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Question 1
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A 26-year-old man is involved in a motorcycle accident that results in an open fracture of his tibia and fibula. The nerve that innervates peroneus tertius is damaged as a consequence of his injuries.
Peroneus tertius receives its innervation from which of the following nerves? Select ONE answer only.Your Answer: Deep peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.
Peroneus longus is innervated by the superficial peroneal nerve.
Peroneus tertius is innervated by the deep peroneal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 2
Correct
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A 55-year-old woman was complaining of headaches. On examination, the patient is found to have weakness on the left side of her body and her eyes are deviated towards the right hand side. These are signs of damage to which of the following areas?
Your Answer: Frontal lobe
Explanation:Some potential symptoms of frontal lobe damage can include loss of movement, either partial or complete, on the opposite side of the body.
In the patient’s case, it is a result of motor cortex damage on the right side since her left side of the body is affected. The conjugate eye deviation symptom towards the side of the lesion is a result of damage to the frontal eye field.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 3
Correct
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Regarding the varicella zoster virus, which of the following statements is CORRECT:
Your Answer: Contracting chickenpox infection while pregnant is associated with a higher risk of developing varicella pneumonitis.
Explanation:Chickenpox infection in neonates, adults/adolescents and pregnant women is associated with more severe disease. Varicella zoster pneumonitis typically occurs in pregnant women or immunocompromised individuals and is associated with a high mortality. A live attenuated-virus vaccine is available and recommended for non-immune healthcare workers but is not part of the routine childhood immunisation schedule. Antiviral treatment is not typically recommended in childhood chickenpox but is indicated for shingles.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 4
Correct
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A migrant from Eastern Europe needs to have screening performed for tuberculosis (TB) because he is a high-risk patient.
Which statement concerning TB screening in the UK is true?
Your Answer: Vaccination with the BCG can result in a false positive test
Explanation:Vaccination with the BCG can result in a false positive test.
The Mantoux test replaced the Heaf test as the TB screening test in the UK in 2005.
The ‘Sterneedle’ gun is used to inject 100,000 units/ml of tuberculin purified protein derivative into the skin for the Heaf testThe Mantoux test involves the injection of 5 Tuberculin units (0.1mL) intradermally and the result read 2-3 days later.
The interferon gamma release assay (IGRA) should NOT be used for neonates
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 5
Correct
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Which of the following is NOT a characteristic of megaloblastic anaemia?
Your Answer: Raised reticulocyte count
Explanation:The LDH level is usually markedly increased in severe megaloblastic anaemia. Reticulocyte counts are inappropriately low, representing a lack of production of RBCs due to massive intramedullary haemolysis. These findings are characteristics of ineffective haematopoiesis that occurs in megaloblastic anaemia as well as in other disorders such as thalassemia major.
The common feature in megaloblastosis is a defect in DNA synthesis in rapidly dividing cells. To a lesser extent, RNA and protein synthesis are impaired. Unbalanced cell growth and impaired cell division occur since nuclear maturation is arrested. More mature RBC precursors are destroyed in the bone marrow prior to entering the bloodstream (intramedullary haemolysis). -
This question is part of the following fields:
- Haematology
- Pathology
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Question 6
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After collapsing at home, a 62-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is rushed to resuscitation and placed on a cardiac monitor, which reveals ventricular tachycardia. An amiodarone infusion is set up.
Which of these statements about amiodarone is correct?Your Answer: It is expressed in breast milk
Explanation:Antiarrhythmic drug amiodarone is used to treat both ventricular and atrial arrhythmias. It’s a class III antiarrhythmic that works by prolonging the repolarization phase of the cardiac action potential, where potassium permeability is normally high and calcium permeability is low.
Dronedarone is sometimes used instead of amiodarone in certain situations. Although amiodarone is more effective than dronedarone, dronedarone has fewer side effects.
Grapefruit juice inhibits the metabolism of amiodarone.
The plasma half-life of amiodarone is very long, ranging from 2 weeks to 5 months. The half-life is about 2 months on average.
