loss(% blood volume) < or = 15%
Pulse rate (bpm) is <100
Respiratory rate is 14-20
Urine output (ml/hr) is >30
Pulse pressure is normal or increased
Systolic BP is normal
CNS/mental status patient is slightly anxiousIn CLASS II:
Blood loss (ml) is 750 – 1500
Blood loss(% blood volume) is 15 – 30%
Pulse rate (bpm) is 100 – 120
Respiratory rate is 20-30
Urine output (ml/hr) is 20-30
Pulse pressure is decreased
Systolic BP is normal
CNS/mental status patient is mildly anxiousIn CLASS III:
Blood loss (ml) is 1500 – 2000
Blood loss(% blood volume) is 30- 40%
Pulse rate (bpm) is 120 – 140
Respiratory rate is 30-40
Urine output (ml/hr) is 5-15
Pulse pressure is decreased
Systolic BP is decreased
CNS/mental status patient is anxious, confusedIn CLASS IV:
Blood loss (ml) is >2000
Blood loss(% blood volume) is >40%
Pulse rate (bpm) is >140
Respiratory rate is >40
Urine output (ml/hr) is negligible
Pulse pressure is decreased
Systolic BP is decreased
CNS/mental status patient is confused, lethargic -
This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 148
Incorrect
-
A 33-year-old woman who is investigated for recurrent renal stones is discovered to have a markedly elevated parathyroid hormone (PTH) level.
Which of the following would stimulate PTH release under normal circumstances? Select ONE answer only.Your Answer:
Correct Answer: Decreased plasma calcium concentration
Explanation:Parathyroid hormone (PTH) is a polypeptide containing 84 amino acids. It is the principal controller of free calcium in the body.
PTH is synthesised by and released from the chief cells of the four parathyroid glands that are located immediately behind the thyroid gland.
PTH is released in response to the following stimuli:
Decreased plasma calcium concentration
Increased plasma phosphate concentration (indirectly by binding to plasma calcium and reducing the calcium concentration)
PTH release is inhibited by the following factors:
Normal/increased plasma calcium concentration
Hypomagnesaemia
The main actions of PTH are:
Increases plasma calcium concentration
Decreases plasma phosphate concentration
Increases osteoclastic activity (increasing calcium and phosphate resorption from bone)
Increases renal tubular reabsorption of calcium
Decreases renal phosphate reabsorption
Increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)
Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol) -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 149
Incorrect
-
Which of the following accurately describes the extensor pollicis brevis muscle?
Your Answer:
Correct Answer: It lies on the medial side of abductor pollicis longus
Explanation:Extensor pollicis brevis is a short and slender muscle located in the posterior compartment of the forearm, extending from the posterior surface of radius to the proximal phalanx of thumb. It is one of the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus and extensor indicis muscles.
Extensor pollicis brevis is a deep extensor of the thumb that lies deep to extensor digitorum muscle. It sits directly medial to abductor pollicis longus and posterolateral to extensor pollicis longus muscle. Just above the wrist, extensor pollicis brevis obliquely crosses the tendons of extensor carpi radialis brevis and extensor carpi radialis longus muscles.
Extensor pollicis brevis is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor pollicis brevis receives its blood supply by posterior interosseous artery and perforating branches from the anterior interosseous artery, which are the branches of common interosseous artery. The common interosseous artery arises immediately below the tuberosity of radius from the ulnar artery.
Together with extensor pollicis longus, extensor pollicis brevis is in charge of extension of the thumb in the first metacarpophalangeal joint. It also extends the thumb in the carpometacarpal joint of the thumb. This movement is important in the anatomy of the grip, as it enables letting go of an object. As it crosses the wrist, extensor pollicis brevis also participates in the extension and abduction of this joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 150
Incorrect
-
Arterial baroreceptors are located primarily in which of the following:
Your Answer:
Correct Answer: Carotid sinus and aortic arch
Explanation:Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 151
Incorrect
-
Campylobacter jejuni is primarily spread via which of the following routes:
Your Answer:
Correct Answer: Faecal-oral route
Explanation:Campylobacter spp. are a common cause of acute infective gastroenteritis, particularly in children, with Campylobacter jejuni responsible for 90% of Campylobacter gastroenteritis. Infection typically follows ingestion of contaminated meat (most frequently undercooked poultry), unpasteurised milk or contaminated water, following which the microorganism invades and colonises the mucosa of the small intestine.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 152
Incorrect
-
You're taking a history of a 59-year-old banker who has had heartburn in the past.
