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  • Question 1 - The medial and lateral pterygoid muscles are innervated by which of the following...

    Incorrect

    • The medial and lateral pterygoid muscles are innervated by which of the following nerves:

      Your Answer: Glossopharyngeal nerve

      Correct Answer: Mandibular division of the trigeminal nerve

      Explanation:

      Both the medial and lateral pterygoids are innervated by the mandibular division of the trigeminal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      57
      Seconds
  • Question 2 - A 40-year-old male presents to your clinic complaining of a cough with bloody...

    Incorrect

    • A 40-year-old male presents to your clinic complaining of a cough with bloody sputum for the past three months. He has also had fever, night sweats, and has noticed some weight loss over the past three months.

      Which ONE of the following statements regarding this disease is correct?

      Your Answer: Tuberculosis is spread by the faeco-oral route

      Correct Answer: It can be diagnosed using the Ziehl-Neelson stain

      Explanation:

      Tuberculosis is an infection caused by the microorganism Mycobacterium tuberculosis. TB can affect any organ system in the body, but it most commonly affects the lungs, followed by the lymph nodes.

      Option Tuberculosis is spread by the faecal-oral route: It is spread by inhalation of droplet nuclei.

      There are different methods to diagnose a tuberculosis infection.
      1) Direct Microscopy: The organisms are visualised using Ziehl-Neelsen or Auramine staining. This is the quickest method to establish a diagnosis and start treatment.
      2) Culture: M. tuberculosis can be grown on Lowenstein-Jensen or Ogawa mediums, but it can take up to 8 weeks; therefore, ZN staining is also performed to start treatment immediately.

      Option There are several types of vaccine currently available: The BCG vaccine is the only vaccine approved to prevent TB and is administered at birth.

      Option Miliary tuberculosis refers to tuberculosis that affects the spine: Miliary tuberculosis refers to a tuberculosis infection disseminated throughout the body’s organ systems via the blood or lymphatics. Pott’s disease is extrapulmonary TB that affects the spine. It usually affects the lower thoracic and upper lumbar regions.

      Option A Ghon focus typically appears at the apex of a lung: The Ghon focus is a primary sign of TB that forms in the lung of previously unaffected patients. It typically occurs in the mid or lower zones of the lung.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      5855.2
      Seconds
  • Question 3 - You are going to prescribe a NSAID to a 50-year-old male patient for...

    Incorrect

    • You are going to prescribe a NSAID to a 50-year-old male patient for his back pain. Which of the following NSAIDs is least likely to cause gastrointestinal side effects:

      Your Answer: Diclofenac

      Correct Answer: Ibuprofen

      Explanation:

      NSAIDs are associated with serious gastrointestinal irritation and drug-induced ulcers.

      Among the NSAIDs included in the choices, ibuprofen has the lowest risk.

      Piroxicam, ketoprofen, and ketorolac trometamol are associated with the highest risk of serious upper gastrointestinal side effects.

      Indomethacin, diclofenac, and naproxen are associated with an intermediate risk of serious upper gastrointestinal side effects.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
      7.3
      Seconds
  • Question 4 - Which of the following immunoglobulin molecules is the most abundant in secretions (such...

    Incorrect

    • Which of the following immunoglobulin molecules is the most abundant in secretions (such as saliva and breast milk):

      Your Answer: IgG

      Correct Answer: IgA

      Explanation:

      IgA is the predominant antibody class in secretions and tremendous quantities are secreted into various body spaces and onto mucosal surfaces (the gut lumen, the pharynx and sinuses, the larger airways, although not the alveoli).
      Because of its size, the majority of IgM is found in the circulation.

      Along with IgM, IgD is predominant among the surface receptors of mature B cells, where it plays a key role in B cells activation.

      IgE has the lowest concentration in normal human serum. It plays a prominent role in immune responses to helminth parasites, and in allergic reactions.
      IgG is the most abundant immunoglobulin and constitutes 75 percent of serum immunoglobulin in an adult human

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      41.1
      Seconds
  • Question 5 - By what mechanism does Vibrio cholerae causes diarrhoea? ...

