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Question 1
Correct
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During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.
Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.
The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:
L– lateral two lumbricals
O– Opponens pollicis
A– Abductor pollicis
F– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.
Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
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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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The percentage of patients with hepatitis B that develop chronic infection is about:
Your Answer: 20%
Correct Answer: 10%
Explanation:With hepatitis B, about 90% of people will develop lifelong immunity after clearing the infection. Chronic hepatitis develops in about 10% of patients and this may be complicated by cirrhosis or hepatocellular carcinoma. There is a very high risk of chronic infection and hepatocellular carcinoma when there is congenital infection. The risk of this in healthy adults is only about 5%.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 3
Incorrect
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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: Haloperidol is the safest antipsychotic drug to use in elderly patients with dementia-related psychosis
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 4
Incorrect
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Which of the following is NOT a common side effect of adenosine:
Your Answer: AV block
Correct Answer: Yellow vision
Explanation:Common side effects of adenosine include:
Apprehension
Dizziness, flushing, headache, nausea, dyspnoea
Angina (discontinue)
AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur) -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 5
Incorrect
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Which statement concerning aerosol transmission is true?
Your Answer: They usually cannot survive outside the body
Correct Answer: They can be spread via ventilation systems in hospitals
Explanation:Aerosols are airborne particles less than 5 µm in size containing infective organisms.
They usually cause infection of both the upper and/or lower respiratory tract.
The organisms can remain suspended in the air for long periods and also survive outside the body.
They can be transmitted through the ventilation systems and can spread over great distances.
Some examples of organisms transmitted by the aerosol route include: Varicella zoster virus, Mycobacterium tuberculosis and measles virus
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 6
Incorrect
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A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been going on for 3 days.
Among the following microorganisms, which is considered to be a cause of infectious bloody diarrhoea?Your Answer: Giardia lamblia
Correct Answer: Entamoeba histolytica
Explanation:The following are organisms that are capable of producing acute, bloody diarrhoea:
– Campylobacter jejuni
– Escherichia coli O157:H7
– Salmonella species
– Shigella species
– Yersinia species
– Entamoeba histolyticaOther E. coli strains, Giardia, Vibrio, and other parasites are associated with watery, but not bloody, diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Incorrect
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A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.
Which of the following statements is TRUE regarding naloxone?Your Answer: It has a longer duration of action than most opioids
Correct Answer: It can be given by a continuous infusion if repeated doses are required
Explanation:Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.
It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.
An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.
If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 8
Incorrect
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You are about to perform an emergency pericardiocentesis on a 26-year-old male who was involved in a car accident and is suspected of having cardiac tamponade due to signs of hypotension, muffled heart sounds, and distended neck veins. Where should you insert the needle to relieve tamponade?
Your Answer: Medial left seventh intercostal space
Correct Answer: Inferior and to the left of the xiphochondral junction
Explanation:Pericardiocentesis is a procedure that removes excess fluid from the pericardium. As a result, it’s used in cases of cardiac tamponade, which occurs when there’s too much fluid in the space around the heart.
During the procedure, a needle and a small catheter are inserted 1 to 2 cm inferior and to the left of the xiphochondral junction into the pericardial cavity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 9
Incorrect
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A 71-year-old man treated with antibiotics for a chest infection returns with a profuse, offensive smelling diarrhoea. A diagnosis of Clostridium difficile diarrhoea is made after investigations.
Which antibiotic is associated with the greatest risk of causing Clostridium Difficile diarrhoea?
Your Answer: Tetracycline
Correct Answer: Ciprofloxacin
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile infection (CDI) occurs. About 80% of Clostridium Difficile infections are seen in people over the age of 65 and its main clinical features are:
Abdominal cramps, severe bloody and/or watery diarrhoea, offensive smelling diarrhoea, and fever.CDI is the most severe consequence of antibiotic treatment and is a major cause of morbidity and mortality.
Risk for CDI has been found to be greatest with clindamycin followed by fluoroquinolones Tetracyclines are not associated with risk for CDI. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 10
Incorrect
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What is the pathophysiology of Cushing's syndrome:
Your Answer: Hyperaldosteronism
Correct Answer: Glucocorticoid excess
Explanation:Cushing’s syndrome is the name given to the clinical symptoms and signs induced by chronic glucocorticoid excess.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 11
Incorrect
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Insulin binds to the insulin receptor (IR) on cell surfaces to exert its action. The IR is a very specific transmembrane receptor belonging to the tyrosine kinase receptor class.
