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WorksheetsGEM Module 4 Mock
Total questions: 100
Worksheet time: 2hrs 40mins
Name
Class
Date
1.
A 45-year-old office worker presents with paraesthesia and pain in her lateral 3.5 fingers, which is worse at night. On examination, there is weakness in thumb abduction and mild thenar wasting. What is the most likely site of nerve compression?
a)
Cubital tunnel
b)
Guyon's canal
c)
Carpal tunnel
d)
Spiral groove of the humerus
e)
Arcade of Struthers
2.
During a lumbar puncture, the needle is correctly inserted between the L3 and L4 vertebrae. Which ligament is the final structure pierced before the needle enters the epidural space?
a)
Supraspinous ligament
b)
Interspinous ligament
c)
Ligamentum flavum
d)
Posterior longitudinal ligament
e)
Anterior longitudinal ligament
3.
A patient presents with a winged scapula. Injury to which nerve is most likely responsible?
a)
Thoracodorsal nerve
b)
Dorsal scapular nerve
c)
Spinal accessory nerve (CN XI)
d)
Long thoracic nerve
e)
Suprascapular nerve
4.
A footballer suffers a violent tackle and subsequently has difficulty rising from a seated position and climbing stairs. Which nerve is most likely injured?
a)
Femoral nerve
b)
Obturator nerve
c)
Sciatic nerve
d)
Superior gluteal nerve
e)
Tibial nerve
5.
The "screw-home" mechanism of the knee joint, which locks the knee in full extension, primarily involves which movement?
a)
Abduction of the tibia on the femur
b)
Adduction of the tibia on the femur
c)
Lateral rotation of the tibia on the femur
d)
Medial rotation of the femur on the tibia
e)
Anterior translation of the tibia on the femur
6.
A patient loses sensation over the tip of their little finger. Which spinal nerve level is most likely affected?
a)
C6
b)
C7
c)
C8
d)
T1
e)
T2
7.
During a total hip replacement, the surgeon must be aware of the artery that is the primary blood supply to the femoral head and is at risk in femoral neck fractures. Which artery is this?
a)
Obturator artery
b)
Superior gluteal artery
c)
Medial circumflex femoral artery
d)
Lateral circumflex femoral artery
e)
Popliteal artery
8.
A patient presents with wrist drop following a mid-shaft fracture of the humerus. Which nerve has been injured?
a)
Axillary nerve
b)
Median nerve
c)
Musculocutaneous nerve
d)
Radial nerve
e)
Ulnar nerve
9.
Which muscle is responsible for unlocking the knee joint to allow flexion from a fully extended position?
a)
Biceps femoris
b)
Semitendinosus
c)
Popliteus
d)
Gastrocnemius
e)
Sartorius
10.
The anterior drawer test of the knee is used to assess the integrity of which structure?
a)
Posterior cruciate ligament (PCL)
b)
Anterior cruciate ligament (ACL)
c)
Medial collateral ligament (MCL)
d)
Lateral collateral ligament (LCL)
e)
Medial meniscus
11.
A patient with chronic kidney disease has persistently low plasma calcium. Which compensatory mechanism will be most directly stimulated?
a)
Increased calcitonin secretion
b)
Increased renal activation of vitamin D
c)
Decreased parathyroid hormone (PTH) secretion
d)
Increased osteoblast activity
e)
Decreased intestinal calcium absorption
12.
Henneman's size principle states that:
a)
Larger motor units are recruited before smaller ones for powerful movements.
b)
Motor unit recruitment is entirely random.
c)
Smaller motor units, with fewer, fatigue-resistant fibers, are recruited first.
d)
The size of a muscle is directly proportional to the strength of its contraction.
e)
All motor units fire synchronously during a maximal contraction.
13.
During the repolarisation phase of a neuronal action potential, what is the primary ionic event?
a)
Inward flux of sodium ions
b)
Outward flux of potassium ions
c)
Inward flux of calcium ions
d)
Outward flux of chloride ions
e)
Activation of the sodium-potassium pump
14.
The Golgi Tendon Organ (GTO) reflex primarily serves to:
a)
Prevent muscle damage from excessive stretch.
b)
Initiate contraction of a stretched muscle.
c)
Monitor and protect against excessive muscle tension.
d)
Increase the sensitivity of muscle spindles.
e)
Coordinate reciprocal inhibition of antagonists.
15.
In the excitation-contraction coupling of skeletal muscle, what is the direct role of calcium ions?
a)
To bind to myosin and activate its ATPase activity.
b)
To depolarise the T-tubules.
c)
To bind to troponin, causing a conformational shift of tropomyosin.
d)
To directly power the myosin power stroke.
e)
To be actively pumped into the sarcoplasmic reticulum by the Na+/K+ ATPase.
16.
