SMWF SBA

Question 1

1) Toby is a 29 year old male who presents to A&E complaining of fever, dyspnoea, and haemoptysis. You also note large oedematous buildup in his legs. You recognise him as a known IV drug user and take a blood culture. What result would you expect to see?
0/1
A) Gram positive, catalase positive, coagulase positive gold colonies on blood agar.
B) Gram negative, non-lactose fermentation, oxidase positive on MacConkey agar.
C) Gram positive, catalase positive, coagulase positive white colonies on blood agar.
D) Gram positive, catalase negative, alpha-haemolysing, optochin resistant colonies.
E) Gram positive creamy colonies on sabourard agar

Answer 1

A) Gram positive, catalase positive, coagulase positive gold colonies on blood agar.
A) Gram positive, catalase positive, coagulase positive gold colonies on blood agar. - correct answer
Toby has used drugs intravenously, which has allowed bacteria to enter into the bloodstream and form colonies in the heart - in this case on the tricuspid valve, which has become big enough to break off, get stuck in the blood vessels in the lungs, and become a pulmonary embolism resulting in dyspnoea, fever and haemoptysis. The oedema has been caused by the bacteria from needles causing fluid buildup in the legs.

Question 2

2) Max, a 25 year old man, comes in complaining of night sweats, weight loss and fever. He has recently come back from working with a charity providing care for those in need in Vadu Chennai in India, and has been complaining of haemoptysis ever since. You suspect tuberculosis and begin your investigations - which of the following results would you not expect to see?
0/1
A) A positive result from an interferon-gamma release assay.
B) A mantoux test showing 2mm of induration.
C) Mycobacterium growth on a Löwenstein-Jensen medium
D) Ziehl-Neelsen staining, showing red mycobacterium on a blue background.
E) Auramine Phenol staining with fluoresence microscopy showing a greenish-yellow fluorescence.

Answer 2

B) A mantoux test showing 2mm of induration
) This would be a negative result. The mantoux test injects tuberculin in the body and sees how much of a reaction there is. If there’s a really big bump, then TB has been inside before. Here are the cut-offs:
0-4mm: Generally negative

Question 3

7) Which of the following is a major risk factor for lynch syndrome?
0/1
A) MSH-1 or 2 gene mutation
B) APC gene mutation
C) CDH-1 (Cadherin) gene mutation
D) HLA-B27 gene mutation
E) NOD-2 mutation

Answer 3

A) MSH-1 or 2 gene mutation
Risk factor for Lynch syndrome AKA Hereditary non-polyposis colon cancer

Question 4

12) Which of the following is not a mechanism of action for antibiotics?
0/1
A) Inhibiting cephalosporin synthesis
B) Inhibiting macrolide synthesis
C) Binding to RNA polymerase
D) Inhibiting folate synthesis
E) Inhibiting ergosterol synthesis

Answer 4

E) Inhibiting ergosterol synthesis
A is an example of inhibiting cell wall synthesis. B is an example of inhibiting protein synthesis. C and D are examples of inhibiting nucleic acid synthesis. E is an example of the mechanism of action for an antifungal

Question 5

15) Arun, a 76 year old man, presents with polyuria and polydipsia. The doctor enquiries more, they find out that he’s been feeling quite anxious and has bad pain in his bones. The doctor gets some bloods done and the results show:
What is the most likely underlying diagnosis?

CA2+- LOW CALCIUM
PTH- HIGH
A) Primary Hyperparathyroidism

B) Diabetes Mellitus
C) Diabetes Insipidus
D) Multiple Myeloma
E) Secondary Hyperparathyroidism

Answer 5

E) Secondary Hyperparathyroidism
PTH Calcium Phosphate ALP
Primary High High Low High
Secondary High Normal/Low Normal/Low High
Tertiary High High High High

Question 6

20) Harry, a 30 year old chef, comes in complaining about pain in his back. He has been experiencing it for more than a week and it has gotten worse. You enquire a bit more and Harry tells you that when he went to the shops to buy soy sauce, he felt some pain in his eyes and fingers. You run some tests and on X-ray, you see a ‘bamboo spine’

What would you also see on X-ray?
0/1
A) Subchondral cysts
B) Hairline Fracure
C) Subcutaneous emphysema
D) Osteophytes
E) Sacroilitis

