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Question 1
Incorrect
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A 30-year-old female presents with a 4-day history of diarrhoea and vomiting. She has been unable to keep fluids down for 4 days and has been treated with metoclopramide. She develops a dystonic reaction. What is the most appropriate treatment for this woman?
Your Answer: Domperidone
Correct Answer: Benztropine
Explanation:Acute dystonic reactions (extrapyramidal symptoms) such as spasmodic torticollis, trismus, and oculogyric crises can occur following the administration of metoclopramide or stemetil and thus, neither is recommended for the treatment of nausea in young women.
Such reactions respond well to treatment with benztropine or procyclidine.
– Benztropine: It is an anticholinergic medication with significant CNS penetration. A single dose of benztropine 1 to 2 mg IV followed by 1 to 2 mg p.o twice a day for up to 7 days to prevent a recurrence. Subsequently, both the offending agent and those from the same group should be avoided.
– Alternatively, diphenhydramine can be used intravenously (up to a dose of 50mg) or intramuscularly followed by p.o therapy every 6 hours for 1 to 2 to prevent a recurrence.- Second-line therapy with IV benzodiazepines is reserved for those patients who do not respond to anticholinergics.
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This question is part of the following fields:
- Medicine
- Pharmacology
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Question 2
Correct
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Which of the following would be a contraindication to thrombolysis?
Your Answer: Intracranial neoplasm
Explanation:Absolute contraindications to thrombolysis include:
- Previous intracranial bleeding at any time
- Stroke in less than 6 months
- Closed head or facial trauma within 3 months
- Suspected aortic dissection
- Ischemic stroke within 3 months (except in ischemic stroke within 3 hours time)
- Active bleeding diathesis
- Uncontrolled high blood pressure (>180 systolic or >100 diastolic)
- Known structural cerebral vascular lesion
- Arterio-venous malformations
- Thrombocytopenia
- Known coagulation disorders
- Aneurysm
- Brain tumours
- Pericardial effusion
- Septic embolus
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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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One of the functions of the spleen with regards to red blood cells is:
Your 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
- Medicine
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Question 4
Correct
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Which intestinal cells play a major role in secretory immunity?
Your Answer: M cells
Explanation:M cells are specialized epithelial cells of the MALT or mucosa-associated lymphoid tissues. They transport antigens from the intestinal lumen to cells of the immune system, thereby initiating an immune response. T and B cells are lymphocytes found in blood. Mucous cells secrete mucous and can be considered as a part of innate immunity. Chief cells in the gastric mucosa secret pepsin.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 5
Incorrect
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In adults, the major site of haematopoiesis is?
Your Answer: The proximal ends of long bones
Correct Answer: The axial skeleton
Explanation:Bone marrow is the flexible tissue in the interior of bones. In humans, red blood cells are produced by cores of bone marrow in the heads of long bones.
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This question is part of the following fields:
- Haematology
- Medicine
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Question 6
Incorrect
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What causes increased insulin sensitivity?
Your Answer: Growth hormone treatment
Correct 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
- Medicine
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Question 7
Correct
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Initial depolarization of cardiac muscle is due to influx of:
Your Answer: Na+
Explanation:Initial depolarization of the cardiac muscle results from opening of the sodium voltage gated channels. This results in the influx of sodium and an increase in the membrane potential towards threshold. Potassium efflux results in repolarization.
The cardiac action potential has 5 phases:
- Phase 0—depolarization because of the opening of fast sodium channels. Potassium flux also decreases.
- Phase 1—partial repolarization because of a rapid decrease in sodium ion passage as fast sodium channels close.
- Phase 2—plateau phase in which the movement of calcium ions out of the cell, maintains depolarization.
- Phase 3—repolarization, sodium, and calcium channels all close and membrane potential returns to baseline.