    Correct

    • By what mechanism does Vibrio cholerae causes diarrhoea?

      Your Answer: Increases Cl- secretory channels in crypt cells

      Explanation:

      Cholera is a severe diarrheal illness caused by the Vibrio cholerae bacteria infecting the bowel. Ingesting cholera-infected food or drink is the a way to contract the disease. In the intestinal crypt cells, the toxigenic bacterium Vibrio cholera activates adenylate cyclase and raises cyclic adenosine monophosphate (cAMP).

      cAMP stimulates the Cl-secretory channels in crypt cells, resulting in the secretion of chloride with sodium ions and water. The toxin it produces causes the body to secrete massive amounts of water, resulting in diarrhoea and significant fluid and electrolyte loss.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      148.3
      Seconds
  • Question 6 - A blood culture was performed from a sample taken from a patient. It...

    Incorrect

    • A blood culture was performed from a sample taken from a patient. It was noted that a Gram-positive coccus organism was grown.

      Among the following microorganisms, which is considered an example of a Gram-positive coccus?

      Your Answer: Escherichia coli

      Correct Answer: Staphylococcus aureus

      Explanation:

      Bacillus cereus = Gram-positive bacillus
      Neisseria meningitidis = Gram-negative coccus
      Salmonella enterica & Escherichia coli = Gram-negative bacilli

      In Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative.
      The Staphylococci that are associated with infections in humans are colonizers of various skin and mucosal surfaces. Because the carrier state is common among the human population, infections are frequently acquired when the colonizing strain gains entrance to a normally sterile site as a result of trauma or abrasion to the skin or mucosal surface.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      140.5
      Seconds
  • Question 7 - You evaluate a 80-year-old man who has a history of persistent heart failure...

    Incorrect

    • You evaluate a 80-year-old man who has a history of persistent heart failure and discover that he has generalised oedema.

      Which of the following claims regarding capillary hydrostatic pressure (P c) is false?

      Your Answer: P c is the most variable of the four Starling factors affecting filtration at capillary beds

      Correct Answer: P c increases along the length of the capillary, from arteriole to venule

      Explanation:

      The capillary hydrostatic pressure (Pc) is normally between 15 and 30 millimetres of mercury. Pc Decreases along the capillary’s length, mirroring the arteriolar and venule pressures proximally and distally.
      Pc is determined by the ratio of arteriolar resistance (RA) to venular resistance (RV).

      When the RA/RV ratio is high, the pressure drop across the capillary is modest, and Pcis is close to venule pressure.

      When the ratio of RA/RV is low, the pressure drop across the capillary is considerable, and Pcis is close to arteriolar pressure.

      Pcis closer to the venule pressure and thus more responsive to changes in venous pressure than arteriolar pressure when RA/RV is high.

      Pcis the major force behind fluid pushing out of the capillary bed and into the interstitium.
      It is also the most variable of the forces affecting fluid transport at the capillary, partly because sympathetic-mediated arteriolar vasoconstriction varies.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      5.4
      Seconds
  • Question 8 - A 40-year-old man with episodes of blood in urine and flank pain that...

    Incorrect

    • A 40-year-old man with episodes of blood in urine and flank pain that are recurrent presents for management. He has a history of hypertension that is difficult to control and recurrent urinary tract infections. Other findings are: bilateral masses in his flanks and haematuria (3+ on dipstick).

      What is the most likely diagnosis?

      Your Answer: Renal cell carcinoma

      Correct Answer: Polycystic kidney disease

      Explanation:

      Autosomal dominant polycystic kidney disease (ADPKD) presents with abdominal or loin discomfort due to the increasing size of the kidneys, acute loin pain with or without haematuria, hypertension, and male infertility. It is the most common cause of serious renal disease and the most common inherited cause of renal failure in adults.

      Alport syndrome has hearing loss and eye abnormalities in addition to symptoms of kidney disease.

      Renal cell carcinoma presents with additional features of unexplained weight loss, loss of appetite, fever of unknown origin and anaemia.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      20.5
      Seconds
  • Question 9 - From which of the following cell types are platelets derived? ...

