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  • Question 1 - Which of the following clinical features would you NOT expect to see in...

    Incorrect

    • Which of the following clinical features would you NOT expect to see in a tibial nerve palsy:

      Your Answer: Weakened inversion of the foot

      Correct Answer: Weakened eversion of the foot

      Explanation:

      Damage to the tibial nerve results in loss of plantarflexion of the ankle and weakness of inversion of the foot resulting in a shuffling gait, clawing of the toes and loss of sensation in its cutaneous distribution.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      50.2
      Seconds

  • Question 2 - You've been summoned to a young man in the resus area who has...

    Incorrect

    • You've been summoned to a young man in the resus area who has an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.

      The use of adenosine is not contraindicated in which of the following situations?

      Your Answer:

      Correct Answer: Concurrent use of a beta-blocker

      Explanation:

      The use of a beta-blocker at the same time increases the risk of myocardial depression, but it is not a contraindication.
      The use of adenosine is contraindicated in the following situations:
      Asthma
      COPD (chronic obstructive pulmonary disease)
      Decompensated heart failure 
      Long QT syndrome
      AV block in the second or third degree
      Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
      Hypotension that is severe

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 3 - Continuous capillaries are typically found where in the body: ...

    Incorrect

    • Continuous capillaries are typically found where in the body:

      Your Answer:

      Correct Answer: Blood-brain barrier

      Explanation:

      Continuous capillaries, found in the skin, lungs, muscles and CNS, are the most selective with low permeability, as junctions between the endothelial cells are very tight, restricting the flow of molecules with MW > 10,000.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 4 - Cryptococcus neoformans is primarily transmitted by which of the following routes: ...

    Incorrect

    • Cryptococcus neoformans is primarily transmitted by which of the following routes:

      Your Answer:

      Correct Answer: Inhalation of spores

      Explanation:

      Cryptococcus neoformans is found in bird droppings and transmission is by inhalation of spores, thus the lung is the primary site of infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 5 - Which of the following acts to inhibit antidiuretic hormone (ADH) release from the...

    Incorrect

    • Which of the following acts to inhibit antidiuretic hormone (ADH) release from the posterior pituitary:

      Your Answer:

      Correct Answer: Atrial natriuretic peptide

      Explanation:

      ADH release is inhibited by low plasma osmolality, alcohol, caffeine, glucocorticoids and atrial natriuretic peptide (ANP).

      ADH release is stimulated primarily by raised plasma osmolality detected by osmoreceptors in the anterior hypothalamus. Other factors that increase ADH release include: extracellular fluid volume depletion, angiotensin II, nausea, pain, stress, exercise, emotion, hypoglycaemia.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
      Seconds

  • Question 6 - Gastrin primarily acts to perform which of the following functions: ...

    Incorrect

    • Gastrin primarily acts to perform which of the following functions:

      Your Answer:

      Correct Answer: Stimulate gastric acid secretion

      Explanation:

      Gastrin primarily  acts to stimulate acid secretion from parietal cells (both directly and indirectly by stimulating release of histamine from ECL cells).

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
      Seconds

  • Question 7 - Which nerve supplies the muscle flexor hallucis longus? ...

    Incorrect

    • Which nerve supplies the muscle flexor hallucis longus?

      Your Answer:

      Correct Answer: Tibial nerve

      Explanation:

      Flexor hallucis longus is innervated by the tibial nerve, composed of spinal roots L4, L5, S1, S2, and S3.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 8 - What is the main mechanism of action of dopamine as an inotropic sympathomimetic: ...

    Incorrect

    • What is the main mechanism of action of dopamine as an inotropic sympathomimetic:

      Your Answer:

      Correct Answer: Beta1-receptor agonist

      Explanation:

      Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 9 - Which coronary artery is mostly likely affected if an ECG shows a tombstone...

    Incorrect

    • Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?

      Your Answer:

      Correct Answer: Left anterior descending artery

      Explanation:

      Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.

      Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern.

      The following ECG leads determine the location and vessels involved in myocardial infarction:

      ECG Leads Location Vessel involved
      V1-V2 Septal wall Left anterior descending
      V3-V4 Anterior wall Left anterior descending
      V5-V6 Lateral wall Left circumflex artery
      II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)
      I, aVL High lateral wall Left circumflex artery
      V1, V4R Right ventricle Right coronary artery
      V7-V9 Posterior wall Right coronary artery

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 10 - What is the effect of activated vitamin D on the renal handling of...