Which of the following best describes the function of the RANK/RANKL/OPG pathway in bone remodelling?
a)
OPG stimulates osteoclast formation by binding to RANK.
b)
RANKL, produced by osteoblasts, binds to RANK on osteoclast precursors to stimulate bone resorption.
c)
RANK is a decoy receptor that inhibits osteoblast activity.
d)
The pathway is primarily involved in cartilage formation.
e)
PTH inhibits bone resorption by blocking RANKL.
17.
A patient hyperventilates and develops perioral and digital paraesthesia. What is the underlying physiological mechanism?
a)
Respiratory acidosis leading to hypercalcaemia.
b)
Respiratory alkalosis leading to increased protein-binding of ionised calcium.
c)
Metabolic acidosis leading to hypokalaemia.
d)
Increased PTH secretion in response to low CO2.
e)
Direct effect of low CO2 on peripheral nerves.
18.
Saltatory conduction in myelinated axons is characterised by:
a)
Continuous propagation of the action potential along the entire axon.
b)
The action potential "jumping" from one Node of Ranvier to the next.
c)
A slower conduction velocity compared to unmyelinated axons.
d)
The requirement for a higher energy expenditure.
e)
The involvement of voltage-gated calcium channels at the internodes.
19.
The muscle spindle is responsible for sensing which of the following?
a)
Muscle tension
b)
Muscle length and the rate of change of length
c)
Joint position
d)
Pain in the muscle
e)
Vibration
20.
Which type of skeletal muscle fiber is characterized by a high myoglobin content, high oxidative capacity, and high resistance to fatigue?
a)
Type I (Slow Oxidative)
b)
Type IIa (Fast Oxidative-Glycolytic)
c)
Type IIx (Fast Glycolytic)
d)
Type IIb (Super Fast)
e)
Cardiac muscle
21.
A patient with myasthenia gravis is prescribed pyridostigmine. What is its mechanism of action?
a)
Competitive antagonist at nicotinic acetylcholine receptors.
b)
Irreversible inhibitor of acetylcholinesterase.
c)
Reversible inhibitor of acetylcholinesterase.
d)
Agonist at muscarinic acetylcholine receptors.
e)
Immunosuppressant that reduces AChR antibody production.
22.
Neostigmine is administered to reverse a non-depolarising neuromuscular block. Why is atropine often co-administered?
a)
To potentiate the effect of neostigmine at the NMJ.
b)
To prevent neostigmine-induced central nervous system excitation.
c)
To counteract the muscarinic side effects of increased acetylcholine.
d)
To provide additional analgesia.
e)
To reverse any residual depolarising block.
23.
According to the WHO analgesic ladder, what is the recommended management for a patient with moderate cancer pain that is not controlled by regular paracetamol?
a)
Add a strong opioid like morphine.
b)
Add a weak opioid like codeine.
c)
Add a non-steroidal anti-inflammatory drug (NSAID).
d)
Switch to a transdermal fentanyl patch.
e)
Refer for a nerve block.
24.
Which of the following is a significant adverse effect associated with long-term use of non-selective NSAIDs?
a)
Tardive dyskinesia
b)
Hepatotoxicity
c)
Gastrointestinal ulceration and bleeding
d)
Pulmonary fibrosis
e)
Ototoxicity
25.
A patient presents with severe salivation, lacrimation, urination, defecation, and bronchoconstriction after accidental exposure to an organophosphate insecticide. What is the mechanism of action of the toxin?
a)
Nicotinic receptor antagonism
b)
Muscarinic receptor agonism
c)
Reversible acetylcholinesterase inhibition
d)
Irreversible acetylcholinesterase inhibition
e)
GABA receptor antagonism
26.
Which local anaesthetic mechanism is correct?
a)
They block voltage-gated calcium channels in the charged form.
b)
They block voltage-gated sodium channels from the outside of the cell.
c)
They cross the membrane in an uncharged form and block sodium channels in a charged form.
d)
They primarily work by hyperpolarising the neuronal membrane.
e)
They are potent agonists at inhibitory GABA receptors.
27.
What is the primary reason for dose adjustment of many drugs in elderly patients?
a)
Increased hepatic first-pass metabolism
b)
Increased gastric acid secretion
c)
Decreased renal clearance
d)
Increased volume of distribution for hydrophilic drugs
e)
Enhanced absorption from the gut
28.
Suxamethonium is classified as a depolarising neuromuscular blocking agent because it:
a)
Competitively antagonises nicotinic ACh receptors.
b)
Initially acts as an agonist at nicotinic ACh receptors, causing persistent depolarisation.
c)
Inhibits the release of acetylcholine from the motor neuron.
d)
Activates acetylcholinesterase.
e)
Blocks sodium channels in the muscle membrane.
29.
The Beers Criteria is a tool used primarily for what purpose in geriatric medicine?
a)
Diagnosing dementia.
b)
Assessing nutritional status.
c)
Identifying potentially inappropriate medications.
d)
Screening for depression.
e)
Calculating life expectancy.
30.
