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  • Question 1 - Which of the following is a potential cause of a positive D-dimer assay?...

    Correct

    • Which of the following is a potential cause of a positive D-dimer assay?

      Your Answer: Deep venous thrombosis

      Explanation:

      A D-dimer test is performed to detect and diagnose thrombotic conditions and thrombosis. A negative result would rule out thrombosis and a positive result although not diagnostic, is highly suspicious of thrombotic conditions like a deep vein thrombosis, pulmonary embolism as well as DIC.

    • This question is part of the following fields:

      • General
      • Physiology
      5.3
      Seconds

  • Question 2 - A 40 year old man suffered severe trauma following an MVA. His BP...

    Correct

    • A 40 year old man suffered severe trauma following an MVA. His BP is 70/33 mmhg, heart rate of 140 beats/mins and very feeble pulse. He was transfused 3 units of blood resulting in his BP returning to 100/70 and his heart rate to 90 beats/min. What decreased following transfusion?

      Your Answer: Total peripheral resistance

      Explanation:

      The patient is in hypovolemic shock, he is transfused with blood to replace the volume lost. It is important not only to replace fluids but stop active bleeding in resuscitation. Fluid replacement will result in a decreased sympathetic discharge and adequate ventricular filling thus reducing total peripheral resistance and increasing cardiac output and cardiac filling pressures.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      17.7
      Seconds

  • Question 3 - Lung compliance is increased by: ...

    Incorrect

    • Lung compliance is increased by:

      Your Answer: Pulmonary fibrosis

      Correct Answer: Emphysema

      Explanation:

      Lung compliance is increased by emphysema, acute asthma and increasing age and decreased by alveolar oedema, pulmonary hypertension, atelectasis and pulmonary fibrosis.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      7.2
      Seconds

  • Question 4 - A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her...

    Incorrect

    • A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her arterial blood gas analysis on room revealed pH: 7.30, p(CO2): 53 mmHg and p(O2): 79 mmHg. What is the most likely cause of these findings?

      Your Answer: Pulmonary embolus

      Correct Answer: Alveolar hypoventilation

      Explanation:

      In the given problem, there is respiratory acidosis due to hypercapnia from a low respiratory rate and/or volume (hypoventilation). Causes of hypoventilation include conditions impairing the central nervous system (CNS) respiratory drive, impaired neuromuscular transmission and other causes of muscular weakness (drugs and sedatives), along with obstructive, restrictive and parenchymal pulmonary disorders. Hypoventilation leads to hypoxia and hypercapnia reduces the arterial pH. Severe acidosis leads to pulmonary arteriolar vasoconstriction, systemic vascular dilatation, reduced myocardial contractility, hyperkalaemia, hypotension and cardiac irritability resulting in arrhythmias. Raised carbon dioxide concentration also causes cerebral vasodilatation and raised intracranial pressure. Over time, buffering and renal compensation occurs. However, this might not be seen in acute scenarios where the rise in p(CO2) occurs rapidly.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      2815.8
      Seconds

  • Question 5 - Rapid Eye Movement (REM) sleep is typically associated with: ...

    Incorrect

    • Rapid Eye Movement (REM) sleep is typically associated with:

      Your Answer: Somnambulism

      Correct Answer: Penile erections

      Explanation:

      Normal sleep comprises of alternate cycles between slow-wave sleep (non-REM sleep) and REM sleep. REM sleep is characterized by increased metabolic brain activity and EEG desynchronization. Somnambulism (sleepwalking), enuresis (bedwetting) and night terrors all occur during slow-wave sleep or during arousal from slow-wave sleep. In comparison, REM sleep is characterized by hypotonia of major muscle groups (excluding ocular muscles), dreams, nightmares and penile erection.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      12.6
      Seconds

  • Question 6 - How much blood can the pulmonary vessels of a 45-year-old healthy man accommodate...

    Incorrect

    • How much blood can the pulmonary vessels of a 45-year-old healthy man accommodate when he is at rest?

      Your Answer: 150 ml

      Correct Answer: 500 ml

      Explanation:

      Pulmonary circulation is the portion of the cardiovascular system which carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. The vessels of the pulmonary circulation are very compliant (easily distensible) and so typically accommodate about 500 ml of blood in an adult man. This large lung blood volume can serve as a reservoir for the left ventricle, particularly during periods when left ventricular output momentarily exceeds venous return.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      9.7
      Seconds

  • Question 7 - A neonate with failure to pass meconium is being evaluated. His abdomen is...

