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  • Question 1 - A 29-year-old male presents with a 3-day history of bloody diarrhoea and abdominal...

    Incorrect

    • A 29-year-old male presents with a 3-day history of bloody diarrhoea and abdominal pain.

      All the following are causes of infectious bloody diarrhoea EXCEPT?

      Your Answer: Schistosoma mansoni

      Correct Answer: Enterotoxigenic Escherichia coli

      Explanation:

      Infective causes of bloody diarrhoea include:
      Salmonella spp
      Campylobacter spp
      Schistosomiasis
      Entamoeba histolytica (Amoebiasis )
      Shigella spp
      Clostridium difficile
      Yersinia spp
      Enteroinvasive Escherichia coli

      Enterotoxigenic Escherichia coli is non-invasive and does not cause inflammation of the gut and bloody diarrhoea. It presents with copious watery diarrhoea and usually are not associated with abdominal cramping.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      15.7
      Seconds

  • Question 2 - An very unwell patient is receiving treatment in your hospital's HDU and is...

    Correct

    • An very unwell patient is receiving treatment in your hospital's HDU and is found to have an Escherichia coli O157 infection.

      Which one of these statements about Escherichia coli O157 is true?

      Your Answer: Haemolytic uraemic syndrome develops in approximately 6% of patients

      Explanation:

      Escherichia coli O157 is a serotype of Escherichia coli.
      The Escherichia coliO157 strain is ‘enterohaemorrhagic’ and causes severe forms of acute haemorrhagic diarrhoea. It can also cause non-haemorrhagic diarrhoea.

      Incubation period of Escherichia coli O157 is usually 3-4 days and bloody diarrhoea usually begins on the 3rd or 4th day of the infection.

      Infections with Escherichia coliO157 are more common during the warmer months than in winter.

      Haemolytic uraemic syndrome develops in approximately 6% of patients. It is commonly seen in children and in the elderly.

      Escherichia coli O157 can also cause:
      Haemorrhagic colitis
      Haemolytic uraemic syndrome
      Thrombotic thrombocytopenic purpura but not immune thrombocytopenic purpura.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      20.5
      Seconds

  • Question 3 - A 25 year old woman who is a known diabetic is brought to...

    Correct

    • A 25 year old woman who is a known diabetic is brought to the ED with diabetic ketoacidosis. She promptly received an insulin infusion. Which of the following are expected to increase upon infusion of insulin?

      Your Answer: Blood pH

      Explanation:

      Ketoacidosis is characterized by hyperglycaemia, glycosuria, hyperkalaemia, and metabolic acidosis with respiratory compensation. An insulin infusion would be able to address these by lowering blood glucose through increased insulin-mediated cellular uptake, lowering urine glucose concentration as cellular glucose uptake is increased, decreasing K+ in her blood by shifting it into cells, and increasing blood ph by addressing the metabolic acidosis. The metabolic acidosis is addressed by the reduction of ketoacids production thereby returning her blood ph to normal and reducing the need for compensatory hyperventilation.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      29.4
      Seconds

  • Question 4 - Na+ is reabsorbed via the Na+/K+/2Cl-symporter in which part of the loop of...

    Incorrect

    • Na+ is reabsorbed via the Na+/K+/2Cl-symporter in which part of the loop of Henle?

      Your Answer: Thin ascending limb

      Correct Answer: Thick ascending limb

      Explanation:

      In the thick ascending limb is the part of the loop of Henle in which there is active reabsorption of Na+and Cl- ions from the tubular fluid. This occurs via the Na+/K+/2Cl-symporter on the apical membrane.
      This mechanism is by:
      1. Na+ions are transported across the basolateral membrane by Na+pumps and the Cl-ions by diffusion.
      2. K+leaks back into the tubular fluid via apical ROMK K+channels which creates a positive charge.
      3. This positive charge drives the reabsorption of cations (Na+, K+, Ca2+, Mg2+) through paracellular pathways.
      4. Due to the thick ascending limb being impermeable to water, the tubular fluid osmolality is reduced by ion reabsorption, the interstitial fluid osmolality is increased, and an osmotic difference is created.

    • This question is part of the following fields:

      • Physiology
      • Renal
      14.6
      Seconds

  • Question 5 - Regarding ciprofloxacin, which of the following statements is INCORRECT: ...

    Correct

    • Regarding ciprofloxacin, which of the following statements is INCORRECT:

      Your Answer: Ciprofloxacin decreases plasma concentrations of theophylline.

      Explanation:

      Ciprofloxacin increases plasma concentrations of theophylline. There is an increased risk of convulsions when quinolones are given with NSAIDs or theophylline. There is an increased risk of tendon damage when quinolones are given with corticosteroids. Quinolones are known to increase the QT-interval and should not be taken with concomitantly with other drugs that are known to cause QT-interval prolongation. There is an increased risk of myopathy when erythromycin or clarithromycin are taken with simvastatin or atorvastatin.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      23.8
      Seconds

  • Question 6 - Regarding NSAIDs, which of the following statements is CORRECT: ...