Which of the following information about antacids is correct?Your Answer:
Correct Answer: Magnesium carbonate can reduce the absorption of drugs taken at the same time
Explanation:Antacids such as aluminium hydroxide and magnesium carbonate are commonly used. They’re both water-insoluble and can reduce the absorption of drugs taken together. Allow at least 1-2 hours between taking these antacids and any other medications.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium carbonate has a laxative effect, whereas aluminium hydroxide has a constipating effect.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 153
Incorrect
-
A dermatological examination on a patient presenting with a lump shows a small visible skin elevation containing an accumulation of pus.
Which one of these best describes the lump you have found on examination?Your Answer:
Correct Answer: Pustule
Explanation:A pustule is a small visible skin elevation containing an accumulation of pus.
A carbuncle is a collection of individual boils clustered together.
A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.
A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.
A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 154
Incorrect
-
A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.
Which of the following statements regarding the pectoralis minor muscle is considered correct?Your Answer:
Correct Answer: It stabilises the scapula
Explanation:The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.
Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 155
Incorrect
-
Which of the following diseases is caused by a build-up of lymphoblasts in the bone marrow?
Your Answer:
Correct Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is a clonal (malignant) bone marrow disorder in which early lymphoid precursors multiply and replace the marrow’s normal hematopoietic cells. ALL is most common between the ages of 3 and 7, with 75 percent of cases occurring before the age of 6.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 156
Incorrect
-
A 42-year-old patient with worsening epigastric pain has been referred to you by a GP. The patient has been taking omeprazole for a month, but her symptoms are getting worse.
Which of the following is NOT a well-known side effect of proton pump inhibitor treatment?Your Answer:
Correct Answer: Pelvic fracture
Explanation:Proton pump inhibitors (PPIs) have a variety of side effects, including:
Vomiting and nausea
Pain in the abdomen
Flatulence
Diarrhoea
Constipation
HeadachePPIs have been linked to a significant increase in the risk of focal tachyarrhythmias (link is external).
Low serum magnesium and sodium levels have been linked to long-term use of PPIs, according to the US Food and Drug Administration (link is external).Long-term PPI use has also been linked to an increased risk of fracture, according to epidemiological evidence (link is external). Observational studies have discovered a slight link between hip, wrist, and spine fractures. However, there is no link between the two and an increased risk of pelvic fracture. For this reason, the MHRA recommends that patients at risk of osteoporosis who take PPIs maintain an adequate calcium and vitamin D intake.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 157
Incorrect
-
Which of the following ions is more abundant in extracellular fluid than in intracellular fluid:
Your Answer:
Correct Answer: Cl -
Explanation:Protein and phosphate are the primary intracellular anions, while chloride (Cl-) and bicarbonate are the predominant extracellular anions (HCO3-).
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 158
Incorrect
-
Which patients are particularly susceptible to infection with herpes simplex, those with:
Your Answer:
Correct Answer: T-cell deficiency
Explanation:Cell-mediated immunity, especially the action of cytotoxic T-cells, is essential in the control of herpesvirus infections and patients with T-cell deficiency are at particular risk of reactivation and severe infection. T-cell deficiency may follow HIV infection, chemotherapy, corticosteroid therapy or organ transplantation.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 159
Incorrect
-
Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a medication review, you discover that she is epileptic and that her antiepileptic therapy has recently been changed.
Which of the following antiepileptics is most likely to impair the oral contraceptive pill's effectiveness?Your Answer:
Correct Answer: Carbamazepine
Explanation:The metabolism of ethinyl oestradiol and progestogens has been shown to be increased by enzyme-inducing antiepileptics. The oral contraceptive pill (OCP) is less effective in preventing pregnancy as a result of this increased breakdown.