    Correct

    • A neonate with failure to pass meconium is being evaluated. His abdomen is distended and X-ray films of the abdomen show markedly dilated small bowel and colon loops. The likely diagnosis is:

      Your Answer: Aganglionosis in the rectum

      Explanation:

      Hirschsprung’s disease (also known as aganglionic megacolon) leads to colon enlargement due to bowel obstruction by an aganglionic section of bowel that starts at the anus. A blockage is created by a lack of ganglion cells needed for peristalsis that move the stool. 1 in 5000 children suffer from this disease, with boys affected four times more commonly than girls. It develops in the fetus in early stages of pregnancy. Symptoms include not having a first bowel movement (meconium) within 48 hours of birth, repeated vomiting and a swollen abdomen. Two-third of cases are diagnosed within 3 months of birth. Some children may present with delayed toilet training and some might not show symptoms till early childhood. Diagnosis is by barium enema and rectal biopsy (showing lack of ganglion cells).

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      7.5
      Seconds

  • Question 8 - The pleural cavity is the space between the two pulmonary pleurae which cover...

    Incorrect

    • The pleural cavity is the space between the two pulmonary pleurae which cover the lungs. What is the normal amount of pleural fluid?

      Your Answer: 250 ml

      Correct Answer: 10 ml

      Explanation:

      Pleural fluid is a serous fluid produced by the serous membrane covering normal pleurae. Most fluid is produced by the parietal circulation (intercostal arteries) via bulk flow and reabsorbed by the lymphatic system. The total volume of fluid present in the intrapleural space is estimated to be only 2–10 ml. A small amount of protein is present in intrapleural fluid. Normally, the rate of reabsorption increases as a physiological response to accumulating fluid.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      7.6
      Seconds

  • Question 9 - During cardiac catheterisation, if the blood sample from the catheter shows an oxygen...

    Incorrect

    • During cardiac catheterisation, if the blood sample from the catheter shows an oxygen saturation of 70%, and the pressure ranging from 12 to 24 mm Hg, it implies that the catheter tip is located in the:

      Your Answer: Left atrium

      Correct Answer: Pulmonary artery

      Explanation:

      Normal values for various parameters are as follows:

      Systolic arterial blood pressure (SBP): 90–140 mmHg.

      Diastolic arterial blood pressure: 60–90 mmHg.

      Mean arterial blood pressure (MAP): SBP + (2 × DBP)/3 (normal range: 70-105 mmHg).

      Right atrial pressure (RAP): 2–6 mmHg.

      Systolic right ventricular pressure (RVSP): 15–25 mmHg.

      Diastolic right ventricular pressure (RVDP): 0–8 mmHg.

      Pulmonary artery pressure (PAP): Systolic (PASP) is 15-25 mmHg and Diastolic (PADP) is 8–15 mmHg.

      Pulmonary artery wedge pressure (PAWP): 6–12 mmHg.

      Left atrial pressure (LAP): 6–12 mmHg.

      Thus, the given value indicates that the position of catheter tip is likely to be in the pulmonary artery.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      21.9
      Seconds

  • Question 10 - Depression of the normal coagulation system and excessive bleeding after surgery can occur...

    Correct

    • Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?

      Your Answer: Liver disease

      Explanation:

      As most of the coagulation factors are synthesized in the liver, liver diseases like hepatitis or cirrhosis will depress the coagulation system. Vitamin K deficiency can also decrease the production of vitamin K dependent coagulation factors VII, XI, X and prothrombin.

    • This question is part of the following fields:

      • General
      • Physiology
      10
      Seconds

  • Question 11 - A 40-year old gentleman, known with a history of peptic ulcer disease, was...

    Incorrect

    • A 40-year old gentleman, known with a history of peptic ulcer disease, was brought to the clinic in a dehydrated state with persistent vomiting. His blood investigations revealed:
      • sodium = 142 mmol/l
      • potassium = 2.6 mmol/l
      • chloride = 85 mmol/l
      • pH = 7.55
      • p(CO2) = 50 mmHg
      • p(O2) = 107 mmHg
      • standard bicarbonate = 40 mmol/l
      This patient has a:

      Your Answer: Respiratory alkalosis

      Correct Answer: Metabolic alkalosis

      Explanation:

      High pH with high standard bicarbonate indicates metabolic alkalosis. The pa(CO2) was appropriately low in compensation. This is hypokalaemic hypochloraemic metabolic acidosis due to prolonged vomiting. Treatment includes treating the cause and intravenous sodium chloride with potassium.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      67.5
      Seconds

  • Question 12 - Which of the following is true about a patient who has undergone total...

    Correct

    • Which of the following is true about a patient who has undergone total colectomy and ileostomy?

      Your Answer: Following total colectomy and ileostomy, the volume and water content of ileal discharge decreases over time

      Explanation:

      After a patient has undergone total colectomy and ileostomy, the volume of ileal discharge, along with its water content gradually decreases over time. Post surgery, most patients can live a normal life. Iron and vitamin B12 absorption do not take place in the colon and hence are not affected significantly by a colectomy.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      25
      Seconds

  • Question 13 - A child defecates a few minutes after being fed by the mother. This...