- Phase 4—resting membrane potential (−90 mV), resulting from the activity of the Na+/K+ ATPase pump which creates a negative intracellular potential because of the exchange of three sodium ions for only two potassium ions.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 8
Incorrect
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With regard to the endothelial structure, the epithelium constitute:
Your Answer: Simple columnar
Correct Answer: Simple squamous
Explanation:The single layer of squamous epithelium lining the heart and blood vessels is known as the endothelium.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 9
Correct
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Using the Cockcroft-Gault formula, what will the estimated creatinine clearance be of a 55 year old male who weighs 75kg and has a serum creatinine of 150mg/dL?
Your Answer: 0.59ml/min
Explanation:A commonly used surrogate marker for estimate of creatinine clearance is the Cockcroft-Gault (CG) formula, which in turn estimates GFR in ml/min:CCr = [(140-age) x Mass(kg)]/[72 x serum creatinine (mg/dL)](multiply by 0.85 for women)Therefore CCr = (85 x 75)/(72 x 150) = 0.59
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This question is part of the following fields:
- Medicine
- Renal
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Question 10
Incorrect
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Impulse conduction through the AV node is slow and depends on the action potential produced by which of the following.
Your Answer: All of the above
Correct Answer: Calcium flux
Explanation:The action potentials in the SA and AV nodes are largely due to Ca2+, with no contribution by Na+ influx.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 11
Correct
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According to Starling's law of the heart:
Your Answer: The extent of the preload is proportional to the end-diastolic volume
Explanation:Frank starlings law describes that an increase in the venous return or the end diastolic volume will cause an increase in the stroke volume/ preload and also cardiac output. It stems from the fact that increased venous return will increase the stretch on the ventricular muscle fibers. The sarcomere will stretch a considerable length that is needed for maximum contraction and the development of tension in the muscle fiber. The greater the venous return the greater the cardiac output. This relationship is directly proportional.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 12
Correct
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With regard to cell membrane proteins:
Your Answer: Carriers are involved in facilitated diffusion
Explanation:Pumps use a source of free energy such as ATP to transport ions against a gradient and is an example of active transport. Unlike channel proteins which only transport substances through membranes passively, carrier proteins can transport ions and molecules either passively through facilitated diffusion, or via secondary active transport. Channels are either in open state or closed state. When a channel is opened, it is open to both extracellular and intracellular. Pores are continuously open to both environments, because they do not undergo conformational changes. They are always open and active.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 13
Correct
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Somatostatin is responsible for?
Your Answer: Decreased gastrin release
Explanation:Somatostatin is an inhibitory hormone secreted from the D cells of the Pancreatic Islets. It causes the inhibition of gastrin (decreasing stomach acid production), CCK (decreasing gallbladder motility), gastrin inhibitory peptide and secretin. Gastrin production is also inhibited by secretin, GIP, VIP, glucagon and calcitonin.
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This question is part of the following fields:
- Gastrointestinal
- Medicine
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Question 14
Incorrect
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Which of the following is the smallest cell of the nervous system?
Your Answer: Astrocyte
Correct Answer: Microglia
Explanation:Microglia are the smallest of the neuroglial cells in the nervous system. They are scattered throughout the central nervous system and have phagocytic properties.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 15
Incorrect
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Question 16
Incorrect
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Question 17
Incorrect
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Question 18
Incorrect
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Which of the following forms the language areas of the cerebral cortex?
Your Answer: Submarginal sulcus
Correct Answer: All of the above
Explanation:Broca’s area, Wernicke’s area, the submarginal sulcus and the angular gyrus all form the language areas of the cerebral cortex.
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This question is part of the following fields:
- Medicine
- Neurology
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Question 19
Incorrect
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Which one of the following transporters is involved in facilitated diffusion?
Your Answer: Na+-linked glucose transport
Correct Answer: GLUT2
Explanation:GLUT 2 is a bidirectional transporter, allowing glucose to flow in 2 directions via facilitated diffusion. Is expressed by renal tubular cells, liver cells and pancreatic beta cells. It is also present in the basolateral membrane of the small intestine epithelium.
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This question is part of the following fields:
- Cell Biology
- Medicine
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Question 20
Incorrect
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What is the effect of oxytocin on the breast?
