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Question 1
Incorrect
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Which of the following happens when anterograde neurons are stimulated?
Your Answer: Basic electrical rhythm is initiated
Correct Answer: Smooth muscle relaxation ahead of the stimulus
Explanation:Nitric oxide is thought to act as an anterograde neurotransmitter. Nitric oxide causes relaxation of smooth muscles ahead of the stimulus. Clinically it is used as a potent vasodilator.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 2
Correct
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A deficiency in Niacin leads to which clinical deficiency syndrome?
Your Answer: Pellagra
Explanation:Pellagra is a disease caused by a lack of the vitamin niacin (vitamin B3). Symptoms include inflamed skin, diarrhoea, dementia, and sores in the mouth. Areas of the skin exposed to either sunlight or friction are typically affected first. Over time affected skin may become darker, stiff, begin to peel, or bleed.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 3
Incorrect
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Absorption of protein antigens i.e. bacterial and viral proteins takes place in the:
Your Answer: Mucosa-associated lymphoid tissue
Correct Answer: Microfold cells (m cells) of the intestine
Explanation:M cells are specialized epithelial cells. They have a high capacity of transcytosis of microorganisms and macromolecules. They rapidly uptake antigens and present them to immune cells associated with the gut. In contrast to absorptive enterocytes, M cells do not exert direct defence mechanisms to antigens and pathogens in the intestinal cavity. Crypts of Lieberkühn are located mainly in the small intestine and large intestine and the main function is to replenish epithelial cells and to secrete intestinal enzymatic juice as well as mucous. Brunner’s glands empty into intestinal glands and their main function is to secrete mucin and to form a protective mucus layer on the duodenal epithelial cells to protect it from acidic chyme coming from the stomach. Islets of Langerhans are located in the pancreas and secrets insulin mainly. Mucosa associated lymphoid tissue plays a role in inducing immune response after presentation of antigens.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 4
Correct
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A 24-year-old women presents following an overdose. Which one of the following would suggest anticholinergic syndrome?
Your Answer: Mydriasis occurs
Explanation:Anticholinergic syndrome results from the inhibition of muscarinic cholinergic neurotransmission. Clinical manifestations can be remembered by the mnemonic, red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, and full as a flask. The mnemonic refers to the symptoms of flushing, dry skin and mucous membranes, mydriasis (dilated pupil) with loss of accommodation, altered mental status, fever, and urinary retention, respectively.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 5
Correct
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Where is Vitamin B 12 absorbed?
Your Answer: Terminal ileum
Explanation:Protein-bound vitamin B12 must be released from the proteins by the action of digestive proteases in both the stomach and small intestine. Gastric acid releases the vitamin from food particles; therefore antacid and acid-blocking medications (especially proton-pump inhibitors) may inhibit absorption of B12. B12 must be attached to Intrinsic Factor (IF) for it to be efficiently absorbed, as receptors on the enterocytes in the terminal ileum of the small bowel only recognize the B12-IF complex; in addition, intrinsic factor protects the vitamin from catabolism by intestinal bacteria.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 6
Correct
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Which intercellular connections are responsible for fastening the cells to one another?
Your Answer: Hemidesmosomes, zonula adherens & desmosomes
Explanation:There are three major types of cell junction:Adherens junctions, desmosomes and hemidesmosomes (anchoring junctions),Gap junctions (communicating junction) &Tight junctions (occluding junctions)
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 7
Incorrect
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The approximate incidence of deep venous thrombosis (DVT) in the general population each year is:
Your Answer: 10 per 1000
Correct Answer: 1 per 1000
Explanation:About 1 in 1000 adults per year has DVT, but as of 2011, available data is dominated by North American and European populations. DVT is rare in children, with an incidence of about 1 in 100,000 a year. From childhood to old age, incidence increases by a factor of about 1000, with almost 1% of the elderly experiencing DVTs yearly.
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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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Corticospinal tracts are located in the ___ of the white matter.
Your Answer: Posterior and lateral funiculi
Correct Answer: Anterior and lateral funiculi
Explanation:The corticospinal tract is a descending or a motor tract which projects nerve fibers from the cortex of the cerebrum down to different levels of the spinal cord. The descending corticospinal tract descends from the origin, through the corona radiata, posterior half of the lateral ventricle, and enters the midbrain through the cerebral peduncle. In the medulla they form the medullary pyramids on either side of midline as lateral and anterior fibers.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 9
Correct
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A study is carried out to assess the efficacy of a new anti-epileptic drug for children with absence seizures. The total number of the children selected for the study was 400, from which 150 children were assigned to take the new drug and 250 children were assigned in the control group. After a period of four months, only 15 children taking the new drug had a seizure compared to 100 children from the control group who had seizure. What is the correct value regarding the relative risk reduction?