    Correct

    • A child defecates a few minutes after being fed by the mother. This is most likely due to:

      Your Answer: Gastrocolic reflex

      Explanation:

      The gastrocolic reflex is a physiological reflex that involves increase in colonic motility in response to stretch in the stomach and by-products of digestion in the small intestine. It is shown to be uneven in its distribution throughout the colon, with the sigmoid colon affected more than the right side of the colon in terms of a phasic response. Various neuropeptides have been proposed as mediators of this reflex, such as serotonin, neurotensin, cholecystokinin and gastrin.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      9.1
      Seconds

  • Question 14 - Calculate the stroke volume in an adult male with the following parameters:

    Heart...

    Incorrect

    • Calculate the stroke volume in an adult male with the following parameters:

      Heart rate 70 beats/min

      Arterial [O2] 0.24 ml O2/min

      Venous [O2] 0.16 ml O2/mi

      Whole body O2 consumption 500 ml/min

      Pulmonary diastolic pressure 15 mmHg

      Pulmonary systolic pressure 25 mmHg

      Wedge pressure 5 mmHg.

      Your Answer: 100 ml

      Correct Answer: 90 ml

      Explanation:

      Fick’s principle states that, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. Cardiac output is also given by product of stroke volume and heart rate. Thus, stroke volume = cardiac output / heart rate = 6.25/70 × 1000 stroke volume = 90 ml approximately.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      8.9
      Seconds

  • Question 15 - What is the result of maltase deficiency in the brush border of the...

    Incorrect

    • What is the result of maltase deficiency in the brush border of the small intestine?

      Your Answer: Decreases rate of absorption of ingested glucose

      Correct Answer: Results in increased passage of maltose in stool

      Explanation:

      Maltase is an enzyme produced from the surface cells of the villi, lining the small intestine and aids in hydrolysing the disaccharide maltose, which splits into two molecules of α-glucose. It is done by breaking the glycosidic bond between the ‘first’ carbon of one glucose and the ‘fourth’ carbon of the other (a 1–4 bond). Hence, a deficiency of enzyme maltase will result in the increased passage of maltose in the stool.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      29.7
      Seconds

  • Question 16 - A lesion involving the lateral portion of the dorsal columns at the level...

    Incorrect

    • A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:

      Your Answer: Vibrations from the contralateral arm

      Correct Answer: Vibratory sensations from the ipsilateral arm

      Explanation:

      At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.

      Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      37.7
      Seconds

  • Question 17 - Which is the site of action of the drug omeprazole? ...

    Correct

    • Which is the site of action of the drug omeprazole?

      Your Answer: H+/K+ ATPase

      Explanation:

      H+/K+-ATPase or ‘proton pump’ located in the canalicular membrane plays a major role in acid secretion. The ATPase here is magnesium-dependent. Omeprazole is a proton pump inhibitor and blocks H+/K+- ATPase.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      25.3
      Seconds

  • Question 18 - A blood sample from a patient with polycythaemia vera will show which of...

    Correct

    • A blood sample from a patient with polycythaemia vera will show which of the following abnormalities?

      Your Answer: High platelet count

      Explanation:

      Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to a myeloproliferative syndrome, chronically low oxygen levels or rarely malignancy. In primary polycythaemia/ polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increased RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.

    • This question is part of the following fields:

      • General
      • Physiology
      6.1
      Seconds

  • Question 19 - A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic...

    Correct

    • A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic normochromic anaemia. What is the best treatment for her?

      Your Answer: Erythropoietin

      Explanation:

      E erythropoietin (EPO) is a hormone that is released by the kidney. It is responsible for the regulation of red blood cell production in the body. It can be made using recombinant technology and is used in the treatment of anaemia of chronic renal failure and in patients under going chemotherapy

    • This question is part of the following fields:

      • General
      • Physiology
      7
      Seconds

  • Question 20 - Which of the following causes the maximum increase in the secretion of antidiuretic...

    Incorrect

    • Which of the following causes the maximum increase in the secretion of antidiuretic hormone (ADH)?

      Your Answer: Decreased plasma volume

      Correct Answer: Increased plasma osmolarity

      Explanation:

      The most potent stimulus for ADH release is increased plasma osmolarity. Decreased plasma volume is a less potent stimulus in comparison. However, decrease blood volume and arterial pressure due to severe haemorrhage does lead to ADH secretion. Hypothalamic releasing factors do not control the release of posterior pituitary hormones ADH and oxytocin.

    • This question is part of the following fields:

      • Endocrinology
      • Physiology
      10.4
      Seconds

  • Question 21 - A 30 year old female presented in the emergency with an irregular pulse....

    Correct

    • A 30 year old female presented in the emergency with an irregular pulse. Her ECG showed absent P-waves with irregular RR interval. What is the most likely diagnosis?

