IRAT Questions Flashcards
- A DVT (deep venous thrombosis) originating in the posterior tibial vein has extended to the level of the inguinal ligament. Further proximal progression will extend the thrombus into which vein next?
- Common iliac vein
- Deep femoral vein (deep vein of the thigh/profunda femoris)
- External iliac vein
- Femoral vein
- Great saphenous vein
C - External iliac
- A patient presents with pain on active flexion of the hip. Which muscle is the most likely source of the pain?
- Biceps femoris
- Gluteus medius
- Gluteus Maximus
- Iliopsoas
- Sartorius
D - Iliopsoas
- A patient presents with anaesthesia in the first web space only. Which part of the nervous system is most likely to be functioning abnormally?
- Deep fibular nerve
- Internal capsule of brain
- L5 posterior nerve root
- Superficial fibular nerve
- Tibial nerve
A - Deep fibular
- A patient presents with muscular back pain, localised immediately to the left of the midline at the level of the iliac crest and worst on active extension & lateral flexion of the spine (vertebral column). Which muscle is the most likely source of the pain?
- Erector spinae
- External oblique
- Gluteus Maximus
- Inferior (ascending) part of trapezius
- Latissimus dorsi
A - Erector spinae
- Which of these structures would be transected as a consequence of a standard laminectomy procedure?
- Anterior longitudinal ligament
- Posterior longitudinal ligament
- Ligamentum flavum
- Annulus fibrosus
- Dura mater
C - ligamentum flavum
- The “ankle jerk” (calcaneal tendon) reflex specifically tests which named nerve/spinal nerve roots?
- Common fibular nerve/L5
- Deep fibular nerve/L5
- Saphenous nerve/L3, 4
- Lateral Plantar nerve/S1, 2
- Tibial nerve/S1, 2
E - tibial
- Dave, age 24, sustains an inversion injury to his right ankle after stumbling off a kerb. Which injury is most likely?
- Rupture of extensor halluces longus (long extensor of the great toe)
- Tear of deltoid ligament
- Avulsion fracture of the base of the 5th metatarsal
- Avulsion fracture of the navicular
- Achilles tendon rupture
C - avulsion of 5th metatarsal
- Angela has had severe left sciatica for 4weeks. Which one of these signs is likely?
- Reduced/absent knee jerk
- Decreased power of hip flexion
- Impaired sensation on the medial side of the left knee
- Decreased power of plantar-flexion
- Decreased power of knee extension
D - decreased power of plantar flexion
- Andy is struggling with calf claudication after walking 100m. You check his peripheral pulses- where would you expect to find the dorsalis pedis pulse? (Dorsal artery of the foot)
- Lateral to extensor (halluces longus) tendon of great (big) toe
- Inferior to medial malleolus
- Posterior to lateral malleolus.
- Medial to extensor (halluces longus) tendon of great (big) toe
- Between 3rd & 4th metatarsals on dorsum of foot
A - lateral to extensor hallicus longus
- Which one of these would be a cause of left foot drop?
a. Fracture of the left neck of the fibula
b. Fractured left neck of femur
c. Stroke affecting the left internal capsule of the brain
d. Left femoral nerve compression
e. Ruptured left Achilles tendon
A - fracture of left neck of fibula
Which of the following statements is true?
A. Renal excretion of sodium is a key mechanism by which the kidneys regulate blood volume.
B. Pseudohyponatraemia is a common cause of abnormally low sodium concentrations.
C. Measurement of urinary sodium has no place in the evaluation of hyponatraemia.
D. Hyponatraemia due to water retention e.g. syndrome of inappropriate ADH (SIADH) secretion is usually associated with clinical evidence of water overload, e.g. oedema.
E. Oedema is always associated with an expanded circulating blood volume.
A
Which of the following statements is true?
A. The sodium loss seen in Addison’s disease is always associated with hyponatraemia.
B. SIADH in association with lung cancer is always due to ectopic secretion of ADH by the tumour.
C. Non-osmotic stimuli and osmotic stimuli (hypernatraemia) cause similar increases in ADH.
D. ADH acts only on the kidneys.
E. DDAVP, the synthetic analogue of AVP (ADH), is used to distinguish between central and nephrogenic diabetes insipidus.
E
Which of the following statements is true?
