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Question 1
Incorrect
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Where are the cell bodies to the preganglionic neurons located?
Your Answer: Premotor cortex
Correct Answer: Midbrain
Explanation:The cell bodies of the preganglionic neurons are located in the lateral grey column of the spinal cord and in the motor nuclei of the 3rd, 7th, 9th and 10th cranial nerves. These cranial nerves take origin from the midbrain.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 2
Correct
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Which of the following is the most common clinical feature of carbon monoxide poisoning?
Your Answer: Headache
Explanation:Carbon monoxide (CO) poisoning:It is considered as the great imitator of other diseases as the patients present with a myriad of symptoms. The carbon monoxide diffuses rapidly across the pulmonary capillary membrane binding to the haem molecule with a very high affinity (240 times that of oxygen) forming carboxy-haemoglobin (COHb). Non-smokers have a baseline COHb of ,3% while smokers have a baseline COHb of 10-15%.Clinical features of carbon monoxide toxicity:Headache: 90% of cases (most common clinical feature)Nausea and vomiting: 50%Vertigo: 50%Confusion: 30%Subjective weakness: 20%Severe toxicity: ‘pink’ skin and mucosa, hyperpyrexia, arrhythmias, extrapyramidal features, coma, deathCherry red skin is a sign of severe toxicity and is usually a post-mortem finding.Management• 100% oxygen• Hyperbaric oxygen therapy (HBOT)The use of Hyperbaric oxygen therapy (HBOT) for treatment mild to moderate CO poisoning is not routine.The selection criteria for HBOT in cases of CO poisoning include:• COHb levels > 20-25%• COHb levels > 20% in pregnant patient • Loss of consciousness• Severe metabolic acidosis (pH <7.1)• Evidence of end-organ ischemia (e.g., ECG changes, chest pain, or altered mental status)
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 3
Correct
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What is the most important way in which heat is lost from the body?
Your Answer: Radiation and conduction
Explanation:The body maintains a constant core temperature by balancing heat loss and heat gain. The mechanisms of heat loss are: radiation, evaporation, convection and conduction. Out of these mechanisms, the most important under normal conditions are radiation, through which body heat is given off to the surrounding atmosphere; and conduction, in which the body releases heat into the objects it comes into contact with.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 4
Correct
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The pontine tegmentum as part of the midbrain, contains which cranial nerve nuclei?
Your Answer: CN 5 to 8
Explanation:The pontine tegmentum also known as dorsal pons is located within the brain stem. Several cranial nerve nuclei are located in the pontine tegmentum. The nuclei of CN V, CN VI, CN VII and CNVIII are located in the pontine tegmentum.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 5
Incorrect
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Activation of the cool receptor (CMR-1), causes:
Your Answer: Activation of the Na-K-ATPase pump
Correct Answer: Influx of Ca++ & Na+
Explanation:Cold and Menthol receptor 1 (CMR1) is a protein that in humans is encoded by TRPM8 gene. It is an ion channel which upon activation causes the influx of Na+ and Ca++ ions into the cell that leads to the depolarization and generation of an action potential.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 6
Correct
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What is the role of cyclin and cyklin-dependent kinases in mitosis:
Your Answer: Phosphorylation of proteins that make up pre-replication complexes
Explanation:There are certain regulators of the cell cycles that mediate progression through the cell cycle. These are cyclins and cyklin-dependent kinases (CDKs). They form a complex that phosphorylates protein involved in the cell cycle.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 7
Incorrect
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Café-au-lait spots are seen in each of the following, except:
Your Answer: Hunter syndrome
Correct Answer: Friedreich's ataxia
Explanation:Café-au-lait spots are hyperpigmented lesions that vary in colour from light brown to dark brown, with borders that may be smooth or irregular.