    Incorrect

    • What is the effect of activated vitamin D on the renal handling of calcium:

      Your Answer:

      Correct Answer: Increases calcium reabsorption in the distal tubule

      Explanation:

      Activated vitamin D acts to:
      GUT:increase calcium and phosphate absorption in the small intestine (the main action)
      KIDNEYS:increase renal calcium reabsorption (in the distal tubule via activation of a basolateral Ca2+ATPase pump), increase renal phosphate reabsorption, inhibit 1-alpha-hydroxylase activity in the kidneys (negative feedback)
      PARATHYROID GLANDS:inhibit PTH secretion from the parathyroid glands

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
      Seconds

  • Question 11 - A 4-year old boy is taken to the emergency room after a sudden...

    Incorrect

    • A 4-year old boy is taken to the emergency room after a sudden onset of coughing and wheezing. Further investigation reveals that he was drawing quietly in his room, when suddenly, he became anxious and started coughing. The parents also noted that the eraser on top of the pencil was missing.

      A plain radiographic chest imaging is conducted, and confirmed foreign body aspiration.

      Which of the following areas in the tracheobronchial tree is the most probable location of the aspirated eraser?

      Your Answer:

      Correct Answer: Right main bronchus

      Explanation:

      In foreign body aspiration, the foreign body is more likely to enter the right main bronchus because it is shorter, wider and more vertical than the left main bronchus. In a patient who is standing or sitting, the foreign body tends to become lodged in the posterobasal segment of the inferior lobe of the right lung.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 12 - You have been called to review a patient and his management in the...

    Incorrect

    • You have been called to review a patient and his management in the resuscitation room. A very sick patient has been started on mannitol in his treatment protocol.

      Out of the following, what is NOT an FDA-recognized indication for the use of mannitol?

      Your Answer:

      Correct Answer: Congestive cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      Mannitol has four FDA approved uses clinically:
      1. Reduction of intracranial pressure and brain mass
      2. reduce intraocular pressure if this is not achievable by other means
      3. promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage
      4. promote diuresis to promote the excretion of toxic substances, materials, and metabolites

      It can be used in rhabdomyolysis-induced renal failure, especially in crush injuries. Mannitol reduces osmotic swelling and oedema in the injured muscle cells and helps restore skeletal muscle function.

      It is a low molecular weight compound and can be freely filtered at the glomerulus and not reabsorbed. This way increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).

      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:

      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 13 - Urine flow rate = 2 ml/min
    Urine concentration of creatinine = 18 mg/ml
    Plasma...

    Incorrect

    • Urine flow rate = 2 ml/min
      Urine concentration of creatinine = 18 mg/ml
      Plasma concentration of creatinine = 0.25 mg/ml

      What is the estimated glomerular filtration rate (eGFR)?

      Your Answer:

      Correct Answer: 144 ml/min

      Explanation:

      GFR can be estimated by:
      GFR = UCr x V / PCr
      Where:
      UCr = urine concentration of creatinine
      PCr = plasma concentration of creatinine
      V = rate of urine flow

      In this case GFR = (18 x 2) / 0.25 = 144 ml/min

      Note: Creatinine is used to estimate GFR because it is an organic base naturally produced by muscle breakdown, it is freely filtered at the glomerulus, it is not reabsorbed from the nephron, it is not produced by the kidney, it is not toxic, and it doesn’t alter GFR.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      0
      Seconds

  • Question 14 - All of the statements regarding vascular tone are correct except: ...

    Incorrect

    • All of the statements regarding vascular tone are correct except:

      Your Answer:

      Correct 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
      0
      Seconds

  • Question 15 - Which of the following is NOT a heritable risk factor for venous thrombosis:...

    Incorrect

    • Which of the following is NOT a heritable risk factor for venous thrombosis:

      Your Answer:

      Correct Answer: Von Willebrand disease

      Explanation:

      Approximately one-third of patients who suffer DVT or PE have an identifiable heritable risk factor, although additional risk factors are usually present when they develop the thrombosis. The history of a spontaneous DVT in a close relative increases an individual’s risk of DVT even if no known genetic predisposition can be identified.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 16 - A patent has weakness of humeral flexion and extension. A CT scan reveals...

