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Question 1
Incorrect
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Which of the following antibiotics is the first line of treatment for a patient who has been diagnosed with chlamydia infection?
Your Answer: Ceftriaxone
Correct Answer: Azithromycin
Explanation:The Centres for Disease Control and Prevention (CDC) recommends azithromycin, a single 1 g dose, and doxycycline, 100 mg bd for 7 days, as first-line medications for chlamydial infection treatment.
Second-line medications (such as erythromycin, penicillins, and sulfamethoxazole) are less effective and have more side effects
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 2
Correct
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A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.
Iliacus is innervated by which of the following nerves? Select ONE answer only.Your Answer: Femoral nerve
Explanation:Iliacus is innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 3
Correct
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Question 4
Incorrect
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Regarding myeloma, which of the following statements is CORRECT:
Your Answer: The cure rate for myeloma is about 50%.
Correct Answer: Myeloma is associated with marked rouleaux formation on blood film.
Explanation:98% of cases of myeloma occur over the age of 40 years with a peak incidence between 65 and 70 years. The disease is twice as common in black individuals compared to those of white or Asian origin. Laboratory findings include presence of a paraprotein in serum/urine (the paraprotein is IgG in 60% of cases, IgA in 20% and light chain only in almost all the rest) and marked Rouleaux formation on blood film. There is no cure for myeloma. The overall median survival is now 7-10 years and in younger (less than 50 years) patients it can be over 10 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 5
Incorrect
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Which of the following does not increase renal phosphate excretion?
Your Answer: Acidosis
Correct Answer: Vitamin D
Explanation:PO43-renal excretion is regulated several mechanisms. These include:
-parathyroid hormone – increases excretion by inhibiting reabsorption in the proximal tubule
-acidosis – increases excretion
-glucocorticoids – increases excretion
-calcitonin – increases excretion
-activated vitamin D – decreases excretion by increasing reabsorption in the distal tubule -
This question is part of the following fields:
- Physiology
- Renal
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Question 6
Incorrect
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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: Trapezius
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 nerveThe 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
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Question 7
Correct
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Regarding benzodiazepines, which of the following statements is INCORRECT:
Your Answer: Diazepam is a short-acting benzodiazepine.
Explanation:Diazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration. Midazolam is a water-soluble benzodiazepine that is often used in preference to intravenous diazepam; recovery is faster than from diazepam, but may be significantly longer in the elderly, in patients with a low cardiac output, or after repeated dosing. Midazolam is associated with profound sedation when high doses are given intravenously or when it is used with certain other drugs.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 8
Incorrect
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A 21-year-old student presents with fever, headache, malaise, fatigue, and muscle aches after returning from a trip to India. A diagnosis of malaria was suspected.
Which of the following statements is considered correct regarding malaria?Your Answer: It is transmitted by male of the Anopheles genus of mosquito
Correct Answer: Haemoglobinuria and renal failure following treatment is suggestive of Plasmodium falciparum
Explanation:Malaria results from infection with single-celled parasites belonging to the Plasmodium genus. Five species of Plasmodium are known to cause disease in humans: P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi.
Chloroquine remains the mainstay of treatment for uncomplicated vivax malaria.
The female Anopheles mosquito serves as the biologic vector and definitive host.
A complication of infection with P. falciparum is blackwater fever, a condition characterized by haemoglobinuria.
Plasmodium ovale has the longest incubation period, which can be up to 40 days. Plasmodium falciparum has a shorter incubation period of 7-14 days.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 9
Correct
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What is the primary route of transmission of Neisseria Gonorrhoeae?
