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Question 1
Correct
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A 78 year old woman presents to the clinic complaining of left sided temporal headaches and jaw claudication that has been going on for a month. A left temporal artery biopsy is negative. Results show:Hb: 130g/lPlatelets: 359*109/lWBC: 10*109/lCRP: 89mg/lWhich of the following options would be the next best step in the management of this patient?
Your Answer: Commence prednisolone
Explanation:Temporal arteritis is a chronic large- and medium-sized vessel vasculitis that typically involves the temporal arteries. Classical symptoms include temporal headaches, jaw claudication, amaurosis fugax. Physical exam shows scalp tenderness, palpation of the temporal area may demonstrate an absent pulse, knot-like swelling and vision loss. Lab results reveal an increased erythematous sedimentation rate and C-reactive protein. Temporal artery biopsy confirms the diagnosis. Management approach: high-dose systemic corticosteroids should be promptly administered even before the diagnosis is established. Temporal artery biopsy confirms the diagnosis. Inability to manage this or administer glucocorticoids might lead to development of blindness.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 2
Incorrect
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Medullary chemoreceptors
Your Answer: Monitor PCO2 concentration of arterial blood
Correct Answer: Monitor H+ concentration of the CSF
Explanation:Central chemoreceptors of the central nervous system, located on the ventrolateral medullary surface in the vicinity of the exit of the 9th and 10th cranial nerves, are sensitive to the pH of their environment. These act to detect the changes in pH of nearby cerebral spinal fluid (CSF) that are indicative of altered oxygen or carbon dioxide concentrations available to brain tissues.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 3
Correct
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The cell membrane:
Your Answer: Is a bilayer of amphipathic lipids
Explanation:The cell membrane consists of a bilayer of amphipathic lipids with embedded proteins. The basic function of the cell membrane is to protect the cell from its surroundings. It is selectively permeable to ions and organic molecules. The entire membrane is held together via non-covalent interaction of hydrophobic tails, however the structure is quite fluid and not fixed rigidly in place. Membranes are typically 7.5–10 nm in thickness and typically have a large content of proteins, around 50% of membrane volume.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 4
Incorrect
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An important hormone controlling the differentiation of monocytes to osteoclasts, by inhibiting the RANKL/ RANK interaction is called?
Your Answer: Rank – blocking ligand
Correct Answer: Osteoprotegerin
Explanation:Osteoprotegerin, also known as osteoclastogenesis inhibitory factor (OCIF) is a glycoprotein that acts as a cytokine receptor. It works as a decoy receptor for the receptor activator of nuclear factor-kappaB ligand (RANKL)/osteoclast differentiation factor, thus inhibiting the differentiation of osteoclasts, which are capable of resorbing bone. Osteoprotegerin has been proposed as a therapeutic agent for osteoporosis.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 5
Incorrect
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The energy needed for glycogen synthesis comes from which compound?
Your Answer: UDP
Correct Answer: UTP
Explanation:Glycogen synthesis is, unlike its breakdown, endergonic—it requires the input of energy. Energy for glycogen synthesis comes from uridine triphosphate (UTP)
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 6
Incorrect
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Cyclic AMP is formed from ATP via which enzyme
Your Answer: Phosphodiesterase
Correct Answer: Adenylate cyclase
Explanation:Cyclic AMP is synthesized from ATP by adenylate cyclase located on the inner side of the plasma membrane and anchored at various locations in the interior of the cell.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 7
Correct
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The superior orbital fissure is the site of entry/exit for which of the following group of nerves?
Your Answer: CN III, IV, V1, VI
Explanation:The superior and inferior divisions of oculomotor nerve (III), trochlear nerve (IV), lacrimal, frontal and nasociliary branches of ophthalmic V1 and the abducens nerve (VI)
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This question is part of the following fields:
- Medicine
- Neurology
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Question 8
Incorrect
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What is the most important source of heat production in the body?