Your Answer: Milk formation
Correct Answer: Milk ejection
Explanation:Oxytocin is a peptide hormone and neuropeptide, produced by the hypothalamus and released by the posterior pituitary. It causes the milk ejection or let-down reflex, causing the milk to be transported to the subareolar sinuses, allowing it to be released through the nipple. This response is initiated by the act of suckling by the baby, but it can be conditioned to be triggered by different stimuli.
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 21
Incorrect
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Which of the following is not a feature of Liddle’s syndrome?
Your Answer: Response to treatment with amiloride
Correct Answer: Autosomal recessive inheritance
Explanation:Liddle’s syndrome is a rare autosomal dominant condition characterized by early, and frequently severe, high blood pressure associated with low plasma renin activity, metabolic alkalosis, low blood potassium, and normal to low levels of aldosterone. Liddle syndrome involves abnormal kidney function, with excess reabsorption of sodium and loss of potassium from the renal tubule, and is treated with a combination of low sodium diet and potassium-sparing diuretic drugs (e.g., amiloride).
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 22
Incorrect
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Regarding restriction fragment length polymorphisms (RFLP) and Gene Knockout Mouse Models. All are true except:
Your Answer: Sequence changes involved in RFLP can be analysed more quickly by PCR.
Correct Answer: In knockout mouse models a gene is turned on through targeted mutation
Explanation:In RFLP, polymorphism occurs in 98% of the non coding genome, resulting in no phenotypical change in the organism. A gene is not turned on by a mutation, rather the mutation at the restriction site will alter the DNA and the DNA will now form fragments of different lengths. PCR is a better technique than RFLP.
A knockout, as related to genomics, refers to the use of genetic engineering to inactivate or remove one or more specific genes from an organism. Scientists create knockout organisms to study the impact of removing a gene from an organism, which often allows them to then learn something about that gene’s function.
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This question is part of the following fields:
- Genetics
- Medicine
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Question 23
Incorrect
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What is the most common cause of primary hyperaldosteronism?
Your Answer: Adrenocortical adenoma
Correct Answer: Bilateral idiopathic adrenal hyperplasia
Explanation:Primary aldosteronism, also known as primary hyperaldosteronism or Conn’s syndrome, is excess production of the hormone aldosterone by the adrenal glands resulting in low renin levels. Primary hyperaldosteronism has a number of causes. About 66% of cases are due to enlargement of both adrenal glands and 33% of cases are due to an adrenal adenoma that produces aldosterone. Other uncommon causes include adrenal cancer and an inherited disorder called familial hyperaldosteronism
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This question is part of the following fields:
- Endocrinology
- Medicine
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Question 24
Incorrect
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A 42 year old obese man complains of a painful swollen ankle. The pain has worsened over the past 2 weeks. He is a diabetic and gives a history of recent alcohol consumption. Joint aspirate shows rhomboid crystals with numerous neutrophils. Radiological examination shows evidence of chondrocalcinosis. Which of the following is the most likely diagnosis?
Your Answer: Charcot’s joint
Correct Answer: Pseudogout
Explanation:Pseudogout is a paroxysmal joint inflammation due to calcium pyrophosphate crystal deposition (calcium pyrophosphate dihydrate). Aetiology includes mostly idiopathic (primary form) and secondary form occurring as a result of joint trauma, familial chondrocalcinosis, hyperparathyroidism, hemochromatosis, gout, hypophosphatemia. Clinical presentation: Often asymptomatic. Acute (pseudogout attack): monoarthritis (rarely oligoarthritis), mostly affecting the knees and other large joints (e.g., hips, wrists, and ankles). It may become chronic (can affect multiple joints). Osteoarthritis with CPPD (most common form of symptomatic CPPD): progressive joint degeneration with episodes of acute inflammatory arthritis typical of pseudogout attacks. Arthrocentesis should be performed, especially in acute cases. Polarized light microscopy: detection of rhomboid-shaped, positively birefringent CPPD crystals. Synovial fluid findings: 10,000-50,000 WBCs/μL with > 90% neutrophils. X-ray findings: cartilage calcification of the affected joint (chondrocalcinosis). Fibrocartilage (meniscus, annulus fibrosus of intervertebral disc) and hyaline cartilage (joint cartilage) may be affected.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 25
Incorrect
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A 31 year old female complains of bilateral proximal muscle weakness. There is marked blanching of fingers especially in response to cold weather. Lab results are as follows: Anti Jo-1: positive ANA: positiveCK: 2000 U/LESR: 60mm/hrEMG: myopathic changesPresence of which of the following signifies the worst prognosis?
