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Question 1
Incorrect
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Which of the following does NOT typically cause a neutrophil leucocytosis:
Your Answer: Corticosteroid therapy
Correct Answer: Glandular fever
Explanation:Causes of neutrophil leucocytosis: Bacterial infection Inflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis) Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout) Pregnancy Acute haemorrhage or haemolysis Neoplasms of all types Drugs (e.g. corticosteroid therapy, lithium, tetracyclines) Asplenia Myeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis) Rare inherited disorders
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This question is part of the following fields:
- Immunology
- Pathology
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Question 2
Incorrect
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The following determines the strength of contraction
Your Answer: Resting membrane potential
Correct Answer: Plateau phase
Explanation:The plateau phase which follows is unique to myocytes and results from a small, but sustained inward calcium current through L-type calcium channels lasting 200-400 ms. This calcium influx is caused by a combined increase in permeability of the cell and especially the sarcolemmal membranes to calcium. This plateau (or refractory) phase in myocyte action potential prevents early reactivation of the myocytes and directly determines the strength of contraction
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 3
Correct
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The V wave in the jugular pulse is caused by:
Your Answer: Atrial filling
Explanation:The V wave indicates the rise in the atrial pressure due to filling of the atria with blood before the tricuspid valve opens during the diastolic phase of contraction.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 4
Correct
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The following occurs as a result of 2,3 Bisphosphoglycerate binding to deoxyhaemoglobin
Your Answer: A reduction in deoxyhaemoglobin's affinity for oxygen
Explanation:2,3-BPG acts as a heteroallosteric effector of haemoglobin, lowering haemoglobin’s affinity for oxygen by binding preferentially to deoxyhaemoglobin. An increased concentration of BPG in red blood cells favours formation of the T, low-affinity state of haemoglobin and so the oxygen-binding curve will shift to the right.
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This question is part of the following fields:
- Haematology
- Physiology
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Question 5
Incorrect
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Tunica intima is made up of?
Your Answer: Endothelial cells and smooth muscle cells
Correct Answer: Endothelial cells
Explanation:Tunica intima is a single cell thick lining of endothelial cells that lines the inside of the blood vessels. It is the inner most layer of the blood vessel.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 6
Correct
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What causes increased insulin sensitivity?
Your Answer: Exercise
Explanation:Physical activity, through its effect on insulin sensitivity, is one of the main modifiable risk factors for type 2 diabetes. It is estimated that by each weekly 500 kcal increment in exercise related energy consumption, the lifetime risk of suffering from type 2 diabetes is reduced by 9%. Up to two hours after exercise, glucose uptake is elevated due to insulin independent mechanisms; however, insulin sensitivity remains increased for at least 16 hours after exercising.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 7
Incorrect
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Question 8
Incorrect
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A 14-year-old girl presents with short stature, webbed neck and primary amenorrhoea.Given the likely clinical diagnosis, which hormone replacement is most crucial over the longer term?
Your Answer: Growth hormone
Correct Answer: Oestrogen
Explanation:This girl most likely has Turner syndrome (TS) also known as 45,X, a condition in which a female is partly or completely missing an X chromosome. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low hairline at the back of the neck, short stature, and swollen hands and feet are seen at birth. Typically, they are without menstrual periods, do not develop breasts, and are unable to have children. Heart defects, diabetes, and low thyroid hormone occur more frequently. Most people with TS have normal intelligence. Many, however, have troubles with spatial visualization such as that needed for mathematics. Vision and hearing problems occur more often. Turner syndrome is not usually inherited from a person’s parents. No environmental risks are known and the mother’s age does not play a role. As a chromosomal condition, there is no cure for Turner syndrome. However, much can be done to minimize the symptoms including prescribing growth hormone, either alone or with a low dose of androgen, and oestrogen replacement therapy which is crucial long term for maintaining good bone integrity, cardiovascular health and tissue health
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 9
Incorrect
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One of the functions of the spleen with regards to red blood cells is:
Your Answer: To manufacture reticulocytes
Correct Answer: To filter and remove aged and abnormal red blood cells
Explanation:The spleen plays important roles in regard to red blood cells (also referred to as erythrocytes) and the immune system. It removes old red blood cells and holds a reserve of blood, which can be valuable in case of haemorrhagic shock, and also recycles iron. As a part of the mononuclear phagocyte system, it metabolizes haemoglobin removed from senescent erythrocytes. The globin portion of haemoglobin is degraded to its constitutive amino acids, and the haem portion is metabolized to bilirubin, which is removed in the liver.