Your Answer: 75%
Explanation:Relative risk reduction (RRR) tells you by how much the treatment reduced the risk of bad outcomes relative to the control group who did not have the treatment. In the previous example, the relative risk reduction of fever and rash in the group of the children on the intervention was 40 per cent (1 – 0.6 = 0.4 or 40 per cent). RRR = (EER -CER) / CER = (0.1 – 0.4) / 0.4 = -0.75 or 75% reduction.
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This question is part of the following fields:
- Medicine
- Research Skills
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Question 10
Correct
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The brainstem reticular formation, consists of which important control system responsible for consciousness and sleep?
Your Answer: RAS reticular activating system
Explanation:The reticular formation is a set of interconnected nuclei that are located along the brainstem. Reticular activating system (RAS) is a set of connected nuclei in the brain that is responsible for regulating wakefulness and sleep wake transitions and is the most influential component in the reticular formation.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 11
Incorrect
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The midbrain, medulla and pons, contain the following cranial nerve nuclei?
Your Answer: CN 5 – 12
Correct Answer: CN 3 - 12
Explanation:The cranial nerves (with the exception of I and II) originate in the brainstem, which includes the midbrain, the pons, and the medulla.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 12
Incorrect
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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: Biopsy the right temporal artery
Correct 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 13
Correct
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Which of the following is NOT an effect of a positive inotropic agent on the heart?
Your Answer: It decreases the rate of rise in ventricular blood pressure during systole
Explanation:Inotropic agents increase the contractility of the heart as well as the rate of rise in ventricular blood pressure during systole, generating a greater pressure and increasing the stroke volume e.g. like catecholamines do.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 14
Incorrect
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The blood supply to the greater curvature of the stomach is via the:
Your Answer: Gastroduodenal artery
Correct Answer: Right and left gastro-epiploic arteries
Explanation:The blood supply to the greater curvature of the stomach is via the left and the right gastro-epiploic arteries branching from the splenic artery near the hilum.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 15
Incorrect
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Which statement about antithrombin III is true?
Your Answer: It inactivates factors V and VIII
Correct Answer: It inhibits particularly factor II and X
Explanation:Antithrombin inactivates its physiological target enzymes, Thrombin (Factor II), Factor Xa and Factor IXa. ATIII binds to thrombin and then forms the thrombin-anti thrombin complex or TAT complex. This is a major natural pathway of anticoagulation. This binding of thrombin to AT is greatly enhanced in the presence of heparin.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 16
Correct
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Coronary arteries fill up during
Your Answer: Diastole
Explanation:During contraction of the ventricular myocardium (systole), the subendocardial coronary vessels (the vessels that enter the myocardium) are compressed due to the high ventricular pressures. This compression results in momentary retrograde blood flow (i.e., blood flows backward toward the aorta) which further inhibits perfusion of myocardium during systole. However, the epicardial coronary vessels (the vessels that run along the outer surface of the heart) remain open. Because of this, blood flow in the sub endocardium stops during ventricular contraction. As a result, most myocardial perfusion occurs during heart relaxation (diastole) when the subendocardial coronary vessels are open and under lower pressure.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 17
Incorrect
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Where does one find the thyroid receptors?
Your Answer: Mitochondria
Correct Answer: Cell nucleus
Explanation:Unlike many of the steroid receptors, inactive receptors for T3 are located in the nucleus. T4 is first converted into T3 within the cytoplasm of the cell, T3 then enters the nucleus and binds to its receptor. The hormone-receptor complex can now bind to DNA and activate specific genes.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 18
Incorrect
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Which one of the following interventions has the least role in management of acne rosacea?
Your Answer: Topical metronidazole
Correct Answer: Low-dose topical corticosteroids
Explanation:Mild cases are often not treated at all, or are simply covered up with normal cosmetics and avoiding sun exposure. Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions. The two primary modalities of rosacea treatment are topical and oral antibiotic agents (including metronidazole and tetracyclines). Laser therapy may be appropriate for patients with prominent telangiectasia.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 19
Incorrect
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A 62 year old female complains of pain and stiffness in her shoulders. She also finds it difficult to get out of her chair. From the list of symptoms below, choose the one most likely to support the diagnosis of polymyalgia rheumatica.