One of these also activates the IR:
Your Answer: Amylin
Correct Answer: IGF-I
Explanation:Insulin receptor (IR), in addition to being activated by insulin, is also activated by IGF-I and IGF-II.
The IR is a dimer with two identical subunits spanning the cell membrane and are connected by a single disulphide bond. The two sub-units include: The alpha chain situated on the exterior of the cell membrane and the beta chain spanning the cell membrane in a single segment.
When insulin is detected, the alpha chains move together folding around the insulin making the beta chains move together, converting them into an active tyrosine kinase. This initiates a phosphorylation cascade increasing the expression of GLUT4 and allowing uptake of glucose by cells.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 12
Incorrect
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C5 - C9 deficiency increases susceptibility to infection with which of the following:
Your Answer: Herpesviridae
Correct Answer: Neisseria spp.
Explanation:If the complement sequence is completed, an active phospholipase (the membrane attack complex, MAC) is produced, which punches holes in the cell membrane and causes cell lysis. Because the MAC appears to be the sole means to destroy the Neisseria family of bacteria, C5 – C9 deficiency increases susceptibility to Neisseria infections.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 13
Correct
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Regarding anaemia, which of the following statements is INCORRECT:
Your Answer: Anaemia is usually associated with a decrease in red cell 2,3 - DPG.
Explanation:Anaemia is defined as a reduction in haemoglobin concentration below the normal range for the age and sex of the individual. Children tend to have lower haemoglobin than adults, and women tend to have lower haemoglobin than men. Anaemia may occur from an actual reduction in total circulating haemoglobin mass, or with an increase in plasma volume e.g. in pregnancy, causing a dilutional anaemia. After acute major blood loss, anaemia is not immediately apparent because total blood volume is reduced and it takes up to a day for plasma volume to be replaced and hence the degree of anaemia to become apparent. The initial clinical features in acute haemorrhage are therefore a result of reduction in blood volume rather than that of anaemia. When anaemia develops slowly, the associated symptoms are often very mild as the body has time to adapt to the fall in haemoglobin. This involves mechanisms such as an increase in red cell 2,3 -diphosphoglycerate (2,3 – DPG), which shifts the oxygen dissociation curve to the right, allowing enhanced delivery of O2 to the tissues, and an increase in stroke volume and heart rate.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 14
Incorrect
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Which of the following statements is incorrect regarding the electron transfer system?
Your Answer: The electron transfer system is located on the cristae of the mitochondrion.
Correct Answer: The electron transfer system occurs in anaerobic respiration.
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 NADH2molecules 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 15
Incorrect
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Regarding alteplase, which of the following statements is INCORRECT:
Your Answer: Alteplase must be given by continuous intravenous infusion.
Correct Answer: Alteplase is commonly associated with hypotensive effects.
Explanation:Alteplase is a recombinant tissue-type plasminogen activator (tPA), a naturally occurring fibrin-specific enzyme that has selectivity for activation of fibrin-bound plasminogen. It has a short half-life of 3 – 4 minutes and must be given by continuous intravenous infusion but is not associated with antigenic or hypotensive effects, and can be used in patients when recent streptococcal infections or recent use of streptokinase contraindicates the use of streptokinase.
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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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Regarding basophils, which of the following statements is INCORRECT:
Your Answer: They have many dark cytoplasmic granules which overlie the nucleus.
Correct Answer: They are the second most common type of granulocyte.
Explanation:Basophils are only occasionally seen in normal peripheral blood comprising < 1% of circulating white cells. However, they are the largest type of granulocyte. They have many dark cytoplasmic granules which overlie the nucleus and contain heparin and histamine. They have immunoglobulin E (IgE) attachment sites and their degranulation is associated with histamine release. Basophils are very similar in both appearance and function to mast cells.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 17
Incorrect
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Which of the following ions normally has the highest concentration in intracellular fluid:
Your Answer: Na +
Correct Answer: K +
Explanation:Potassium (K+) is the principal intracellular ion; approximately 4 mmol/L is extracellular (3%) and 140 mmol/L intracellular (97%).
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 18
Incorrect
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What is the mechanism of action of captopril:
Your Answer: Acetylcholinesterase inhibitor
Correct Answer: Angiotensin-converting enzyme inhibitor
Explanation:Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 19
Incorrect
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In patients who are not at risk of hypercapnic respiratory failure but are requiring oxygen, the oxygen saturations should be maintained at which of the following?
