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Question 1
Correct
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HCL is secreted by which cells in the stomach
Your Answer: Parietal cells
Explanation:Parietal cells are the epithelial cells that secrete hydrochloric acid (HCl) and intrinsic factor. These cells are located in the gastric glands found in the lining of the fundus and in the body of the stomach.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 2
Incorrect
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The coronary arteries supply which part of the heart’s subendocardial region exclusively in diastole?
Your Answer: All chambers of the heart ( all of the above if you want )
Correct Answer: Left ventricle
Explanation:It is only during diastole that the blood flows to the subendocardial portion of the left ventricle, as the heart muscle relaxes and the coronary arteries regain their patency.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 3
Correct
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A 42 year old female with a history of SLE presents with an exacerbation of wrist pain. Which of the following markers would be the most suitable for monitoring disease activity?
Your Answer: Anti-dsDNA titres
Explanation:A high level of anti-dsDNA in the blood is strongly associated with lupus and is often significantly increased during or just prior to a flare-up. When the anti-dsDNA is positive and the person tested has other clinical signs and symptoms associated with lupus, it means that the person tested likely has lupus. This is especially true if an anti-Sm test is also positive.In the evaluation of someone with lupus nephritis, a high level (titre) of anti-dsDNA is generally associated with ongoing inflammation and damage to the kidneys.A very low level of anti-dsDNA is considered negative but does not exclude a diagnosis of lupus. Only about 65-85% of those with lupus will have anti-dsDNA.Low to moderate levels of the autoantibody may be seen with other autoimmune disorders, such as Sjögren syndrome and mixed connective tissue disease (MCTD).
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 4
Correct
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Which of the following proteins are NOT synthesized in the liver?
Your Answer: Steroid
Explanation:Human steroidogenesis occurs in a number of locations:- Corticosteroids are produced in the adrenal cortex.- Oestrogen and progesterone are made primarily in the ovary and the placenta during pregnancy, and testosterone in the testes.- Testosterone is also converted to oestrogen to regulate the supply of each in females and males.- Some neurons and glia in the central nervous system (CNS) express the enzymes required for the local synthesis of pregnant neurosteroids, de novo or from peripheral sources.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 5
Incorrect
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A 68 year old man presents with acute symptoms of gout on his first metatarsophalangeal joint. Which option best explains the underlying mechanism of gout?
Your Answer: Increased endogenous production of uric acid
Correct Answer: Decreased renal excretion of uric acid
Explanation:Primary gout is related more often to underexcretion of uric acid or overproduction.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 6
Incorrect
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A 47 year old woman presents with joint pains and a history of recurrent infections over the past few months. Labs reveal a positive rheumatoid factor and low white cell count. Given the likely diagnosis, which of the following features would be present in her case?
Your Answer: Distal interphalangeal joint involvement
Correct Answer: Splenomegaly
Explanation:Felty syndrome is a severe subtype of seropositive Rheumatoid arthritis. Clinical triad consists of arthritis, splenomegaly, and neutropenia (leads to an increased risk of recurrent bacterial infections). Other symptoms include skin ulcers of the lower limbs (indicating vasculitis), hepatomegaly, fever, and chest pain (indicating pleuritis or pericarditis). It is associated with increased risk of developing non-Hodgkin lymphoma.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 7
Incorrect
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Stimulation of the carotid sinus results in:
Your Answer: Tachycardia
Correct Answer: Drop in blood pressure
Explanation:Stimulation of the carotid sinus will result in an increase in the baroreceptor discharge. This will travel via the afferent nerves to the medulla. Signals will pass through the vagus nerve to decrease the sympathetic outflow to the heart and the blood vessels. This inhibition will result in vasodilation of the blood vessels, venodilation and bradycardia hence decreasing the total peripheral resistance and lowering the blood pressure.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 8
Incorrect
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An 80-year-old woman with advanced COPD has been admitted to the medicine ward in an unconscious state. She appears to have an acute lower respiratory tract infection. After consulting with an anaesthesiologist it was concluded that she was not a candidate for intensive care unit admission and thus, a decision was made to start the patient on doxapram therapy. Which of the following best fits the characteristics of doxapram?
Your Answer: It has a half-life of 12 h
Correct Answer: It is contraindicated in hyperthyroidism
Explanation:The two statements that fit the characteristics of doxapram are, epilepsy is a contraindication for doxapram use and concurrent use with theophylline may increase agitation.Doxapram is a central respiratory stimulant. In clinical practice, doxapram is usually used for patients who have an acute exacerbation of chronic obstructive pulmonary disease (COPD) who are unsuitable for admission to the intensive therapy unit for ventilatory support. Doxapram infusion may buy an extra 24 h to allow for recovery.Contraindications include: ischaemic heart disease, epilepsy, cerebral oedema, acute stroke, asthma, hypertension, hyperthyroidism, and pheochromocytoma. The infusion may worsen agitation and dyspnoea and lead to hypertension, nausea, vomiting and urinary retention.Drug interactions:Concomitant administration of doxapram and aminophylline (theophylline) can cause increased skeletal muscle activity, agitation, and hyperactivity.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 9
Correct
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Question 10
Incorrect
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A 25-year-old woman presented to the ED with carbon monoxide poisoning. High-flow oxygen was administered immediately. She had a GCS of 15 and her vitals were stable. Which one of the following is not an indication for hyperbaric oxygen therapy in this scenario?