    Incorrect

    • A patent has weakness of humeral flexion and extension. A CT scan reveals that he has suffered damage to the nerve that innervates pectoralis major.
      Pectoralis major receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Lateral and medial pectoral nerves

      Explanation:

      Pectoralis major is a thick, fan-shaped muscle situated in the chest. It makes up the bulk of the chest musculature in the male and lies underneath the breast in the female. It overlies the thinner pectoralis minor muscle.
      Superficial muscles of the chest and arm showing pectoralis major (from Gray’s Anatomy)
      Pectoralis major has two heads; the clavicular head and the sternocostal head. The clavicular head originates from the anterior border and medial half of the clavicle. The sternocostal head originates from the anterior surface of the sternum, the superior six costal cartilages and the aponeurosis of the external oblique muscle. It inserts into the lateral lip of the bicipital groove of the humerus.
      Pectoralis major receives dual innervation from the medial pectoral nerve and the lateral pectoral nerve.
      Its main actions are as follows:
      Flexes humerus (clavicular head)
      Extends humerus (sternocostal head)
      Adducts and medially rotates the humerus
      Draws scapula anteriorly and inferiorly

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 17 - A 20-year-old male patient lives in a travelling community and has never...

    Incorrect

    • A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.

      Which of these statements concerning indications and contraindications for vaccination is FALSE?

      Your Answer:

      Correct Answer: Premature infants should have the their immunisation schedule adjusted for gestational age

      Explanation:

      All vaccines are contraindicated in individuals with:
      A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.
      A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycin

      Live attenuated vaccines are contraindicated in pregnancy except in cases where risk of infection is more than the risks of vaccination.

      During times of acute febrile illness, vaccination should be avoided.

      12 weeks should elapse after a dose of human immunoglobulin before a live vaccine is administered.

      The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should NOT be implemented.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      0
      Seconds

  • Question 18 - Which of the following leukaemias is most common in children in the UK:...

    Incorrect

    • Which of the following leukaemias is most common in children in the UK:

      Your Answer:

      Correct Answer: Acute lymphoblastic leukaemia

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. There is a secondary rise after the age of 40 years. 85% of cases are of B-cell lineage and have an equal sex incidence; there is a male predominance for the 15% of T-cell lineage.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 19 - A young pregnant woman is in the late stages of her pregnancy. She...

    Incorrect

    • A young pregnant woman is in the late stages of her pregnancy. She is administered a drug that results in her newborn being born with respiratory depression. The baby also suffers from neonatal withdrawal syndrome.

      Out of the following, which drug is most likely responsible for the baby's condition?

      Your Answer:

      Correct Answer: Diazepam

      Explanation:

      Benzodiazepines are used as a first-line treatment in breaking seizures and in status epilepticus as they are rapid-acting.

      Use of benzodiazepines in the late third-trimester or exposure during labour is associated with great risks to the foetus/neonate. Babies can exhibit either floppy infant syndrome, or marked neonatal withdrawal symptoms. Symptoms vary from mild sedation, hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. These symptoms have been reported to persist for periods from hours to months after birth.

      They also cross into breast milk and should be used with caution in breastfeeding mothers

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 20 - A patient suffers a lower limb fracture that causes damage to the nerve...

    Incorrect

    • A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.
      Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Superficial 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
      0
      Seconds

  • Question 21 - A 30-year-old man suffers from an open femoral shaft fracture after being involved...

    Incorrect

    • A 30-year-old man suffers from an open femoral shaft fracture after being involved in a road traffic accident. As a consequence of his injury, the nerve that was damaged innervates the popliteus muscle.

      In which of the following nerves is the popliteus muscle innervated by?

      Your Answer:

      Correct Answer: Tibial nerve

      Explanation:

      The popliteus muscle is innervated by the tibial nerve (L4, 5 and S1).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 22 - Intrinsic factor is vital for gastrointestinal absorption of which of the following: ...