Answer 6

E- SACROLITIS

Patient has Ankylosing Spondylitis, an inflammatory condition affecting the spine, causing progressive stiffness and pain.
Associated symptoms include Anterior uveitis, enthesitis, dactylitis.
On X-ray you see Bamboo spine, sacroiliitis, square vertebral bodies and syndesmophytes (Fusion of vertebral bodies)

Question 7

26) Aidan, an attractive hunk of a man who has sickle cell disease comes in complaining of a painful right wrist for the past week and fever for the past 3 days. The wrist was erythematous, shiny and swollen and painful to palpation and movement. Routine bloods were done showing:
WBC = 15.1 (4.5-11x10^9)
CRP = 40 ( < 0.4mg/dL)
Biopsy was taken from the site of bone.
He has had no recent illness, fractures or open wounds.
Which micro-organism is most likely to be cultured:
0/1
A) Staphylococcus Aureus
B) Pseudomonas
C) E.Coli
D) Salmonella
E) Staphylococcus Epidermidis

Answer 7

D) Salmonella
A) Incorrect- Staphylococcus Aureus is most common in most situations*
B) Incorrect- Pseudomonas is most common with IVDU along with E.coli
C) Incorrect- see above
D) Correct- Salmonella osteomyelitis is most common in patients with sickle cell disease
E) Staphylococcus Epidermidis- most common with new joint prosthesis’

Question 8

27) What are the layers of a gram negative cell wall from inside to out?
0/1
A) Plasma membrane > Peptidoglycan > Capsule
B) Peptidoglycan > Plasma membrane > Capsule
C) Inner membrane > Peptidoglycan > Outer membrane > LPS > Capsule
D) Inner membrane > Peptidoglycan > LPS > Outer membrane > Capsule
E) Peptidoglycan > Inner membrane > LPS > Outer membrane > Capsule

Answer 8

Correct answer
C) Inner membrane > Peptidoglycan > Outer membrane > LPS > Capsule

A) Incorrect- plasma membrane > peptidoglycan > capsule is a gram +ve cell wall
B) Incorrect
C) Correct- Inner membrane > Peptidoglycan > Outer membrane > LPS is gram -ve
D) Incorrect
E) Incorrect

Known your bacteria cell walls!, also good to know endotoxin (basically LPS) vs exotoxin(produced in cell), is easy to confuse but is relative to the human body, not the cell

Question 9

29) You, a hungover 2nd year are thinking about the dodgy oasis pizza you ate last night at 5am combined with the numerous orange VKs you put in your body. You then stop day dreaming and look up to the lecturer talking about pilocarpine and think to yourself, ahh i can ignore this, it wont come up.
Which receptor does Pilocarpine act on?
0/1
A) M1
B) M2
C) M3
D) α1
E) β2

Answer 9

Correct answer
C) M3
A) Incorrect- google drugs if you want- didn’t know any when we googled and didnt want to confuse you
B) Incorrect- Atropine M2 but also acts on all 1-5- is general antimuscarinic, M2 is on heart and atropine is given in bradycardic rhythms- quite a fun drug i think- stops all parasympathetic input and only allows inotropic/chronotropic sympathetic signals making heart go quick again.
C) Correct- Pilocarpine- M3 agonist found on Iris sphincter muscle to contract- improves aqueous humour drainage- good for closed angle glaucomas.
D) Incorrect- Tamsulosin-α1 antagonist- look at BPH if you dont recognise this drug name!
E) Incorrect- SABA β2 agonist - look at asthma if you dont recognise this one!- can also be used in hyperkalemia- shifts potassium out of blood into cells- bit like insulin/dextrose which does the same.

This question is hard and mean and very inspired. Learn your muscarinic/adrenergic and sympathetic/parasympathetic pathways, receptors and physiological effects they have- its not too overwhelming if you just start simple e.g rest & digest, fight and flight, then build from there. Good lecture on it if i remember correctly.

Question 10

30) Sagar, a lazy question maker, is with you in a clinical setting or something of the like. He is 60 years old and recalls having a few heart attacks in the past, he says to you he has some heart blocky thing but doesn’t really know. When you take his heart-rate its 42 bpm. You decide to administer the drug Atropine.
What does it do?
0/1
A) Increases sympathetic nervous system activity, in turn causing a faster rate

B) Decreases sympathetic nervous system activity, decreasing blood pressure, in turn causing a faster rate
C) Increases parasympathetic system activity, decreasing blood pressure, in turn causing a faster rate
D) Decreases parasympathetic system input to the heart, in turn causing a faster rate
E) It helps the body retain fluid.