Your Answer: Thyroid hormone secretion
Correct Answer: Skeletal muscle contraction
Explanation:Thermogenesis is the process by which organisms produce heat. Through skeletal muscle contraction, or shivering, ATP is converted into kinetic energy, some of which converts into heat. These muscle contractions produce about 70% of total body heat.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 9
Correct
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What is the primary problem of achalasia
Your Answer: Deficiency of myenteric plexus at the lower oesophageal sphincter
Explanation:Oesophageal achalasia is an oesophageal motility disorder involving the smooth muscle layer of the oesophagus is characterized by the failure of the lower oesophageal sphincter (LES) relaxation and aperistalsis, caused primarily by the loss of the inhibitory innervation of the oesophageal myenteric plexus.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 10
Correct
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Tunica intima is made up of?
Your Answer: Endothelial cells
Explanation:Tunica intima is a single cell thick lining of endothelial cells that lines the inside of the blood vessels. It is the inner most layer of the blood vessel.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 11
Incorrect
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A 62 year old female has complained she feels unsteady when she is walking. She is examined and is found to have pyramidal weakness of her left lower leg. She also has reduced pain and temperature sensation on her right leg and right side of her torso up to the umbilicus. Her joint position sense is also impaired in her left big toe but is found to be normal elsewhere. She has definite left extensor plantar response, and the right plantar response is equivocal. Where is the lesion?
Your Answer: Left lumbo-sacral plexus
Correct Answer: Left mid-thoracic cord
Explanation:In Brown-Sequard syndrome, there is paralysis and loss of proprioception, which occurs on the same (ipsilateral) side of the body, as the lesion. Loss of pain and temperature sensation, therefore, occurs on the opposite (contralateral) side of the body as the lesion.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 12
Correct
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A 34-year-old man was brought to the ER following a road-traffic-accident. An X-ray of his left thigh revealed a fractured shaft of the left femur. He has a known history of opioid abuse. You are called to the ward to assess him after he becomes unwell. Which of the following clinical features are NOT compatible with a diagnosis of opioid withdrawal?
Your Answer: Hypothermia
Explanation:Among the options provided, hypothermia is not a symptom of opioid withdrawal.Symptoms of opioid withdrawal include dysphoric mood, yawning, insomnia, muscle aches, lacrimation/rhinorrhoea, papillary dilatation, piloerection, fever, sweating, nausea/vomiting, diarrhoea.If the patient is having an opioid withdrawal reaction, then give 10 mg of methadone syrup and wait about 60 min to determine its effect.COWS (Clinical Opioid Withdrawal Scale) assessment for opioid withdrawal is commonly used to determine the severity of opioid withdrawal.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 13
Correct
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Question 14
Incorrect
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Which among the following antihypertensives is centrally acting?
Your Answer: Hydralazine
Correct Answer: Moxonidine
Explanation:Moxonidine and alpha-methyl dopa are centrally acting antihypertensives and modify blood pressure through modifying sympathetic activity.Other options:Verapamil is a calcium antagonist.Minoxidil and hydralazine are both vasodilators.Phenoxybenzamine is an alpha-blocker.Adverse effects:Dry mouth and somnolence were the most frequently reported adverse events, followed by headache, dizziness, nausea and allergic skin reactions.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 15
Incorrect
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Which of the following takes place during fasting
Your Answer: Basic electrical rhythm
Correct Answer: Migrating motor complex
Explanation:Migrating motor complexes (MMC) are waves of electrical activity that sweep through the intestines in a regular cycle during fasting. These motor complexes trigger peristaltic waves, which facilitate transportation of indigestible substances such as bone, fiber, and foreign bodies from the stomach, through the small intestine, past the ileocecal sphincter, and into the colon.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 16
Correct
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Which of the following is first to rise following myocardial infarction?
Your Answer: Myoglobin
Explanation:Myoglobin, is a sensitive indicator of muscle injury and is first to rise following MI within two hours but is nonspecific.Troponin and CK-MB both begin to rise approximately three hours after MI. The cardiac troponins T and I which are released within 4–6 hours of an attack of MI and remain elevated for up to 2 weeks, have nearly complete tissue specificity and are now the preferred markers for assessing myocardial damage.Lactate dehydrogenase (LDH) begins to rise approximately 12 hours after MI.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 17
Correct
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Question 18
Incorrect
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With regards to the deiodinases, where would you find D1?