Your Answer: Sexually transmitted
Explanation:Neisseria gonorrhoeae is primarily spread by sexual contact or through transmission during childbirth. It causes gonorrhoea which is a purulent infection of the mucous membrane surfaces.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 10
Incorrect
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The percentage of patients with hepatitis B that develop chronic infection is about:
Your Answer: 20%
Correct Answer: 10%
Explanation:With hepatitis B, about 90% of people will develop lifelong immunity after clearing the infection. Chronic hepatitis develops in about 10% of patients and this may be complicated by cirrhosis or hepatocellular carcinoma. There is a very high risk of chronic infection and hepatocellular carcinoma when there is congenital infection. The risk of this in healthy adults is only about 5%.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 11
Correct
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Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Incorrect
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Gastrin is secreted by which of the following cell types in the stomach:
Your Answer: Principal cells
Correct Answer: G-cells
Explanation:Gastrin is secreted by antral G-cells and acts on cholecystokinin B (CCKB) receptors.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 13
Incorrect
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A 18 year old student presents to ED with a headache, fever and photophobia. You suspect meningitis and agree to observe your junior performing a lumbar puncture. What is the highest safest vertebral level to perform lumbar puncture in adults:
Your Answer: L2/L3
Correct Answer: L3/L4
Explanation:In adults, the spinal cord typically ends between L1/L2 whereas the subarachnoid space extends to approximately the lower border of vertebra S2. Lumbar puncture is performed in the intervertebral space L4/L5 or L3/L4.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 14
Incorrect
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On her most recent blood tests, a 55 year-old female with a history of hypertension was discovered to be hypokalaemic. She  is diagnosed with primary hyperaldosteronism.
Which of the following is a direct action of aldosterone?
Your Answer: Reabsorption of K + into the proximal convoluted tubule
Correct Answer: Secretion of H + into the distal convoluted tubule
Explanation:Aldosterone is a steroid hormone produced in the adrenal cortex’s zona glomerulosa. It is the most important mineralocorticoid hormone in the control of blood pressure. It does so primarily by promoting the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane of the nephron’s distal tubules and collecting ducts, as well as stimulating apical sodium and potassium channel activity, resulting in increased sodium reabsorption and potassium secretion. This results in sodium conservation, potassium secretion, water retention, and a rise in blood volume and blood pressure.
Aldosterone is produced in response to the following stimuli:
Angiotensin II levels have risen.
Potassium levels have increased.
ACTH levels have risen.
Aldosterone’s principal actions are as follows:
Na+ reabsorption from the convoluted tubule’s distal end
Water resorption from the distal convoluted tubule (followed by Na+)
Cl is reabsorbed from the distal convoluted tubule.
K+ secretion into the convoluted distal tubule’sÂ
H+ secretion into the convoluted distal tubule’s -
This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 15
Correct
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Regarding apoptosis, which of the following statements is INCORRECT:
Your Answer: Apoptosis leads to cell swelling and eventual cell lysis.
Explanation:Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 16
Incorrect
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Regarding Helicobacter pylori, which of the following statements is INCORRECT:
Your Answer: It is spiral-shaped.
Correct Answer: It is found as part of normal colonic flora.
Explanation:Helicobacter pyloriis a Gram-negative, helix shaped (curved rod), microaerophilic bacterium. It typically has 4-6 lophotrichous flagellae and is therefore highly motile. It has an outer membrane consisting of phospholipids and lipopolysaccharide.
Helicobacter pyloriIs found in the upper gastrointestinal tract of approximately 50% of the population.
Colonization withHelicobacter pyloriconfers a 10-20% lifetime risk of developing peptic ulcers and a 1-2% lifetime risk of developing gastric cancer.
There is a strong association between mucosa-associated lymphoid tissue (MALT) lymphoma andHelicobacter pyloricolonization.
The most reliable method for testing for colonization withHelicobacter pyloriis by biopsy during endoscopy and histological examination.
Typically eradication requires a 14-day course of triple therapy with amoxicillin, clarithromycin and a proton pump inhibitor. Metronidazole is also often used as an alternative antibiotic in a triple therapy regime.