Your Answer: Extrapyramidal features
Correct Answer: A carboxyhaemoglobin concentration of 16%
Explanation:Carbon monoxide (CO) poisoning, considered as the great imitator of other diseases, as the patients present with a myriad of symptoms. The carbon monoxide diffuses rapidly across the pulmonary capillary membrane binding to the haem molecule with a very high affinity (240 times that of oxygen) forming carboxy-haemoglobin (COHb). Non-smokers have a baseline COHb of ,3% while smokers have a baseline COHb of 10-15%.Use of Hyperbaric oxygen therapy (HBOT) for treatment of mild to moderate CO poisoning is not routine.The selection criteria for HBOT in cases of CO poisoning include:• COHb levels > 20-25%• COHb levels > 20% in pregnant patient • Loss of consciousness• Severe metabolic acidosis (pH <7.1)• Evidence of end-organ ischemia (e.g., ECG changes, chest pain, or altered mental status)Principle of HBOT:Exposing patients to 100 percent oxygen under supra-atmospheric conditions results in a decrease in the half-life (t1/2) of COHb, from , 90 min in atmospheric air to , 30 minutes. The amount of oxygen dissolved in the blood also rises from , 0.3 to 6 mL/dL, increasing the delivery of non-haemoglobin-bound oxygen to the tissues.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 11
Incorrect
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An important enzyme in renal tissue responsible for the conversion of glutamine to glutamate and the subsequent production of NH4 is called?
Your Answer: Glutamic dehydrogenase
Correct Answer: Glutaminase
Explanation:Glutaminase catalyses the following reaction:Glutamine + H2O → Glutamate + NH3
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This question is part of the following fields:
- Medicine
- Renal
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Question 12
Incorrect
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Male to male transmission is a key factor of which type of inheritance?
Your Answer: X linked recessive
Correct Answer: Autosomal dominant
Explanation:Autosomal dominant type of inheritance can include both sexes in the same ratio. There is no skipping a generation and father to son transmission is common. The passing of the trait is sex independent.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 13
Incorrect
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On which presynaptic receptor does noradrenalin act to inhibit noradrenalin secretion?
Your Answer: Α1 receptor
Correct Answer: Α2 receptor
Explanation:Adregenic receptors are A1, A2, B1, B2, B3. Out of these, the function of the A2 receptor is inhibition of transmitter release including nor adrenalin and acetylcholine of the autonomic nervous system.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 14
Correct
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Select a factor which stimulates glucagon secretion.
Your Answer: Protein meal
Explanation:Several studies have shown that glucagon levels are increased in individuals with a high protein diet. It is still debated, however, whether this type of diet affects insulin levels as well.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 15
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 16
Correct
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Which of the following conditions results from chromosomal ‘non-disjunction’?
Your Answer: All of the options
Explanation:Non-disjunction can result in aneuploidy i.e. abnormal number of chromosomes in a cell. It results due to uneven division of chromosomes in the meiosis 1 or 2 phase. All the above mentioned examples are of non-disjunction.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 17
Incorrect
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Question 18
Correct
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Which of the following is a precursor to the tissue macrophage?
Your Answer: Monocyte
Explanation:Monocytes are a type of white blood cell, or leukocyte. They are the largest type of leukocyte and can differentiate into macrophages or dendritic cells.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 19
Incorrect
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Which of the following skin coloration abnormalities occurs due to adrenal insufficiency due to primary adrenal disease?
Your Answer: Vitiligo
Correct Answer: Hyperpigmentation
Explanation:Addison’s disease, also known as primary adrenal insufficiency, or hypocortisolism is an endocrine disorder. Hyperpigmentation is one of its most common signs; it occurs as a result of an increase in pro-opiomelanocortin to produce more ACTH in response to the decreased levels of cortisol. Pro-opiomelanocortin is a precursor of melanocyte stimulating hormone (MSH), which stimulates melanocytes, causing darkening of the skin.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 20
Incorrect
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The following are examples of the functions of the vascular endothelium except:
Your Answer: Modulation of immune responses
Correct Answer: Tumour suppression
Explanation:Vascular endothelium has many important functions including regulation of vascular tone, molecular exchange between blood and tissue compartments, hemostasis and signaling for the immune regulation and inflammation. Depending on specific tissue needs and local stresses, endothelial cells are capable of evoking either antithrombotic or prothrombotic events. Tumor suppression is related to genes, or anti-oncogenes, that regulate a cell during cell division and replication.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 21
Correct
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The structure of haemoglobin A in adults includes
Your Answer: Haem, globin polypeptide chains α and β
Explanation:Haemoglobin A (HbA), also known as adult haemoglobin or α2β2, is the most common human haemoglobin tetramer, comprising over 97% of the total red blood cell haemoglobin. It consists of two alpha chains and two beta chains.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 22
Correct
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What is the function of the acute phase protein, C-reactive protein?