    Incorrect

    • From which of the following cell types are platelets derived?

      Your Answer: Monocytes

      Correct Answer: Megakaryocytes

      Explanation:

      Synthesis of platelets occurs in the bone marrow by fragmentation of megakaryocytes cytoplasm, derived from the common myeloid progenitor cell. The average time for differentiation of the human stem cell to the production of platelets is about 10 days. The major regulator of platelet formation is thrombopoietin and 95% of this is produced by the liver. Normal platelet count is 150 – 450 x 109/L and the normal lifespan of a platelet is about 10 days. Usually about one-third of the marrow output of platelets may be trapped at any one time in the normal spleen.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      338.8
      Seconds
  • Question 10 - Which of the following is NOT a function of antibodies: ...

    Incorrect

    • Which of the following is NOT a function of antibodies:

      Your Answer: Opsonise antigens for phagocytosis

      Correct Answer: Act as antigen receptors on T lymphocytes

      Explanation:

      Antibodies:
      Neutralise toxins and prevent attachment of pathogens
      Target, opsonise or agglutinate (clump together) antigens for phagocytosis
      Activate the complement cascade (leading to lysis or opsonisation of the pathogen)
      Act as antigen receptors on B lymphocytes
      Activate antibody-dependent cell-mediated cytotoxicity by natural killer (NK) cells or T cytotoxic cells
      Provide mucosal immunity (IgA-mediated)
      Stimulate degranulation of mast cells (IgE and IgG mediated)
      Provide passive immunity to the newborn (through transplacental passage of IgG and secretion of IgA in breast milk)

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      41.7
      Seconds
  • Question 11 - A 30 year old man stabbed in the upper arm presents to the...

    Incorrect

    • A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination.

      The brachial pulse can be best palpated at ?

      Your Answer: In the antecubital fossa, lateral to the tendon of the biceps brachii

      Correct Answer: In the antecubital fossa, medial to the tendon of the biceps brachii

      Explanation:

      The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      195.8
      Seconds
  • Question 12 - On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP...

    Incorrect

    • On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP reading of 152/96 mmHg (ABPM).

      Which of the following would be the patient's first-line drug treatment?

      Your Answer: No medication is required at this stage

      Correct Answer: Ramipril

      Explanation:

      An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.

      A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 48-year-old Afro-Caribbean man.

      An ACE inhibitor, such as ramipril, or a low-cost angiotensin-II receptor blocker (ARB), such as losartan, would be the most appropriate medication for a 48-year-old Caucasian man.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      85.8
      Seconds
  • Question 13 - A 64-year-old man presents with an acute episode of gout. He has a...

    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: Corticosteroids should be avoided in acute gout

      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
      143.3
      Seconds
  • Question 14 - Regarding dermatophytes, which of the following statement is CORRECT: ...

    Incorrect

    • Regarding dermatophytes, which of the following statement is CORRECT:

      Your Answer: First-line treatment is usually with oral terbinafine.

      Correct Answer: Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings.

      Explanation:

      Diagnosis is made from microscopy and culture of skin scrapings, hair samples or nail clippings depending on the site of infection. The lesions of ringworm typically have a dark outer ring with a pale centre. Tinea capitis is ringworm affecting the head and scalp. Spread is via direct skin contact. Treatment is usually topical, oral antifungals are reserved for refractory infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      41.7
      Seconds
  • Question 15 - Which of the following drugs used in the management of hyperkalaemia does not...

    Incorrect

    • Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:

      Your Answer: Insulin

      Correct Answer: Calcium gluconate

      Explanation:

      Calcium gluconate is given to antagonise cardiac cell membrane excitability to reduce the risk of arrhythmias. It has no effect on serum potassium levels unlike the alternative drugs listed above.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      1143.7
      Seconds
  • Question 16 - Elevation of the eyeball is primarily produced by which of the following muscles:...

    Incorrect

    • Elevation of the eyeball is primarily produced by which of the following muscles:

      Your Answer: Inferior rectus and superior oblique

      Correct Answer: Superior rectus and inferior oblique

      Explanation:

      Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      22.9
      Seconds
  • Question 17 - Hartmann's solution contains how much sodium: ...