Your Answer: Brain
Correct Answer: Liver
Explanation:The liver produces an important amount of T3 by outer ring deiodination thanks to its elevated concentration of type I deiodinase. It can also be found in the kidney.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 19
Correct
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The percentage of blood supplied to the liver by the hepatic artery is?
Your Answer: 25%
Explanation:The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic portal vein delivers approximately 75% of the liver’s blood supply, and carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remaining quarter of its blood flow. Oxygen is provided from both sources; approximately half of the liver’s oxygen demand is met by the hepatic portal vein, and half is met by the hepatic arteries
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 20
Incorrect
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During which phase are the 2 chromatids pulled apart at the centromere?
Your Answer: Metaphase
Correct Answer: Anaphase
Explanation:During the prometaphase the microtubule organizing centre completely develops. The spindle fibers attach to the chromosome and the centriole. It is in the Anaphase however that the spindle fibers contract pulling the sister chromatids apart. Later in the anaphase a cleave furrow beings to forms.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 21
Incorrect
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The cells that secrete pepsinogen and gastric lipase are found in which part of the stomach?
Your Answer: Antrum
Correct Answer: Body and fundus
Explanation:Stomach can be divided in to different regions. Cardia, fundus, body, antrum and pylorus from proximal end to distal end respectively. Cells that secret the inactive form of pepsin or pepsinogen are chief cells and are abundant in the body (corpus) and the fundus region of the stomach.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 22
Incorrect
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In a study, 50 out of 100 smokers developed lung cancers and 50 out of 200 non-smokers developed lung cancers. Which of the following is accurate?
Your Answer: Relative risk =5
Correct Answer: Relative risk=2
Explanation:Relative risk = (Incidence in exposed group)/incidence in unexposed group). So in this case RR = (50/100)/(50/200) = 2.
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This question is part of the following fields:
- Medicine
- Research Skills
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Question 23
Correct
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A 50-year-old male was brought to the ER after the accidental consumption of 300 ml of diethylene glycol. Blood investigations were suggestive of metabolic acidosis and renal failure. What is the appropriate management in this patient?
Your Answer: Haemodialysis and oral ethanol
Explanation:Among the given options the most appropriate management in this patient would be ethanol and haemodialysis.Ethanol competes with ethylene glycol for alcohol dehydrogenase and thus, helps manage a patient with ethylene glycol toxicity.Ethylene glycol is a type of alcohol used as a coolant or antifreezeFeatures of toxicity are divided into 3 stages:Stage 1: (30 min to 12 hours after exposure) Symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness (CNS depression)Stage 2: (12 – 48 hours after exposure) Metabolic acidosis with a high anion gap and high osmolar gap. Also tachycardia, hypertensionStage 3: (24 – 72 hours after exposure) Acute renal failureManagement has changed in recent times:Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.Ethanol has been used for many years works by competing with ethylene glycol for the enzyme alcohol dehydrogenase this limits the formation of toxic metabolites (e.g. glycolaldehyde and glycolic acid) which are responsible for the hemodynamic/metabolic features of poisoning.Haemodialysis has a role in refractory cases.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 24
Correct
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Which of the following is true with AV nodal delay?
Your Answer: Shortened by sympathetic stimulation
Explanation:AV nodal delay Is about 0.1s before the action potential spreads to the ventricles. It is shortened by stimulation of the sympathetic nervous system and lengthened by stimulation of the parasympathetic system.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 25
Incorrect
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The apical enzyme responsible for the oxidation and reaction of iodide with thyroglobulin is:
Your Answer: Pendrin
Correct Answer: Thyroid peroxidise
Explanation:Thyroid peroxidase is an enzyme that is secreted into the thyroid colloid. It works by oxidizing iodide ions into iodine which are incorporated into thyroglobulin, in order to produce T3 and T4.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 26
Correct
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A 72 year old retired fisherman presents with weakness of shoulders and hips over the last four months. Finger flexion is also weak but the extension is normal. There has been some difficulty swallowing liquids. Past medical history is not significant except for sexually transmitted disease that he caught some 40 years ago in South Pacific and got treated with antibiotics. He smokes and drinks one or two tots of rum at the weekend. Creatine kinase level is 125. Which of the following investigations is most significant in establishing a diagnosis?