    Incorrect

    • Intrinsic factor is vital for gastrointestinal absorption of which of the following:

      Your Answer:

      Correct Answer: Vitamin B12

      Explanation:

      Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
      Seconds

  • Question 23 - The movement of molecules across the cell membrane relies greatly on active transport.

    Which of...

    Incorrect

    • The movement of molecules across the cell membrane relies greatly on active transport.

      Which of the following statements about active transport is correct?

      Your Answer:

      Correct Answer: Active transport occurs in glucose absorption from the gut

      Explanation:

      The movement of a material against a concentration gradient, i.e. from a low to a high concentration, is known as active transport. Primary active transport is defined as active transport that involves the use of chemical energy, such as adenosine triphosphate (ATP). Secondary active transport occurs when an electrochemical gradient is used.

      The sodium-potassium pump, calcium ATPase pump, and proton pump are all key active transport systems that use ATP. An electrochemical gradient is used by the sodium-calcium co-transporter, which is an example of secondary active transport.

      The sodium-dependent hexose transporter SGLUT-1 transports glucose and galactose into enterocytes. Secondary active transport is exemplified here.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      0
      Seconds

  • Question 24 - Which of the following globin chains makes up normal adult haemoglobin (HbA)? ...

    Incorrect

    • Which of the following globin chains makes up normal adult haemoglobin (HbA)?

      Your Answer:

      Correct Answer: Two alpha and two beta chains

      Explanation:

      Total adult haemoglobin comprises about 96 – 98 % of normal adult haemoglobin (HbA). It consists of two alpha (α) and two beta (β) globin chains.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 25 - A 45-year old man presented to the emergency room with complains of chest...

    Incorrect

    • A 45-year old man presented to the emergency room with complains of chest pain and breathlessness. Upon history taking and examination, it was discovered that he had a right-sided spontaneous pneumothorax and had a failed attempt at pleural aspiration. The pneumothorax is still considerable in size, but he remains breathless. A Seldinger chest drain was inserted but it started to drain frank blood shortly after.

      Which of the following complications is most likely to have occurred?

      Your Answer:

      Correct Answer: Intercostal artery laceration

      Explanation:

      Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions.

      Traditional anatomy teaching describes the ICA as lying in the intercostal groove, protected by the flange of the rib. This is the rationale behind the recommendation to insert needles just above the superior border of the rib. Current recommendations for chest drain insertion suggest that drains should be inserted in the ‘safe triangle’ in order to avoid the heart and the mediastinum and be above the level of the diaphragm.

      The safe triangle is formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla. Imaging guidance also aids in the safety of the procedure.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 26 - A six-year-old boy presents with coryzal symptoms that have persisted for more than...

    Incorrect

    • A six-year-old boy presents with coryzal symptoms that have persisted for more than two weeks. He was born and raised in the Middle East. His mother claims he has been tired and has complained of various 'aches and pains.' On examination, you find splenomegaly and enlarged cervical lymph nodes. His legs and arms are covered in petechiae.

      In this case, what is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute lymphoblastic leukaemia (ALL)

      Explanation:

      ALL is the most common leukaemia in children, with a peak incidence between the ages of 2 and 5.
      ALL has a wide range of clinical symptoms, but many children present with an acute illness that resembles coryza or a viral infection. ALL also has the following features:
      Weakness and sluggishness all over
      Muscle, joint, and bone pain that isn’t specific
      Anaemia
      Petechiae and unexplained bruising
      Oedema
      Lymphadenopathy
      Hepatosplenomegaly

      The following are typical features of a full blood count in patients with ALL:
      Anaemia (normocytic or macrocytic)
      Leukopenia affects about half of the patients (WCC 4 x 109/l).
      Around 25% of patients have leucocytosis (WCC > 10 x 109/l).
      Around 25% of patients have hyperleukocytosis (WCC > 50 x 109/l).
      Thrombocytopaenia

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 27 - Which of the following statements is correct regarding homeostasis? ...

    Incorrect

    • Which of the following statements is correct regarding homeostasis?

      Your Answer:

      Correct Answer: In negative feedback mechanisms, effectors always act to move the variable in the opposite direction to the change that was originally detected.