      Your Answer: Atrial fibrillation

      Explanation:

      Atrial fibrillation is one of the most common cardiac arrhythmias. It is often asymptomatic but may present with symptoms of palpitations, fainting, chest pain and heart failure. Characteristic findings are: absence of P-waves, unorganised electrical activity in their place, irregularity of RR interval due to irregular conduction of impulses to the ventricles and if paroxysmal AF is suspected, episodes may be documented with the use of Holter monitoring

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      12.1
      Seconds

  • Question 22 - A patient presents with loss of fine touch and sense of proprioception in...

    Incorrect

    • A patient presents with loss of fine touch and sense of proprioception in the lower part of the body (below T6). He is likely to have a lesion involving:

      Your Answer: Descending corticospinal tract

      Correct Answer: Gracile nucleus

      Explanation:

      The gracile nucleus is located in the medulla oblongata and is one of the dorsal column nuclei involved in the sensation of fine touch and proprioception. It contains second-order neurons of the dorsal column–medial lemniscus system, that receive inputs from sensory neurones of the dorsal root ganglia and send axons that synapse in the thalamus.

      The gracile nucleus and fasciculus carry epicritic, kinaesthetic and conscious proprioceptive information from the lower part of the body (below the level of T6 in the spinal cord). Similar information from the upper part of body (above T6, except for face and ear) is carried by the cuneate nucleus and fasciculus. The information from face and ear is carried by the primary sensory trigeminal nucleus.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      11.6
      Seconds

  • Question 23 - Hormones of the anterior pituitary include which of the following? ...

    Incorrect

    • Hormones of the anterior pituitary include which of the following?

      Your Answer: Oxytocin

      Correct Answer: Prolactin

      Explanation:

      The anterior pituitary gland (adenohypophysis or pars distalis) synthesizes and secretes:

      1. FSH (follicle-stimulating hormone)

      2. LH (luteinizing hormone)

      3. Growth hormone

      4. Prolactin

      5. ACTH (adrenocorticotropic hormone)

      6. TSH (thyroid-stimulating hormone).

      The posterior pituitary gland (neurohypophysis) stores and secretes 2 hormones produced by the hypothalamus:

      1. ADH (antidiuretic hormone or vasopressin)

      2. Oxytocin

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      16.9
      Seconds

  • Question 24 - Which of the following associations is correctly matched with the body's defence mechanism...

    Correct

    • Which of the following associations is correctly matched with the body's defence mechanism in fighting infection?

      Your Answer: Specific cellular mechanism → cytotoxic T cells

      Explanation:

      The immune system has certain levels of defence against pathogens. First line includes simple barriers such as skin, mucosa and stomach acid that prevent the pathogen from entering into the body. If this barrier is breached then the innate immune system is activated which includes leukocytes (macrophages, neutrophils, mast cells, eosinophils, basophils, natural killer cells). If the pathogens invade the second layer of defence then the third layer, adaptive immunity is activated, which includes B and T lymphocytes. B cells provide a humoral response whereas cytotoxic T cells have specific cellular mechanisms. They maintain a memory of past infections and are activated faster following a recurrence.

    • This question is part of the following fields:

      • General
      • Physiology
      28.4
      Seconds

  • Question 25 - If a 55-year old gentleman who has suffered a stroke, develops a tremor...

    Correct

    • If a 55-year old gentleman who has suffered a stroke, develops a tremor in his fingers that worsens on reaching for an object, what part of his brain is likely to be involved?

      Your Answer: Cerebellum

      Explanation:

      The cerebellum plays an important role in the integration of sensory perception and motor output. Multiple neural pathways link the cerebellum with the motor cortex and the spinocerebellar tract. The cerebellum uses the constant feedback on body position to fine-tune the movements and integrates these pathways. The patient described here has a characteristic cerebellar tremor that is a slow, broad tremor of the extremities and occurs at the end of a purposeful movement.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      13.7
      Seconds

  • Question 26 - Ventricular filling follows a delay caused by? ...

    Incorrect

    • Ventricular filling follows a delay caused by?

      Your Answer: Bundle branches

      Correct Answer: AV node

      Explanation:

      The AV node is a conducting tissue found between the atria and the ventricles of the heart. It conducts electrical signal from the atria to the ventricles and acts a delaying mechanism preventing the atria and the ventricles from contracting at the same time. This decremental conduction prevents premature ventricular contraction in cases such as atrial fibrillation. A delay in the AV node is the reason for the PR segment seen on the ECG. In certain types of supraventricular tachycardia, a person could have two AV nodes; this will cause a loop in electrical current and uncontrollably rapid heart beat. When this electricity catches up with itself, it will dissipate and return to a normal heart rate.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      1851.4
      Seconds

  • Question 27 - A glycogen storage disorder is characterised by increased liver glycogen with a normal...

    Correct

    • A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?

