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Question 1
Incorrect
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A 22-year-old man arrives at the emergency department with a sore throat, low-grade fever, and malaise. His partner has infectious mononucleosis, which was recently diagnosed. In this situation, which of the following cells is the most proliferative:
Your Answer: Monocytes
Correct Answer: Lymphocytes
Explanation:Histologic findings in EBV infectious mononucleosis: Oropharyngeal epithelium demonstrates an intense lymphoproliferative response in the cells of the oropharynx. The lymph nodes and spleen show lymphocytic infiltration primarily in the periphery of a lymph node.
Relative lymphocytosis (≥ 60%) plus atypical lymphocytosis (≥ 10%) are the characteristic findings of Epstein Barr virus (EBV) infectious mononucleosis. -
This question is part of the following fields:
- Immune Responses
- Pathology
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Question 2
Incorrect
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Infection with Campylobacter jejuni is one of the most common risk factors for which of the following conditions?
Your Answer: Haemolytic uraemic syndrome
Correct Answer: Guillain-Barre syndrome
Explanation:One of the most common risk factors for GBS is infection with Campylobacter jejuni, which causes diarrhoea.
Guillain-BarrĂ© syndrome (GBS) is a rare autoimmune disorder in which the body’s immune system attacks the nerves, resulting in muscle weakness and paralysis.
Infection with Streptococcus pyogenes can cause acute glomerulonephritis and rheumatic fever.
Haemolytic uraemic syndrome is commonly linked to E. coli infection.
Following measles infection, subacute sclerosing panencephalitis develops.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 3
Incorrect
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A foot drop is a sign of damage to which of the following nerves?
Your Answer: Common fibular nerve
Correct Answer: Deep fibular nerve
Explanation:The deep fibular nerve was previously referred to as the anterior tibial nerve.
It starts at the common fibular nerve bifurcation, between the fibula and the proximal part of the fibularis longus. Damage to this nerve can cause foot drop or loss of dorsiflexion since this nerve controls the anterior leg muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 4
Incorrect
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A novel anti-tuberculosis medicine was compared to standard treatment and shown to cut the risk of death from 30 to 10 per 1000 people. How many patients would need to be treated (number need to treat (NNT)) in order to prevent 10 additional tuberculosis deaths:
Your Answer: 50
Correct Answer: 500
Explanation:The risk of mortality in the control group (usual therapy) minus the risk of death in the treatment group equals the absolute risk reduction (ARR) of treatment.
30/1000 minus 10/1000 = 20/1000 = 0.02NNT = 1/ARR = 1/0.02 = 50
As a result, 50 people would need to be treated in order to prevent one additional fatality, and 500 people would need to be treated in order to avoid 10 additional deaths. -
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 5
Incorrect
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Regarding haemoglobin, which of the following statements is CORRECT:
Your Answer: Normal adult red blood cells contain only HbA.
Correct Answer: In degradation of haemoglobin, the haem group is split from the haemoglobin and converted to biliverdin and ultimately to bilirubin.
Explanation:Haemoglobin is composed of four polypeptide globin chains each with its own iron containing haem molecule. Haem synthesis occurs largely in the mitochondria by a series of biochemical reactions commencing with the condensation of glycine and succinyl coenzyme A under the action of the key rate-limiting enzyme delta-aminolevulinic acid (ALA) synthase. The globin chains are synthesised by ribosomes in the cytosol. Haemoglobin synthesis only occurs in immature red blood cells.
There are three types of haemoglobin in normal adult blood: haemoglobin A, A2 and F:
– Normal adult haemoglobin (HbA) makes up about 96 – 98 % of total adult haemoglobin, and consists of two alpha (α) and two beta (β) globin chains.Â
– Haemoglobin A2 (HbA2), a normal variant of adult haemoglobin, makes up about 1.5 – 3.5 % of total adult haemoglobin and consists of two α and two delta (δ) globin chains.
– Foetal haemoglobin is the main Hb in the later two-thirds of foetal life and in the newborn until approximately 12 weeks of age. Foetal haemoglobin has a higher affinity for oxygen than adult haemoglobin.Â
Red cells are destroyed by macrophages in the liver and spleen after , 120 days. The haem group is split from the haemoglobin and converted to biliverdin and then bilirubin. The iron is conserved and recycled to plasma via transferrin or stored in macrophages as ferritin and haemosiderin. An increased rate of haemoglobin breakdown results in excess bilirubin and jaundice. -
This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 6
Incorrect
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A 66-year-old female presents to the Emergency Department with a nose bleed. She says that she has been having frequent episodes of nose bleeds over the past four months, along with increasing fatigue and some weight loss. On examination, she has a diffuse petechial rash and hypertrophy of the gingiva.