    Correct

    • Regarding NSAIDs, which of the following statements is CORRECT:

      Your Answer: Diclofenac is contraindicated in people with ischaemic heart disease.

      Explanation:

      Due to their increased risk of cardiovascular adverse events, coxibs and diclofenac are contraindicated in people with ischaemic heart disease, cerebrovascular disease, peripheral arterial disease and mild, moderate, or severe heart failure. Other NSAIDs are only contraindicated in people with severe heart failure. Selective inhibition of COX-2 is associated with less gastrointestinal intolerance. In single doses NSAIDs have analgesic activity comparable to that of paracetamol, therefore given their side effect profile, paracetamol is preferred, particularly in the elderly. Pain relief starts soon after taking the first dose and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to 3 weeks. Mefenamic acid has only very mild anti-inflammatory properties.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
      38.7
      Seconds

  • Question 7 - A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago....

    Correct

    • A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago. The boy is healthy and has no known comorbid or drug history.

      Out of the following metabolic pathways, which one is primarily responsible for the toxic effects of paracetamol?

      Your Answer: N-hydroxylation

      Explanation:

      Paracetamol is predominantly metabolized in the liver by three main metabolic pathways:
      1. Glucuronidation (45-55%)
      2. Sulphate conjugation (30-35%)
      3. N-hydroxylation via the hepatic cytochrome P450 enzyme system (10-15%)

      Cytochrome P450 enzymes catalyse the oxidation of acetaminophen to the reactive metabolite N-acetyl-p-benzoquinoneimine (NAPQI). NAPQI primarily contributes to the toxic effects of acetaminophen. NAPQI is an intermediate metabolite that is further metabolized by fast conjugation with glutathione. The conjugated metabolite is then excreted in the urine as mercapturic acid. High doses of acetaminophen (overdoses) can lead to hepatic necrosis due to depleting glutathione and high binding levels of reactive metabolite (NAPQI) to important parts of liver cells.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      16.5
      Seconds

  • Question 8 - A 21 year old student presents to the emergency room with severe acute...

    Incorrect

    • A 21 year old student presents to the emergency room with severe acute asthma. Salbutamol and ipratropium bromide nebuliser are prescribed. The most appropriate dose of salbutamol that should be prescribed initially for this patient is which of the following?

      Your Answer: 0.5 mcg every 10 - 20 minutes

      Correct Answer: 5 mg every 15 - 30 minutes

      Explanation:

      The first line treatment for acute asthma is high-dose inhaled short-acting beta2-agonists like salbutamol or terbutaline. Oxygen use should be reserved for hypoxemic patients in order to maintain oxygen saturations of 94 – 98%. In patients with moderate to severe asthma, a pressurised metered dose inhaler with spacer device is preferred (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). For patients with life-threatening features or poorly responsive severe asthma, the oxygen-driven nebuliser route is recommended (salbutamol 5 mg at 15 – 30 minute intervals). In patients with severe acute asthma that is poorly responsive to initial bolus dose, continuous nebulisation should be considered (salbutamol at 5 – 10 mg/hour). For those in whom inhaled therapy cannot be used reliably, the intravenous route is usually reserved.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      32.7
      Seconds

  • Question 9 - Which of the following statements is correct regarding anti-D immunoglobulin? ...

    Incorrect

    • Which of the following statements is correct regarding anti-D immunoglobulin?

      Your Answer: It is only administered after sensitising events in rhesus-negative mothers.

      Correct Answer: It is administered as part of routine antenatal care for rhesus-negative mothers.

      Explanation:

      In all non-sensitised pregnant women who are RhD-negative, it is recommended that routine antenatal anti-D prophylaxis is offered. Even if there is previous anti-D prophylaxis, use of routine antenatal anti-D prophylaxis should be given for a sensitising event early in the same pregnancy. Postpartum anti-D prophylaxis should also be given even if there has been previous routine antenatal anti-D prophylaxis or antenatal anti-D prophylaxis for a sensitising event in the same pregnancy.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      33.2
      Seconds

  • Question 10 - After an accidental fall, a 75-year-old patient complains of neck pain and weakness...

    Incorrect

    • After an accidental fall, a 75-year-old patient complains of neck pain and weakness in his upper limbs. Select the condition that most likely caused the neck pain and weakness of the upper limbs of the patient.

      Your Answer: Anterior cord syndrome

      Correct Answer: Central cord syndrome

      Explanation:

      The cervical spinal cord is the section of the spinal cord that goes through the bones of the neck.

      It is injured incompletely in the central cord syndrome (CCS). This will result in arm weakness more than leg weakness.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      16.8
      Seconds

  • Question 11 - A 25-year-old man suffers from a shoulder injury that damaged the nerve that...

    Incorrect

    • A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.

      Which of the following nerves may most likely be affected?

      Your Answer: The axillary nerve

      Correct Answer: The suprascapular nerve

      Explanation:

      The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      12.6
      Seconds

  • Question 12 - An 82 year old man has fever, left sided abdominal and back pain...