      Explanation:

      The vast majority of systems within the body work by negative feedback mechanisms. This negative feedback refers to the way that effectors act to move the variable in the opposite direction to the change that was originally detected. Because there is an inherent time delay between detecting a change in a variable and effecting a response, the negative feedback mechanisms cause oscillations in the variable they control. There is a narrow range of values within which a normal physiological function occurs and this is called the ‘set point’. The release of oxytocin in childbirth is an example of positive feedback.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 28 - A 35-year-old man suffered a severe road traffic accident and has been brought...

    Incorrect

    • A 35-year-old man suffered a severe road traffic accident and has been brought to the hospital. As part of his treatment, he requires a blood transfusion and experiences a transfusion reaction.

      The most common type of transfusion reaction is which of the following?

      Your Answer:

      Correct Answer: Febrile transfusion reaction

      Explanation:

      During or shortly after transfusion, febrile transfusion reactions, also known as non-haemolytic transfusion reactions, present with an unexpected temperature rise (38oC or 1oC above baseline, if baseline is 37oC). This is usually a one-off occurrence. The fever is sometimes accompanied by chills.

      The most common type of transfusion reaction is febrile transfusion reactions, which occur in about 1 in every 8 transfusions.

      The most common event leading to symptoms of febrile transfusion reactions is cytokine accumulation during storage of cellular components (especially platelet units). White cells secrete cytokines, and pre-storage leucodepletion has reduced this risk.

      Recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leukocyte antigen (HLA) or other antigens can also cause febrile transfusion reactions. Donor lymphocytes, granulocytes, and platelets all contain these antigens.

      Treatment is reassuring. Other causes should be ruled out, and antipyretics like paracetamol can help with fever relief. If another cause of fever is suspected, the transfusion should be stopped; however, if other causes of fever have been ruled out, it can be restarted at a slower rate.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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      Seconds

  • Question 29 - A young man develops an infection spread via aerosol transmission.

    Which of these organisms...

    Incorrect

    • A young man develops an infection spread via aerosol transmission.

      Which of these organisms is commonly spread by aerosol transmission?

      Your Answer:

      Correct Answer: Measles virus

      Explanation:

      Aerosols are airborne particles less than 5 µm in size, containing infective organisms that usually cause infection of the upper or lower respiratory tract.

      Examples of organisms commonly spread by aerosol transmission are:
      Measles virus
      Varicella zoster virus
      Mycobacterium tuberculosis

      The following table summarises the various routes of transmission with example organisms:
      Route of transmission
      Example organisms
      Aerosol (airborne particle < 5 µm)
      Mycobacterium tuberculosis
      Varicella zoster virus
      Measles virus

      Hepatitis A and Rotavirus are spread by the faeco-oral route.

      Neisseria gonorrhoea is spread by sexual route.

      Staphylococcus aureus is spread by direct contact.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
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      Seconds

  • Question 30 - Eosinophils comprise what percentage of circulating white cells: ...

    Incorrect

    • Eosinophils comprise what percentage of circulating white cells:

      Your Answer:

      Correct Answer: 1 - 3%

      Explanation:

      Eosinophils comprise 1 – 3% of circulating white cells. Eosinophils are similar to neutrophils, except that the cytoplasmic granules are coarser and more deeply red staining, and there are rarely more than three nuclear lobes. They are less motile, but longer lived. They enter inflammatory exudates and have a special role in allergic responses, defence against parasites and removal of fibrin formed during inflammation. Thus they play a role in local immunity and tissue repair.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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      Seconds

  • Question 31 - A 26-year-old woman is currently 9 weeks pregnant. Upon interview and history taking,...

    Incorrect

    • A 26-year-old woman is currently 9 weeks pregnant. Upon interview and history taking, she mentioned that she visited a friend whose child had just been diagnosed with slapped cheek disease.

      If the mother contracts an illness during pregnancy, which among the following is not known to cause fetal abnormalities?

      Your Answer:

      Correct Answer: Hepatitis A

      Explanation:

      Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.

      When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.

      TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)toxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.
      Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 32 - Which of the following is the most likely causative organism of acute epiglottitis...

    Incorrect

    • Which of the following is the most likely causative organism of acute epiglottitis in a 6 year old?

