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Question 1
Incorrect
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Which enzyme deficiency causes Beriberi?
Your Answer: Riboflavin
Correct Answer: Thiamine
Explanation:Beriberi refers to a cluster of symptoms caused primarily by thiamine (vitamin B1) deficiency. Symptoms of beriberi include weight loss, emotional disturbances, impaired sensory perception, weakness and pain in the limbs, and periods of irregular heart rate.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 2
Correct
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The approximate incidence of deep venous thrombosis (DVT) in the general population each year is:
Your Answer: 1 per 1000
Explanation:About 1 in 1000 adults per year has DVT, but as of 2011, available data is dominated by North American and European populations. DVT is rare in children, with an incidence of about 1 in 100,000 a year. From childhood to old age, incidence increases by a factor of about 1000, with almost 1% of the elderly experiencing DVTs yearly.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 3
Correct
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The first enzyme carbohydrates encounter in the digestive tract is?
Your Answer: Amylase
Explanation:Carbohydrate digesting enzymes are known as amylase. Salivary amylase or ptyalin is the first enzyme to begin carbohydrate digestion in he oral cavity. Amylose is a component of carbohydrates and is not an enzyme. Isomaltase, maltase and sucrase are enzymes found in the small intestines that digest disaccharides like maltose and sucrose to monosaccharides.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 4
Correct
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Question 5
Correct
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Calcium is mobilized from the sarcoplasmic reticulum through:
Your Answer: Ryanodine receptor (RyR2) calcium release channels
Explanation:During the plateau phase of the action potential, calcium from the extracellular fluid enters through the L type of calcium channels. This entry triggers the release of more calcium from the sarcoplasmic reticulum via the ryanodine receptors. As a result intracellular calcium increases binding to troponin C resulting in contraction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 6
Correct
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Question 7
Correct
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Question 8
Incorrect
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Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?
Your Answer: Being a smoker
Correct Answer: Anti-CCP antibodies
Explanation:Rheumatoid arthritis is both common and chronic, with significant consequences for multiple organ systems. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. However, its sensitivity is low, and a negative result does not exclude disease. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid arthritis. The other factors that are mentioned do not play a key prognostic role.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 9
Incorrect
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The haemostatic plug formation in response to injured blood vessel wall is stimulated by exposure of which substance to platelets?
Your Answer: Tissue thromboplastin
Correct Answer: Collagen
Explanation:When the endothelium is damaged, the normally isolated, underlying collagen is exposed to circulating platelets, which bind directly to collagen with collagen-specific glycoprotein Ia/IIa surface receptors. This adhesion is strengthened further by von Willebrand factor (vWF), which is released from the endothelium and from platelets.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 10
Correct
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A 70-year-old woman is having trouble in speaking following a stroke. Her limbs are paralyzed, both left upper and lower limbs. Which anatomical site is most likely affected?
Your Answer: Internal capsule
Explanation:– The given scenario is typical of lesion in internal capsule. – Memory impairment is caused by a hippocampal lesion, – Impairment of arousal, facial paresis, visual field defect, facial paresis, hemiataxia, and hemispacial neglect are just some of the conditions caused by thalamic lesion. – Brainstem stroke on the other hand causes breathing abnormality, altered consciousness, and blood pressure disorder.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 11
Correct
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Which of the following stimulate the release of aldosterone from the adrenal cortex?
Your Answer: Angiotensin 2
Explanation:Angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the renal tubules to increase the reabsorption of sodium and water into the blood, while at the same time causing the excretion of potassium (to maintain electrolyte balance).
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This question is part of the following fields:
- Medicine
- Renal
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Question 12
Incorrect
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Question 13
Correct
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Organophosphates, such as Sarin, have been used as chemical-warfare agents by terrorists. Which of the following statements is true concerning organophosphate poisoning?