Antiepileptic drugs that induce enzymes include:
Carbamazepine
Phenytoin
Phenobarbital
TopiramateAntiepileptics that do not induce enzymes are unlikely to affect contraception. Non-enzyme-inducing anticonvulsants include the following:
Clonazepam
Gabapentin
Levetiracetam
Piracetam
Sodium valproate is a type of valproate that is used toLamotrigine is an antiepileptic drug that does not cause the production of enzymes. It does, however, require special consideration, unlike other non-enzyme-inducing antiepileptics. The OCP does not appear to affect epilepsy directly, but it does appear to lower lamotrigine levels in the blood. This could result in a loss of seizure control and the occurrence of seizures.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 160
Incorrect
-
Regarding the flexor digitorum profundus muscle, which of the following is true?
Your Answer:
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 161
Incorrect
-
Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:
Your Answer:
Correct Answer: Hyperacusis
Explanation:Hyperacusis is increased acuity of hearing with hypersensitivity to low tones resulting from paralysis of the stapedius muscle, innervated by the facial nerve. General sensation to the face and to the anterior two-thirds of the tongue is carried by the divisions of the trigeminal nerve (although taste to the anterior two-thirds of the tongue is supplied by the facial nerve). Eye movements are mediated by the oculomotor, trochlear and abducens nerve. Ptosis results from paralysis of the levator palpebrae superioris, innervated by the oculomotor nerve, or the superior tarsal muscle, innervated by the sympathetic chain.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 162
Incorrect
-
Nitrous oxide is associated with which of the following adverse effects:
Your Answer:
Correct Answer: Megaloblastic anaemia
Explanation:Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 163
Incorrect
-
The correct statement regarding the parasympathetic nervous system is which of the following?
Your Answer:
Correct Answer: Parasympathetic preganglionic neurones run in cranial nerves III, VII, IX and X.
Explanation:The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2 molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 164
Incorrect
-
Which of the following is characterised by passive carrier-mediated transport down a chemical concentration gradient:
Your Answer:
Correct Answer: Facilitated diffusion
Explanation:Facilitated diffusion is the process of spontaneous passive transport of molecules or ions down their concentration gradient across a cell membrane via specific transmembrane transporter (carrier) proteins. The energy required for conformational changes in the transporter protein is provided by the concentration gradient rather than by metabolic activity.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 165
Incorrect
-
Nifedipine commonly causes which of the following adverse effects?
Your Answer:
Correct Answer: Ankle oedema
Explanation:Most common adverse effects of Nifedipine include:
Peripheral oedema (10-30%)
Dizziness (23-27%)
Flushing (23-27%)
Headache (10-23%)
Heartburn (11%)
Nausea (11%) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 166
Incorrect
-
The functional residual capacity (FRC) will be increased in which of the following:
Your Answer:
Correct Answer: Emphysema
Explanation:Factors increasing FRC:
Emphysema
Air trapping in asthma
Ageing (due to loss of elastic properties)
Increasing height of patient -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 167
Incorrect
-
What proportion of peripheral blood leukocytes are monocytes?
Your Answer:
Correct Answer: 5 - 10%
Explanation:Monocytes account for around 5 to 10% of peripheral white cells. Monocytes in peripheral blood are generally bigger than other leukocytes and feature a large central oval or indented nucleus with clumped chromatin. The abundant cytoplasm staining blue and containing numerous fine vacuoles gives the appearance of ground glass. Cytoplasmic granules are another type of granule.
Monocytes evolve from the granulocyte-macrophage progenitor to become monoblasts, promonocytes, monocytes, and tissue macrophages (in increasing order of maturity). Monocytes only stay in the bone marrow for a short time before exiting to circulate in the bloodstream for 20-40 hours before becoming macrophages.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 168
Incorrect
-
A 45-old woman is on several medications and being treated for epilepsy and bipolar disorder. In the ward rounds, you are asked to examine her in detail and discover she has a noticeable tremor. You believe that one of her medications may be responsible for this new onset tremor.
Which of the following medications is least likely to be responsible for this tremor?Your Answer:
Correct Answer: Carbamazepine
Explanation:The only medication that does not commonly cause tremors is carbamazepine.
The other drugs present with the following types of tremors as a side effect to their usage:
1. Sodium valproate – Postural tremor is most common, but a resting tremor can also occur. Approximately 25% of patients taking sodium valproate are found to develop a tremor within 12 months of starting therapy.
2. Lithium – fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer.
3. Atypical antipsychotics, such as olanzapine and quetiapine – tremor and limb shakiness. -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 169
Incorrect
-
A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.
She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.