      Your Answer:

      Correct Answer: Streptococcus pneumoniae

      Explanation:

      Since the introduction of the HIB vaccine, most cases of acute epiglottitis are now caused by Streptococcus spp. The condition is now rare in children.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 33 - A 21 year old student presents to the emergency room with severe acute...

    Incorrect

    • A 21 year old student presents to the emergency room with severe acute asthma. Salbutamol and ipratropium bromide nebuliser are prescribed. The most appropriate dose of salbutamol that should be prescribed initially for this patient is which of the following?

      Your Answer:

      Correct Answer: 5 mg every 15 - 30 minutes

      Explanation:

      The first line treatment for acute asthma is high-dose inhaled short-acting beta2-agonists like salbutamol or terbutaline. Oxygen use should be reserved for hypoxemic patients in order to maintain oxygen saturations of 94 – 98%. In patients with moderate to severe asthma, a pressurised metered dose inhaler with spacer device is preferred (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). For patients with life-threatening features or poorly responsive severe asthma, the oxygen-driven nebuliser route is recommended (salbutamol 5 mg at 15 – 30 minute intervals). In patients with severe acute asthma that is poorly responsive to initial bolus dose, continuous nebulisation should be considered (salbutamol at 5 – 10 mg/hour). For those in whom inhaled therapy cannot be used reliably, the intravenous route is usually reserved.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 34 - A 45-year-old African American male presents to your clinic complaining of swelling of...

    Incorrect

    • A 45-year-old African American male presents to your clinic complaining of swelling of his feet for the past six months. On examination, there is periorbital and pedal oedema. A 24-hour urine collection is ordered, which shows 8 g of protein. The serum cholesterol is ten mmol/L. You order a renal biopsy to confirm the diagnosis.

      Which one of the following findings are you most likely to see in this patient's biopsy?

      Your Answer:

      Correct Answer: Focal segmental glomerulosclerosis

      Explanation:

      This patient has Nephrotic Syndrome confirmed by the presence of 1. Heavy proteinuria (greater than 3-3.5 g/24 hours)
      2. Hypoalbuminemia (serum albumin < 25 g/L)
      3. Generalised oedema (often with periorbital involvement)
      4. Severe hyperlipidaemia (total cholesterol is often > 10 mmol/L).

      Focal Segmental Glomerulosclerosis will be the most likely answer as it is the most common cause of Nephrotic Syndrome in African American adults.

      Minimal change disease is the most common cause of nephrotic syndrome in children.

      Membranous glomerulonephritis is the most common cause of Nephrotic Syndrome in Caucasian adults.

      In IgA nephropathy, patients will complain of cola-coloured urine.

      Mesangiocapillary glomerulonephritis presents with features of Nephritic Syndrome.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 35 - One of the benefits of wound healing through first intention is: ...

    Incorrect

    • One of the benefits of wound healing through first intention is:

      Your Answer:

      Correct Answer: Minimisation of scar tissue formation

      Explanation:

      Primary wound healing, or healing by first intention, occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents. Healing by first intention can occur when the wound edges are opposed, the wound is clean and uninfected and there is minimal loss of cells and tissue i.e. surgical incision wound. The wound margins are joined by fibrin deposition, which is subsequently replaced by collagen and covered by epidermal growth.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
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  • Question 36 - You examine a 48-year-old woman's blood results and notice that her glucose level...

    Incorrect

    • You examine a 48-year-old woman's blood results and notice that her glucose level is elevated. When you tell her about it, she tells you that her doctor recently ran some tests and discovered that she has impaired glucose tolerance.

      Which of the following medications has not been linked to a reduction in glucose tolerance?

      Your Answer:

      Correct Answer: Amlodipine

      Explanation:

      The following drugs have been linked to impaired glucose tolerance:
      Thiazide diuretics, e.g. Bendroflumethiazide
      Loop diuretics, e.g. furosemide
      Steroids, e.g. prednisolone
      Beta-blockers, e.g. atenolol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 37 - The correct statement about the glomerular filtration barrier is which of the following?...

    Incorrect

    • The correct statement about the glomerular filtration barrier is which of the following?

      Your Answer:

      Correct Answer: The basement membrane is negatively charged, restricting filtration of negatively charged molecules.