Your Answer: Atropine is useful in the management of organophosphate poisoning
Explanation:The principal action of organophosphates is the inhibition of acetylcholinesterase’s, therefore leading to the accumulation of acetylcholine at muscarinic receptors (miosis, hypersalivation, sweating, diarrhoea, excessive bronchial secretions), nicotinic receptors (muscle fasciculations and tremor) and in the central nervous system (anxiety, loss of memory, headache, coma). Removal from the source of the organophosphate, adequate decontamination, supplemental oxygen and atropine are the initial treatment measures. Pralidoxime, an activator of cholinesterase, should be given to all symptomatic patients.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 14
Correct
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Critical shortening of Telomeres result in:
Your Answer: Activation of p53 and prb and cell crisis
Explanation:Telomeres are repetitive nucleotide sequences at the ends of chromosomes that protect them from deterioration or from fusion with neighboring chromosomes. Each time a cell divides, its telomeres shorten. When they become critically short, they can no longer protect the chromosome ends, triggering a DNA damage response.
This response leads to the activation of tumor suppressor proteins p53 and pRb (retinoblastoma protein). Activated p53 can induce cell cycle arrest, allowing time for DNA repair or triggering apoptosis if the damage is irreparable. Similarly, pRb helps regulate cell cycle progression and can halt the cell cycle to prevent the proliferation of cells with damaged DNA.
As a result, the cell enters a state of crisis, characterized by widespread cell death and genomic instability, which ultimately prevents the propagation of cells with critically shortened telomeres.
Therefore, the correct answer is:
Activation of p53 and pRb and cell crisis
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This question is part of the following fields:
- Genetics
- Medicine
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Question 15
Incorrect
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A 45 year old man presents with fever, malaise, weight loss and myalgias that have been occurring for a month. You suspect polyarteritis nodosa and arrange for some lab investigations. Which of the following abnormality would most likely be present?
Your Answer: Thrombocytosis
Correct Answer: Elevated creatinine
Explanation:People with polyarteritis nodosa often exhibit anaemia of chronic disease. Leucocytosis and eosinophilia may also be present. ANCA is only rarely positive. As polyarteritis nodosa affects the kidneys as well, the creatinine is elevated in most cases.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 16
Incorrect
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Which factors increase the end-diastolic volume?
Your Answer: Infiltrative disease
Correct Answer: Constriction of veins
Explanation:End diastolic volume is also known as preload. It is the amount of blood the heart contracts against. Constriction of veins will decrease venous pooling and increase venous return, hence increasing the end diastolic volume. Standing will increase venous pooling hence decreasing venous return and end diastolic volume. Raised intrapericardial pressure will also decrease venous return and hence end diastolic volume.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 17
Incorrect
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Which cells produce the immunoglobulin proteins involved in mediating humoral immunity?
Your Answer: Cytotoxic T cells
Correct Answer: Differentiated forms of B lymphocytes known as plasma cells
Explanation:After the B cells have been activated by a certain antigens, they transform into plasma cells. These plasma cells are responsible for the generation of antibodies (or immunoglobulins Ig) which are also known as regulators of humoral immunity. There are fives classes of Ig: IgA, IgG, IgM, IgE and IgD
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This question is part of the following fields:
- Immunology
- Medicine
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Question 18
Incorrect
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Vitamin K deficiency can be found in which of the following condition?