Answer 10

Correct answer
D) Decreases parasympathetic system input to the heart, in turn causing a faster rate
) is correct- parasympathetic/Ach/muscarinic receptor activity at the sinoatrial node slows the heart rate. Atropine antagonises muscarinic ACh receptors, reversibly binding to them so ACh can’t- preventing action of parasympathetic nervous system. So only sympathetic input meaning higher heartrate. Don’t you just love medicine, this is a really fun MOA in my opinion and easy to remember because of how fun it is!
Side effects include, pupi dilatation, urinary retention, dry eyes/mouth, constipation

Question 11

31) Mrs Sell-Turnover is a 59 year old female who comes into A&E dripping with sweat, complaining of a really bad pain in her chest that started 30 minutes prior when she was shopping in tesco. You, a panicked F1 decides initially to prescribe her a loading dose of drug X.
What is X’s mechanism of action?
0/1
A) Activates Plasminogen (tPA)
B) Inhibits Clotting Factors 10, 9, 7 and 2
C) Inhibits COX-1 and COX-2
D) Binds to μ receptors
E) Placebo- see if she’s faking it

Answer 11

Correct answer
C) Inhibits COX-1 and COX-2

A) Incorrect- If you’re thinking alteplase/fibrinolysis- nice idea but initially is not first (see NICE guidance on Acute Coronary Syndromes)
B) Incorrect- This is Warfarin- not really one to think of straight away for MI- good to know however but not really what your patients needs immediately.
C) Correct- Aspirin 300mg is what X was- you star- works by inhibiting COX-1 and COX-2- initially you give loading dose of this (if not allergic) then go onto PCI/fibrinolysis depending on timings (learn it within 12 hours and 2 hours access PCI!!!, then learn dual antiplatelet therapy)
D) Incorrect- morphine nice of you to give her some pain relief but NICE doesnt say to do that initially, like the idea though
E) Incorrect- be better.

This required you to know a little bit of nice management in acute coronary syndromes as well as your mechanism of actions- if you’re learning drugs its really helpful to understand its MOA as it can make you understand what physiological effects it has and why it used for a certain disease

Question 12

32) Morphines oral bioavailability is 50%. So if prescribing it from IV to oral:

5mg IV = 10mg oral, as around 50% is lost in all the gutty liverry metabolismy stuff.
Which of these statements is the incorrect one:

0/1
A) Pharmacodynamics- effect the drug has on the body
B) Pharmacokinetics- effect the body has on the drug (ADME)
C) Phase 1 metabolism is non-conjugation aiming to slightly increase hydrophilicity- e.g. CYP450

D) Phase 2 metabolism is conjugation, adding functional groups- e.g. glucoronidation
E) Therapeutic range is how much drug is uptaken systemically for effect
Correct answer
E) Therapeutic range is how much drug is uptaken systemically for effect
Feedback

Answer 12

A) Pharmacodynamics- effect the drug has on the body
B) Pharmacokinetics- effect the body has on the drug (ADME)
C) Phase 1 metabolism is non-conjugation aiming to slightly increase hydrophilicity- e.g. CYP450
D) Phase 2 metabolism is conjugation, adding functional groups- e.g. glucoronidation
E) FALSE- Bioavailability is how much drug is uptaken systemically for effect,

Therapeutic range is the upper and lower bounds of safe doses of a drug.

Question 13

The second part of this question tests your knowledge of paracetamol doses. For adults weighing less than 50Kg you give only 1 tablet- 500mg. Then if over 50kg you give 1g- 2 tablets.

Question 14

35) A 50 year old male Luis; avid baker, animal lover and naturist, has recently started a new medication after he is found to have a “funny heart rhythm”.
Which drug would you be the least cautious prescribing amiodarone with?
0/1
A) Verapamil
B) Metformin
C) Warfarin
D) Metoprolol
E) Atorvastatin

Answer 14

Correct answer
B) Metformin
Amiodarone is a class III antiarrhythmic drug used in all sorts of funky rhythms.
It is highly interactive with other drugs as it inhibits CYP450 metabolism.