Causes include:
- Neurofibromatosis type I
- McCune–Albright syndrome
- Legius syndrome
- Tuberous sclerosis
- Fanconi anaemia
- Idiopathic
- Ataxia-telangiectasia
- Basal cell nevus syndrome
- Benign congenital skin lesion
- Bloom syndrome
- Chediak-Higashi syndrome
- Congenital nevus
- Gaucher disease
- Hunter syndrome
- Maffucci syndrome
- Multiple mucosal neuroma syndrome
- Noonan syndrome
- Pulmonary Stenosis
- Silver–Russell syndrome
- Watson syndrome
- Wiskott–Aldrich syndrome
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 8
Incorrect
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A 28-year-old female admitted for a course of chemotherapy, has been taking high dose steroids for a few days. The nurses report that she is very agitated and talks about trying to open the window of her room and jump out from the fourth floor.You review her notes and see that she admits to drinking a few glasses of wine per week and has smoked cannabis on a few occasions.On examination her BP is 145/88 mmHg, her pulse is 80 bpm.Blood investigations reveal:Haemoglobin: 12.1 g/dL (11.5-16.5)WBC count: 16.2 x 103/dL (4-11)Platelets: 200 x 109/L (150-400)C-reactive protein: 9 nmol/l (<10)Sodium: 140 mmol/l (135-146)Potassium: 3.9 mmol/l (3.5-5)Creatinine: 92 μmol/l (79-118)Which of the following is the most likely diagnosis?
Your Answer: Alcohol withdrawal
Correct Answer: Corticosteroid-related psychosis
Explanation:Agitation, hypomania and suicidal intent within a few days after initiating corticosteroid therapy is highly suggestive of a diagnosis of corticosteroid-induced psychosis.In some patients corticosteroid related psychosis has been diagnosed up to 12 weeks or more after commencing therapy.Euphoria and hypomania are considered to be the most common psychiatric symptoms reported during short courses of steroids.During long-term treatment, depressive symptoms were the most common. Higher steroid doses appear to carry an increased risk for such adverse effects; however, there is no significant relationship between dose and time to onset, duration, and severity of symptoms. Management: Reduction or cessation of corticosteroids is the mainstay of treatment for steroid psychosis. For those patients who cannot tolerate this reduction/cessation of steroids, mood stabilizers may be of some benefit.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 9
Incorrect
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On which chromosome is the gene for insulin located?
Your Answer: Chromosome 6
Correct Answer: Chromosome 11
Explanation:Humans have 23 pairs of chromosomes, and usually, two pairs of copies of chromosome 11. It is one of the most complex, gene-rich chromosomes in the human genome, and it is associated with a number of diseases. Studies have shown they the human insulin gene is located on the short arm of chromosome 11.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 10
Correct
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A 46 year old male, known with Rheumatoid Arthritis presents with a swollen and painful right ankle. No drug allergies are reported. On examination, the vitals are as follows: Temp: 38.8BP: 90/60 mmHgPulse: 110/min. Right ankle examination reveals tenderness, warmth, erythema and tense joint effusion. Blood samples including blood cultures are collected and fluid resuscitation is initiated. Which of the following interventions would be most appropriate for this man?
Your Answer: Administer i.v. flucloxacillin, and arrange joint aspiration urgently
Explanation:Although microscopic analysis of joint fluid aspirate and culture is the basis of septic arthritis diagnosis and should usually be collected before the administration of antibiotics, the patient is showing signs of septic shock. A delay in antibiotics might lead to worsening of symptoms so they are administered first.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 11
Incorrect
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The hyperpolarization phase of pacemaker cells is dominated by ____ current.
Your Answer: Ca++
Correct Answer: K+
Explanation:The hyperpolarization phase is a continuation of the repolarization phase but the membrane potential dips below the resting membrane potential. This results due to the fact that the K+ channels take a longer time to close than the Na+ channels. Hence efflux of the K+ will result in hyperpolarization.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 12
Incorrect
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A 42 year old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?
Your Answer: Kidneys
Correct Answer: Lungs
Explanation:Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common. Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases).
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 13
Incorrect
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Somatostatin is responsible for?
Your Answer: Increased pancreatic secretions
Correct Answer: Decreased gastrin release
Explanation:Somatostatin is an inhibitory hormone secreted from the D cells of the Pancreatic Islets. It causes the inhibition of gastrin (decreasing stomach acid production), CCK (decreasing gallbladder motility), gastrin inhibitory peptide and secretin. Gastrin production is also inhibited by secretin, GIP, VIP, glucagon and calcitonin.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 14
Correct
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Pacemaker cells in the SA node and the AV node are connected by?