Your Answer: Pernicious anaemia
Correct Answer: Cholestatic jaundice
Explanation:Vitamin K1-deficiency may occur by disturbed intestinal uptake (such as would occur in a bile duct obstruction), by therapeutic or accidental intake of a vitamin K1-antagonist such as warfarin, or, very rarely, by nutritional vitamin K1 deficiency.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 19
Incorrect
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“Ploidy” is a term used to refer to the number of chromosomes in cells. Cancer cells are commonly:
Your Answer: Tetraploidy
Correct Answer: Aneuploidy
Explanation:Cancer cells most commonly undergo disordered cell growth and cell division. This results in an additional number of chromosomes called aneuploidy. This is a characteristic of cancer cells along with variation in differentiation of the cells.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 20
Correct
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Interruption of the entero-hepatic circulation causes:
Your Answer: The amount of fat in the stool to be increased
Explanation:Enterohepatic circulation refers to the circulation of biliary acids, bilirubin, drugs, or other substances from the liver to the bile, followed by entry into the small intestine, absorption by the enterocyte and transport back to the liver. One of the causes of the interruption of enterohepatic circulation is the resection of the ileum where fat is mainly absorbed. Fat malabsorption results in increased fat in stools. Pale stools and dark urine is caused by obstruction of the biliary ductal system especially the common bile duct where urobilin and stercobilin are formed.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 21
Incorrect
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In the cardiac cycle, all of the following are true except:
Your Answer: The ejection fraction is about 55%
Correct Answer: Mitral valve is closed by contraction of papillary muscles
Explanation:Mitral valve is closed by contraction of papillary muscles: This statement is incorrect. The mitral valve closes due to the pressure difference between the left ventricle and the left atrium at the onset of ventricular systole. The papillary muscles contract to prevent prolapse of the valve into the atrium but do not cause the valve to close.
The left ventricular volume is maximal at the end of atrial systole: This statement is true. At the end of atrial systole, the atria have pushed the remaining blood into the ventricles, making the ventricular volume maximal (end-diastolic volume).
The left ventricular pressure is maximal just before the aortic valve opens: This statement is true. Left ventricular pressure peaks just before the aortic valve opens, as the ventricle contracts to overcome the pressure in the aorta.
The ejection fraction is about 55%: This statement is true. The ejection fraction, which is the percentage of blood ejected from the ventricles with each contraction, is typically around 55%.
The ‘a’ wave is due to atrial systole: This statement is true. The ‘a’ wave on the venous pressure curve corresponds to atrial systole, reflecting the increased pressure from atrial contraction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 22
Incorrect
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Which of the following conditions is NOT X-linked recessive?
Your Answer: Complete testicular feminisation
Correct Answer: Cystic fibrosis
Explanation:Cystic fibrosis is a autosomal recessive disease with an incidence of about 1 in 2500 live births. The most common mutation occurs in the long arm of chromosome 7 which codes for the chloride channel (cystic fibrosis transmembrane conductance regulator) gene.
To have CF, a child must inherit two abnormal genes—one from each parent. The recessive CF gene can occur in both boys and girls because it is located on non-sex-linked chromosomes called autosomal chromosomes.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 23
Correct
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Telomeres are best described as:
Your Answer: A repetitive DNA sequence at the end of a DNA molecule.
Explanation:Telomeres are non-coding DNA consisting of repetitive nucleotide sequences plus proteins that are found at the end of the linear chromosomes. They maintain the integrity of the chromosomes and prevent their shortening.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 24
Incorrect
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A 85 year old male with a history of faecal impaction, who lived at a nursing-home presented with abdominal pain and distension, confusion and agitation. Which of the following is the first step of the management.
Your Answer: Senna
Correct Answer: Phosphate enema
Explanation:The most probable cause for this presentation is faecal impaction following constipation, which is common among old people who live in nursing-homes. There can be number of reason for constipation in old age, including medications, endocrine and metabolic diseases, neurologic disorders, myopathic disorders, dietary habits etc. Enemas are a way of removing impacted faeces, which helps rectal evacuation.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 25
Incorrect
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Cholesterol is synthesized in all of these organs EXCEPT?