A. ‘Mineralocorticoid activity’ refers to exchange of Na+ for any cation, e.g. K+, H+,Ca++, Mg++.
B. Random cortisol measurements have no place in the investigation of the hypothalamic-pituitary-adrenal (HPA) axis.
C. Patients with adrenal insufficiency are less able to retain infused saline (sodium) than normal subjects.
D. Palmar pigmentation is a feature of secondary adrenal insufficiency.
E. In patients with suppression of the HPA axis by long-term prescription of prednisolone, 1 mg daily reliably provides adequate steroid replacement, i.e. the patient is getting enough exogenous steroid to cover any insufficiency of
endogenous steroid production.
C
Which of the following statements is true?
A. Replacement steroids e.g hydrocortisone do not interfere with the cortisol assay and therefore do not need to be withheld if cortisol is being measured.
B. Failure of the adrenals to respond to synacthen in a short synacthen test unequivocally indicates primary adrenal insufficiency.
C. Measurement of ACTH may be used to distinguish primary and secondary adrenal insufficiency.
D. In intensive therapy unit (ITU) patients, synacthen tests are most often done to diagnose primary adrenal insufficiency.
E. ‘Adrenal insufficiency’ refers specifically to the adrenal cortex; the adrenal medulla is preserved.
C
Which of the following statements is true?
A. Patients with malignancy-associated hypercalcaemia have high circulating concentrations of PTH.
B. Long-term immobilisation (e.g. bed-bound patients) is a common cause of hypercalcaemia.
C. Secondary hyperparathyroidism results from pituitary stimulation of the parathyroid glands, whereas primary hyperparathyroidism originates within the parathyroid glands themselves.
D. PTH is stable for up to three days and can be added retrospectively within this timeframe.
E. Primary hyperparathyroidism is diagnosed much earlier than in the past because of hypercalcaemia; as a result, radiological changes like osteitis fibrosa cystica are rarely seen any more.
E
Which of the following statements is true?
A. Rehydration is always instituted early in the management of severe hypercalcaemia. This is because hypercalcaemia interferes with proximal tubular reabsorption of sodium and so causes loss of sodium and water – patients are
usually dehydrated.
B. Most patients in intensive therapy units (ITU) have a low adjusted total calcium concentration.
C. Following removal of a parathyroid adenoma, the remaining parathyroid glands adjust immediately to the new calcium concentration.
D. Widespread bony metastases are almost invariably associated with severe hypercalcaemia.
E. The finding of low vitamin D levels should routinely prompt prescription of vitamin D supplements.
A
Which of the following statements is true?
A. Separated plasma and serum give similar potassium results in patients with clotting disorders.
B. Some GP surgeries store blood samples in the fridge overnight. This is associated with artefactually low potassium results.
C. Benchtop centrifuges are rarely used in rural general practice surgeries to minimize the problem of pseudohyperkalaemia.
D. In the laboratory, haemolysis is detected by visual inspection of separated samples.
E. Once haemolysis and renal failure have been excluded, antihypertensive drugs e.g. spironolactone, are the most likely cause of hyperkalaemia.
E
Which of the following statements is true?
A. Renal failure is likely in rhabdomyolysis when the CK exceeds 500 U/L.
B. The finding of gross hyperkalaemia and hypocalcaemia suggests contamination with potassium EDTA, the anticoagulant used in the FBC (‘purple-top’) bottle.
C. Potassium salts of intravenous drugs are the commonest cause of hyperkalaemia in hospital patients.
D. In treatment of DKA, potassium should not be given if the [K+] is normal.
E. Tented/peaked T waves are the only ECG abnormality seen in severe
B
Q1: The immune system is commonly divided into“innate”versus“adaptive” immunity. Which of the following statements correctly describes aspects of this category?
A) CD4+helperT-cellsarethecentralhubofinnateimmunity.
B) Phagocytes such as macrophages cannot attack microbes without first undergoing clonal expansion of the ‘right’ clone fitting a specific microbe
C) Deficiency ininnate immunity wouldn’t be expected to cause clinical problems as long as adaptive immunity remains
intact.
D) NK cells represent a part of innate immunity because they don’t require prior learning to know which cells to kill.
E) Innate immunity is a key feature required for vaccination
D
Q2: Which of the following statements correctly describes the complement system?