      Your Answer: Glucose-6-phosphatase

      Explanation:

      The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      7.5
      Seconds

  • Question 28 - A 56 year old gentleman, who is a chronic smoker presents to the...

    Correct

    • A 56 year old gentleman, who is a chronic smoker presents to the clinic with dyspnoea. His Chest X-ray shows intercostal space widening with increased blackening bilaterally. What is the most likely finding on his pulmonary function test?

      Your Answer: Increased total lung capacity

      Explanation:

      In patients suspected of having chronic obstructive pulmonary disease, pulmonary function testing (PFT) is useful to confirm airway obstruction, to quantify its severity and reversibility, for following disease progression and monitoring response to treatment. These tests include:

      FEV1 – volume of air forcefully expired during the first second after a full breath

      Forced vital capacity (FVC) – total volume of air expired with maximal force and flow-volume loops. The hallmark of airway obstruction is reduction of FEV1, FVC and the ratio of FEV1/FVC, with a concave pattern in expiratory tracing on the flow-volume loop. FEV1 and forced vital capacity (FVC) are easily measured with office spirometry and are useful to assess the severity of disease. Other parameters include increased total lung capacity, functional residual capacity and residual volume, which can help distinguish chronic obstructive pulmonary disease (COPD) from restrictive pulmonary disease where these values are lower than normal. Along with these, other tests are decreased vital capacity; and decreased diffusing capacity for carbon monoxide (DLCO). DLCO is non-specific and can be low in other disorders that affect the pulmonary vascular bed, such as interstitial lung disease. DLCO is however useful to distinguish COPD from asthma, in which DLCO is normal or elevated.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      103
      Seconds

  • Question 29 - Which of the following is true about myasthenia gravis? ...

    Incorrect

    • Which of the following is true about myasthenia gravis?

      Your Answer: A large dose of physostigmine is likely to improve the symptoms

      Correct Answer: Response of skeletal muscle to nerve stimulation is weakened

      Explanation:

      An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      43.3
      Seconds

  • Question 30 - Chronic obstructive pulmonary disease (COPD) is likely to result in: ...

    Correct

    • Chronic obstructive pulmonary disease (COPD) is likely to result in:

      Your Answer: Respiratory acidosis

      Explanation:

      COPD leads to respiratory acidosis (chronic). This occurs due to hypoventilation which involves multiple causes, such as poor responsiveness to hypoxia and hypercapnia, increased ventilation/perfusion mismatch leading to increased dead space ventilation and decreased diaphragm function.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      18.2
      Seconds

  • Question 31 - A patient came into the emergency in a state of shock. His blood...

    Correct

    • A patient came into the emergency in a state of shock. His blood group is not known, but on testing it clotted when mixed with Type A antibodies. Which blood should be transfused?

      Your Answer: B +ve

      Explanation:

      There are two stages to determine the blood group, known as ABO typing. The first stage is called forward typing. In this method, RBCs are mixed with two separate solutions of type A or type B antibodies to see if they agglutinate. If this blood clumps, this indicates the presence of antigens within the blood sample. For example, a sample of type B blood will clump when tested with type A antibodies as it contains type B antigens. Group B – has only the B antigen on red cells (and A antibody in the plasma)

      Group B – has only the B antigen on red cells (and A antibody in the plasma)

      Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)

      Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Many people also have a Rh factor on the red blood cell’s surface. This is also an antigen and those who have it are called Rh+. Those who have not are called Rh–. A person with Rh– blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance) but they can develop Rh antibodies in the blood plasma if they receive blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh– blood without any problems. The patient’s blood group is B positive as he has antigen B, antibody A and Rh antigens.

    • This question is part of the following fields:

      • General
      • Physiology
      29.5
      Seconds

  • Question 32 - A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness....

    Correct

    • A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:

      Your Answer: Metabolic acidosis

      Explanation:

      Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      100
      Seconds

  • Question 33 - A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of...

    Incorrect

    • A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of choice for parenteral nutrition is:

      Your Answer: Darrow’s solution

      Correct Answer: Crystalline amino acids

      Explanation:

      Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. It is normally used in the following situations: surgery, when feeding by mouth is not possible, when a person’s digestive system cannot absorb nutrients due to chronic disease or if a person’s nutrient requirement cannot be met by enteral feeding and supplementation. A sterile bag of nutrient solution, between 500 ml and 4L, is provided. The pump infuses a small amount (0.1–10 ml/h) continuously to keep the vein open. The nutrient solution consists of water, glucose, salts, amino acids, vitamins and sometimes emulsified fats. Ideally each patient is assessed individually before commencing on parenteral nutrition, and a team consisting of doctors, nurses, clinical pharmacists and dietitians evaluate the patient’s individual data and decide what formula to use and at what rate.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      7.5
      Seconds

  • Question 34 - A syndrome responsible for failure to absorb vitamin B12 from the GIT is...