Your Answer: Skin
Correct Answer: Stomach
Explanation:The liver primarily synthesizes about 20-25% of the total daily cholesterol. Cholesterol is also synthesized to smaller extents in the adrenal glands, reproductive organs (as cholesterol is the precursor of sex hormones), skin and is also produced in the intestines.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 26
Incorrect
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The spinal cord receive its blood supply from the following arteries except:
Your Answer: Segmental radicular arteries
Correct Answer: Lateral spinal artery
Explanation:The spinal cord (SC) is supplied by the single anterior spinal artery which supplies the anterior two thirds of the SC and paired posterior spinal arteries supplying the posterior one third. Anastomoses between the spinal arteries supply the lateral column. These arteries originate near the cervico-occipital junction and therefore have a smaller calibre and often discontinue. Thus, they require reinforcement by segmental/radicular arteries which are branches of the ascending cervical artery, deep cervical artery, intercostal arteries, lumbar arteries and lateral sacral arteries
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This question is part of the following fields:
- Medicine
- Neurology
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Question 27
Incorrect
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A 72 year old female, known with rheumatoid arthritis for last 17 years, presents with recurrent attacks of red eyes with a sensation of grittiness. Which of the following is most likely cause of the red eyes?
Your Answer: episcleritis
Correct Answer: keratoconjunctivitis sicca
Explanation:Rheumatoid arthritis is an inflammatory systemic disease associated with some extraarticular manifestations. Keratoconjunctivitis sicca, episcleritis, scleritis, corneal changes, and retinal vasculitis are the most common ocular complications among extraarticular manifestations of RA. The overall prevalence of keratoconjunctivitis sicca also known as dry eye syndrome among patients of RA is 21.2% and is the most common with sense of grittiness in the eyes.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 28
Incorrect
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Question 29
Incorrect
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A 62 year old female complains of pain and stiffness in her shoulders. She also finds it difficult to get out of her chair. From the list of symptoms below, choose the one most likely to support the diagnosis of polymyalgia rheumatica.
Your Answer: Muscle tenderness
Correct Answer: Low grade fever
Explanation:Polymyalgia rheumatica is an inflammatory disease which usually causes stiffness and pain in the shoulder – this can also occur in the pelvic girdle muscles. Its onset can either be subacute or acute and is associated with a systemic inflammatory response. This, therefore, causes symptoms such as fever, weight loss, anorexia, and malaise. Polymyalgia rheumatica is unpredictable in its course and it is known that 30 per cent of patients also present with giant cell arteritis. The cause of this disease is unknown but studies have shown it have infectious origins. Diagnosis of polymyalgia rheumatica can be difficult and other inflammatory diseases have to be excluded first. Patients with this disease are usually over 60 years of age (it is very rarely seen in those under 50). Muscle weakness does not present, although this can be hard to assess when the patient is in pain. Low-grade fever and weight loss are typical of this disease due to chronic inflammation. As such, weight gain is very rare and peripheral joints are usually not affected (they can be affected but it is very rare). Also, muscle tenderness is not a specific symptom of the disease – it is therefore not a classical finding of polymyalgia rheumatica. Although patients usually complain of stiffness and pain, the muscles are usually not significantly tender – this is usually more associated with fibromyalgia or myositis. When investigated, a normochromic/normocytic anaemia; a raised erythrocyte sedimentation rate often over 50 mm/hr., and raised C reactive protein are usually revealed. Symptoms of giant cell arteritis should also be sought, such as headaches, visual disturbances, TIAs (transient ischemic attacks), jaw claudication, and thickened temporal arteries. The patient response to a moderate dose of steroids is useful when confirming a diagnosis of polymyalgia rheumatica. The maximum dose of prednisolone should not exceed 20mg once a day. After treatment, patients should show a 70 per cent improvement in symptoms within a month (between 3-4 weeks). Inflammatory markers should also fall back to their normal levels. Non-steroidal anti-inflammatories are of little use and are associated with morbidity. There is also little evidence for the use of steroidal-sparing agents.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 30
Incorrect
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Which part of the cerebellum is primarily responsible for equilibrium and eye movements?
Your Answer: Medial hemispheric portions
Correct Answer: Vestibulocerebellum
Explanation:The vestibulocerebellum develops at the same time as the vestibular apparatus in the inner ear. Its regulates balance between agonist and antagonist muscle contractions of the spine, hips, and shoulders during rapid movements.
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This question is part of the following fields:
- Medicine
- Neurology
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