ABSTRACT
Purkinje fibres c. They are prevented from reaching the ventricles by the annulus
femoralis d. The process is modulated by the autonomic nervous system
15. Sensory nerve supply of the face a. The sensory information from the face is transmitted via the
trigeminal nerve b. The maxillary division of the trigeminal nerve has four cutaneous
branches c. The skin over the nose is supplied solely by the maxillary division
of the trigeminal nerve d. Lesions on the tip of the nose in shingles suggest ocular
involvement
16. Glucagon a. This acts as a positive inotrope b. It is released from b cells in the pancreas c. It increases the production of free fatty acids d. It increases glycogen synthesis
17. The enteric nervous system a. The submucous plexus innervates the smooth muscle layers
of the gut b. The myenteric plexus is responsible for control of secretions c. Peristalsis requires input from the autonomic nervous system d. Vagal stimulation results in gastrin secretion
18. Accelerated (malignant) or very severe hypertension a. This requires immediate intravenous therapy b. A b blocker such as atenolol would be an appropriate first agent c. It may cause blindness if blood pressure is reduced too quickly d. It is associated with a previous history of myocardial infarction
19. The following are RNA viruses a. Chlamydia b. CMV c. Measles d. Rubella
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20. a. Polycythaemia vera is a malignant marrow stem cell disorder b. Renal carcinoma may be the sole cause c. It may be associated with smoking d. The condition may present with epistaxis or bleeding gums
21. Lidocaine a. This has a duration of action of approximately 2 hours after
intravenous injection b. It is not useful orally as it is largely inactivated by first-pass
hepatic metabolism c. It is the drug of choice to treat ventricular arrhythmias after
myocardial infarction d. It works by blocking inactivated Kþ channels
22. Lung compliance a. This is defined as the change in flow rate per unit change in
pressure b. It is increased in emphysema c. It depends on lung volume d. It is increased in early pulmonary oedema
23. The large intestine a. The psoas muscle is closely related to the caecum b. It is supplied by the inferior mesenteric artery from the distal third
of the transverse colon c. It receives its sympathetic supply from T10-L2 d. McBurney’s point is one-third of the way along the oblique line
joining the umbilicus and the right anteroinferior iliac spine
24. b-Adrenergic receptors a. These may be excitatory or inhibitory b. They are of two main types:
1. Type 1, which are located in the heart and airways 2. Type 2, which are located in the peripheral vasculature
c. When stimulated they cause a release of intracellular cyclic AMP via activation of adenylyl cyclase
d. They may be blocked by drugs that are used in the treatment of asthma
25. Compartments of the hand a. There are five compartments in the hand b. There are two potential spaces in the hand c. The compartments prevent the spread of infection from the hand
to the forearm d. The fibrous lateral septum divides the central and thenar
compartment and runs from the lateral border of the palmar aponeurosis to the second metacarpal
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26. a. Adrenaline (epinephrine) is secreted from the adrenal medulla b. The adrenal cortex produces corticosteroids from cholesterol c. Aldosterone is produced from the innermost layer of the adrenal
cortex d. Cortisol is produced from the outermost layer of the adrenal gland
27. Regarding the cavernous sinus a. Cranial nerves III (oculomotor), IV (trochlear) and VI (abducens)
pass through the cavernous sinus b. The internal carotid artery passes through the sinus c. The sinus receives venous drainage from the face d. Thrombophlebitis can result in meningitis
28. The following antibiotics are used in the treatment of communityacquired pneumonia a. Cefotaxime b. Ciprofloxacin c. Amoxicillin d. Erythromycin
29. In paroxysmal nocturnal haemoglobinuria (PNH) a. A urine specimen taken at 07:00 will be light in colour b. Red cells are extremely sensitive to immunoglobulin, resulting in
intravascular haemolysis and haemoglobinuria c. PNH may present with Budd-Chiari syndrome d. Stem cell transplantation may be curative
30. Insulin a. It increases amino acid uptake in skeletal muscle b. It increases protein catabolism c. It reduces hunger d. It decreases lipolysis
31. The urinary tract a. The right kidney usually lies slightly inferior to the left kidney b. Renal pathology may result in hip joint pain c. Fractures of the bony pelvis, especially those resulting from
separation of the pubic symphysis and puboprostatic ligaments, usually rupture the intermediate part of the urethra
d. Straddle injuries most commonly rupture the spongy urethra
32. Helicobacter pylori a. Infection is nearly always symptomatic b. H. pylori secretes urease c. It attaches to mucus via a flagellum d. It is associated with an increased risk of stomach cancer