A) Calcium channel blocker- increased risk of heart block/bradycardia- combination can excessively slow the heart rate- if prescribed together have to be very cautious and monitored
B) Correct- metformin is used to treat type 2 diabetes, does not react significantly.
C) Warfarin is another drug to be very cautious of when adding or taking away drugs- a lot can affect ones INR, INR- international normalised ratio- how well your blood clots- PT/PT (extrinsic pathway). Warfarins a vitamin k epoxide reductase inhibitor (10,9,7,2 - 1972). Also is metabolised by cyp450.
D) Beta blocker- increased risk of heart block/bradycardia- combination can excessively slow the heart rate- if prescribed together have to be very cautious and monitored
E) Atorvastatin- good to know: statin + amiodarone can highly increase someones risk of Rhabdomyolysis. - If youve not read up on this condition it would be worthwhile- its interesting and will go over importance of electrolyte imbalances and kidneys.

Question 15

Erythromycin is a macrolide, macrolides are good for gram +ve cover

Know your antibiotic classes and MOAs!
A) Incorrect- metronidazole is a DNA polymerase inhibitor
B) Incorrect- rifampicin is a rna polymerase inhibitor
C) Incorrect- your thinking of tetracyclines, like doxycycline, or aminoglycosides like gentamicin
D) Correct- also 50s subunit targets are your clindamycin and chloramphenicol
E) Incorrect- trimethoprim and sulfonamides are your folate synthesis inhibitors

Question 16

37) Josephina is a Female Medical student who has struggled with obesity for many years. She has a history of Type 2 Diabetes Mellitus and Hypertension. Josephina also has a history of migraines in the past usually related to doing exercise. One day during a microbiology practical Josephina experiences sudden vision loss and face drooping. Josephina’s friend also notices she is struggling to talk normally. These symptoms last for around 5 minutes. When a doctor carries out an examination they report an abnormal Neurological Examination.

Considering Josephina’s symptoms, what is the most likely diagnosis?
0/1
A) Ischemic Stroke
B) Middle Cerebral Artery Transient Ischemic Attack

C) Subarachnoid Hemorrhagic Stroke
D) Middle Cerebral and Posterior Cerebral Artery Transient Ischemic Attack
E) Migraine

Answer 16

Correct answer
D) Middle Cerebral and Posterior Cerebral Artery Transient Ischemic Attack

Question 17

41) Mr Kent an 85-year-old man has come into the GP surgery reporting how he has been struggling with everyday tasks as he has had a problem with balance and being able to hold things in his hands saying he has struggled to button up his shirt in the morning which he requires his girlfriend’s help with. Mr Kent also has a history of Rheumatoid Arthritis. You notice his hands aren’t still at rest and when coming into the room he was very slow moving.

Considering Mr Kent’s presentation, what methods would you use to make a diagnosis?
0/1
A) MRI Brain and Spinal Cord

B) Mini Mental State Exam
C) X-Ray
D) Neurological Examination
E) Bloods and Serology

Answer 17

Correct answer
D) Neurological Examination

Neurological Physical Examination parkinson’s is used in diagnosis of Parkinson’s as it is based on history and examination Usually bradykinesia and 1 or more other cardinal signs.
MRI Brain and Spinal Cord isn’t used to diagnose Parkinson’s but can be used to rule out other causes.
Mini Mental State Exam is used in diagnosing Alzheimers.
Bloods and Serology - not used for parkinsons but is useful in rheumatoid arthritis

Question 18

44) Joseph is a Medical Student who is getting quizzed on by his consultant on a ward round on Motor Neurone Disease. The consultant asks him to name some Upper Motor Neurone (UMN) Lesion signs, but Joseph fails to do so.
Which of the following is an UMN lesion sign?
0/1
A) Fasciculations
B) Ptosis
C) Greater Power in Flexor muscles over Extensor muscle in arms
D) Respiratory Failure
E) Babinski Negative

Answer 18

Correct answer
C) Greater Power in Flexor muscles over Extensor muscle in arms

Question 19

46) Arun and Sagar are Phase 2B medical students practising Neurological Examination on each other. When testing for cranial nerves, Arun notices how Sagar’s left eye is down and out with upper eyelid drooping and is unresponsive to Arun’s flashlight.