    Correct

    • A syndrome responsible for failure to absorb vitamin B12 from the GIT is called?

      Your Answer: Pernicious anaemia

      Explanation:

      Pernicious anaemia is a type of autoimmune disease in which antibodies form against the parietal cells or intrinsic factor. Intrinsic factor is required for the absorption of vitamin B12. Blood testing typically shows a macrocytic, normochromic anaemia and low levels of serum vitamin B12. A Schilling test can then be used to distinguish between pernicious anaemia, vitamin B12 malabsorption and vitamin B12 deficiency. Symptoms include shortness of breath, pallor and diarrhoea etc.

    • This question is part of the following fields:

      • General
      • Physiology
      6.2
      Seconds

  • Question 35 - During a normal respiratory exhalation, what is the recoil alveolar pressure? ...

    Incorrect

    • During a normal respiratory exhalation, what is the recoil alveolar pressure?

      Your Answer: –10 cmH2O

      Correct Answer: +10 cmH2O

      Explanation:

      To determine compliance of the respiratory system, changes in transmural pressures (in and out) immediately across the lung or chest cage (or both) are measured simultaneously with changes in lung or thoracic cavity volume. Changes in lung or thoracic cage volume are determined using a spirometer with transmural pressures measured by pressure transducers. For the lung alone, transmural pressure is calculated as the difference between alveolar (pA; inside) and intrapleural (ppl; outside) pressure. To calculate chest cage compliance, transmural pressure is ppl (inside) minus atmospheric pressure (pB; outside). For the combined lung–chest cage, transmural pressure or transpulmonary pressure is computed as pA – pB. pA pressure is determined by having the subject deeply inhale a measured volume of air from a spirometer. Under physiological conditions the transpulmonary or recoil pressure is always positive; intrapleural pressure is always negative and relatively large, while alveolar pressure moves from slightly negative to slightly positive as a person breathes.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      15.8
      Seconds

  • Question 36 - A patient with a long standing lower motor neuron lesion will have: ...

    Incorrect

    • A patient with a long standing lower motor neuron lesion will have:

      Your Answer: Hyper-reflexia

      Correct Answer: Muscle wasting

      Explanation:

      Lower motor neurons (LMNs) connect the brainstem and spinal cord to muscle fibres. Damage to lower motor neurons is indicated by abnormal electromyographic potentials, fasciculations, paralysis, weakening and wasting of skeletal muscles.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      4.5
      Seconds

  • Question 37 - Which of the following compensatory parameters is responsible for causing an increase in...

    Correct

    • Which of the following compensatory parameters is responsible for causing an increase in the blood pressure in a 30 year old patient with a BP of 40 mmHg?

      Your Answer: Baroreceptor reflex

      Explanation:

      The baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for regulating blood pressure. It provides a negative feedback response in which an elevated blood pressure will causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise. The system relies on specialised neurones (baroreceptors) in the aortic arch, carotid sinuses and elsewhere to monitor changes in blood pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated by the autonomic nervous system. Baroreceptors include those in the auricles of the heart and vena cava, but the most sensitive baroreceptors are in the carotid sinuses and aortic arch. The carotid sinus baroreceptors are innervated by the glossopharyngeal nerve (CN IX); the aortic arch baroreceptors are innervated by the vagus nerve (CN X).

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      11.7
      Seconds

  • Question 38 - A 42-year old woman presents to the doctor with jaundice. Her investigations show...

    Incorrect

    • A 42-year old woman presents to the doctor with jaundice. Her investigations show conjugated hyperbilirubinemia, raised urine bilirubin levels and low urine urobilinogen levels. What is the likely cause of her jaundice?

      Your Answer: Haemolytic anaemia

      Correct Answer: Blockage of the common bile duct

      Explanation:

      The description of the patient here fits the diagnosis of obstructive jaundice or cholestasis, which results in conjugated hyperbilirubinemia. Cholestasis occurs due to impairment of bile flow, which can be anywhere from the liver cell canaliculus to the ampulla of Vater. Causes can be divided into intrahepatic and extrahepatic.

      – Intrahepatic causes include hepatitis, drug toxicity, alcoholic liver disease, primary biliary cirrhosis, cholestasis of pregnancy and metastatic cancer.

      – Extrahepatic causes include common duct stone, pancreatic cancer, benign stricture of the common duct, ductal carcinoma, pancreatitis and sclerosing cholangitis.

      There is absence of bile constituents in the intestine, which causes spillage in the systemic circulation. Symptoms include pale stools, dark urine, pruritus, malabsorption leading to steatorrhea and deficiency of fat-soluble vitamins. Chronic cases can result in osteoporosis or osteomalacia due to vitamin D deficiency and Ca2+ malabsorption. Cholesterol and phospholipid retention produces hyperlipidaemia despite fat malabsorption (although increased liver synthesis and decreased plasma esterification of cholesterol also contribute); triglyceride levels are largely unaffected. The lipids circulate as a unique, low-density lipoprotein called lipoprotein X.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      14
      Seconds

  • Question 39 - Which of the following is a true statement regarding secretion of gastric acid?...