Serum antibody levels fall slowly and therefore cannot be used to accurately assess eradication. Either of the 13C-urea breath test or the stool antigen test are viable options for assessing successful eradication. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 17
Correct
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Which of the following vitamins is not paired correctly with its deficiency syndrome:
Your Answer: Vitamin B12 - Wernicke-Korsakoff syndrome
Explanation:Clinical Effects of vitamin deficiency include:
Vitamin C – Scurvy
Thiamine (Vitamin B1) – Beriberi/Wernicke-Korsakoff syndrome
Vitamin B12 – Megaloblastic anaemia/Subacute combined degeneration of spinal cord
Folate – Megaloblastic anaemia
Vitamin D – Osteomalacia/Rickets
Vitamin K – Defective clotting
Vitamin A – Blindness -
This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 18
Incorrect
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Which of the following nerves is responsible for the symptoms of a patient with history of recurrent herpes simplex outbreaks on his face and presents with ophthalmic herpes zoster and a painful vesicle on the tip of his nose?
Your Answer: Nasopalatine nerve
Correct Answer: Nasociliary nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve.
The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 19
Correct
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Which of the following is NOT a contraindication to the use of diazepam:
Your Answer: Acute alcohol withdrawal
Explanation:Benzodiazepines are used to treat symptoms in patients with acute alcohol withdrawal syndrome.
Benzodiazepines are contraindicated in:
Respiratory depression
Marked neuromuscular respiratory weakness, such as unstable myasthenia gravis
Obstructive sleep apnoea syndrome (symptoms may be aggravated)
Severe hepatic impairment (the elimination half-life of diazepam may be prolonged; increased risk of coma)
Phobic or obsessional states, chronic psychosis or hyperkinesis (paradoxical reactions may occur). -
This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 20
Correct
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A 39-year-old guy comes to the emergency room with a persistent nasal bleed. You suspect the bleeding is coming from Little's area based on your examination. Which of the blood vessels listed below is most likely to be involved:
Your Answer: Sphenopalatine and superior labial arteries
Explanation:The Kiesselbach plexus is a vascular network formed by five arteries that supply oxygenated blood to the nasal septum, which refers to the wall separating the right and left sides of the nose. The five arteries that form the Kiesselbach plexus: the sphenopalatine artery, which branches from the maxillary artery originating behind the jawbone; the anterior ethmoidal artery, which branches from the ophthalmic artery behind the eye; the posterior ethmoidal artery, which also branches from the ophthalmic artery; the septal branch of the superior labial artery, which is a branch of the facial artery supplying blood to all of the superficial features of the face; and finally, the greater palatine artery, which is a terminal branch of the maxillary artery.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 21
Correct
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Which one these is an example of a cause of an exudate?
Your Answer: Subphrenic abscess
Explanation:An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.
Some common causes of exudates are: pneumonia, empyema, lung cancer, breast cancer, cancer of the pleura, SLE, rheumatoid arthritis, pericarditis, subphrenic abscess, chylothorax.
Myxoedema, nephrotic syndrome, congestive cardiac failure, and liver cirrhosis all cause TRANSUDATE.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 22
Correct
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A newborn baby is born by vaginal delivery to a mother who has a Chlamydia infection and who is started on treatment after the delivery. The neonate subsequently develops an infection also.
Which one of these is the most common neonatal manifestation of Chlamydia trachomatis infection?Your Answer: Conjunctivitis
Explanation:Conjunctivitis is the most common neonatal manifestation of Chlamydia trachomatis infection. The second commonest neonatal manifestation is pneumonia
Ophthalmia neonatorum refers to any conjunctivitis in the newborn period, irrespective of causative organism. Presently, chlamydia is the single most common cause, accounting for up to 40% of cases. Ophthalmia neonatorum caused by chlamydia typically presents 5 to 14 days after birth with unilateral or bilateral watery discharge that progressively becomes more copious and purulent. There is no associated risk of ulceration and perforation, and the eyes are less inflamed.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 23
Correct
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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: Staphylococcus aureus
Explanation:Bacillus cereus = Gram-positive bacillus
Neisseria meningitidis = Gram-negative coccus
Salmonella enterica & Escherichia coli = Gram-negative bacilliIn 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
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Question 24
Incorrect
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If the null hypothesis is wrongly rejected when it is actually true, this is an example of:
Your Answer: A test with a type II error
Correct Answer: A test with a type I error
Explanation:A type I error occurs when the null hypothesis is wrongly rejected when it is actually true and we conclude that there is a difference of effect when in reality there is none (a false positive result).