Out of the following, which antibiotic is most appropriate to be prescribed to this patient?Your Answer:
Correct Answer: Fosfomycin
Explanation:The NICE guidelines for women with lower UTIs who are not pregnant are:
1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibioticThe first choice of antibiotics for non-pregnant women aged 16 years and over is:
1. Nitrofurantoin
100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
2. Trimethoprim
200 mg PO BD for three daysThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
1. Nitrofurantoin
100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
2. Pivmecillinam
400 mg PO initial dose, then 200 mg PO TDS for three days
3. Fosfomycin 3 g single sachet dose -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 170
Incorrect
-
You examine a 43-year-old woman who was referred to you by a friend. She suffers from a variety of medical conditions and takes a variety of medications, including amitriptyline.
Which of the following is NOT a contraindication to amitriptyline treatment?Your Answer:
Correct Answer: Breastfeeding
Explanation:Amitriptyline is a tricyclic antidepressant (TCA) that is most commonly used to treat depression, but it can also be used to treat anxiety disorders, chronic pain, and attention deficit hyperactivity disorder (ADHD). It inhibits reuptake, raising serotonin and noradrenaline levels while also inhibiting acetylcholine action.
TCAs have a number of drawbacks, including:
Acute Porphyria
Arrhythmias
During bipolar disorder’s manic phase
Heart block
After a myocardial infarction, there is an immediate recovery period.TCA levels in breast milk are too low to be harmful, and use can be continued while breastfeeding.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 171
Incorrect
-
What is the primary function of the mitochondria?
Your Answer:
Correct Answer: The production of the cell's supply of chemical energy
Explanation:The mitochondria is responsible for the production of the cell’s supply of chemical energy. It does this by using molecular oxygen, sugar and small fatty acid molecules to generate adenosine triphosphate (ATP) by a process ss known as oxidative phosphorylation. An enzyme called ATP synthase is required.
Transcription of ribosomal RNA occurs in the nucleolus
Production of messenger RNA occur in the nucleus
Production of lysosome occurs in the Golgi apparatus
The post-translational processing of newly made proteins occurs in the endoplasmic reticulum
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 172
Incorrect
-
A 71-year-old patient has been diagnosed with a dopamine-secreting neuroendocrine tumour.
Which of the following statements about dopamine is correct?Your Answer:
Correct Answer: It inhibits prolactin release from the anterior pituitary
Explanation:Dopamine is a neurotransmitter and amine hormone that is derived from the amino acid tyrosine. It is made in a number of places throughout the human body, both inside and outside the central nervous system. The adrenal medulla, dopamine neurons in the arcuate nucleus of the hypothalamus, the substantia nigra, and other areas of the brain produce dopamine.
The tuberoinfundibular pathway refers to the dopamine neurons in the arcuate nucleus of the hypothalamus’ tubeal region. Dopamine is discharged into the hypothalamo-hypophyseal portal system from these neurons’ neurosecretory terminals at the median eminence.
The major function of dopamine produced from the hypothalamus is to suppress prolactin production from the anterior pituitary, and it is released in reaction to excessive levels of prolactin secretion. Modulation of motor-control centres and activation of reward centres are two more crucial activities of the brain.
Dopamine-secreting cells can also be found in other areas of the body, where they perform mostly paracrine functions (acting on nearby cells). -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 173
Incorrect
-
A 43 year old lady who has a previous medical history of hyperthyroidism presents to the emergency room with sweating, palpitations and agitation. On examination, she is tachycardic, hypertensive and hyperpyrexic. She recently had a stomach bug and has not been able to take her medication regularly. The best medication to immediately treat her symptoms is which of the following?
Your Answer:
Correct Answer: Propranolol
Explanation:There is a high suspicion of a thyroid crisis in this patient and emergent treatment should be initiated even before the results of TFT’s have returned. Antiadrenergic drugs like IV propranolol should be administered immediately to minimise sympathomimetic symptoms. Antithyroid medications like propylthiouracil or carbimazole should be administered to block further synthesis of thyroid hormones. After thionamide therapy has been started to prevent stimulation of new hormone synthesis, there should then be delayed administration of oral iodine solution. Hydrocortisone administration is also recommended as it treats possible relative adrenal insufficiency while also decreases peripheral conversion of T4 to T3.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 174
Incorrect
-
A patient had a left Colles' fracture, which you were able to repair. It was their second fragility fracture this year, and you'd like to provide them some tips on how to keep their bones healthy.