    Correct

    • An 82 year old man has fever, left sided abdominal and back pain and presents to the emergency room. Imaging reveals a large perinephric abscess. Which of the following most likely describes the fluid location:

      Your Answer: Between the renal capsule and the renal fascia

      Explanation:

      The perinephric fat is immediately external to the renal capsule and completely surrounds the kidney. The renal fascia surrounds the perinephric fat and the paranephric fat is external to the renal fascia. The location of a perinephric abscess is in the perinephric fat between the renal capsule and the renal fascia.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      102.4
      Seconds

  • Question 13 - A 46-year-old male who is suffering from a chest infection. You decide to start giving...

    Correct

    • A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give.

      From the following choices, which is considered an example of bacteriostatic antibiotic?

      Your Answer: Trimethoprim

      Explanation:

      Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:

      Bactericidal antibiotics
      Bacteriostatic antibiotics

      Vancomycin
      Metronidazole
      Fluoroquinolone, such as ciprofloxacin
      Penicillins, such as benzylpenicillin
      Cephalosporin, such as ceftriaxone
      Co-trimoxazole
      Tetracyclines, such as doxycycline
      Macrolides, such as erythromycin
      Sulphonamides, such as sulfamethoxazole
      Clindamycin
      Trimethoprim
      Chloramphenicol

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      14.2
      Seconds

  • Question 14 - Which of the following best describes the process of opsonisation: ...

    Correct

    • Which of the following best describes the process of opsonisation:

      Your Answer: The coating of foreign particles with molecules which allow easier recognition of that cell by phagocytes

      Explanation:

      An opsonin is any molecule that enhances phagocytosis by marking an antigen for an immune response, for example, immunoglobulin or complement. Opsonisation is the molecular mechanism whereby molecules, microbes, or apoptotic cells are chemically modified to have a stronger attraction to the cell surface receptors on phagocytes and natural killer cells. With the antigen coated in opsonins, binding to immune cells is greatly enhanced. Opsonisation also mediates phagocytosis via signal cascades from cell surface receptors.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      15.7
      Seconds

  • Question 15 - Which JVP waveform correlates to atrial systole? ...

    Correct

    • Which JVP waveform correlates to atrial systole?

      Your Answer: The a wave

      Explanation:

      JVP Waveform in Cardiac Cycle Physiology: a wave Right atrial contraction causes atrial systole (end diastole). the c wave During right isovolumetric ventricular contraction, the tricuspid valve bulges into the right atrium, resulting in isovolumetric contraction (early systole). descent by x Rapid ventricular ejection (mid systole) is caused by a combination of right atrial relaxation, tricuspid valve downward movement during right ventricular contraction, and blood ejection from both ventricles. the v-wave Ventricular ejection and isovolumetric relaxation (late systole) occur as a result of venous return filling the right atrium. y lineage Ventricular filling occurs when the tricuspid valve opens, allowing blood to flow rapidly from the right atrium to the right ventricle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      4.2
      Seconds

  • Question 16 - Which of the following is NOT a side effect of phenytoin: ...

    Correct

    • Which of the following is NOT a side effect of phenytoin:

      Your Answer: Ototoxicity

      Explanation:

      Adverse effects of phenytoin include:
      Nausea and vomiting
      Drowsiness, lethargy, and loss of concentration
      Headache, dizziness, tremor, nystagmus and ataxia
      Gum enlargement or overgrowth
      Coarsening of facial features, acne and hirsutism
      Skin rashes
      Blood disorders

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      6.7
      Seconds

  • Question 17 - All of the following are physiological effects of thyroid hormones except: ...

    Incorrect

    • All of the following are physiological effects of thyroid hormones except:

      Your Answer: Increased cardiac output

      Correct Answer: Increased glycogenesis

      Explanation:

      Thyroid hormones have multiple physiological effects on the body. These include:
      1. Heat production (thermogenesis)
      2. Increased basal metabolic rate
      3. Metabolic effects:
      (a) Increase in protein turnover (both synthesis and degradation are increased, although overall effect is catabolic)
      (b) Increase in lipolysis
      (c)Increase in glycogenolysis and gluconeogenesis
      4. Enhanced catecholamine effect – Increase in heart rate, stroke volume and thus cardiac output
      5. Important role in growth and development

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      13.8
      Seconds

  • Question 18 - You are about to perform an emergency pericardiocentesis on a 26-year-old male who...

    Correct

    • You are about to perform an emergency pericardiocentesis on a 26-year-old male who was involved in a car accident and is suspected of having cardiac tamponade due to signs of hypotension, muffled heart sounds, and distended neck veins. Where should you insert the needle to relieve tamponade?

      Your Answer: Inferior and to the left of the xiphochondral junction

      Explanation:

      Pericardiocentesis is a procedure that removes excess fluid from the pericardium. As a result, it’s used in cases of cardiac tamponade, which occurs when there’s too much fluid in the space around the heart.