Considering Sagar’s symptoms at which cranial nerve is the lesion most likely to be at?

0/1
A) 6
B) 7
C) 4

D) 3
E) 2

Answer 19

Correct answer
D) 3
CN 3 is occulomotor and symptoms described occurs when there’s a lesion at CN 3.
2 is optic so vision/light reaction messy
4 is trochlear- up and in pupil
6 is abducens- cant move eye outward
7 is facial- bells palsy!

Question 20

47) The STI/HIV transmission model is R= BCD
In this model what does R stand for?

0/1
A) Infectivity Rate

B) Reproductive Rate
C) Partners Over time
D) Duration of infection
E) Number of People Infected

Answer 20

Correct answer
B) Reproductive Rate
Feedback
The equation for the transmission model is R= BCD where
R = reproductive rate (rate at which the organism reproduces itself (>1 = incidence will rise, <1 = incidence will decline)
B = infectivity rate (chance of infection passing per potential exposure, dep on factors e.g. condom use, type of sex, microbio characteristics of the organism
C = Partners over time (number of opportunities for transmission)
D = Duration of infection (reduced by easy access to services e.g. screening, health
awareness, health seeking behaviour)

Question 22

0) Graham, a 72 year old Stoke City fan, presents complaining of ‘the worst pain of his life’ in his right big toe. He is obese and drinks 5-6 pints of beer a night. On examination, his toe is very tender and swollen. He has never experienced an episode like this before. On further questioning, you discover he is also in stage 5 renal failure.

What is the most appropriate first line medication to give Graham in this acute phase of his condition?

0/1
A) Naproxen
B) Ibuprofen
C) Prednisolone
D) Allopurinol
E) Advise dietary changes

Answer 22

Correct answer
C) Prednisolone
Feedback
C Prednisolone - this is a typical presentation of Gout. For acute presentations of this condition, the normal pharmacological management involves NSAIDs, steroids and colchicine. However in this case, the NSAIDs (naproxen and ibuprofen) should be avoided due to the patient’s renal disease. Corticosteroid (prednisolone) is therefore the most appropriate option.

Question 23

52) A 70 year old woman has just found out she has a secondary bone cancer.
Which of the following is the LEAST likely to have been the primary cancer?
0/1
A) Hepatocellular carcinoma
B) Renal cell carcinoma
C) Bronchial carcinoma
D) Medullary thyroid cancer
E) Invasive Ductal carcinoma

Answer 23

Correct answer
A) Hepatocellular carcinoma
Feedback
A Hepatocellular carcinoma - The cancers which most commonly metastasise to bone originate in the kidneys, prostate, breast, lung and thyroid. You can remember this from the acronym KP BLT. Ductal carcinoma is a type of breast cancer. Therefore, the least likely origin in this scenario is hepatocellular carcinoma of the liver.

Question 24

55) A 65 year old man was brought into hospital 3 days ago after suffering a myocardial infarction. During the morning ward round, it is noticed that the patient is now suffering from oliguria and his serum creatinine has risen significantly in the last 48 hours. The man is diagnosed with an AKI and further bloods show he is hyperkalaemic. He is given intravenous insulin to treat his hyperkalaemia.
What other drug must doctors also prescribe with the IV insulin to prevent a potential serious complication?

0/1
A) Calcium chloride
B) Sodium chloride
C) Calcium gluconate

D) Metformin
E) Dextrose

Answer 24

Correct answer
E) Dextrose
Feedback
E Dextrose - Insulin is given to patients suffering from hyperkalaemia as it drives potassium out of the bloodstream and into cells. However, it also does the same to glucose. It is therefore vital that dextrose is prescribed alongside IV insulin to prevent the complication of hypoglycaemia.

Question 25

56) You are a medical student attending placement on a renal ward and find yourself speaking to a 70 year old patient who has recently been diagnosed with chronic kidney disease. The man is telling you about his vast past medical history. When he was younger, he suffered from several urinary tract infections and had to have kidney stones surgically removed when he was in his 30’s. He goes onto explain that he has had high blood pressure for the last 10 years or and suffered 2 heart attacks when he was in his 50’s. He was diagnosed with ischaemic heart disease 2 years ago and is now undergoing tests to see if he also has heart failure.
Which factor is the most likely cause of the man’s chronic kidney disease?