Your Answer: Opsonises bacteria
Explanation:There are various immune reactions that become activated once the barrier between the body and environment has been compromised. There are certain opsonins that bind to the bacteria and facilitate phagocytosis. One of them is the acute phase protein: C protein. others include antibodies and complement.
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This question is part of the following fields:
- Immunology
- Medicine
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Question 23
Incorrect
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Interruption of the entero-hepatic circulation causes:
Your Answer: Pale stools
Correct Answer: The amount of fat in the stool to be increased
Explanation:Enterohepatic circulation refers to the circulation of biliary acids, bilirubin, drugs, or other substances from the liver to the bile, followed by entry into the small intestine, absorption by the enterocyte and transport back to the liver. One of the causes of the interruption of enterohepatic circulation is the resection of the ileum where fat is mainly absorbed. Fat malabsorption results in increased fat in stools. Pale stools and dark urine is caused by obstruction of the biliary ductal system especially the common bile duct where urobilin and stercobilin are formed.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 24
Incorrect
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Which of the following is false with regard to the following statement: Proto- oncogenes can be transformed to oncogenes in the following ways.
Your Answer: Gene amplification
Correct Answer: Inhibition of P53
Explanation:Proto oncogenes cannot be transformed into oncogenes due to inhibition of P53 gene. There has to be a mutation in the proto oncogene. All the other options are true.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 25
Incorrect
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Which substance has the lowest taste threshold concentration, in other words which substance can be present in the lowest concentration before taste buds will respond?
Your Answer: Glucose (sweet)
Correct Answer: Strychnine hydrochloride (bitter)
Explanation:The lowest concentration of a gustatory stimulus to which the taste buds respond is considered to be the threshold concentration for that substance. The threshold concentration for strychnine is 0.0001 mm; this is because it allows the body to detect potentially dangerous substances (bitter plant components) at lower concentrations.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 26
Incorrect
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A 23 year old male presents with a history of lower back pain for the last one year. Presence of which of the following features most likely points towards ankylosing spondylitis?
Your Answer: Limited lumbar spine motion on physical examination
Correct Answer: Bilateral erosion of sacroiliac joints on X-ray
Explanation:Bilateral erosions of the sacroiliac joints on pelvic radiographs of patients with ankylosing spondylitis are an important feature of the modified New York classification criteria. Although HLA-B27 is commonly associated with AS, it can also be found in normal individuals. Back stiffness is worse in the morning and gets better as the day progresses. Tenderness and limited lumbar motion can be associated with other spine problems as well and is not characteristic of rheumatoid arthritis.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 27
Incorrect
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Which of the following vitamin deficiencies is associated with xerophthalmia?
Your Answer: Ascorbic acid (vitamin C)
Correct Answer: Vitamin A
Explanation:Xerophthalmia caused by a severe vitamin A deficiency is described by pathologic dryness of the conjunctiva and cornea. The conjunctiva becomes dry, thick and wrinkled. If untreated, it can lead to corneal ulceration and ultimately to blindness as a result of corneal damage.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 28
Correct
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A patient with achalasia
Your Answer: Has decreased production of vasoactive intestinal polypeptide (VIP)
Explanation:Oesophageal achalasia is an oesophageal motility disorder involving the smooth muscle layer of the oesophagus and the lower oesophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the oesophagus (inability of smooth muscle to move food down the oesophagus) in the absence of other explanations like cancer or fibrosis. In achalasia, there is loss of nitric oxide (NO) and vasoactive intestinal polypeptide (VIP) releasing inhibitory neurons.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 29
Correct
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The conversion of haem to bilirubin is catalysed by which of these enzymes?
Your Answer: Biliverdin reductase
Explanation:Bilirubin is created by the activity of biliverdin reductase on biliverdin, a green tetrapyrrolic bile pigment that is also a product of haem catabolism.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 30
Incorrect
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The pontine tegmentum as part of the midbrain, contains which cranial nerve nuclei?
Your Answer: CN 1 to 2
Correct Answer: CN 5 to 8
Explanation:The pontine tegmentum also known as dorsal pons is located within the brain stem. Several cranial nerve nuclei are located in the pontine tegmentum. The nuclei of CN V, CN VI, CN VII and CNVIII are located in the pontine tegmentum.
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This question is part of the following fields:
- Medicine
- Neurology
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