Your Answer: Proximal muscle weakness
Correct Answer: Low grade fever
Explanation:Polymyalgia rheumatica is an inflammatory disease which usually causes stiffness and pain in the shoulder – this can also occur in the pelvic girdle muscles. Its onset can either be subacute or acute and is associated with a systemic inflammatory response. This, therefore, causes symptoms such as fever, weight loss, anorexia, and malaise. Polymyalgia rheumatica is unpredictable in its course and it is known that 30 per cent of patients also present with giant cell arteritis. The cause of this disease is unknown but studies have shown it have infectious origins. Diagnosis of polymyalgia rheumatica can be difficult and other inflammatory diseases have to be excluded first. Patients with this disease are usually over 60 years of age (it is very rarely seen in those under 50). Muscle weakness does not present, although this can be hard to assess when the patient is in pain. Low-grade fever and weight loss are typical of this disease due to chronic inflammation. As such, weight gain is very rare and peripheral joints are usually not affected (they can be affected but it is very rare). Also, muscle tenderness is not a specific symptom of the disease – it is therefore not a classical finding of polymyalgia rheumatica. Although patients usually complain of stiffness and pain, the muscles are usually not significantly tender – this is usually more associated with fibromyalgia or myositis. When investigated, a normochromic/normocytic anaemia; a raised erythrocyte sedimentation rate often over 50 mm/hr., and raised C reactive protein are usually revealed. Symptoms of giant cell arteritis should also be sought, such as headaches, visual disturbances, TIAs (transient ischemic attacks), jaw claudication, and thickened temporal arteries. The patient response to a moderate dose of steroids is useful when confirming a diagnosis of polymyalgia rheumatica. The maximum dose of prednisolone should not exceed 20mg once a day. After treatment, patients should show a 70 per cent improvement in symptoms within a month (between 3-4 weeks). Inflammatory markers should also fall back to their normal levels. Non-steroidal anti-inflammatories are of little use and are associated with morbidity. There is also little evidence for the use of steroidal-sparing agents.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 20
Correct
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A 52-year-old man has squamous-cell carcinoma of his lower lip. Which of the following is most likely to be a feature of this type of carcinoma?
Your Answer: It is capable of metastasising via the lymphatics
Explanation:Squamous-cell skin cancer usually presents as a hard lump with a scaly top but can also form an ulcer. Onset is often over months and it is more likely to spread to distant areas than basal cell cancer vie the lymphatics. The greatest risk factor is high total exposure to ultraviolet radiation from the Sun. Other risks include prior scars, chronic wounds, actinic keratosis, lighter skin, Bowen’s disease, arsenic exposure, radiation therapy, poor immune system function, previous basal cell carcinoma, and HPV infection. While prognosis is usually good, if distant spread occurs five-year survival is ,34%
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 21
Incorrect
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Functions of the glossopharyngeal nerve include the following except:
Your Answer: Transmission of afferent impulses from the carotid baro- and chemoreceptors to the nucleus tractus solitarius in the medulla
Correct Answer: Proprioceptive input from muscles of the tongue and larynx
Explanation:The glossopharyngeal nerve is a mixed nerve consisting of both sensory and motor fibers. It has several branches and five distinct general functions:Branchial motor- Special visceral efferent- supplies the Stylopharyngeus muscle and superior constrictor muscle.Visceral motor- general visceral efferent- provides parasympathetic innervation of the parotid gland.Visceral sensory- general visceral afferent- carries visceral sensory information from the carotid sinus and carotid body.General sensory- general somatic afferent- provides general sensory information from the inner surface of the tympanic membrane, upper pharynx and posterior one third of the tongue.Visceral afferent- special visceral afferent- provides taste sensation from the posterior one third of the tongue including the circumvallate papillae.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 22
Correct
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 23
Incorrect
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A 34 year old woman presents to the emergency department due to right sided weakness. Past history reveals a DVT following the birth of her daughter, and two miscarriages. Head CT confirms an ischaemic stroke in the territory of left middle cerebral artery. What would be the most likely finding on echocardiography?