      During the procedure, a needle and a small catheter are inserted 1 to 2 cm inferior and to the left of the xiphochondral junction into the pericardial cavity.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      22.8
      Seconds

  • Question 19 - A 40-year-old man has been admitted for alcohol detoxification. You are asked to...

    Incorrect

    • A 40-year-old man has been admitted for alcohol detoxification. You are asked to review the patient's treatment chart and notice that he has been prescribed Pabrinex by one of your colleagues.

      Out of the following, which vitamin is not found in Pabrinex?

      Your Answer: Vitamin C

      Correct Answer: Vitamin B12

      Explanation:

      Pabrinex is indicated in patients that require rapid therapy for severe depletion or malabsorption of water-soluble vitamins B and C, particularly in alcoholism detoxification.

      Pabrinex has the following:
      1. Thiamine (vitamin B1)
      2. Riboflavin (vitamin B2)
      3. Nicotinamide (Vitamin B3, niacin and nicotinic acid)
      4. Pyridoxine (vitamin B6)
      5. Ascorbic acid (vitamin C)
      6. Glucose

      Suspected or established Wernicke’s encephalopathy is treated by intravenous infusion of Pabrinex/ The dose is 2-3 pairs three times a day for three to five days, followed by one pair once daily for an additional three to five days or for as long as improvement continues.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pharmacology
      11.5
      Seconds

  • Question 20 - Which of the following blood groups is the universal donor: ...

    Correct

    • Which of the following blood groups is the universal donor:

      Your Answer: O

      Explanation:

      Blood group O has no antigens, but both anti-A and anti-B antibodies and thus is the universal donor.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      2.5
      Seconds

  • Question 21 - Which of the following is true regarding respiration? ...

    Correct

    • Which of the following is true regarding respiration?

      Your Answer: The diaphragm is responsible for abdominal breathing

      Explanation:

      The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.

      Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.

      In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.

      Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      12.7
      Seconds

  • Question 22 - A patient presents with a rash for a dermatological examination. A flat circumscribed...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      111.9
      Seconds

  • Question 23 - A 77 year old lady presents to ED with her left leg shortened...

    Incorrect

    • A 77 year old lady presents to ED with her left leg shortened and externally rotated following slipping and falling on a wet bathroom floor. There is an intracapsular fracture of the neck of femur seen on imaging studies. She is at risk of avascular necrosis of the head of femur.

      This is caused by lack of blood supply from which of these arteries?

      Your Answer: Inferior gluteal artery

      Correct Answer: Medial circumflex artery

      Explanation:

      The primary blood supply to the head of the femur is from branches of the medial femoral circumflex artery.

      The superior and inferior gluteal arteries supply the hip joint but not the head of femur.

      The lateral circumflex artery anastomoses with the medial femoral circumflex artery and assists in supplying the head of femur.

      The obturator artery is an important source of blood supply in children up to about 8 years. It gives rise to the artery of the head of femur which runs in the ligamentum teres and is insufficient to supply the head of femur in adults.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      302.9
      Seconds

  • Question 24 - Which of the following is NOT a typical feature of lithium toxicity: ...

    Correct

    • Which of the following is NOT a typical feature of lithium toxicity:

      Your Answer: Miosis

      Explanation:

      Features of toxicity include:
      Increasing gastrointestinal disturbances (vomiting, diarrhoea, anorexia)
      Visual disturbances
      Polyuria and incontinence
      Muscle weakness and tremor
      Tinnitus
      CNS disturbances (dizziness, confusion and drowsiness increasing to lack of coordination, restlessness, stupor)
      Abnormal reflexes and myoclonus
      Hypernatraemia
      With severe overdosage (serum-lithium concentration > 2 mmol/L) seizures, cardiac arrhythmias (including sinoatrial block, bradycardia and first-degree heart block), blood pressure changes, electrolyte imbalance, circulatory failure, renal failure, coma and sudden death may occur.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      38.1
      Seconds

  • Question 25 - Regarding cross-sectional studies, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cross-sectional studies, which of the following statements is CORRECT:

      Your Answer: They are useful for considering trends over time.

      Correct Answer: They are particularly suitable for estimating point prevalence.

      Explanation:

      Cross-sectional studies aim to provide data about population health, normal ranges of biological parameters, and disease prevalence or severity by observing the entire population, or a representative subset, at a single point in time. Cross-sectional studies are relatively simple and quick to perform and can be used to study multiple outcomes, but are subject to confounding and recall bias and are not suitable for studying rare diseases. Cross-sectional studies cannot be used to assess causation or to consider trends over time.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      34.8
      Seconds

  • Question 26 - Regarding the resting membrane potential, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the resting membrane potential, which of the following statements is CORRECT:

      Your Answer: A neurone has a resting membrane potential of about -90 mV.

      Correct Answer: The resting cell membrane is more permeable to K + ions than to Na + ions.