      Explanation:

      The main factor in determining whether a substance is filtered or not is molecular weight. Molecules < 7 kDa in molecular weight e.g. glucose, amino acids, urea, ions are filtered freely, but larger molecules are increasingly restricted up to 70 kDa, and there is very little filtration for anything above this.
      There is further restriction of negatively charged molecules because they are repelled by negative charges, particularly in the basement membrane. Albumin, which has a molecular weight of 69 kDa and is negatively charged, is filtered but only in very small amounts. All of the filtered albumin is reabsorbed in the proximal tubule. Small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. Other than the ultrafiltrate being essentially protein free, it has an otherwise identical composition of plasma. Bowman’s capsule consists of:
      – an epithelial lining which consists of a single layer of cells called podocytes
      – endothelium which is perforated by pores or fenestrations – this allows plasma components with a molecular weight of < 70 kDa to pass freely.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 38 - A 70-year-old patient diagnosed with Cushing's syndrome and has a history of weight...

    Incorrect

    • A 70-year-old patient diagnosed with Cushing's syndrome and has a history of weight gain, hypertension, and easy bruising.

      Which of these assertions about Cushing's syndrome is correct?

      Your Answer:

      Correct Answer: Diagnosis can be confirmed by a dexamethasone suppression test

      Explanation:

      Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids.

      Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome. Cushing’s illness is the second most prevalent cause of Cushing’s syndrome. Cushing’s disease is distinct from Cushing’s syndrome in that it refers to a single cause of the illness, a pituitary adenoma that secretes high quantities of ACTH, which raises cortisol levels.

      Because cortisol enhances the vasoconstrictive impact of endogenous adrenaline, patients with Cushing’s syndrome are usually hypertensive.

      Hyperglycaemia (due to insulin resistance) rather than hypoglycaemia is a common symptom.
      Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep. The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.

      A dexamethasone suppression test or a 24-hour urine free cortisol collection can both be used to establish the existence of Cushing’s syndrome.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 39 - The most important nerves for inversion of the foot are: ...

    Incorrect

    • The most important nerves for inversion of the foot are:

      Your Answer:

      Correct Answer: Tibial and deep fibular nerve

      Explanation:

      Inversion of the foot is achieved by the tibialis anterior which is innervated by the deep fibular nerves, and the tibialis posterior muscles which is innervated by the tibial nerve respectively.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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  • Question 40 - Which of the following corticosteroids has the most potent mineralocorticoid effect: ...

    Incorrect

    • Which of the following corticosteroids has the most potent mineralocorticoid effect:

      Your Answer:

      Correct Answer: Fludrocortisone

      Explanation:

      Fludrocortisone has the most potent mineralocorticosteroid activity, making it ideal for mineralocorticoid replacement in adrenal insufficiency.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
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  • Question 41 - Gastrin release from antral G-cells is stimulated by all but which one of...

    Incorrect

    • Gastrin release from antral G-cells is stimulated by all but which one of the following:

      Your Answer:

      Correct Answer: Secretin

      Explanation:

      Gastrin secretion is stimulated by:
      The presence of small peptides and amino acids in chyme
      Gastric distension
      Vagal stimulation directly via acetylcholine and indirectly via gastrin-releasing peptide (GRP)
      Raised gastric pH

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 42 - Which of the following is a contraindication to using nitrous oxide: ...

    Incorrect

    • Which of the following is a contraindication to using nitrous oxide:

      Your Answer:

      Correct Answer: Raised intracranial pressure

      Explanation:

      Nitrous oxide should not be utilized in patients with an air-containing confined area because it diffuses into these spaces, causing a rise in pressure. This includes circumstances like pneumothorax, intracranial air after a head injury, imprisoned air from a recent undersea dive, a recent intraocular gas injection, or intestinal blockage. Nitrous oxide increases cerebral blood flow and should be avoided in individuals who have or are at risk of having high intracranial pressure.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 43 - Which of the following is NOT a common side effect of amiodarone: ...

    Incorrect

    • Which of the following is NOT a common side effect of amiodarone:

      Your Answer:

      Correct Answer: Blue/green teeth discolouration

      Explanation:

      Common side effects of amiodarone include: Bradycardia, Nausea and vomiting, Thyroid disorders – hypothyroidism and hyperthyroidism, Persistent slate grey skin discoloration, Photosensitivity, Pulmonary toxicity (including pneumonitis and fibrosis), Hepatotoxicity, Corneal microdeposits (sometimes with night glare), Peripheral neuropathy and Sleep disorders.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 44 - You see a patient in the Emergency Department with features consistent with a...