Your Answer: Dilated cardiomyopathy
Correct Answer: Normal
Explanation:The patient most likely suffers from antiphospholipid syndrome. The clinical criteria consist of vascular thrombosis and pregnancy morbidity. Vascular thrombosis is defined as one or more clinical episodes of arterial, venous, or small-vessel thrombosis in any tissue or organ confirmed by findings from imaging studies, Doppler studies, or histopathology. ASD, VSDs would cause paradoxical emboli and stroke, however the recurrent pregnancy loss in this case is strongly suggestive of antiphospholipid syndrome. The ECG would be normal in most cases associated with anti phospholipid syndrome.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 24
Incorrect
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With regard to X-linked disorders which of the following are true:
Your Answer: They are relatively common but their expression is variable
Correct Answer: X linked recessive disorders usually present in males and only very rarely present in homozygous females
Explanation:X linked disorders are more common in males as they only need one mutated copy of the X chromosome to manifest the disease with full severity while the females need two X chromosomes to manifest the disease, even with one defected X chromosome the severity is less than that seen in males.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 25
Correct
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After exercise, O2 debt repay may take up to:
Your Answer: 90 min
Explanation:Physical activity or exercise requires oxygen for production of ATP or energy via aerobic pathways of energy production. When the amount of oxygen that reaches muscles depletes, cells start producing energy anaerobically by partial breakdown of glucose resulting in lactic acid. Lactic acid should be removed from cells as it causes muscle fatigue. Oxygen is needed to oxidize lactic acid in to carbon dioxide and water and this need is known as oxygen debt. The existence of an oxygen debt explains why we continue to breathe deeply and quickly for a while after exercise. This may take up from 60 – 90 mins.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 26
Incorrect
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Which of the following biochemical profiles is seen in a normal 65 year old female? (in comparison to a normal 24 yr. old female)
Your Answer: Decreased FSH, LH; decreased oestrogen, progesterone
Correct Answer: Increased FSH, LH; decreased oestrogen, progesterone
Explanation:During menopause, a woman’s number of ovarian follicles becomes depleted; as a result, oestrogen and progesterone levels drop, and LH and FSH levels increase. One of the criteria to diagnose menopause is the absence of menstrual period for a year, along with a serum FSH level increased to 30 mIU/ml or higher. LH also rises with the onset of menopause.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 27
Correct
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The complete oxidation of 1 molecule of glucose to CO2 and H20 produces a total of __ATP.
Your Answer: 38
Explanation:Textbooks often state that 38 ATP molecules can be made per oxidised glucose molecule during cellular respiration (2 from glycolysis, 2 from the Krebs cycle, and about 34 from the electron transport system). However, this maximum yield is never quite reached because of losses due to leaky membranes as well as the cost of moving pyruvate and ADP into the mitochondrial matrix, and current estimates range around 29 to 30 ATP per glucose.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 28
Incorrect
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Protein digestion starts in the stomach by which enzyme?
Your Answer: Chymotrypsin
Correct Answer: Pepsin
Explanation:Pepsinogen is the inactive form of pepsin which is secreted by gastric chief cells and is converted to pepsin, in the presence of gastric HCL. Pepsin is a peptidase that breaks down proteins into smaller peptides.
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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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Carcinogens found in cigarette smoke can transform proto-oncogenes to oncogenes through:
Your Answer: Point mutations in genomic DNA
Explanation:80% of the pancreatic cancers are environmentally influenced by smoking which increases the risk by 50%. Mutation can occur in the KRAS, p16, SMAD4, and TP53 genes among other tumour suppression genes. Smoking can be implicated in transformation of all these genes. Apart from KRAS all the genes are inactivated in pancreatic cancer. As KRAS is the most commonly altered gene, mutation occurs as point mutation. As smoking is the most common aetiology in pancreatic cancer, and KRAS is the most important gene that is altered. Most commonly cigarette smoke causes point mutation.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 30
Correct
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A 32 year old complains of pain in her hands bilaterally. Which of the following symptoms would point towards an inflammatory joint disease such as rheumatoid arthritis?
Your Answer: Marked stiffness for more than an hour in the mornings
Explanation:In rheumatoid arthritis (RA), clinical symptoms of joint stiffness, pain, and functional disability are commonly most severe in the early morning. These symptoms closely follow the circadian rhythm of the pro-inflammatory cytokine, interleukin (IL)-6. In RA, the increase in nocturnal anti-inflammatory cortisol secretion is insufficient to suppress ongoing inflammation, resulting in the morning symptoms characteristic of RA. Established diagnostic criteria for RA include prolonged morning stiffness that could last up to an hour. Loss of joint mobility, pain, malaise and swelling of finger joints are features that are not specific to rheumatoid arthritis, and are found in many other conditions.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