      Explanation:

      A membrane potential is a property of all cell membranes, but the ability to generate an action potential is only a property of excitable tissues. The resting membrane is more permeable to K+and Cl-than to other ions (and relatively impermeable to Na+); therefore the resting membrane potential is primarily determined by the K+equilibrium potential. At rest the inside of the cell is negative relative to the outside. In most neurones the resting potential has a value of approximately -70 mV.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      63.6
      Seconds

  • Question 27 - Which of the following nerves supplies innervation to the extensor hallucis longus? ...

    Incorrect

    • Which of the following nerves supplies innervation to the extensor hallucis longus?

      Your Answer: Common peroneal nerve

      Correct Answer: Deep peroneal nerve

      Explanation:

      Extensor hallucis longus is innervated by the deep fibular nerve (root value L5 and S1).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      51.5
      Seconds

  • Question 28 - In the extrinsic pathway of the coagulation cascade, the tenase complex is: ...

    Incorrect

    • In the extrinsic pathway of the coagulation cascade, the tenase complex is:

      Your Answer: Factor IXa-VIIIa complex

      Correct Answer: Factor VIIa-tissue factor complex

      Explanation:

      The extrinsic pathway for initiating the formation of prothrombin activator begins with a traumatized vascular wall or traumatized extravascular tissues that come in contact with the blood. Exposed and activated by vascular injury, with plasma factor VII. The extrinsic tenase complex, factor VIIa-tissue factor complex, activates factor X to factor Xa.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      26.6
      Seconds

  • Question 29 - A 30-year-old female presented to the Emergency Department after a fall during a...

    Correct

    • A 30-year-old female presented to the Emergency Department after a fall during a hiking expedition caused severe pain in her left arm and wrist drop. An X-ray revealed a mid-shaft fracture of the humerus, which most likely damaged the radial nerve.

      Which one of the following statements best describes the healing process of peripheral nerves?

      Your Answer: Peripheral nerve fibres regenerate at around 1mm per day

      Explanation:

      Peripheral nerves are nerves that lie outside the brain and spinal cord. Peripheral nerves readily regenerate, while central nervous system axonal injury does not spontaneously regenerate.
      If there is damage to the axons of peripheral nerves, the nerves will regenerate at a slow rate of 1 mm per day. The slow regeneration process may lead to muscle atrophy before regeneration is complete.

      Each peripheral nerve has a single cell body that supplies nutrients to the growing nerve fibre. The cell body does not undergo mitosis; only the axon is regenerated.

      Schwann cells of the peripheral nervous system provide support for this process, while the analogous oligodendrocytes of the central nervous system do not. Schwann cells themselves do not cause regeneration. Schwann cells provide myelin for myelinated fibres and surround non-myelinated fibres with their cytoplasm.

      If an axon is completely severed, as in the case of amputation, the axonal fibres regenerating from the cell body may never find their original route back to the muscle. Instead, they may form a traumatic neuroma, a painful collection of nerve fibres and myelin.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      16.1
      Seconds

  • Question 30 - You are asked to review the blood results on a 56-year-old man who...

    Correct

    • You are asked to review the blood results on a 56-year-old man who appears to be acutely unwell. His results show that he is neutropenic.
      Which ONE of the following is NOT a recognized cause of a neutropenia?

      Your Answer: Hyposplenism

      Explanation:

      Neutropenia is defined as a total neutrophil count of < 2.0 x 109/l.
      It can be caused by:
      Viral infections
      Collagen disease e.g. SLE and RA
      Chemotherapy and radiotherapy
      Hypersplenism
      Marrow infiltration
      Vitamin and folate deficiency
      Drug reactions
      Drugs that cause neutropenia include flecainide, phenytoin, carbimazole, indomethacin and co-trimoxazole.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      62.8
      Seconds

  • Question 31 - What is the mechanism of action of penicillin antibiotics: ...

    Correct

    • What is the mechanism of action of penicillin antibiotics:

      Your Answer: Inhibition of bacterial cell wall synthesis

      Explanation:

      Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
      The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      46.2
      Seconds

  • Question 32 - A young male has presented to you with respiratory depression and small pupils...

    Correct

    • A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.

      Which of the following statements is TRUE regarding naloxone?

      Your Answer: It can be given by a continuous infusion if repeated doses are required

      Explanation:

      Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity.

      It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.

      Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.

      An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg.

      If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      43.8
      Seconds

  • Question 33 - Which of the following best describes an intention to treat analysis: ...

    Incorrect

    • Which of the following best describes an intention to treat analysis:

      Your Answer: Only patients who were not lost to follow-up are included in the analysis.

      Correct Answer: All patients are included in the analysis according to the group into which they were randomised even if they are withdrawn from the study.

      Explanation:

      An intention to treat (ITT) analysis is one in which all patients are included in the analysis, classified according to the group into which they were randomised, even if they were withdrawn from the study and did not actually receive the treatment, did not comply with treatment or drop-out. Intention to treat analysis is a more reliable estimate of true treatment effectiveness by replicating what happens in the ‘real world’ (e.g. noncompliance and protocol violations commonly affect therapies).