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This question is part of the following fields:
- Haematology
- Physiology
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Question 10
Incorrect
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What happens first during depolarisation of the membrane potential?
Your Answer:
Correct Answer: Gated Na channels open allowing the influx of Na
Explanation:Generation of an action potential in response to a stimulus is a result of a previously maintained resting membrane potential (RMP). Generation of resting membrane potential is mediated mainly by potassium ions. Several membrane proteins maintain RMP by transport of ions in and out of cell. Na+/K+ ATPase pump maintains a concentration gradient of Na+ and K+ ions. Na+ concentration in extracellular fluid is higher compared to intracellular fluid and K+ ion concentration is higher intracellularly. Generation of an action potential facilitates opening of Na+ ion channels which allow for Na+ to diffuse inside the cell according to the concentration gradient.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 11
Incorrect
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Which of the following is matched correctly with regard to stem cells of the bone marrow?
Your Answer:
Correct Answer: Hemopoietic stem cells - basophils
Explanation:Hematopoietic stem cells (HSCs) or hemocytoblasts are the stem cells that give rise to all the other blood cells through the process of haematopoiesis. They give rise to both the myeloid and lymphoid lineages of blood cells. (Myeloid cells include monocytes, macrophages, neutrophils, basophils, eosinophils, erythrocytes, dendritic cells, and megakaryocytes or platelets. Lymphoid cells include T cells, B cells, and natural killer cells.)
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This question is part of the following fields:
- Haematology
- Physiology
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Question 12
Incorrect
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Question 13
Incorrect
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A 27 year old man presents with a regular tachycardia of 190 bpm. He is healthy and has no past medical history. Blood pressure and bloods are all within normal parameters however the ECG confirms a narrow complex tachycardia. The tachycardia persists after giving IV adenosine 3mg and then 6mg. What should be the next step in management of this patient?
Your Answer:
Correct Answer: IV 12mg adenosine
Explanation:For narrow complex tachycardias with no compromise then vagal manoeuvres should be trialled first. The Valsalva manoeuvre should be the first vagal manoeuvre tried and works by increasing intra-thoracic pressure and affecting baroreceptors (pressure sensors) within the arch of the aorta. It is carried out by asking the patient to hold his/her breath while trying to exhale forcibly as if straining during a bowel movement. Adenosine, an ultra-short-acting AV nodal blocking agent, is indicated if vagal manoeuvres are not effective. Adenosine may be safely used during pregnancy. After giving 3mg of adenosine with no effect, 6mg should be tried. If this fails then 12mg should be trialled. If adenosine fails then Verapamil or a beta blocker can be used as alternatives. If the patient is hemodynamically unstable or other treatments have not been effective, synchronized electrical cardioversion may be used.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 14
Incorrect
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All of the following are consistent with the indicator dilution method except---
Your Answer:
Correct Answer: In thermodilution, the indicator used is warm saline
Explanation:In thermodilution, the indicator used is cold saline.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 15
Incorrect
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You see a patient on the ward who is acutely short of breath and perform an ABG. The results are as follows
Your Answer:
Correct Answer: Respiratory Acidosis
Explanation:This patient has acidosis as the pH is low <7.35 The pO2 is irrelevant. The pCO2 is raised i.e. the respiratory system is causing acidosis. The patient is acidotic so this is a respiratory acidosis The Base Excess is normal. You would typically expect the base excess to rise but metabolic compensation is slower than respiratory compensation so this picture may be seen acutely.
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This question is part of the following fields:
- Cell Biology
- Physiology
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Question 16
Incorrect
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The direct determinants of cardiac output are
Your Answer:
Correct Answer: Stroke volume and heart rate
Explanation:Cardiac output is classically defined alongside stroke volume (SV) and the heart rate (HR) as:Cardiac Output [L/min] = Stroke Volume [L/beat] x Heart Rate [beats/min]
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 17
Incorrect
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The reflex responses activated by cold are controlled by which area?
Your Answer:
Correct Answer: Posterior hypothalamus
Explanation:The posterior nucleus of the hypothalamus is responsible for thermoregulation and thermogenesis. Studies have shown that the neurons in the posterior hypothalamus which mediate the reflex of shivering are sensitive to temperature; damage to this nucleus produces hypothermia.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 18
Incorrect
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The axons of the POST ganglionic neurons are mostly?