What percentage of the calcium in the body is kept in the bones? Only ONE response is acceptable.Your Answer:
Correct Answer: 99%
Explanation:Calcium is stored in bones for nearly all of the body’s calcium, but it is also found in some cells (most notably muscle cells) and the blood. The average adult diet comprises roughly 25 mmol of calcium per day, of which the body absorbs only about 5 mmol.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 175
Incorrect
-
A 36-year-old woman is 22-weeks pregnant and is investigated for a possible thyroid disorder. When her total thyroid hormone levels does not correlate with her thyrometabolic status, her thyroid-binding globulin levels are checked.
What percentage of circulating thyroid hormones is bound to thyroid-binding globulin?Your Answer:
Correct Answer: 70%
Explanation:Only a very small fraction of the thyroid hormones circulating in the blood are free. The majority is bound to transport proteins. Only the free thyroid hormones are biologically active, and measurement of total thyroid hormone levels can be misleading.
The relative percentages of bound and unbound thyroid hormones are:
Bound to thyroid-binding globulin -70%
Bound to albumin -15-20%
Bound to transthyretin -10-15%
Free T3 -0.3%
Free T4 -0.03% -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 176
Incorrect
-
A 30-year-old woman with type 1 diabetes mellitus is brought in drowsy and confused. Her BM is 2.2 mmol/l and a dose of IM glucagon is administered.
What is the principal stimulus for the secretion of glucagon?Your Answer:
Correct Answer: Hypoglycaemia
Explanation:Glucagon, a peptide hormone, is produced and secreted by alpha cells of the islets of Langerhans, located in the endocrine portion of the pancreas.
Its main physiological role is stimulation of hepatic glucose output leading to increase in blood glucose. It is the major counter-regulatory hormone to insulin in maintaining glucose homeostasis.
The principal stimulus for the secretion of glucagon is hypoglycaemia. Hypoglycaemia then stimulates:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue leading to increased glycaemia.Secretion of glucagon is also stimulated by arginine, alanine, adrenaline, acetylcholine and cholecystokinin
Secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea production -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 177
Incorrect
-
Which of the following is where the rectovesical fascia is located:
Your Answer:
Correct Answer: Between the fundus of the bladder and the ampulla of the rectum
Explanation:In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 178
Incorrect
-
Which of the following clinical features is NOT a typical feature of haemolytic anaemias:
Your Answer:
Correct Answer: Angular cheilitis
Explanation:Features include:
Anaemia
Jaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)
Pigment gallstones
Splenomegaly
Ankle ulcers
Expansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia major
Aplastic crisis caused by parvovirus -
This question is part of the following fields:
- Haematology
- Pathology
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Question 179
Incorrect
-
A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how to deal with her symptoms. In the first instance, the pharmacist advises her to take an over-the-counter antacid. She buys an antacid that contains aluminium hydroxide, which relieves her symptoms but has a negative side effect.
She's most likely to have developed which of the following side effects?Your Answer:
Correct Answer: Constipation
Explanation:Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.
When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 180
Incorrect
-
Compliance is decreased by all but which one of the following:
Your Answer:
Correct Answer: Aging
Explanation:Factors increasing compliance:
Old age
EmphysemaFactors decreasing compliance:
Pulmonary fibrosis
Pulmonary oedema
Atelectasis
Extremes of lung volumes (at higher lung volumes the compliance of the lung becomes less as the lung becomes stiffer) -
This question is part of the following fields:
- Physiology
- Respiratory
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Question 181
Incorrect
-
Which nerve innervates the brachioradialis muscle?
Your Answer:
Correct Answer: The radial nerve
Explanation:Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 182
Incorrect
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Question 183
Incorrect
-
A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.
The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: The recurrent branch of the median nerve
Explanation:Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.
Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.
The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 184
Incorrect
-
An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:
Your Answer:
Correct Answer: Thick ascending limb
Explanation:Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 185
Incorrect
-
Question 186
Incorrect
-
Regarding chemical control of respiration, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: The blood-brain barrier is freely permeable to HCO3 - ions.