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      32
      Seconds

  • Question 34 - Regarding skeletal muscle contraction, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding skeletal muscle contraction, which of the following statements is CORRECT:

      Your Answer: The force of contraction of a muscle is controlled by increasing the strength of contraction of muscle fibres.

      Correct Answer: The force of contraction of a muscle can be controlled by increasing recruitment of motor units.

      Explanation:

      Each motor unit contracts in an all or nothing fashion, i.e. if a motor unit is excited, it will stimulate all of its muscle fibres to contract. The force of contraction of a muscle is controlled by varying the motor unit recruitment (spatial summation), and by varying the firing rate of the motor units (temporal summation). During a gradual increase in contraction of a muscle, the first units start to discharge and increase their firing rate, and, as the force needs to increase, new units are recruited and, in turn, also increase their firing rate. For most motor units, the firing rate for a steady contraction is between 5 and 8 Hz. Because the unitary firing rates for each motor unit are different and not synchronised, the overall effect is a smooth force profile from the muscle. Increasing the firing rate of motor units is temporal summation where the tension developed by the first action potential has not completely decayed when the second action potential and twitch is grafted onto the first and so on. If the muscle fibres are stimulated repeatedly at a faster frequency, a sustained contraction results where it is not possible to detect individual twitches. This is called tetanus.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      61.9
      Seconds

  • Question 35 - The proximal convoluted tubule (PCT) is the first part of the renal tubule...

    Correct

    • The proximal convoluted tubule (PCT) is the first part of the renal tubule and lies in the renal cortex. The bulk of reabsorption of solute occurs is the PCT and 100% of glucose is reabsorbed here.

      Which of the following is the mechanism of glucose reabsorption in the PCT?

      Your Answer: Secondary active transport

      Explanation:

      Glucose reabsorption occurs exclusively in the proximal convoluted tubule by secondary active transport through the Na.Glu co-transporters, driven by the electrochemical gradient for sodium.
      The co-transporters transport two sodium ions and one glucose molecule across the apical membrane, and the glucose subsequently crosses the basolateral membrane by facilitated diffusion.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      20.4
      Seconds

  • Question 36 - ACE inhibitors are indicated for all of the following EXCEPT for: ...

    Correct

    • ACE inhibitors are indicated for all of the following EXCEPT for:

      Your Answer: Angina

      Explanation:

      ACE inhibitors have many uses and are generally well tolerated. They are indicated for:

      • Heart failure
      • Hypertension
      • Diabetic nephropathy
      • Secondary prevention of cardiovascular events

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      11.4
      Seconds

  • Question 37 - A man presents to the emergency department with an injury that has damaged...

    Incorrect

    • A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.

      Which of the following statements regarding the opponens pollicis muscle is considered correct?

      Your Answer: It assists with the abduction of the thumb

      Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint

      Explanation:

      Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.

      Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.

      It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      59.6
      Seconds

  • Question 38 - You contact the intensive care outreach team to inquire about a severely hypotensive...

    Correct

    • You contact the intensive care outreach team to inquire about a severely hypotensive resuscitated patient. They make the decision to start a dopamine infusion.

      Dopamine primarily has which of the following effects at high doses (>15 g/kg/min)?

      Your Answer: Alpha-adrenergic stimulation

      Explanation:

      Dopamine is a catecholamine that occurs naturally and is used to treat low cardiac output, septic shock, and renal failure. It is both adrenaline and noradrenaline’s immediate precursor.

      Dopamine acts on D1 and D2 dopamine receptors in the renal, mesenteric, and coronary beds at low doses (1-5 g/kg/min). Dopamine causes a significant decrease in renal vascular resistance and an increase in renal blood flow at these doses. Within this dose range, it is also involved in central modulation of behaviour and movement.

      Dopamine stimulates beta- and alpha-adrenergic receptors directly and indirectly at higher doses. Beta-stimulation predominates at a rate of 5-10 g/kg/min, resulting in a positive inotropic effect that increases cardiac output and coronary blood flow. Alpha-stimulation predominates at infusion rates greater than 15 g/kg/min, resulting in peripheral vasoconstriction and an increase in venous return and systolic blood pressure.

      Because clearance varies greatly in critically ill patients, plasma concentrations cannot be predicted reliably from infusion rates.
      Dopamine is given as an intravenous infusion, and because extravasation can cause tissue necrosis and sloughing, a central line is usually used (especially at higher doses >240 g/min). In an emergency, however, dopamine can be administered through a large vein (cephalic or basilic) while a central line is being prepared. Alkaline intravenous solutions inactivate it, so sodium bicarbonate should not be infused with it.

      The following are the most common dopamine side effects:
      Nausea and vomiting
      Tachycardia
      Dysrhythmias
      Angina
      Hypertension

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      29
      Seconds

  • Question 39 - A patient presents with a laceration on his hand and wrist that has...

    Correct

    • A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.
      The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer: The recurrent branch of the median nerve

      Explanation:

      Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.
      Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.
      The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      13.4
      Seconds

  • Question 40 - Which of the following laboratory findings are indicative of von Willebrand disease (VWD):...