Because amiodarone is excreted in breast milk, it should be avoided by breastfeeding mothers. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 7
Correct
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Glucagon is secreted by which of the following pancreatic cell types:
Your Answer: α cells
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 8
Correct
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Which of the following is a primary action of aldosterone:
Your Answer: Renal sodium reabsorption
Explanation:Aldosterone acts mainly at the renal distal convoluted tubule (DCT) to cause sodium retention and potassium loss. It increases the synthesis of transport mechanisms in the distal nephron including the Na+pump, Na+/H+symporter, and Na+and K+channels in principal cells, and H+ATPase in intercalated cells. Na+(and thus water) reabsorption and K+and H+secretion are thereby enhanced.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 9
Correct
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Discontinuous capillaries are typically found where in the body:
Your Answer: Reticuloendothelial system
Explanation:Discontinuous capillaries, found in the reticuloendothelial system (bone marrow, liver and spleen), have large gaps between endothelial cells and are permeable to red blood cells.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 10
Correct
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A 74-year-old woman with a history of ischaemic heart disease and heart failure is complaining of worsening oedema, bloating, and a loss of appetite. She has ascites and peripheral oedema on examination. Her oedema is being controlled by an oral diuretic, but it appears that this is no longer enough. You discuss her care with the on-call cardiology registrar, who believes she is very likely to have significant gut oedema that is interfering with her diuretic absorption and that she will need to change her medication.
Which of the following oral diuretics is most likely to help you overcome this problem?Your Answer: Bumetanide
Explanation:Bumetanide is primarily used in patients with heart failure who have failed to respond to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency. In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. As a result, when it has a better bioavailability than furosemide, it is commonly used in patients with gut oedema.
When taken alone, Bendroflumethiazide is a moderately potent diuretic that is unlikely to control her oedema.
Mannitol is a type of osmotic diuretic used to treat cerebral oedema and high intracranial pressure.
Acetazolamide is a weak diuretic that inhibits carbonic anhydrase. It’s a rare occurrence.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 11
Correct
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A 60-year-old man diagnosed with chronic kidney disease has an elevated creatinine level and a reduced glomerular filtration rate (GFR).
Which statement concerning glomerular filtration is true?Your Answer: Creatinine is freely filtered at the glomerulus
Explanation:Glomerular filtration is a passive process. It depends on the net hydrostatic pressure across the glomerular capillaries, the oncotic pressure, and the intrinsic permeability of the glomerulus.
The mean values for glomerular filtration rate (GFR) in young adults are 130 ml/min/1.73m2 in males and 120 ml/min/1.73m2in females.
The GFR declines with age after the age of 40 at a rate of approximately 1 ml/min/year.
The Cockcroft and Gault formula overestimates creatinine in obese patients. This is because their endogenous creatinine production is less than that predicted by overall body weight.
Creatinine is used in the estimation of GFR because it is naturally produced by muscle breakdown, not toxic, not produced by the kidney, freely filtered at the glomerulus, not reabsorbed from the nephron, and does not alter GFR.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 12
Correct
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A patient complains of headache and visual loss. CT scan demonstrates a lesion of the temporal lobe. What type of visual field defect would you most expect to see in this patient:
Your Answer: Contralateral homonymous superior quadrantanopia
Explanation:Axons from the lateral geniculate nucleus (LGN) carry visual information, via the upper and lower optic radiations, to the visual cortex in the occipital lobe:
The upper optic radiation carries fibres from the superior retinal quadrants (corresponding to the inferior visual field quadrants) and travels through the parietal lobe to reach the visual cortex.
The lower optic radiation carries fibres from the inferior retinal quadrants (corresponding to the superior visual field quadrants) and travels through the temporal lobe to reach the visual cortex of the occipital lobe. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 13
Correct
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What is the direct mechanism of action of digoxin as a positive inotrope:
Your Answer: Inhibition of Na+/K+ ATPase pump
Explanation:Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 14
Correct
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How does an action potential in the motor end plate rapidly spread to the central portions of the muscle cells?
Your Answer: Transverse tubules
Explanation:When the concentration of intracellular Ca2+rises, muscle contraction occurs. The pathway of an action potential is down tube-shaped invaginations of the sarcolemma called T-tubules (transverse tubules). These penetrate throughout the muscle fibre and lie adjacent to the terminal cisternae of the sarcoplasmic reticulum. The voltage changes in the T-tubules result in the opening of sarcoplasmic reticulum Ca2+channels and there is there is release of stored Ca2+into the sarcoplasm. Thus muscle contraction occurs via excitation-contraction coupling (ECC) mechanism.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 15
Correct
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A patient is complaining of painless jaundice. His bilirubin levels are abnormally high.
Which of the following statements about bile is correct?Your Answer: Bile acids are amphipathic
Explanation:The liver produces bile on a constant basis, which is then stored and concentrated in the gallbladder. In a 24-hour period, around 400 to 800 mL of bile is generated.
Bile is involved in the following processes:
Fats are broken down into fatty acids.
Waste products are eliminated.