Your Answer: 92 - 96%
Correct Answer: 94 - 98%
Explanation:Oxygen saturation should be 94 – 98% in most acutely ill patients with a normal or low arterial carbon dioxide (PaCO2). In some clinical situations, however, like cardiac arrest and carbon monoxide poisoning, it is more appropriate to aim for the highest possible oxygen saturation until the patient is stable.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 20
Incorrect
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Which of the following is a clinical effect of hyperkalaemia:
Your Answer: Polyuria
Correct Answer: Muscle weakness
Explanation:Clinical features of hyperkalaemia may include:
paraesthesia, muscle weakness or paralysis, cardiac conduction abnormalities and dysrhythmias.Clinical features of hypokalaemia may include:
muscle weakness, muscle cramps, rhabdomyolysis and myoglobinuria, ascending paralysis resulting in respiratory failure, constipation, gut ileus with distension, anorexia, nausea and vomiting, impaired ADH action with polyuria and polydipsia, ECG changes and cardiac arrhythmias. -
This question is part of the following fields:
- Physiology
- Renal
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Question 21
Incorrect
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The least likely feature of anaemia is:
Your Answer: Bounding pulse
Correct Answer: Narrow pulse pressure
Explanation:Non-specific signs of anaemia include:
1. pallor of mucous membranes or nail beds (if Hb < 90 g/L),
2. tachycardia
3. bounding pulse
4. wide pulse pressure
5. flow murmurs
6. cardiomegaly
7. signs of congestive cardiac failure (in severe cases) -
This question is part of the following fields:
- Haematology
- Pathology
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Question 22
Correct
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A 54-year-old woman presents with polyuria and polydipsia. She is known to suffer from bipolar disorder, which has been well controlled by the use of lithium for many years.
What is the SINGLE most likely diagnosis?Your Answer: Nephrogenic diabetes insipidus
Explanation:Diabetes insipidus is the inability to produce concentrated urine. It is characterised by the presence of excessive thirst, polyuria and polydipsia. There are two distinct types of diabetes insipidus:
Cranial (central) diabetes insipidus and;
Nephrogenic diabetes insipidus
Cranial diabetes insipidus is caused by a deficiency of vasopressin (anti-diuretic hormone). Patients with cranial diabetes insipidus can have a urine output as high as 10-15 litres per 24 hours, but adequate fluid intake allows most patients to maintain normonatraemia. 30% of cases are idiopathic, and a further 30% are secondary to head injuries. Other causes include neurosurgery, brain tumours, meningitis, granulomatous disease (e.g. sarcoidosis) and drugs, such as naloxone and phenytoin. A very rare inherited form also exists that is associated with diabetes mellitus, optic atrophy, nerve deafness and bladder atonia.
Nephrogenic diabetes insipidus is caused by renal resistance to the action of vasopressin. As with cranial diabetes insipidus, urine output is markedly elevated. Serum sodium levels can be maintained by secondary polydipsia or can be elevated. Causes of nephrogenic diabetes insipidus include chronic renal disease, metabolic disorders (e.g. hypercalcaemia and hypokalaemia) and drugs, including long-term lithium usage and demeclocycline.
In view of the history of long-term lithium use, in this case, nephrogenic diabetes insipidus is the most likely diagnosis. -
This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 23
Incorrect
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A 30-year-old man presents with diarrhoea, fever, vomiting, and abdominal cramps. A stool culture was ordered and showed growth of Salmonella spp.
Among the following serotypes of Salmonella spp., which is considered to be the most common cause of salmonella gastroenteritis?Your Answer: Serotype C
Correct Answer: Serotype D
Explanation:A common cause of gastroenteritis, Salmonella enteritidis, and Salmonella typhi, which causes enteric fever, are both group D. Therefore, serotype D Salmonella species are most commonly associated with gastroenteritis.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 24
Incorrect
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A 24-year-old student with red and painful right eye presents. Conjunctival erythema, mucopurulent discharge and lid crusting are seen on examination, and patient denies presence of itching of the eye. All his observations are normal, he has no fever and is otherwise well.
Which of these is the most likely causative organism?
Your Answer: Staphylococcus epidermidis
Correct Answer: Haemophilus influenzae
Explanation:The most frequent cause of red eye is conjunctivitis. It is caused by inflammation of the conjunctiva which can be infective or allergic and accounts for about 35% of all eye problems presenting to general practice.
Viral conjunctivitis is commonly caused by adenoviruses and it is the most common infectious conjunctivitis.