    Incorrect

    • Which of the following laboratory findings are indicative of von Willebrand disease (VWD):

      Your Answer: Thrombocytopaenia

      Correct Answer: Prolonged APTT

      Explanation:

      Laboratory results often show that:
      PFA-100 test results are abnormal.
      Low levels of factor VIII (if a factor VIII/VWF binding assay is conducted)
      APTT is Prolonged (or normal)
      PT is normal
      VWF values are low.
      Defective Platelet aggregation
      The platelet count is normal.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      10.8
      Seconds

  • Question 41 - A CT pulmonary angiography of a patient with a massive pulmonary embolus will...

    Correct

    • A CT pulmonary angiography of a patient with a massive pulmonary embolus will most likely show which of the following signs?

      Your Answer: Increased alveolar dead space

      Explanation:

      A CT pulmonary angiogram is an angiogram of the blood vessels of the lungs. It is a diagnostic imaging test used to check for pulmonary embolism.

      A pulmonary embolism is caused by a blood clot or thrombus that has become lodged in an artery in the lung and blocks blood flow to the lung. A patient with pulmonary embolism may feel an abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia. Also, pulmonary embolism can result in alveolar dead space.

      Dead space represents the volume of ventilated air that does not participate in gas exchange. The alveolar dead space is caused by ventilation/perfusion imbalances in the alveoli. It is defined as the sum of the volumes of alveoli that are ventilated but not perfused.

      Aside from pulmonary embolism, smoking, bronchitis, emphysema, and asthma are among the other causes of alveolar dead space.

      The other types of dead space are the following: Anatomical dead space is the portion of the airways that conducts gas to the alveoli. This is usually around 150 mL, and there is no possibility of gas exchange in these areas. Physiological dead space is the sum of anatomical and alveolar dead spaces.

      Physiological dead space can account for up to 30% of the tidal volume.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      14.2
      Seconds

  • Question 42 - Which of the following is first-line for management of status epilepticus: ...

    Correct

    • Which of the following is first-line for management of status epilepticus:

      Your Answer: Intravenous lorazepam

      Explanation:

      First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      10.6
      Seconds

  • Question 43 - Salivary glands produce saliva which is mostly water, but it also contains a...

    Correct

    • Salivary glands produce saliva which is mostly water, but it also contains a range of essential chemicals such as mucus, electrolytes, antibiotic agents, and enzymes.

      Which of the following is a carbohydrate-digesting enzyme found in saliva?

      Your Answer: Amylase

      Explanation:

      The acinar cells of the parotid and submandibular glands release amylase. Amylase begins starch digestion before food is even eaten, and it works best at a pH of 7.4.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      12.2
      Seconds

  • Question 44 - Among the following microorganisms, which is considered to be transmitted by invasion of...

    Incorrect

    • Among the following microorganisms, which is considered to be transmitted by invasion of intact skin?

      Your Answer: Staphylococcus aureus

      Correct Answer: Leptospira spp.

      Explanation:

      Rodents and domestic animals are the primary reservoirs for the Leptospira spp, although other animals, including cows, horses, mongooses, and frogs, can also harbour the leptospires. Humans may be directly infected from animal urine or indirectly by contact with soil or water that is contaminated with urine from infected animals. Infected humans can shed leptospires in urine for up to 11 months, infected cows for 3.5 months, infected dogs for 4 years, and infected rodents possibly for their entire lifetime.

      The organisms enter the host through mucous membranes or abraded skin. The incubation period ranges from 5 to 14 days.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      10.9
      Seconds

  • Question 45 - A 35-year-old man suffered a severe road traffic accident and has been brought...

    Correct

    • A 35-year-old man suffered a severe road traffic accident and has been brought to the hospital. As part of his treatment, he requires a blood transfusion and experiences a transfusion reaction.

      The most common type of transfusion reaction is which of the following?

      Your Answer: Febrile transfusion reaction

      Explanation:

      During or shortly after transfusion, febrile transfusion reactions, also known as non-haemolytic transfusion reactions, present with an unexpected temperature rise (38oC or 1oC above baseline, if baseline is 37oC). This is usually a one-off occurrence. The fever is sometimes accompanied by chills.

      The most common type of transfusion reaction is febrile transfusion reactions, which occur in about 1 in every 8 transfusions.

      The most common event leading to symptoms of febrile transfusion reactions is cytokine accumulation during storage of cellular components (especially platelet units). White cells secrete cytokines, and pre-storage leucodepletion has reduced this risk.

      Recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leukocyte antigen (HLA) or other antigens can also cause febrile transfusion reactions. Donor lymphocytes, granulocytes, and platelets all contain these antigens.

      Treatment is reassuring. Other causes should be ruled out, and antipyretics like paracetamol can help with fever relief. If another cause of fever is suspected, the transfusion should be stopped; however, if other causes of fever have been ruled out, it can be restarted at a slower rate.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      20
      Seconds

  • Question 46 - A 64-year-old woman with a history of chronic breathlessness is referred for lung...