Your Answer:
Correct Answer: C fibers
Explanation:According to Erlanger- Grasser classification preganglionic fibers are B fibers whereas post ganglionic fibers are C fibers.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 19
Incorrect
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Of the daily production of CSF, the vast majority is produced in the:
Your Answer:
Correct Answer: Choroid plexus
Explanation:About 80% of CSF is produced by the choroid plexus. It is also produced by a single layer of column shaped ependymal cells.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 20
Incorrect
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All valves are closed in which phase of the cardiac cycle?
Your Answer:
Correct Answer: Isovolumetric relaxation
Explanation:The cardiac cycle refers to a complete heartbeat from its generation to the beginning of the next beat, and so includes the diastole, the systole, and the intervening pause.The first stage, diastole, is when the semilunar valves (the pulmonary valve and the aortic valve) close, the atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the whole heart is relaxed. The second stage, atrial systole, is when the atrium contracts, and blood flows from atrium to the ventricle.The third stage, isovolumic contraction is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. The fourth stage, ventricular ejection, is when the ventricles are contracting and emptying, and the semilunar valves are open. During the fifth stage, isovolumic relaxation time, pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 21
Incorrect
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The pathway responsible for the discriminative aspect of pain, is called the:
Your Answer:
Correct Answer: Neospinothalamic tract
Explanation:The spinothalamic tract is an ascending or a sensory tract, responsible for transmission of pain and temperature. The neospinothalamic tract is responsible for fast pain or discriminative pain whereas the palaeospinothalamic tract is responsible for transmission of slow pain.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 22
Incorrect
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Most of the venous blood returns to the heart through the:
Your Answer:
Correct Answer: Coronary sinus and anterior cardiac veins
Explanation:Most of the venous blood returns to the heart via the coronary sinus and the anterior cardiac veins which drain into the right atrium.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 23
Incorrect
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The predominant receptors in the conduction system are?
Your Answer:
Correct Answer: Î’1
Explanation:The heart is predominately under the control of the parasympathetic system. Nerves from the parasympathetic system activate the B1 receptors on the heart, most specifically on the SA node, AV node and the purkinje system.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 24
Incorrect
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Which of the following concerning PR interval is INCORRECT?
Your Answer:
Correct Answer: Always measured from the beginning of p wave to the beginning of r wave
Explanation:The PR interval measures the time from the start of atrial depolarization to the start of ventricular depolarization. The PR interval is only measured from the beginning of P wave to beginning of R wave if the Q wave is absent.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 25
Incorrect
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Where does one find the thyroid receptors?
Your Answer:
Correct Answer: Cell nucleus
Explanation:Unlike many of the steroid receptors, inactive receptors for T3 are located in the nucleus. T4 is first converted into T3 within the cytoplasm of the cell, T3 then enters the nucleus and binds to its receptor. The hormone-receptor complex can now bind to DNA and activate specific genes.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 26
Incorrect
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With regard to X linked disorders which of the following are true
Your Answer:
Correct Answer: X linked recessive disorders usually present in males and only very rarely present in homozygous females
Explanation:All are true for autosomal recessive disorders. Dominance rules for sex-linked gene loci are determined by their behaviour in the female: because the male has only one allele (except in the case of certain types of Y chromosome aneuploidy), that allele is always expressed regardless of whether it is dominant or recessive.
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This question is part of the following fields:
- Genetics
- Physiology
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Question 27
Incorrect
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Which protein in the HIV genome is responsible for binding to the host CD4 cells?
Your Answer:
Correct Answer: gp120
Explanation:HIV can infect a variety of immune cells such as CD4+ T cells, macrophages, and microglial cells. HIV-1 entry to macrophages and CD4+ T cells is mediated through interaction of the virion envelope glycoproteins (gp120) with the CD4 molecule on the target cells and also with chemokine coreceptors.
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This question is part of the following fields:
- Infectious Diseases
- Physiology
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Question 28
Incorrect
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Which of the following suggests the presence of mitral regurgitation as well as mitral stenosis?
Your Answer:
Correct Answer: Displaced apex beat
Explanation:Mitral stenosis on its own does not lead to left ventricular dilatation and hence a displaced apex beat. Thus a displaced apex beat is suggestive of mixed mitral disease. The other options occur in mitral stenosis.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 29
Incorrect
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Which afferent information is carried by the dorsal column?
Your Answer:
Correct Answer: Proprioception/ discriminative touch
Explanation:The posterior grey column (dorsal column) is responsible for carrying the sensation of proprioception, two-point discrimination, and vibration to the nucleus proprius, situated anterior to the substantia gelatinosa throughout the spinal cord.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 30
Incorrect
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Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer:
Correct Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.
Explanation:A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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SESSION STATS - PERFORMANCE PER SPECIALTY