Your Answer: Dysphagia
Correct Answer: Interstitial lung disease
Explanation:Polymyositis is an inflammatory disorder causing symmetrical, proximal muscle weakness. It is thought to be a T-cell mediated cytotoxic process directed against muscle fibres. It may be idiopathic or associated with connective tissue disorders. It may also be associated with malignancy for example small cell lung carcinoma.Dermatomyositis is a variant of the disease where skin manifestations are prominent, for example a purple (heliotrope) rash on the cheeks and eyelids.It typically affects middle-aged, female: male 3:1. Features include proximal muscle weakness +/- tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia, dysphagia, dysphonia. Investigations: elevated creatine kinase, other muscle enzymes (lactate dehydrogenase (LD), aldolase, AST and ALT) are also elevated in 85-95% of patients, EMG, muscle biopsy. Anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever. Interstitial lung disease plays a major role in morbidity and mortality in patients with polymyositis and is considered a major risk factor for premature death in patients with myositis.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 26
Correct
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Which receptor type is associated with bronchial muscle relaxation?
Your Answer: β2
Explanation:β2-adrenoceptors are widely distributed in the respiratory tract. When they are activated, an intracellular response induces the activation of cyclic AMP; this, in turn, produces airway relaxation through phosphorylation of muscle regulatory proteins and modification of cellular Ca2+concentrations.
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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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If O2 makes up 21% of air, then at one atmosphere (760mmHg) it would be expected that the PO2 of inspired air should be 0,21 x 760 = 160mmHg. In the alveoli the actual measure is 149mmHg because…
Your Answer: N2 diffuses easily
Correct Answer: Water is equilibrated with air
Explanation:There are several factors that determine the value of alveolar partial oxygen pressure including: the pressure of outside air, the partial pressure of inspired oxygen and carbon dioxide, the rates of total body oxygen consumption and carbon dioxide production, the rates of alveolar ventilation and perfusion. The alveolar partial pressure is lower than the atmospheric oxygen partial pressure. One reason is, as the air enters the lungs, it is humidified by the upper airway and thus the partial pressure of water vapour reduces the oxygen partial pressure as water is equilibrated with air.
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This question is part of the following fields:
- Medicine
- Respiratory
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Question 28
Incorrect
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Which of the following cancers is responsible in producing osteoblastic bone metastases instead of osteolytic?
Your Answer: Granulosa cell tumour of the ovary
Correct Answer: Prostate adenocarcinoma
Explanation:Osteoblastic (or sclerotic) bone metastases, characterized by deposition of new bone, present in prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma or medulloblastoma.
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This question is part of the following fields:
- Connective Tissue
- Medicine
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Question 29
Correct
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Which of the following makes up the thick filaments in muscle fibers?
Your Answer: Myosin
Explanation:The thick filaments are made up of myosin and the thin filaments are made up of actin. The thick filaments are twice the size of the thin filaments and are aligned to form the A band. The thin filaments extending out from the A band form the less dense I bands.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 30
Correct
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Type 2 hypersensitivity is mediated by:
Your Answer: IgG, IgM & complement
Explanation:In type II hypersensitivity the antibodies, IgG and IgM bind to antigens to form complexes that activate the classical pathway of complement to eliminate cells presenting foreign antigens.
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This question is part of the following fields:
- Immunology
- Medicine
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