    Incorrect

    • A 64-year-old woman with a history of chronic breathlessness is referred for lung function testing.
      Which of the following statements regarding lung function testing is FALSE? Select ONE answer only.

      Your Answer: In obstructive lung disease, the FEV 1 /FVC ratio is reduced to <0.7

      Correct Answer: In restrictive lung disease, the FVC is increased

      Explanation:

      In restrictive lung disorders there is a reduction in the forced vital capacity (FVC) and the forced expiratory volume in one second (FEV1). The decline in the FVC is greater than that of the FEV1, resulting in preservation of the FEV1/FVC ratio (>0.7%).
      In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to <0.7.
      According to the latestNICE guidelines(link is external), airflow obstruction is defined as follows:
      Mild airflow obstruction = an FEV1 of >80% in the presence of symptoms
      Moderate airflow obstruction = FEV1 of 50-79%
      Severe airflow obstruction = FEV1 of 30-49%
      Very severe airflow obstruction = FEV1<30%.
      Spirometry is a poor predictor of durability and quality of life in COPD but can be used as part of the assessment of severity.
      COPD can only be diagnosed on spirometry if the FEV1 is <80% and FEV1/FVC ratio is < 0.7.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      13.5
      Seconds

  • Question 47 - Most of the lymph from vessels that drain the breast is collected in...

    Correct

    • Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?

      Your Answer: Axillary nodes

      Explanation:

      Lymph is the fluid that flows through the lymphatic system.

      Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly.

      The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      11.4
      Seconds

  • Question 48 - The Frank-Starling curve is shifted downhill in heart failure due to which of...

    Correct

    • The Frank-Starling curve is shifted downhill in heart failure due to which of the following?

      Your Answer: Decrease in contractility

      Explanation:

      The Frank–Starling mechanism states that the left ventricle can increase its force of contraction and hence stroke volume in response to increases in venous return and thus preload.

      Changes in afterload or inotropy cause the Frank–Starling curve to rise or fall. In heart failure, the Frank–Starling curve is shifted downward (flattened), requiring higher venous return and filling pressure to enhance contractility and stroke volume.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      4.8
      Seconds

  • Question 49 - Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely...

    Incorrect

    • Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely caused by which of the following:

      Your Answer:

      Correct Answer: Diabetes mellitus

      Explanation:

      Compressive causes of CN III palsy cause early pupillary dilatation because the parasympathetic fibres run peripherally in the nerve and are easily compressed. In diabetes mellitus the lesions are ischaemic rather than compressive and therefore typically affect the central fibres resulting in pupillary sparing.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      0
      Seconds

  • Question 50 - The correct statement about the glomerular filtration barrier is which of the following?...

    Incorrect

    • The correct statement about the glomerular filtration barrier is which of the following?

      Your Answer:

      Correct Answer: The basement membrane is negatively charged, restricting filtration of negatively charged molecules.

      Explanation:

      The main factor in determining whether a substance is filtered or not is molecular weight. Molecules < 7 kDa in molecular weight e.g. glucose, amino acids, urea, ions are filtered freely, but larger molecules are increasingly restricted up to 70 kDa, and there is very little filtration for anything above this.
      There is further restriction of negatively charged molecules because they are repelled by negative charges, particularly in the basement membrane. Albumin, which has a molecular weight of 69 kDa and is negatively charged, is filtered but only in very small amounts. All of the filtered albumin is reabsorbed in the proximal tubule. Small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. Other than the ultrafiltrate being essentially protein free, it has an otherwise identical composition of plasma. Bowman’s capsule consists of:
      – an epithelial lining which consists of a single layer of cells called podocytes
      – endothelium which is perforated by pores or fenestrations – this allows plasma components with a molecular weight of < 70 kDa to pass freely.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Microbiology (1/3) 33%
Specific Pathogen Groups (1/2) 50%
Endocrine (1/2) 50%
Physiology (6/12) 50%
Renal (0/1) 0%
Infections (3/3) 100%
Pharmacology (11/14) 79%
Musculoskeletal (1/1) 100%
CNS Pharmacology (2/2) 100%
Respiratory (0/1) 0%
Immunoglobulins And Vaccines (0/1) 0%
Anatomy (5/10) 50%
Central Nervous System (3/4) 75%
Upper Limb (2/4) 50%
Abdomen (1/1) 100%
Immune Responses (2/2) 100%
Pathology (5/7) 71%
Cardiovascular (3/3) 100%
Thorax (2/2) 100%
Fluids & Electrolytes (0/1) 0%
General Pathology (1/2) 50%
Lower Limb (0/2) 0%
Evidence Based Medicine (0/2) 0%
Study Methodology (0/2) 0%
Basic Cellular (0/3) 0%
Haematology (2/3) 67%
Renal Physiology (1/1) 100%
Cardiovascular Pharmacology (1/1) 100%
Respiratory Physiology (1/2) 50%
Gastrointestinal Physiology (1/1) 100%
Principles Of Microbiology (0/1) 0%
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