0/1
A) Persistent UTI’s
B) Nephrolithiasis
C) Hypertension
D) Ischaemic heart disease
E) Heart failure

Answer 25

Correct answer
C) Hypertension
Feedback
C Hypertension - the most common causes of chronic kidney disease are hypertension and diabetes mellitus. CKD increases a persons risk of suffering from UTIs, kidney stones, IHD and heart failure.

Question 26

58) You are a FY2 junior doctor starting your GP rotation at a practice in Rotherham. A 28 year old non-pregnant woman presents with pain on urination and recent onset of urinary frequency and urgency. A urine dipstick is positive for both nitrites and leukocytes. You suspect a UTI.
What is the most appropriate course of antibiotic therapy in this case?
0/1
A) 3 days Amoxicillin
B) 7 days Amoxicillin
C) 3 days Nitrofurantoin
D) 7 days Nitrofurantoin

E) 28 days Trimethoprim

Answer 26

Correct answer
C) 3 days Nitrofurantoin
Feedback
C 3 days nitrofurantoin - this is an uncomplicated UTI as it has occurred in a non-pregnant woman who has a normal urinary tract. Therefore, a 3 day course of nitrofurantoin is the best option. If the patient was male, a 7 day course would be more appropriate. If the patient was pregnant, either a 7 day course of nitrofurantoin or amoxicillin would be more appropriate options.

Question 27

59) A 68 year old retired chemical plant worker presents to you saying he is seeing blood in his urine. He is also having to get up more frequently at night to use the toilet. You are very concerned about the patient’s symptoms so refer him for a flexible cystoscopy - which shows bladder cancer. Further investigations show the cancer has invaded local muscles of the bladder, but has not metastasised to other organs.
What is the most appropriate management option for this patient?
0/1
A) Trans urethral resection of bladder tumour

B) Cystectomy
C) BCG immunotherapy
D) Chemotherapy
E) Watch and wait

Answer 27

Correct answer
B) Cystectomy
Feedback
answer: B Cystectomy - treatment for bladder cancer depends on the spread of the tumour and the risk of the patientNon muscle invasive - trans urethral resection (+ BCG immunotherapy in high risk patients)Muscle invasive, as in the above case - cystectomyMetastasis - chemotherapy

Question 28

62) You are at a graduation dinner with your colleagues, when all of a sudden one of them develops a red swollen itchy rash on his body, and becomes short of breath , with a tight throat and wheeze and finds it hard to swallow. They faint. What of the following is not a part of management of this crisis?
0/1
A) Epinephrine
B) Oxygen
C) Morphine
D) Fluids bolus
E) Crystalloid Fluids

Answer 28

Correct answer
C) Morphine
Feedback
Morphine not typically used- google anaphylaxis treatment

Question 29

72) Which is not a function of the liver?
0/1
A) Cytokine production
B) Oestrogen regulation
C) Metabolises carbohydrates

D) Clotting factor production
E) Immunity

Answer 29

Correct answer
A) Cytokine production
Feedback
cytokines are produced by white blood cells

Question 30

76) One day during lectures Joe licks Rudges face out of curiosity and realises he tastes really salty and orders him to go get checked out. The doctor does the sweat test on him to test his Na+ and Cl- levels and the test indicates previously undetected Cystic fibrosis, what is the threshold reading that indicates CF?
0/1
>50 mmol/L

> 30 mmol/L
90 mmol/L
40 mmol/L
60 mmol/L

Answer 30

Correct answer
>60 mmol/L
Feedback
correct answer - E greater than 60 mmol is indicative of CF and is the threshold for the sweat test.