The common bacterial causes of conjunctivitis are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.
The clinical features of infective conjunctivitis include:
Acute onset of conjunctival erythema
Feeling ‘grittiness’, ‘foreign body’ or ‘burning’ sensation in the eye.
Watering and discharge which may cause transient blurring of visionThe discharge for viral conjunctivitis is less than that of bacterial conjunctivitis and usually watery.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 25
Incorrect
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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 26
Incorrect
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All of the following statement about the microcirculation are correct except:
Your Answer:
Correct Answer: Over the capillary bed, there is a net absorption of fluid.
Explanation:The hydrostatic pressure along the length of the capillary is usually greater than plasma oncotic pressure. As a result, there is a small net filtration of fluid from the capillary into the interstitial space. The regulation of blood flow into the microcirculation is via the vasoconstriction of small arterioles, which is activated by the sympathetic nervous system through numerous nerve endings in their walls. Unlike proteins, most ions and small molecules diffuse easily across capillary walls and thus the crystalloid osmotic pressure they exert is roughly the same on either side of the capillary wall. Because the plasma colloid osmotic pressure is higher than interstitial colloid osmotic, fluid is drawn intravascularly. A reduction of hydrostatic capillary pressure and transient increase in absorption of fluid is a result of arteriolar constriction.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 27
Incorrect
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Regarding Hodgkin lymphoma, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Some patients may complain alcohol-induced nodal pain and pruritus
Explanation:Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 28
Incorrect
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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 29
Incorrect
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Regarding fat digestion, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Chylomicrons consist of a cholesterol and triglyceride core with a phospholipid coat studded with apolipoproteins.
Explanation:Dietary fat is chiefly composed of triglycerides. In the duodenum fat is emulsified by bile acids, a process where larger lipid droplets are broken down into much smaller droplets providing a greater surface area for enzymatic digestion. Once inside the epithelial cell, lipid is taken into the smooth endoplasmic reticulum where much of it is re esterified. Dietary and synthesised lipids are then incorporated into chylomicrons in the Golgi body, which are exocytosed from the basolateral membrane to enter lacteals. Chylomicrons consist mainly of triglyceride with small amounts of cholesterol and cholesteryl esters in the centre with a phospholipid coat studded with apolipoproteins. Fat-soluble are absorbed into enterocytes from micelles by simple diffusion together with the products of fat digestion.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 30
Incorrect
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A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part in a powerlifting competition, he felt a painful snap at the front of his shoulder and chest. There is also the presence of bruising and swelling over the left side of his chest. A ruptured pectoralis major muscle was suspected upon examining the injured area.
Which of the following statements regarding the surface markings of the pectoralis major muscle is considered correct?Your Answer:
Correct Answer: It inserts into the lateral lip of the bicipital groove of the humerus
Explanation:The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.
Its origin lies anterior surface of the medial half of the clavicle, the anterior surface of the sternum, the first 7 costal cartilages, the sternal end of the sixth rib, and the aponeurosis of the external oblique of the anterior abdominal wall.
The insertion of the pectoralis major is at the lateral lip of the intertubercular sulcus of the humerus. There are 2 heads of the pectoralis major, the clavicular and the sternocostal, which reference their area of origin.
The function of the pectoralis major is 3-fold and dependent on which heads of muscles are involved:
– Flexion, adduction and medial rotation of the arm at the glenohumeral joint
– Clavicular head causes flexion of the extended arm
– Sternoclavicular head causes extension of the flexed armArterial supply of the pectoralis major, the pectoral artery, arises from the second branch of the axillary artery, the thoracoacromial trunk.
The 2 heads of the pectoralis major have different nervous supplies. The clavicular head derives its nerve supply from the lateral pectoral nerve. The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the medial pectoral nerve arises from the medial cord.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 31
Incorrect
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The resting membrane potential of a neurone is usually about:
Your Answer:
Correct Answer: -70 mV
Explanation:In most neurones the resting potential has a value of approximately -70 mV. The threshold potential is generally around -55 mV. Initial depolarisation occurs as a result of a Na+influx through ligand-gated Na+channels. Action potential is an all or nothing response; because the size of the action potential is constant, the intensity of the stimulus is coded by the frequency of firing of a neuron. Repolarisation occurs primarily due to K+efflux.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 32
Incorrect
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A 23-year-old student presents to the emergency department with a terrible headache, photophobia, and a fever. On her lower limbs, you see a non-blanching purpuric rash. In the department, a lumbar puncture is conducted. What do you think you'll notice on Gram stain:
Your Answer:
Correct Answer: Gram negative diplococci
Explanation:Bacterial meningitis and septicaemia are most commonly caused by meningococcal bacteria. The Gram-negative diplococci Neisseria Meningitidis causes meningitis. Gram stain and culture of CSF identify the etiologic organism, N meningitidis. In bacterial meningitis, Gram stain is positive in 70-90% of untreated cases, and culture results are positive in as many as 80% of cases.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 33
Incorrect
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You've been asked to visit a 20-year-old patient who has been complaining of stomach pain, diarrhoea, and bloating. The GP recently saw the patient and is now looking into numerous possible reasons for stomach hypermotility.