    Correct

    • Which of the following is a true statement regarding secretion of gastric acid?

      Your Answer: Acetylcholine increases gastric acid secretion

      Explanation:

      Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      9.5
      Seconds

  • Question 40 - Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically...

    Correct

    • Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically ill patients, and can be triggered by events such as trauma and sepsis. Which of the following variables is most likely to be lower than normal in a patient with ARDS?

      Your Answer: Lung compliance

      Explanation:

      Acute (or Adult) respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. The development of acute respiratory distress syndrome (ARDS) starts with damage to the alveolar epithelium and vascular endothelium, resulting in increased permeability to plasma and inflammatory cells. These cells pass into the interstitium and alveolar space, resulting in pulmonary oedema. Damage to the surfactant-producing type II cells and the presence of protein-rich fluid in the alveolar space disrupt the production and function of pulmonary surfactant, leading to micro atelectasis and impaired gas exchange. The pathophysiological consequences of lung oedema in ARDS include a decrease in lung volumes, compliance and large intrapulmonary shunts. ARDS may be seen in the setting of pneumonia, sepsis, following trauma, multiple blood transfusions, severe burns, severe pancreatitis, near-drowning, drug reactions, or inhalation injuries.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      37.9
      Seconds

  • Question 41 - Which statement is correct regarding coagulation? ...

    Correct

    • Which statement is correct regarding coagulation?

      Your Answer: Thrombin converts fibrinogen to fibrin

      Explanation:

      Coagulation of blood is a complex process and an important part of haemostasis. There are two main pathways related to coagulation: the contact activation pathway/intrinsic pathway and tissue factor/extrinsic pathway. The extrinsic pathway is activated by external trauma that causes blood to escape from the vascular system. This pathway is quicker than the intrinsic pathway and involves factor VII. The intrinsic pathway is activated by trauma inside the vascular system, and initiated by platelets, exposed endothelium, chemicals, or collagen. This pathway is slower than the extrinsic pathway, but more important. It involves factors XII, XI, IX, VIII. Both pathways meet to finish the formation of a clot in what is known as the common pathway. The common pathway involves factors I, II, V, and X. They converge on the common pathway in which activation of prothrombin to thrombin leads to conversion of fibrinogen to fibrin and clot formation.

    • This question is part of the following fields:

      • General
      • Physiology
      11.8
      Seconds

  • Question 42 - After surgery, a patient developed a stitch granuloma . Which leukocyte in the...

    Correct

    • After surgery, a patient developed a stitch granuloma . Which leukocyte in the peripheral blood will become an activated macrophage in this granuloma?

      Your Answer: Monocyte

      Explanation:

      Monocytes are leukocytes that protect the body against infections and move to the site of infection within 8-12 hours to deal with it. They are produced in the bone marrow and shortly after being produced are released into the blood stream where they circulate until an infection is detected. When called upon they leave the circulation and transform into macrophages within the tissue fluid and thus gain the capability to phagocytose the offending substance. Monocyte count is part of a complete blood picture. Monocytosis is the state of excess monocytes in the peripheral blood and may be indicative of various disease states. Examples of processes that can increase a monocyte count include: • chronic inflammation • stress response • hyperadrenocorticism • immune-mediated disease • pyogranulomatous disease • necrosis • red cell regeneration.

    • This question is part of the following fields:

      • General
      • Physiology
      18.3
      Seconds

  • Question 43 - After a severe asthma attack, a 26-year-old woman is left in a markedly...

    Incorrect

    • After a severe asthma attack, a 26-year-old woman is left in a markedly hypoxic state. In which of the following organs are the arterial beds most likely to be vasoconstricted due to the hypoxia?

      Your Answer: Gut

      Correct Answer: Lungs

      Explanation:

      Hypoxic pulmonary vasoconstriction is a local response to hypoxia resulting primarily from constriction of small muscular pulmonary arteries in response to reduced alveolar oxygen tension. This unique response of pulmonary arterioles results in a local adjustment of perfusion to ventilation. This means that if a bronchiole is obstructed, the lack of oxygen causes contraction of the pulmonary vascular smooth muscle in the corresponding area, shunting blood away from the hypoxic region to better-ventilated regions. The purpose of hypoxic pulmonary vasoconstriction is to distribute blood flow regionally to increase the overall efficiency of gas exchange between air and blood.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      13.4
      Seconds

  • Question 44 - Signals pass through neuromuscular junctions via the neurotransmitter acetylcholine. After release from the...