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 25
Incorrect
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Which of the following is NOT a typical feature of an abducens nerve palsy:
Your Answer: Loss of abduction
Correct Answer: Inability to look up
Explanation:CN VI palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 26
Correct
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What is the primary function of collagen in wound healing?
Your Answer: Strength and support
Explanation:Key elements of the maturation stage include collagen cross-linking, collagen remodelling, wound contraction, and repigmentation. The tensile strength of the wound is directly proportional to the amount of collagen present. Numerous types of collagen have been identified; types I and III predominate in the skin and aponeurotic layers. Initially, a triple helix (tropocollagen) is formed by three protein chains; two are identical alpha-1 protein chains, and the third is an alpha-2 protein.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 27
Correct
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A 42-year-old man presented to the emergency room with complains of a dry cough and fever that has been going on for the past few days. Upon history taking and observation, it was established that he works as a Jacuzzi and whirlpool installer and smokes 15 cigarettes per day. The presence of a non-productive cough, several episodes of diarrhoea, developed bilateral pleuritic chest pain, and shortness of breath most notably on exertion were also noted.
Which of the following is most likely the causative agent of the case presented above?Your Answer: Legionella pneumophila
Explanation:Legionella species are ubiquitous, Gram-negative bacilli acquired primarily through inhalation. Infections caused by Legionella spp. produce a spectrum of symptoms ranging from mild upper respiratory tract infections to pneumonia. Legionella spp. are responsible for 2% to 15% of community-acquired pneumonia.
Clinical manifestations of Legionella infections include febrile disease with pneumonia (legionnaires’ disease), febrile disease without pulmonary involvement (Pontiac fever), and asymptomatic infection.
The mode of transmission and the number of infecting organisms in the inoculum play a role in the clinical features of the infection. In addition, host factors, such as a suppressed immune system, chronic lung disease, alcoholism, and heavy smoking, predispose individuals to legionnaires’ disease.Legionella spp. can tolerate chlorine concentrations of 3 mg/L, they resist water treatment and subsequently gain entry into and colonize human-made water supplies and distribution systems. Hot water systems, cooling towers, and evaporative condensers are major reservoirs. Other sources include cold water systems, ornamental fountains, whirlpool spas, humidifiers, respiratory
therapy equipment, and industrial process waters. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 28
Correct
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Which of the following is the primary indication for loop diuretics?
Your Answer: Acute pulmonary oedema
Explanation:Loop diuretics have long been the cornerstone of pulmonary oedema treatment, with furosemide being the most commonly used of these drugs. Premedication with drugs that decrease preload (e.g., nitro-glycerine [NTG]) and afterload (e.g., angiotensin-converting enzyme [ACE] inhibitors) before the administration of loop diuretics can prevent adverse hemodynamic changes.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 29
Incorrect
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A patient presents with a rash for a dermatological examination. A flat circumscribed area of discoloured skin measuring 0.7 cm in diameter is seen on examination.
What is the best description of this rash that you have found on examination?
Your Answer: Papule
Correct Answer: Macule
Explanation:A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.
A vesicle is a visible collection of clear fluid measuring less than 0.5 cm in diameter.
A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.
A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.
A plaque is a palpable skin lesion that is elevated and measures >1cm in diameter.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 30
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: ALL is the most common malignancy of childhood.
Explanation:Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.
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This question is part of the following fields:
- Haematology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