Question 31

86) which one of the following is the type of necrosis that will most commonly occur in the brain?
0/1
A) liquefactive
B) caseous
C) gangrene
D) coagulative
E) degenerative

Answer 31

Correct answer
A) liquefactive
correct answer A) due to its lack of supporting stroma it can cause the necrotic brain tissue to turn into liquid

caseous necrosis is the soft cheese look often seen in TB

Gangrene is the necrosis of tissue due to a lack of blood supply usually happens to limbs and fingers/toes

Coagulative is the commonest type and is caused by ischemia, due to a lack of blood supply tissue will die and initially will be firm but then become soft

Question 32

89) A 68 year old man presents to A&E with central crushing chest pain which radiates down his left arm and into his jaw. An ECG is performed which shows ST elevation in leads I, aVL, V4-6. Which artery has been occluded and caused the MI?
0/1
A) Right coronary artery

B) Right marginal artery
C) Left circumflex artery
D) Left anterior descending artery
E) Left marginal artery

Answer 32

Correct answer
C) Left circumflex artery
A) Incorrect - Inferior MI - leads II, III, aVF (supplies the SA node and the AV node)
B) Incorrect - Inferior MI
C) Correct - Lateral MI - leads I, aVL, V5-6 (supplies lateral surface of left ventricle)
D) Incorrect - Anterior MI - leads V1-4 (supplies anterior surface of the heart)
E) Incorrect - Later MI (supplies the inferior margin of the heart)

Question 34

91) A 64 year old man attends the GP for a recurrent cough. He is examined and on auscultation of his heart, a late diastolic murmur, louder on expiration, is heard. Mitral stenosis is the most likely cause of this murmur. What is the most common cause of mitral stenosis?
0/1
A) Connective tissue disorder
B) Ischaemic heart disease
C) Left ventricular hypertrophy

D) Patent ductus arteriosus
E) Rheumatic fever

Answer 34

Correct answer
E) Rheumatic fever
A) Incorrect - can cause mitral regurgitation and aortic regurgitation (high-pitched pansystolic murmur radiating to axilla with S3 sound)
B) Incorrect - can cause mitral regurgitation due to ischaemic damage to papillary muscles (high-pitched pansystolic murmur)
C) Incorrect - can occur secondary to aortic stenosis due to the increased afterload
D) Incorrect - can cause a loud crunchy machine-like murmur
E) Correct - inflammatory response to streptococcal bacterium leads to autoimmune valvular damage due to similar antigens (molecular mimicry)

Question 35

92) Joe, a 59 year old man, is a fiend for a night in the Foundry and has been on a 3 day bender of Tuesday Club, Roar and Soul Jam but has forgotten to take his regular medication. He has presented to A&E with palpitations and feeling his heart is racing. His general observations are:

Heart rate - 121
Blood pressure - 135/75
Respiratory rate - 17
Temperature - 36.7
Oxygen saturation - 99% on air

Which drug, when abruptly stopped, can cause this abnormality in his vital signs?
0/1
A) Amlodipine

B) Bisoprolol
C) Furosemide
D) Ramipril
E) Spironolactone

Answer 35

Correct answer
B) Bisoprolol
Feedback
A) Incorrect
B) Correct - beta-blocker which reduces a sinus tachycardia. Joe has experienced rebound tachycardia, a phenomenon which occurs when withdrawing from beta-blockers
C) Incorrect
D) Incorrect
E) Incorrect

Question 36

95) Sydney, a 72-year-old female presents to the cardiology clinic with complaints of palpitations and shortness of breath over the past week. She has a history of hypertension and type 2 diabetes mellitus. On examination, her pulse is irregularly irregular, and auscultation reveals no murmurs. An electrocardiogram (ECG) confirms the presence of atrial fibrillation. Which of the following is the most appropriate initial management strategy for this patient?
0/1
A) Immediate electrical cardioversion
B) IV beta-blockers

C) Anticoagulation therapy
D) Amiodarone
E) Watchful waiting

Answer 36

Correct answer
C) Anticoagulation therapy
Feedback
A) Incorrect - it is not the initial management strategy for atrial fibrillation
B) Incorrect - may be used for rate control in acute settings of atrial fibrillation with rapid ventricular response and hemodynamic instability but the risk of thromboembolic events is not reduced
C) Correct - Associated with an increased risk of thromboembolic events, particularly stroke, due to blood stasis in the fibrillating atria, which can lead to the formation of atrial thrombi. Therefore, the most appropriate initial management strategy for this patient is to initiate anticoagulation therapy to reduce the risk of stroke. Anticoagulation options may include direct oral anticoagulants (DOACs) or warfarin
D) Incorrect - not a first-line treatment for stable atrial fibrillation and is only used in acute settings but the risk of thromboembolic events is not reduced
E) Incorrect - immediate initiation of anticoagulation therapy is crucial to reduce the risk of thromboembolic events