    Incorrect

    • Hartmann's solution contains how much sodium:

      Your Answer: 126 mmol/L

      Correct Answer: 131 mmol/L

      Explanation:

      Hartmann’s solution (compound sodium lactate) contains: Na+131 mmol/L, K+5 mmol/L, HCO3-29 mmol/L (as lactate), Cl-111 mmol/L, Ca2+2 mmol/L. It can be used instead of isotonic sodium chloride solution during or after surgery, or in the initial management of the injured or wounded; it may reduce the risk of hyperchloraemic acidosis.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      590.7
      Seconds
  • Question 18 - Which of the following muscles are primarily involved in passive inspiration: ...

    Correct

    • Which of the following muscles are primarily involved in passive inspiration:

      Your Answer: Diaphragm and external intercostal muscles

      Explanation:

      Passive inspiration is produced by contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, elevation of the sternal ends of the ribs (‘pump handle’ movement), elevation of the lateral shafts of the ribs (‘bucket handle’ movement) and depression of the diaphragm result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in an increased intrathoracic volume and decreased intrathoracic pressure and thus air is drawn into the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      192.8
      Seconds
  • Question 19 - A patient complains of stomach ache. You see a midline scar in the...

    Incorrect

    • A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.

      The gastric ECL cells secrete which of the following substances?

      Your Answer: Secretin

      Correct Answer: Histamine

      Explanation:

      Enterochromaffin-like cells (ECL cells) are a type of neuroendocrine cell located beneath the epithelium in the stomach glands. They’re most typically located near the parietal cells of the stomach. The ECL cells’ primary role is to produce histamine, which stimulates the formation of stomach acid by the parietal cells.

      The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:

      Cell type/ Substance secreted/ Function of secretion
      Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
      Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
      Chief cells/ Pepsinogen/ Protein digestion
      Chief cells/ Gastric lipase/ Fat digestion
      G-cells/ Gastrin/ Stimulates gastric acid secretion
      Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
      Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
      D-cells/ Somatostatin/ Inhibits gastric acid secretion

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      171.6
      Seconds
  • Question 20 - A 23 year old student presents to ED with a widespread maculopapular rash....

    Correct

    • A 23 year old student presents to ED with a widespread maculopapular rash. She recently had a sore throat and was started on a course of antibiotics. The most likely antibiotic that she was prescribed is:

      Your Answer: Amoxicillin

      Explanation:

      Maculopapular rashes are commonly seen with ampicillin and amoxicillin. However they are not usually related to true penicillin allergy. Very often, they occur in patients with glandular fever and so, broad-spectrum penicillins should not be used blindly, for management and treatment of a sore throat. There is also an increased risk of rash in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      100.7
      Seconds
  • Question 21 - A patient suffers a stab wound to the neck. The entry point of...

    Incorrect

    • 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: Sternohyoid

      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 nerve

      The 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
      199.4
      Seconds
  • Question 22 - Which of the following risk ratios indicates no difference in risk between two groups:...

    Incorrect

    • Which of the following risk ratios indicates no difference in risk between two groups:

      Your Answer: 0

      Correct Answer: 1

      Explanation:

      A risk ratio of 1 indicates no difference in risk between groups.If the risk ratio of an event is > 1, the rate of that event is increased in the exposed group compared to the control group.If the risk ratio is < 1, the rate of that event is reduced in the exposed group compared to the control group.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      43.6
      Seconds
  • Question 23 - A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
    Which...

    Incorrect

    • A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
      Which of the following is NOT an action of the gluteus maximus muscle? Select ONE answer only.

      Your Answer: Raising the trunk from a flexed position

      Correct Answer: Hip abduction

      Explanation:

      Gluteus maximus is the main extensor muscle of the hip and assists with lateral rotation of the thigh at the hip joint. It also acts as a hip adductor, steadies the thigh, and assists in raising the trunk from a flexed position.
      Gluteus maximus is innervated by the inferior gluteal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      213
      Seconds
  • Question 24 - A 49-year-old man known sickle cell disease patient received a blood transfusion and...