Which one of the following conditions is this patient most likely to have?Your Answer: Chronic myeloid leukaemia (CML)
Correct Answer: Acute myeloid leukaemia (AML)
Explanation:The history of nosebleeds and fatigue, and gingival hyperplasia presents a typical picture of acute myeloid leukaemia. Leukemic infiltrates within the gingiva cause hypertrophy and distinguish this condition from other types of leukaemia. The fatigue is secondary to anaemia, while the nosebleeds are caused by thrombocytopenia secondary to leukemic infiltration of bone marrow. Patients may also report frequent infections secondary to neutropenia and hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 7
Incorrect
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Which of these is NOT a naturally occurring anticoagulant:
Your Answer: Protein S
Correct Answer: Factor V Leiden
Explanation:It’s crucial that thrombin’s impact is restricted to the injured site. Tissue factor pathway inhibitor (TFPI), which is produced by endothelial cells and found in plasma and platelets, is the first inhibitor to function. It accumulates near the site of harm induced by local platelet activation. Xa and VIIa, as well as tissue factor, are inhibited by TFPI. Other circulating inhibitors, the most potent of which is antithrombin, can also inactivate thrombin and other protease factors directly. Coagulation cofactors V and VIII are inhibited by protein C and protein S. Tissue plasminogen activator (TPA) from endothelial cells facilitates fibrinolysis by promoting the conversion of plasminogen to plasmin.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 8
Incorrect
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A 66-year-old female with a history of stroke one year ago presents to the Family Medicine clinic complaining of fatigue, weight loss, and tongue discolouration. On examination, she seems malnourished, her tongue is beefy red, and an ataxic gait pattern is noticed.
Which ONE of the following conditions does this patient most likely have?Your Answer: Iron-deficiency anaemia
Correct Answer: Vitamin B12 deficiency
Explanation:A history of stroke and poor nutritional status points towards a nutritional deficiency as the most likely cause of her symptoms. The examination would differentiate between Vitamin B12 and Folic acid deficiency as in the former. The patient has a beefy red tongue and symptoms indicating peripheral nervous system involvement or subacute combined spinal cord degeneration. The patient may also have a lemon-yellow skin colour, loss of proprioception and vibratory sense and oral ulceration.
Investigations in B12 deficiency can reveal the following:
1. Macrocytic anaemia
2. Neutropoenia
3. Thrombocytopaenia
4. Blood film: anisocytosis, poikilocytosis
5. Low serum B12
6. Raised serum bilirubin (haemolysis)
7. Intrinsic factor antibodies
8. Positive Schilling test -
This question is part of the following fields:
- Haematology
- Pathology
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Question 9
Incorrect
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A 30-year old male is taken to the emergency room after suffering a blunt trauma to the abdomen. He is complaining of severe abdominal pain, however all his other vital signs remain stable. A FAST scan is performed to assess for hemoperitoneum.
If hemoperitoneum is present, it is most likely to be observed in which of the following areas?Your Answer: Spleen
Correct Answer: Liver
Explanation:The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%.
The FAST exam evaluates four regions for pathologic fluid: (1) the right upper quadrant, (2) the subxiphoid (or subcostal) view, (3) the left upper quadrant, and (4) the suprapubic region.
The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The probe is positioned in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The hand is placed against the bed to ensure visualization of the retroperitoneal kidney. The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Recent retrospective evidence suggests the area along the caudal edge of the left lobe of the liver has the highest sensitivity, exceeding 93%.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 10
Incorrect
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You are asked to review the blood results on a 56-year-old man who appears to be acutely unwell. His results show that he is neutropenic.
Which ONE of the following is NOT a recognized cause of a neutropenia?Your Answer:
Correct Answer: Hyposplenism
Explanation:Neutropenia is defined as a total neutrophil count of < 2.0 x 109/l.
It can be caused by:
Viral infections
Collagen disease e.g. SLE and RA
Chemotherapy and radiotherapy
Hypersplenism
Marrow infiltration
Vitamin and folate deficiency
Drug reactions
Drugs that cause neutropenia include flecainide, phenytoin, carbimazole, indomethacin and co-trimoxazole. -
This question is part of the following fields:
- Haematology
- Pathology
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