    Incorrect

    • You see a patient in the Emergency Department with features consistent with a diagnosis of type I diabetes mellitus.

      Which of these is MOST suggestive of type I diabetes mellitus?

      Your Answer:

      Correct Answer: History of recent weight loss

      Explanation:

      A history of recent weight loss is very suggestive of an absolute deficiency of insulin seen in type I diabetes mellitus.

      An age of onset of less than 20 years makes a diagnosis of type I diabetes mellitus more likely. However, an increasing number of obese children and young people are being diagnosed with type II diabetes.

      Microalbuminuria, peripheral neuropathy, and retinopathy all occur in both type I and type II diabetes mellitus. They are not more suggestive of type I DM.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 45 - Cystic fibrosis patients have a weakened lung surfactant system. Which of the following...

    Incorrect

    • Cystic fibrosis patients have a weakened lung surfactant system. Which of the following cell types is in charge of surfactant secretion?

      Your Answer:

      Correct Answer: Type II pneumocytes

      Explanation:

      Alveolar type II cells are responsible for four primary functions: surfactant synthesis and secretion, xenobiotic metabolism, water transepithelial transport, and alveolar epithelium regeneration following lung injury.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 46 - Which of the following pathogens is the common cause of diarrhoea in a...

    Incorrect

    • Which of the following pathogens is the common cause of diarrhoea in a patient who has had a prolonged course of a broad spectrum of antibiotics?

      Your Answer:

      Correct Answer: Clostridium difficile

      Explanation:

      Clostridium difficile is the most likely cause of diarrhoea after a long course of broad-spectrum antibiotic treatment.

      Clostridium difficile-associated diarrhoea appeared to be linked to an increase in the usage of third-generation cephalosporins.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 47 - EMLA cream is a topical local anaesthetic containing which of the following: ...

    Incorrect

    • EMLA cream is a topical local anaesthetic containing which of the following:

      Your Answer:

      Correct Answer: 50/50 mixture 2.5% lidocaine and 2.5% prilocaine

      Explanation:

      EMLA cream, an effective topical local anaesthetic, is a 50/50 mixture of 2.5% prilocaine and 2.5% lidocaine.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 48 - Regarding skeletal muscle, which of the following best describes the Z-line: ...

    Incorrect

    • Regarding skeletal muscle, which of the following best describes the Z-line:

      Your Answer:

      Correct Answer: A line dividing muscle fibres into sarcomeres

      Explanation:

      Each muscle fibre is divided at regular intervals along its length into sarcomeres separated by Z-lines. The sarcomere is the functional unit of the muscle.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 49 - Thyroid cancer has spread to the regional lymph nodes of a patient as...

    Incorrect

    • Thyroid cancer has spread to the regional lymph nodes of a patient as seen in a staging CT scan.

      The lymph from the thyroid gland will drain directly to which of the following nodes?

      Your Answer:

      Correct Answer: Deep lateral cervical lymph nodes

      Explanation:

      Lymphatic drainage of the thyroid gland involves the lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes. The paratracheal and lower deep cervical nodes, specifically, receive lymphatic drainage from the isthmus and the inferior lateral lobes. The superior portions of the thyroid gland drain into the superior pretracheal and cervical nodes.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 50 - A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment....

    Incorrect

    • A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs.

      Which one is a nucleic acid synthesis inhibitor?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.
      The following is a summary of the many modes of action of various types of antimicrobial agents:

      Action Mechanisms- Examples:

      Cell wall production is inhibited
      Vancomycin
      Vancomycin
      Cephalosporins

      The function of the cell membrane is disrupted
      Nystatin
      Polymyxins
      Amphotericin B 

      Inhibition of protein synthesis
      Chloramphenicol
      Macrolides
      Aminoglycosides
      Tetracyclines

      Nucleic acid synthesis inhibition
      Quinolones
      Trimethoprim
      Rifampicin
      5-nitroimidazoles
      Sulphonamides
      Anti-metabolic activity
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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