Question 37

96) A 65-year-old male presents to the emergency department with dizziness, fatigue, and near-syncope. He has a history of hypertension and coronary artery disease. On examination, his heart rate is 40 beats per minute, and auscultation reveals a regular rhythm with no murmurs. An electrocardiogram (ECG) shows a prolonged PR interval (>200 ms) with occasional dropped beats. Which of the following is the most likely diagnosis?
0/1
A) Sinus bradycardia
B) Type I AV block

C) Type II AV block
D) Type III AV block
E) Sick sinus syndrome
Correct answer
D) Type III AV bloc

Answer 37

Feedback
A) Incorrect - slow heart rate originating from the sinoatrial (SA) node
B) Incorrect - progressive prolongation of the PR interval until a dropped beat occurs but there is still atrioventricular conduction, and the P waves are usually conducted to the ventricles, resulting in a normal QRS complex following the dropped beat
C) Incorrect - intermittent failure of atrial impulses to conduct to the ventricles without progressive prolongation of the PR interval resulting in dropped beats without prior PR interval prolongation
D) Correct - Third-degree AV block, also known as complete heart block, is characterised by the complete dissociation of atrial and ventricular electrical activity. This results in an atrial rate that is independent of the ventricular rate. Patients typically present with symptoms of bradycardia, including dizziness, fatigue, and syncope.
E) Incorrect - sick sinus syndrome refers to a group of conditions characterised by dysfunction of the SA node, resulting in various arrhythmias, including sinus bradycardia, sinus arrest, and alternating episodes of bradycardia and tachycardia

Question 38

97) A 55-year-old male presents to the emergency department with complaints of exertional dyspnea and fatigue for the past month. He has a history of hypertension and tobacco use. On examination, his blood pressure is 150/90 mmHg, heart rate is 78 beats per minute, and respiratory rate is 18 breaths per minute. Auscultation reveals an S3 gallop and no murmurs. An electrocardiogram (ECG) shows a widened QRS complex (>120 ms) with a slurred S wave in leads I, aVL, V5, and V6, and a broad, notched R wave in leads V1 and V2. Which of the following is the most likely diagnosis?
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A) Left anterior fascicular block
B) Wolff-Parkinson-White syndrome

C) Atrial fibrillation
D) Right bundle branch block
E) Left bundle branch block

Answer 38

Correct answer
E) Left bundle branch block
Feedback
A) Incorrect - characterised by left axis deviation on the ECG, with QRS axis between -45° and -90° and RS complexes in leads II, III, and aVF and QR complexes in leads I and aVL
B) Incorrect - characterised by an accessory pathway between the atria and ventricles, known as the bundle of Kent, which bypasses the atrioventricular node. This results in a shortened PR interval (<120 ms) and a delta wave on the ECG
C) Incorrect - characterised by absent P waves and an irregularly irregular QRS complex
D) Incorrect - characterised by a widened QRS complex (>120 ms), broad R wave in leads V1 and V2 and a wide S wave in lateral leads
E) Correct - characterised by delayed activation of the left ventricle due to blockage or delay in the conduction through the left bundle branch. This results in a widened QRS complex (>120 ms) on the ECG, slurred S wave in leads I, aVL, V5, and V6 and a broad R wave in leads V1 and V2. LBBB is commonly associated with structural heart disease, such as hypertension, coronary artery disease, or cardiomyopathy

Question 39

98) A 35 year old man has been suffering from recurrent respiratory infections and has undergone immunological evaluation. It is suspected that there is a defect in the activation of B-cell. The immunoglobulin in question acts as a receptor, activating B-cells. What immunoglobulin is this?
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A) IgA
B) IgD
C) IgE
D) IgG
E) IgM

Answer 39

Correct answer
B) IgD
Feedback
A) Incorrect - involved in mucosal immunity such as within the respiratory or gastrointestinal epithelium
B) Correct - IgD acts as a receptor binding antigens to naive B cells to initiate activation, proliferation and differentiation into either antibody-producing cells or memory cells.
C) Incorrect - hypersensitivity type I reactions such as in allergic reactions or parasitic infection
D) Incorrect - most common immunoglobulin in blood and extracellular fluid
E) Incorrect - first antibody produced after antigen exposure but it does act as a receptor