A)The main feature of the complement system is to facilitate interaction between B- and T-lymphocytes.
B)The so-called ‘lectin’ pathway allows bacteria to be better eliminated by coating sugars on their surface through binding proteins such as MBL
C)The so-called ‘alternative pathway’ exists as a last-ditch reserve in case the ‘classical pathway’ is exhausted
D)Inborn deficiency in complement proteins would not be expected to cause hyper-active immunity leading to autoimmune disease
E) Liver cirrhosis predisposes to pneumococcal infection because hepatic macrophages eliminate complement-opsonized streptococci.
B
Q3: One of the central aspects of immunity is constant surveillance to detect enemies on home territory. Which of the following statement captures some of this best?
A) Lymph nodes and the spleen are clearing zones where a foreign material presented by dendritic cells can result in rapid generation of lymphocytes highly selective for the microbe bearing that material.
B) Toll-like receptors enable phagocytes exclusively to recognise viral intruders.
C) NK-cells can detect virus-infected host cells because viruses usually up-regulate the expression of MHC-molecules.
D) Antigen recognition is primarily achieved through innate immunity while adaptive immunity only improves the overall immune response.
E) In order to proliferate, T-cells don’t require cytokines such as interleukin 2 as long as they are stimulated with antigenic material.
A
Q4: Which of the following statements correctly describes aspects of vaccination?
A) The schedule of the so-called “5-in-1” DPT/Polio/Hib vaccine (given at 3 months, 4 months, 3 years (DPT+polio), 13-18 years) is primarily done because it contains several different antigens.
B) If you’ve had the MMR shot within the last four weeks, you should stay away from pregnant women or babies.
C) A 20 year-old male student is in doubt whether he had all the required MMR vaccinations. Finding his immunization record is critical because an extra MMR shot (if he had been vaccinated) would be risky.
D) Vaccination of HIV patients produces the same results as in healthy patients because only T-helper cells, but not B-lymphocytes, are reduced in HIV.
E) The formation of memory B cells accounts for the rapid production of IgG at re- exposure to a microbe after vaccination.
E
Q5: Deficiency of different aspects of immunity has various clinical consequences. Which of the following statements correctly describes immune-deficiency correlations?
A) Common variable immune-deficiency(CVID)would mostly present with recurrent shingles.
B) Selective IgA deficiency commonly presents with gastrointestinal infections.
C) The infections sustained in Severe Combined Immunodeficiency can resemble that of advanced stage HIV because CD4 T-helper cells are massively reduced in both conditions.
D) Shingles is a commonly encountered problem in the elderly because Herpes virus is more readily spread in advanced age.
E) Measuring serum Ig levels makes no sense in a teenager with a history of recurrent upper respiratory and G.I. infections.
C
Q6: Which of the following statements is true concerning granulomatous infections?
A) Demonstration of granuloma by biopsy is proof of an infectious disease.
B) Granulomas are formed as a protective encasement by the interplay of Interferon-gamma secreting T-lymphocytes and Interleukin-12 secreting macrophages.
C) Biologicdrugstargetinginterleukin-12(e.g.ustekinumab) pose a risk for TB as opposed to biologic drugs targeting TNF alpha.
D) If a middle-aged person is found to have granulomas in the lung by CXR, he/she very likely has acquired a fresh TB infection.
E) So-called type 1 Interferons (IFN alpha/ IFN beta) are the main cytokine responsible for formation of functional granulomas.
B
Q7: Drugs can modulate the immune system therapeutically. Which of the following statements correctly describes aspects of that?
A) Anti-TNFdrugsareoftenreferredtoas“biological”becausetheycanalsobe made by the body.
B) Biologicals such as anti-TNF(e.g. Etanercept, Adalimumab)represent a form of passive immunisation.
C) Immune-stimulatorytreatmentsactingthroughToll-likereceptors,suchas imiquimod, trigger a non-specific inflammation in response to specific pathogens.
D) Drugs given to suppress transplant rejection, such as rapamycin or cyclosporine, act mainly on the innate immune system.
E) Immunoglobulins are administered in Ig-deficient states, such as CVID or leukemia, but not in hyperactive immune dysfunction such as pemphigus, dermatomyositis, or Guillain Barre syndrome.
B