Which of the following factors contributes to increased stomach motility?Your Answer:
Correct Answer: Gastrin
Explanation:Gastrin is a peptide hormone that aids in gastric motility by stimulating the generation of gastric acid by the parietal cells of the stomach. G-cells in the stomach’s pyloric antrum, the duodenum, and the pancreas release it.
The following stimuli cause the release of gastrin:
Stimulation of the vagus nerve
Hypercalcaemia
stomach bloating
Proteins that have been partially digested, particularly amino acids.
The presence of acid and somatostatin inhibits the release of gastrin.
Gastrin’s main actions are as follows:
Gastric parietal cells are stimulated to release hydrochloric acid.
ECL cells are stimulated to produce histamine.
Gastric parietal cell maturation and fundal growth stimulation
Causes the secretion of pepsinogen by the gastric chief cells.
Improves antral muscle mobility
stimulates gastric contractions
Increases gastric emptying rate and stimulates pancreatic secretion
Gallbladder emptying is induced. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 34
Incorrect
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On which of the following types of receptors does loperamide act?
Your Answer:
Correct Answer: Opioid receptors
Explanation:Loperamide inhibits acetylcholine release from the myenteric plexus acts by action on opioid mu-receptors, and this then reduces bowel motility. The intestinal transit time is increased, thereby facilitating water reabsorption.
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This question is part of the following fields:
- Gastrointestinal
- Pharmacology
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Question 35
Incorrect
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Which of the following best describes the order in which blood passes through the nephron?
Your Answer:
Correct Answer: Afferent arteriole→Glomerular capillary→Efferent arteriole→Peritubular capillary→Vasa recta
Explanation:The nephron’s blood flow is as follows:
Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa recta – Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa rectaThe kidney is the only vascular network in the body with two capillary beds. With arterioles supplying and draining the glomerular capillaries, higher hydrostatic pressures at the glomerulus are maintained, allowing for better filtration. A second capillary network at the tubules enables for secretion and absorption in the tubules, as well as concentrating urine.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 36
Incorrect
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A 33 year old lady with a known nut allergy was having dinner at a Thai restaurant. She suddenly complained of lip and tongue swelling and difficulty breathing and is brought to ED by ambulance with suspected anaphylaxis. She received intramuscular adrenaline in the ambulance.
The most appropriate doses of the second line treatments for anaphylaxis are which of the following?Your Answer:
Correct Answer: 10 mg chlorphenamine and 200 mg hydrocortisone
Explanation:Second line drugs to reduce the severity and duration of anaphylactic symptoms are intravenous or intramuscular chlorpheniramine and hydrocortisone. The recommended dose is 10 mg chlorpheniramine and 200 mg hydrocortisone in adults.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 37
Incorrect
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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 38
Incorrect
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Gastric emptying is inhibited by all of the following EXCEPT for:
Your Answer:
Correct Answer: Parasympathetic stimulation
Explanation:Gastric emptying is decreased by:
Enterogastric inhibitory reflexes stimulated by – Distension of the duodenum, The presence of fats in the duodenum (by stimulating release of cholecystokinin), A fall in the pH of chyme in the duodenum, An increase in the osmolality of chyme in the duodenum, Irritation of the mucosal lining of the duodenum, Hormones: Cholecystokinin, Secretin -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 39
Incorrect
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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 40
Incorrect
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Gastric emptying is increased by all of the following EXCEPT for:
Your Answer:
Correct Answer: Secretin
Explanation:Gastric emptying is increased by:
Distension of the pyloric antrum
A fall in the pH of chyme in the stomach
Parasympathetic stimulation (via vagus)
Gastrin
The hormones secretin, cholecystokinin and gastric inhibitory polypeptide (GIP) inhibit gastric emptying. -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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