Explanation:CSF is separated from the blood by the blood-brain barrier. This barrier is impermeable to polar molecules such as H+and HCO3-but CO2can diffuse across it easily. The pH of CSF is therefore determined by the arterial PCO2and the CSF HCO3-and is not affected by blood pH.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 187
Incorrect
-
A dermatological examination on a patient presenting with a skin lesion which shows a solid, well circumscribed, lump measuring 0.8 cm in diameter. Which one of these best describes the lump you have found on examination?
Your Answer:
Correct Answer: Papule
Explanation:Macule— a small patch of skin that is altered in colour, but is not elevated.
Patch — a large area of colour change, with a smooth surface.
Papule— elevated, solid, palpable lesion that is ≤ 1 cm in diameter. They may be solitary or multiple. Papules may be:
Nodule — elevated, solid, palpable lesion > 1 cm usually located primarily in the dermis and subcutis (deeper layers of the skin). The greatest portion of the lesion may be above or beneath the skin surface.
Vesicle — a small blister. It is a circumscribed lesion ≤ 1 cm in diameter that contains liquid (clear, serous or haemorrhagic).
Cyst — papule or nodule that contains fluid or semi-fluid material so is fluctuant
Plaque — a circumscribed, palpable lesion more than 1 cm in diameter; most plaques are elevated.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 188
Incorrect
-
You examine an elderly man who is experiencing chest pain. He doesn't recall all of his medications, but he does know that he takes a diuretic.
The enzyme carbonic anhydrase is inhibited by which of the following diuretics?Your Answer:
Correct Answer: Acetazolamide
Explanation:Acetazolamide is a non-competitive, reversible inhibitor of carbonic anhydrase found in the cytosol of cells and on the brush border of the proximal convoluted tubule. Bicarbonate and hydrogen ions are converted to carbonic acid by carbonic anhydrase, which then converts carbonic acid to carbon dioxide and water. As a result, acetazolamide reduces the availability of hydrogen ions, causing sodium and bicarbonate ions to accumulate in the renal tubule, resulting in diuresis.
The mechanism of action of the various types of diuretics is summarised below:1) Loop diuretics, e.g. furosemide, bumetanide
Act on the Na.K.2Cl co-transporters in the ascending loop of Henlé to inhibit sodium, chloride and potassium reabsorption.2) Thiazide diuretics, e.g. Bendroflumethiazide, hydrochlorothiazide
Act on the Na.Cl co-transporter in the distal convoluted tubule to inhibit sodium and chloride reabsorption.3) Osmotic diuretics, e.g. mannitol
Increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect.4) Aldosterone antagonists, e.g. spironolactone
Acts in the distal convoluted tubule as a competitive aldosterone antagonist resulting in inhibition of sodium reabsorption and increasing potassium reabsorption.5) Carbonic anhydrase inhibitors, e.g. acetazolamide
Inhibit the enzyme carbonic anhydrase preventing the conversion of bicarbonate and hydrogen ions into carbonic acid. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 189
Incorrect
-
Which of the following problems is associated with Helicobacter pylori infection?
Your Answer:
Correct Answer: Gastric malignancy
Explanation:Helicobacter pylori is a ubiquitous organism that is present in about 50% of the global population. Chronic infection with H pylori causes atrophic and even metaplastic changes in the stomach, and it has a known association with peptic ulcer disease. The most common route of H pylori infection is either oral-to-oral or faecal-to-oral contact.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 190
Incorrect
-
A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.
She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.
Which of the following statements is true regarding heparin?Your Answer:
Correct Answer: It activates antithrombin III
Explanation:Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
1. Unfractionated: widely varying polymer chain lengths
2. Low molecular weight: Smaller polymers onlyHeparin works by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.
Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.
Heparin is used for:
1. Prevention and treatment of venous thromboembolism
2. Treatment of disseminated intravascular coagulation
3. Treatment of fat embolism
4. Priming of haemodialysis and cardiopulmonary bypass machinesThere is no evidence that heparin is superior to low-molecular-weight heparins in preventing mortality from thrombosis.