Your Answer: Gap junctions
Explanation:Gap junctions allows for rapid propagation of the action potential from one cell to the other. The cells of the heart are connected by gap junctions.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 15
Correct
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Bile salts are responsible for:
Your Answer: The emulsification of fats
Explanation:The main function of bile acids is to allow digestion of dietary fats and oils by acting as a surfactant that emulsifies them into micelles, allowing them to be colloidally suspended in the chyme before further processing.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 16
Correct
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Question 17
Incorrect
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Which statement is correct regarding mRNA?
Your Answer: mRNA is only single stranded and cannot hybridize with a complementary sequence of single stranded DNA.
Correct Answer: mRNAs are mainly found in the nucleus and cytoplasm of a cell.
Explanation:mRNA is transcribed from DNA and is carried to the cytosol to be translated. Hence it is mainly found in the cytosol and the nucleus of a cell. It is single stranded and contains the base uracil instead of thymine.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 18
Incorrect
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Which of the following statements is most suitable to describe necrosis?
Your Answer: Tightly regulated involving activation and enzymatic steps.
Correct Answer: Significant inflammatory response
Explanation:Necrosis is the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply. Cellular death due to necrosis does not follow the (regulated) apoptotic signal transduction pathway, but rather various receptors are activated, and result in the loss of cell membrane integrity and an uncontrolled release of products of cell death into the extracellular space. This initiates in the surrounding tissue an inflammatory response which attracts leukocytes and nearby phagocytes which eliminate the dead cells by phagocytosis.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 19
Correct
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Which immunological cells are predominant in the lymph node (almost 98 % residence)?
Your Answer: Lymphocytes
Explanation:Lymph nodes are a lymphoid organ mostly consisting of lymphocytes: B cells in the cortex from where they mature and proliferate and T cells in the paracortex. The medulla is also composed of lymphocytes and macrophages.
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This question is part of the following fields:
- Immunology
- Medicine
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Question 20
Correct
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A 82-year-old woman admitted following a fractured neck of femur has been discharged. On review, she is making good progress but consideration is given to secondary prevention of further fractures. What is the most appropriate step in the prevention of further fractures?
Your Answer: Start oral bisphosphonate
Explanation:In such a clinical scenario, NICE guidelines support initiating treatment with bisphosphonates without waiting for a DEXA scan.Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures.Management:Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D repleteAlendronate is the first-line treatment. Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate.Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates.Other medications that are useful in the treatment of osteoporosis are denosumab, teriparatide, raloxifene, etc.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 21
Incorrect
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Regarding integrins, which option is false?
Your Answer: Can bind to ligands and stimulate secondary signals resulting in endocytosis, proliferation and apoptosis
Correct Answer: Play no role in cell signalling.
Explanation:Integrins are transmembrane receptors that facilitate cell-extracellular matrix (ECM) adhesion. Upon ligand binding, integrins activate signal transduction pathways that mediate cellular signals such as regulation of the cell cycle, organization of the intracellular cytoskeleton, and movement of new receptors to the cell membrane. Integrins are obligate heterodimers, meaning that they have two subunits: α (alpha) and β (beta). Integrins play an important role in cell signalling by modulating the cell signalling pathways of transmembrane protein kinases such as receptor tyrosine kinases (RTK).
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 22
Incorrect
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Which is true of the composition of bile in the human hepatic duct?
Your Answer: The ratio of bile acids: phosphatidylcholine: cholesterol  is 1:3: 20
Correct Answer: Contains only actively secreted substances
Explanation:Hepatic bile is an isotonic fluid and its electrolyte composition resembles that of plasma. 97% of water is found in the gallbladder bile, not hepatic duct. Hepatic bile is alkaline. The ratio of bile acids: phosphatidylcholine: cholesterol is 20:1:3. Hepatic bile contai9ns only actively secreted substances.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 23
Incorrect
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Stem cell characteristics include the following except
Your Answer: Plasticity
Correct Answer: Differentiation and proliferation into progenitor cells committed to multiple cell lines
Explanation:The classical definition of a stem cell requires that it possess two properties:Self-renewal: the ability to go through numerous cycles of cell division while maintaining the undifferentiated state.Potency: the capacity to differentiate into specialized cell types. In the strictest sense, this requires stem cells to be either totipotent or pluripotent to be able to give rise to any mature cell type
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This question is part of the following fields:
- Haematology
- Medicine
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Question 24
Incorrect
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Which of the following predominate in the adrenal medulla?