    Incorrect

    • A 49-year-old man known sickle cell disease patient received a blood transfusion and developed a mild fever and dark urine 6 days after transfusion. His investigations show raised bilirubin, raised LDH, and a positive Direct Antiglobulin Test (DAT).

      Which transfusion reaction is most likely occurred?

      Your Answer: TACO

      Correct Answer: Delayed haemolytic reaction

      Explanation:

      Delayed haemolytic transfusion reactions (DHTRs) commonly occurs 4-8 days after blood transfusion, but can occur up to a month after. Signs and symptoms include jaundice, fever, an inadequate rise in PCV, reticulocytosis, a positive antibody screen and a positive Direct Antiglobulin Test (Coombs test). DHTRs usually have a benign course and require no treatment but sometimes, life-threatening haemolysis with severe anaemia and renal failure can occur so haemoglobin levels and renal function should be monitored.

      Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.

      Febrile transfusion reaction presents with a 1 degree rise in temperature from baseline during transfusion. Patient may have chills and malaise. It is the most common transfusion reaction (1 in 8 transfusions) and is usually caused by cytokines released from leukocytes in transfused red cell or platelet components.

      Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.

      Graft versus host disease(GVHD) is an immune mediated condition that arises from a complex interaction between donor and recipients adaptive immunity. It presents as dermatitis, hepatitis and enteritis developing within 100 days after stem cell or bone marrow transplant.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      18.4
      Seconds
  • Question 25 - A 23-year-old male presents to his family physician with the complaint of repeated...

    Incorrect

    • A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia.

      Which one of the following disorders is this patient most likely to have?

      Your Answer: Multiple myeloma

      Correct Answer: Paroxysmal nocturnal haemoglobinuria

      Explanation:

      Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight.

      Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.

      Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections.

      Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections.

      Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      179.4
      Seconds
  • Question 26 - About what percentage of filtered Na+is reabsorbed in the proximal tubule: ...

    Incorrect

    • About what percentage of filtered Na+is reabsorbed in the proximal tubule:

      Your Answer: 45 - 55%

      Correct Answer: 65 - 70%

      Explanation:

      Of the filtered sodium, about 65% is reabsorbed in the proximal tubule.

    • This question is part of the following fields:

      • Physiology
      • Renal
      62.9
      Seconds
  • Question 27 - A patient presents to your clinic with fever of unknown origin. His...

    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: IL-2

      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.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      18
      Seconds
  • Question 28 - Leukaemia has been diagnosed in a 6-year-old child on your list. He comes...

    Incorrect

    • Leukaemia has been diagnosed in a 6-year-old child on your list. He comes to the ER with a complication related to this diagnosis.

      Which type of leukaemia do you think this is?

      Your Answer: Chronic myeloid leukaemia

      Correct Answer: Acute lymphoblastic leukaemia

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer that primarily affects children. ALL is most common between the ages of 2 and 4, and it is uncommon in adults.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      26
      Seconds
  • Question 29 - The following are all examples of type II hypersensitivity EXCEPT for: ...

    Incorrect

    • The following are all examples of type II hypersensitivity EXCEPT for:

      Your Answer:

      Correct Answer: Post-streptococcal glomerulonephritis

      Explanation:

      Examples of type II reactions include:
      Incompatible blood transfusions
      Haemolytic disease of the newborn
      Autoimmune haemolytic anaemias
      Goodpasture’s syndrome
      Rheumatic heart disease
      Bullous pemphigoid

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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      Seconds
  • Question 30 - The following are all examples of type III hypersensitivity EXCEPT for: ...

    Incorrect

    • The following are all examples of type III hypersensitivity EXCEPT for:

      Your Answer:

      Correct Answer: Goodpasture's syndrome

      Explanation:

      Examples of type III reactions include:
      Extrinsic allergic alveolitis
      Systemic lupus erythematosus (SLE)
      Post-streptococcal glomerulonephritis
      Reactive arthritis
      Rheumatoid arthritis

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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