Vitamin K is used to reverse the effects of warfarin but not heparin. For heparin, protamine sulphate is used to counteract its effects.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 191
Incorrect
-
Which of the following is NOT a typical effect caused by adrenaline:
Your Answer:
Correct Answer: Bronchoconstriction
Explanation:Actions of adrenaline:
Cardiovascular system
– Increased rate and force of cardiac contraction
– Vasoconstriction of vessels in skin, mucous membranes and splanchnic bed
– Vasodilation of skeletal muscle vessels
– Increased cardiac output and blood pressure
Respiratory system
– Bronchodilation
– Increased ventilation rate
Gastrointestinal system
– Smooth muscle relaxation
– Contraction of sphincters
– Metabolism
– Decreased insulin release
– Increased glucagon release
– Increased thermogenesis
– Increased glycolysis
– Increased lipolysis
Eye
– Pupillary dilation -
This question is part of the following fields:
- Endocrine
- Physiology
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Question 192
Incorrect
-
In a VF arrest, a 6-year-old child is brought to your Emergency Department resuscitation area. He weighs 16 kilogrammes. He's had three DC shocks, but he's still in VF and doesn't have an output.
What amiodarone dose should he get now, according to the most recent APLS guidelines?Your Answer:
Correct Answer: 80 mg
Explanation:In a shockable (Vf/pVT) paediatric cardiac arrest, amiodarone should be administered after the third and fifth shocks. The dose is 5 mg/kg (maximum 300 mg) and should be administered over a three-minute period. If at all possible, administration via a central line is recommended.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 193
Incorrect
-
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:
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 194
Incorrect
-
Detection of urinary Bence-Jones protein would be most suggestive of which of the following malignancies:
Your Answer:
Correct 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.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 195
Incorrect
-
You are examining the lower limbs of a 54 year old man who presented after falling from a ladder at home. During your neurological assessment you note a weakness of hip flexion. Which of the following nerves is the most important for flexion of the thigh at the hip joint:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the thigh at the hip joint is produced by the sartorius, psoas major, iliacus and pectineus muscles, assisted by the rectus femoris muscle, all innervated by the femoral nerve (except for the psoas major, innervated by the anterior rami of L1 – 3).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 196
Incorrect
-
A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give.
From the following choices, which is considered an example of bacteriostatic antibiotic?
Your Answer:
Correct Answer: Trimethoprim
Explanation:Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:
Bactericidal antibiotics
Bacteriostatic antibioticsVancomycin
Metronidazole
Fluoroquinolone, such as ciprofloxacin
Penicillins, such as benzylpenicillin
Cephalosporin, such as ceftriaxone
Co-trimoxazole
Tetracyclines, such as doxycycline
Macrolides, such as erythromycin
Sulphonamides, such as sulfamethoxazole
Clindamycin
Trimethoprim
Chloramphenicol -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 197
Incorrect
-
You want to give colchicine to a patient who has acute gout. Which of the following is a contraindication to the use of colchicine?
Your Answer:
Correct Answer: Blood dyscrasias
Explanation:Colchicine is used to prevent or treat gout attacks (flares). It works by reducing swelling and the development of uric acid crystals, which cause pain in the affected joint(s).
Colchicine should be avoided by patients who have blood dyscrasias or bone marrow disorders.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 198
Incorrect
-
The mechanism of action of abciximab is by:
Your Answer:
Correct Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites
Explanation:Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 199
Incorrect
-
A 52-year-old female visits the Emergency Department complaining of an acute worsening of her asthma symptoms. A detailed history reveals that she took one of her brother's heart pills without a prescription as she was experiencing palpitations and thought it would cure her. Her shortness of breath was suddenly exacerbated after ingesting this medicine.
Which one of the following medications has this woman most likely consumed?Your Answer:
Correct Answer: Propranolol
Explanation:Propranolol, like other non-selective beta-blockers, is contraindicated in patients with asthma. These drugs can cause acute bronchospasm, therefore worsening symptoms, especially in high doses. However, there has been some recent evidence that long-term use of selective beta-blockers in mild or moderate asthma patients can be safe.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 200
Incorrect
-
Which of the following is NOT a mineralocorticoid effect of corticosteroids:
Your Answer:
Correct Answer: Hyperglycaemia
Explanation:Mineralocorticoid side effects include:hypertensionsodium retentionwater retention and oedemapotassium losscalcium loss
Glucocorticoid side effects include:weight gainhyperglycaemia and diabetesosteoporosis and osteoporotic fracturesmuscle wasting (proximal myopathy)peptic ulceration and perforationpsychiatric reactions -
This question is part of the following fields:
- Endocrine
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