    Incorrect

    • Signals pass through neuromuscular junctions via the neurotransmitter acetylcholine. After release from the skeletal neuromuscular junction, acetylcholine:

      Your Answer: Activates presynaptic potassium channels

      Correct Answer: Causes postsynaptic depolarisation

      Explanation:

      Acetylcholine is released from the presynaptic membrane into the cleft where it binds to the ion gated channels on the post synaptic membrane, causing them to open. This results in sodium entering into the fibre and further depolarizing it, creating an action potential.

    • This question is part of the following fields:

      • General
      • Physiology
      18.9
      Seconds

  • Question 45 - A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular...

    Incorrect

    • A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular fluid and extracellular fluid are respectively:

      Your Answer: 65 l, 2.5 l, 2.5 l

      Correct Answer: 45 l, 30 l, 15 l

      Explanation:

      The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. The total body water (TBW) content of humans is approximately 60% of body weight. Two-thirds is located in the intracellular and one-third in the extracellular compartment. So, in a 75-kg individual, TBW = 60 × 75/100 = 45 l. Intracellular content = 2/3 × 45 = 30 l and extracellular content = 1/3 × 45 = 15 l.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      23.6
      Seconds

  • Question 46 - A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect: ...

    Incorrect

    • A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:

      Your Answer: Vision

      Correct Answer: Regulation of circadian rhythm

      Explanation:

      The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      7.6
      Seconds

  • Question 47 - Different substances have different renal clearance rates. Which of the following substances should...

    Incorrect

    • Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?

      Your Answer: Creatinine

      Correct Answer: Glucose

      Explanation:

      Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      24.1
      Seconds

  • Question 48 - A suspected recreational drug user was brought to the Emergency department in an...

    Correct

    • A suspected recreational drug user was brought to the Emergency department in an unconscious state, and was found to be hypoventilating. Which of the following set of arterial blood gas analysis report is most consistent with hypoventilation as the primary cause? pH, pa(CO2) (mmHg), pa(O2) (mmHg).

      Your Answer: 7.28, 55, 81

      Explanation:

      Hypoventilation (or respiratory depression) causes an increase in carbon dioxide (hypercapnia) and respiratory acidosis. It can result due to drugs such as alcohol, benzodiazepines, barbiturates, opiates, mechanical conditions or holding ones breath. Strong opioids such as heroin and fentanyl are commonly implicated and can lead to respiratory arrest. In recreational drug overdose, acute respiratory acidosis occurs with an increase in p(CO2) over 45 mm Hg and acidaemia (pH < 7.35)

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      30.4
      Seconds

  • Question 49 - A neurotransmitter of the nigrostriatal pathway is: ...

    Incorrect

    • A neurotransmitter of the nigrostriatal pathway is:

      Your Answer: Gamma-aminobutyric acid (GABA)

      Correct Answer: Dopamine

      Explanation:

      Dopamine acts as a neurotransmitter in the brain, activating dopamine receptors. It is also a neurohormone released from the hypothalamus. It plays an important role in the reward system. It is believed that dopamine provides a teaching signal to parts of the brain responsible for acquiring new motor sequences (behaviours), by activation of dopamine neurons when an unexpected reward is presented. Loss of dopamine neurones in the nigrostriatal pathway causes Parkinson’s disease. In the frontal lobes, dopamine controls the flow of information from other areas of the brain, and thus, dopamine disorders in this region can cause a decline in neurocognitive functions, especially memory, attention and problem solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention-deficit disorder and some symptoms of schizophrenia. Dopamine is also the primary neuroendocrine regulator of the secretion of prolactin from the anterior pituitary gland. Dopamine is also commonly associated with the pleasure system of the brain. This plays a key role in understanding the mechanism of action of drugs (such as cocaine and the amphetamines), which seem to be directly or indirectly related to the increase of dopamine.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      6.2
      Seconds

  • Question 50 - A 35-year-old woman is in a comatose state following a traumatic head injury,...

    Correct

    • A 35-year-old woman is in a comatose state following a traumatic head injury, and is receiving intravenous (IV) antibiotics and IV fluids containing saline and 5% dextrose. A serum biochemistry analysis is performed five days later which shows a low serum potassium level. This is most likely to be due to:

      Your Answer: Nothing per oral regimen

      Explanation:

      In this patient the cause for hypokalaemia is insufficient consumption of potassium as she is nil-per mouth with no intravenous supplementation. Parenteral nutrition has been used for comatose patients, although enteral feeding is usually preferable, and less prone to complications.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      29.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

General (9/10) 90%
Physiology (25/50) 50%
Cardiovascular (3/6) 50%
Respiratory (4/11) 36%
Neurology (1/8) 13%
Gastroenterology (6/8) 75%
Endocrinology (0/1) 0%
Endocrine (0/1) 0%
Fluids & Electrolytes (2/5) 40%
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