Your Answer: Muscle biopsy with electron microscopy
Explanation:Inclusion body myositis (IBM) is a progressive muscle disorder characterized by muscle inflammation, weakness, and atrophy (wasting). It is a type of inflammatory myopathy. IBM develops in adulthood, usually after age 50. The symptoms and rate of progression vary from person to person. The most common symptoms include progressive weakness of the legs, arms, fingers, and wrists. Some people also have weakness of the facial muscles (especially muscles controlling eye closure), or difficulty swallowing (dysphagia). Muscle cramping and pain are uncommon, but have been reported in some people. The underlying cause of IBM is poorly understood and likely involves the interaction of genetic, immune-related, and environmental factors. Some people may have a genetic predisposition to developing IBM, but the condition itself typically is not inherited. Elevated creatine kinase (CK) levels in the blood (at most ,10 times normal) are typical in IBM. Muscle biopsy may display several common findings including; inflammatory cells invading muscle cells, vacuolar degeneration, inclusions or plaques of abnormal proteins.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 27
Correct
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A 50-year-old patient was started on ezetimibe, for his cholesterol a few days back. Which among the following statements is true regarding ezetimibe?
Your Answer: Its principal action is to reduce intestinal cholesterol absorption
Explanation:Ezetimibe is a cholesterol-lowering agent that acts to prevent cholesterol absorption by directly inhibiting cholesterol receptors on enterocytes.It does not affect the absorption of drugs (e.g. digoxin, thyroxine) or fat-soluble vitamins (A, D and K) as the anion-exchange resins do. It does not affect the cytochrome P450 enzyme system.The increased risk of myositis associated with the statins is not seen with ezetimibe.The most common adverse effects include headache, runny nose, and sore throat. Less common reactions include body aches, back pain, chest pain, diarrhoea, joint pain, fatigue, and weakness.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 28
Incorrect
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Which of the following tracts are involved in the control of vital functions?
Your Answer: Spinocerebellar
Correct Answer: Reticulospinal
Explanation:Reticulospinal tract pass down from the reticular formation of the mid brain, pons and medulla. It descends in the lateral white column. Both sets of fibers enter the anterior grey column and may facilitate or inhibit the gamma and alpha neurons. By this means the reticulospinal tract controls voluntary and reflex activities. It also contains the descending autonomic fiber, thus providing a pathway for the hypothalamus to control the sympathetic and parasympathetic pathways.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 29
Correct
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The amount of a substance taken up by an organ (or whole body) per unit time is = (the arterial level - the venous level) * the blood flow. This statement describes?
Your Answer: The Fick principle
Explanation:The essence of the Fick principle is that blood flow to an organ can be calculated using a marker substance if the following information is known:- Amount of marker substance taken up by the organ per unit time- Concentration of marker substance in arterial blood supplying the organ- Concentration of marker substance in venous blood leaving the organ
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 30
Incorrect
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A 65-year-old man presents to you three weeks after initiating metformin for type 2 diabetes mellitus. His body mass index is 27.5 kg/m^2. At a dose of 500mg TDS the patient has experienced significant diarrhoea. Even on reducing the dose to 500mg BD his symptoms persisted. What is the most appropriate next step in this patient?
Your Answer: Switch to pioglitazone 15mg od
Correct Answer: Start modified release metformin 500mg od with evening meal
Explanation:Here, the patient seems to be intolerant to standard metformin. In such cases, modified-release preparations is considered as the most appropriate next step. There is some evidence that these produce fewer gastrointestinal side-effects in patients intolerant of standard-release metformin.Metformin is a biguanide and reduces blood glucose levels by decreasing the production of glucose in the liver, decreasing intestinal absorption and increasing insulin sensitivity. Metformin decreases both the basal and postprandial blood glucose.Other uses: In Polycystic Ovarian Syndrome (PCOS), Metformin decreases insulin levels, which then decreases luteinizing hormone and androgen levels. Thus acting to normalize the menstruation cycle.Note:Metformin is contraindicated in patients with severe renal dysfunction, which is defined as a glomerular filtration rate (GFR) less than 30 ml/min/1.732m2. Metformin overdose has been associated with hypoglycaemia and lactic acidosis, for this reason, it has a black box warning for lactic acidosis.
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This question is part of the following fields:
- Medicine
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