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33. When a. The neutrophil count may be increased as a result of trauma b. The neutrophil count may be decreased in vitamin B12 deficiency c. Fungal infections can result in a raised lymphocyte count d. A raised eosinophil count is pathognomonic of anaphylaxis
34. The following are the results of a trial of the diagnostic test ‘Procalysis’ in the diagnosis of ischaemic heart disease
Ischaemic heart disease
Procalysis Present Absent
Positive 200 50 Negative 300 150
a. There were 50 true positives b. The number of false negatives is fewer than the number of false
positives c. The number of people with the disease in this trial was 250 d. The specificity of Procalysis to detect ischaemic heart disease is
50% (150/300)
35. The following drugs may cause bradycardia a. Amitriptyline b. Sotalol c. Clonidine d. Digoxin
36. Diabetes insipidus a. This may occur after a head injury b. Most patients will have polyuria and polydipsia c. The plasma osmolarity will be low d. It may be secondary to lithium therapy
37. Multiple myeloma a. This is a T-cell malignancy b. Hypercalcaemia is common c. The ESR is moderately raised d. Lytic lesions are commonly seen on radiograph
38. In the treatment of diabetes mellitus a. Metformin may cause a normal anion gap acidosis b. Metformin rarely causes hypoglycaemia c. Sulphonylureas require some functioning b cells to be effective d. Metformin requires some functioning b cells to be effective
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39. a. The causative wound/injury is always obvious b. Intravenous drug users are a high-risk group c. A surgical airway is often needed if the patient suffers a cardiac
arrest d. Once affected, a patient will have life-long immunity
40. Collagen a. This is synthesised by fibroclasts b. It provides strength to tendons c. Osteogenesis imperfecta results from defective type IV collagen d. It requires vitamin C for its synthesis
41. Regarding the nerve supply to the lower limb a. Damage to the femoral nerve results in anaesthesia to the
posterior thigh b. Compression of the sciatic nerve causes weakness of knee flexion c. The tibial nerve is commonly injured in fractures of proximal
fibula d. Superficial peroneal nerve injury results in sensory loss to the first
toe web space
42. Sodium bicarbonate a. 50 mL of 8.4% solution contains 50 mmol bicarbonate b. This can be given combined with calcium chloride in the treat-
ment of hyperkalaemia c. It may exacerbate intracellular acidosis d. It may be useful in the treatment of b-blocker overdose
43. Aortic dissection a. This is associated with Marfan’s syndrome b. It is associated with heroin use c. It may present with a hemiplegia and mimic a stroke d. Most patients are hypertensive at presentation
44. The concomitant use of which of these medications will increase bleeding risk in patients on warfarin? a. Metronidazole b. Paracetamol c. Fluoxetine d. Aspirin
45. In a normal distribution a. The mean is the same as the mode b. The mean is higher than the median c. 95% of observations lie within 1 standard deviation of the mean d. The Mann-Whitney test is suitable for analysis
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46. Knee joint a. The menisci are attached to the collateral ligaments b. The popliteus muscle locks the knee joint c. The anterior cruciate ligament runs from the anterior aspect of the
tibial plateau to the medial aspect of the medial femoral condyle d. The knee has six bursae, two of which communicate with the joint
capsule
47. The following results are given for a patient in the emergency department (ED)
pH 7.28 PaO2 9.5 kPa (71 mmHg) PaCO2 7.5 kPa (56 mmHg) HCO3
2 36.0 mmol/L BE 23.8 Lactate 2.4 mmol/L
Which of the following statements is/are likely to be true? a. The patient has a metabolic acidosis b. The patient may have a reduced GCS c. There is no evidence of acid-base compensation d. The patient should be given high-flow oxygen
48. Immune system a. Macrophages are circulating polymorphonuclear cells b. Complement acts as an opsonin c. Dendritic cells and natural killer cells form part of the innate
immune system d. B cells are the predominant lymphocytes
49. Staphylococcus aureus a. This is a Gram-positive coccus b. Food poisoning occurs approximately 48 hours after its ingestion c. It is coagulase negative d. It colonises the noses of up to 25% of healthy individuals
50. Catecholamines a. Noradrenaline (norepinephrine) causes vasoconstriction via
b1-receptors b. Adrenaline (epinephrine) dilates blood vessels in skeletal muscle c. b2-Receptor stimulation increases heart rate and contractility d. Noradrenaline is the principal hormone secreted from the adrenal
medulla
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1a. T 1b. T 1c. F 1d. T Hypokalaemia results from either depletion/loss of potassium, secondary to intracellular shifts of potassium. Potassium moves into cells under the influence of insulin and b2-adrenergic agonists such as adrenaline (epinephrine) and salbutamol.