Cholesterol homeostasis is the balance of cholesterol in the body.The enteric hormones cholecystokinin and secretin are primarily responsible for bile secretion. When chyme from an unprocessed meal enters the small intestine, they are released, and they play the following function in bile secretion and flow:
Cholecystokinin promotes gallbladder and common bile duct contractions, allowing bile to reach the intestine.
Secretin enhances the secretion of bicarbonate and water by biliary duct cells, increasing the amount of bile and its flow into the gut.Bile acids have a hydrophobic and hydrophilic area, making them amphipathic. Bile acids’ amphipathic nature allows them to perform the following crucial functions:
Emulsification of lipid aggregates increases the surface area of fat and makes it easier for lipases to digest it.
Lipid solubilization and transport: solubilizes lipids by creating micelles, which are lipid clumps that float in water. -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 16
Correct
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A 13-year-old male presents to the Emergency Department with a heavy nosebleed. His medical record shows that he was diagnosed with Haemophilia B as a child.
What is the mode of inheritance of this disease?Your Answer: X-linked recessive
Explanation:Deficiency of Factor IX causes Haemophilia B, and like the other Haemophilia’s, it has an X-linked recessive pattern of inheritance, affecting males born to carrier mothers.
Haemophilia B is the second commonest form of haemophilia and is rarer than haemophilia A. Haemophilia B is similar to haemophilia A but is less severe. You can distinguish the two disorders by specific coagulation factor assays.
The incidence of Haemophilia B is one-fifth of that of haemophilia A.
In laboratory findings, you get prolonged APTT, normal PT and low factor IX for Haemophilia B.
There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 17
Correct
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A 30-year-old male presents with easy bruising and bleeding gums, feeling very tired lately, and recurrent chest infections over the past few months. He had glandular fever approximately 6 months ago and feels that his symptoms started after that.
His full blood count today is as follows:
Hb 6.3 g/dl (11.5-14 g/dl)
MCV 90 fl (80-100 fl)
WCC 2.0 x 10 9 /l (4-11 x 10 9 /l)
Platelets 15 x 10 9 /l (150-450 x 10 9 /l)
The SINGLE most likely diagnosis is?Your Answer: Aplastic anaemia
Explanation:Aplastic anaemia is a life-threatening failure of haemopoiesis characterised by pancytopenia and hypocellular bone marrow. It is rare and patients present with features of recurrent infections secondary to (leukocytopenia), increased bleeding tendency (secondary to thrombocytopenia) and anaemia. In aplastic anaemia, there is damage to the bone marrow and the haematopoietic stems cells leading to pancytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 18
Correct
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A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes.
The lymph from the testes will drain to which of the following nodes?Your Answer: Para-aortic lymph nodes
Explanation:Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.
The scrotum is the one which drains into the nearby superficial inguinal nodes.
The glans penis and clitoris drains into the deep inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 19
Correct
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Which of the following is NOT a typical side effect of thiopental sodium:
Your Answer: Seizures
Explanation:Extravasation of thiopental during injection can lead to tissue damage. Accidental intra-arterial injection causes vasospasm and may lead to thrombosis and tissue necrosis. Other side effects include involuntary muscle movements on induction, cough and laryngospasm, arrhythmias, hypotension, headache and hypersensitivity reactions. Thiopental sodium has anticonvulsant properties and does not cause seizures.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 20
Correct
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All of the statements regarding vascular tone are correct except:
Your Answer: Most endogenous vasodilators act by decreasing levels of cAMP or cGMP.
Explanation:Most vasoconstrictors bind to G-protein coupled receptors. These mediate elevation in intracellular [Ca2+] which leads to vascular smooth muscle contraction. Important vasoconstrictors include noradrenaline, endothelin-1 and angiotensin II.
Increased intracellular Ca2+ is as a result of the release of Ca2+from the sarcoplasmic reticulum and depolarisation and entry of Ca2+via L-type voltage-gated Ca2+channels. Most types of vascular smooth muscle do not generate action potentials – instead, the depolarisation is graded, which allows graded entry of Ca2+.
sequestration by the sarcoplasmic reticulum Ca2+ATPase, removal from the cell by a plasma membrane Ca2+ATPase and Na+/Ca2+exchange decreases intracellular Ca2+, resulting in vasodilation. Relaxation is a result of most endogenous vasodilators when there is an increase in cyclic guanosine monophosphate (cGMP) like nitric oxide) or cyclic adenosine monophosphate (cAMP) like prostacyclin and beta-adrenergic receptor agonists. These activate protein kinases causing substrate level phosphorylation.
Clinically effective vasodilators are L-type Ca2+channel blocker drugs. -
This question is part of the following fields:
- Cardiovascular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