Your Answer: Paraganglia cells
Correct Answer: Epinephrine secreting cells
Explanation:Chromaffin cells, also known as pheochromocytes, are cells located in the adrenal medulla which specialize in the synthesis, storage, and secretion of catecholamines: 80% epinephrine and 20% norepinephrine is released into the bloodstream. For this reason, they are considered to be neuroendocrine cells.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 25
Incorrect
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Vitamin B12 is transported from the enterocytes to the bone marrow by which factor?
Your Answer: Transcobalamin I (TC 1)
Correct Answer: Transcobalamin II (TC IIi)
Explanation:B12 must be attached to 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. Once the IF/B12 complex is recognized by specialized ileal receptors, it is transported into the portal circulation. The vitamin is then transferred to transcobalamin II (TC-II/B12), which serves as the plasma transporter.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 26
Correct
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Which enzyme deficiency can lead to ammonia intoxication?
Your Answer: Ornithine transcarbamylase
Explanation:Ornithine transcarbamylase deficiency also known as OTC deficiency is the most common urea cycle disorder in humans. Ornithine transcarbamylase, the defective enzyme in this disorder is the final enzyme in the proximal portion of the urea cycle, responsible for converting carbamoyl phosphate and ornithine into citrulline. OTC deficiency is inherited in an X-linked recessive manner, meaning males are more commonly affected than females.
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This question is part of the following fields:
- Medicine
- Metabolism
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Question 27
Incorrect
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The AV Node:
Your Answer: It is a complex spindle shaped structure located in the interventricular septum
Correct Answer: It decelerates impulses passing to the ventricles
Explanation:The action potentials in the sinoatrial (SA) and atrioventricular (AV) nodes are largely due to Ca2+, with no contribution by Na+ influx. The depolarization continues to conduct slowly through the atrioventricular (AV) node. The AV node is located in the right posterior portion of the interatrial septum. This is small and bean-shaped. The atrial conductive system is organized so that the cardiac impulse does not travel from the atria into the ventricles too rapidly; this delay allows the atria to empty before ventricular contraction begins. It is the AV node and its adjacent conductive fibers that delay this transmission into the ventricles. Conduction through the AV Node is represented on the ECG by the PR interval.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 28
Correct
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Question 29
Correct
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A 32 year old man presents with blistering and hyperpigmentation on his face and hands, after a beach holiday with friends. Tests reveal high levels of uroporphyrinogen in the urine. The most likely diagnosis is:
Your Answer: Porphyria cutanea tarda
Explanation:Porphyria cutanea tarda (PCT) is the most common of the porphyries. It is characterised by fragility and blistering of exposed skin. Typically, patients who are ultimately diagnosed with PCT first seek treatment following the development photosensitivities in the form of blisters and erosions on commonly exposed areas of the skin. This is usually observed in the face, hands, forearms, and lower legs. It heals slowly and with scarring. Though blisters are the most common skin manifestations of PCT, other skin manifestations like hyperpigmentation (as if they are getting a tan) and hypertrichosis (mainly on top of the cheeks) also occur. Risk factors for the development of PCT include alcohol and sun.
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This question is part of the following fields:
- Dermatology
- Medicine
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Question 30
Correct
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Which of the following would provide relief from nausea and vomiting?
Your Answer: Cannabinoids
Explanation:Ondansetron, chlorpromazine and haloperidol are effective antiemetic agents. Corticosteroids, cannabinoids, and benzodiazepines, alone or in combination with 5-HT3 and D2 antagonists, are also useful in the treatment of vomiting produced by chemotherapy.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