Paracetamol overdose is dangerous primarily because of the toxic metabolite that causes which organ damage?
a)
Cardiac
b)
Renal
c)
Hepatic
d)
Pulmonary
e)
Pancreatic
31.
A 60-year-old woman presents with symmetrical pain and stiffness in the small joints of her hands, worse in the morning for over an hour. Blood tests are positive for rheumatoid factor and anti-CCP antibodies. What is the most likely diagnosis?
a)
Osteoarthritis
b)
Gout
c)
Rheumatoid Arthritis
d)
Systemic Lupus Erythematosus
e)
Pseudogout
32.
The pathological hallmark of Osteoarthritis is:
a)
Pannus formation and bony erosion.
b)
Deposition of monosodium urate crystals.
c)
Degeneration and loss of articular cartilage.
d)
Bacterial infection of the joint space.
e)
Autoantibodies against synovial tissue.
33.
A 70-year-old man presents with an acutely hot, swollen, and painful knee. Joint aspiration reveals negatively birefringent, needle-shaped crystals. What is the most likely diagnosis?
a)
Septic arthritis
b)
Rheumatoid arthritis
c)
Gout
d)
Pseudogout
e)
Osteoarthritis
34.
What is the primary pathological process in compartment syndrome?
a)
Infection of the muscle compartment
b)
Ischaemia due to increased pressure within a fascial compartment
c)
Inflammation of the synovial tendon sheaths
d)
Venous thrombosis in the deep leg veins
e)
Denervation of the muscles within a compartment
35.
A 55-year-old post-menopausal woman with a history of chronic steroid use for asthma sustains a low-trauma wrist fracture. Which underlying bone disease is she most likely to have?
a)
Osteomalacia
b)
Paget's disease of bone
c)
Osteoporosis
d)
Osteogenesis imperfecta
e)
Osteosarcoma
36.
The autoimmune destruction of nicotinic acetylcholine receptors at the neuromuscular junction is the key pathology in which condition?
a)
Lambert-Eaton myasthenic syndrome
b)
Multiple sclerosis
c)
Myasthenia Gravis
d)
Guillain-Barré syndrome
e)
Amyotrophic lateral sclerosis
37.
A herniated intervertebral disc at the L4/L5 level most commonly compresses which spinal nerve?
a)
L3
b)
L4
c)
L5
d)
S1
e)
S2
38.
Which of the following is a characteristic feature of Paget's disease of bone?
a)
Generalised reduction in bone mass.
b)
Inadequate mineralisation of osteoid.
c)
Disorganised bone remodeling with mixed osteolytic and osteoblastic activity.
d)
Defective synthesis of type I collagen.
e)
Localised malignant bone-forming tumour.
39.
A child presents with bone deformities such as bowing of the legs. Radiographs show widened, cupped metaphyses. This is most likely due to a deficiency in:
a)
Vitamin C
b)
Vitamin D
c)
Vitamin A
d)
Parathyroid hormone
e)
Calcitonin
40.
What is the most common organism causing osteomyelitis?
a)
Streptococcus pyogenes
b)
Escherichia coli
c)
Pseudomonas aeruginosa
d)
Mycobacterium tuberculosis
e)
Staphylococcus aureus
41.
According to the UK's Equality Act (2010), a person is defined as disabled if they have a physical or mental impairment that has what kind of effect on their ability to do normal daily activities?
a)
A minor and short-term effect
b)
A substantial and long-term effect
c)
An intermittent and unpredictable effect
d)
An effect only in the workplace
e)
Any effect, regardless of duration or severity
42.
In the context of a clinical trial, the "Number Needed to Treat" (NNT) is best described as:
a)
The number of patients who must be treated to see one adverse event.
b)
The number of patients in the treatment group who benefit from the intervention.
c)
The number of patients you need to treat with the intervention to prevent one additional bad outcome compared to the control.
d)
The percentage reduction in risk achieved by the treatment.
e)
The cost of treating one patient for one year.
43.
A patient with terminal cancer has capacity and clearly states they do not want cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest. This decision should be:
a)
Ignored, as the medical team's duty is to preserve life.
b)
Respected and documented as an advance decision to refuse treatment.
c)
Overruled by their next of kin.
d)
Only followed if a court order is in place.
e)
Considered as a sign of depression and treated accordingly.
44.
Which of the following is a "red flag" symptom in a patient presenting with back pain?
a)
Pain that improves with rest.
b)
Pain that radiates down the leg in a dermatomal pattern.
c)
Saddle anaesthesia and bladder dysfunction.
d)
Pain worse on flexion.
e)
Morning stiffness lasting 15 minutes.
45.
The PICO framework is a tool used in Evidence-Based Medicine primarily to:
a)
Interpret the results of a randomised controlled trial.
b)
Formulate a focused clinical question.
c)
Assess the risk of bias in a cohort study.
d)
Calculate a p-value.
e)
Determine patient capacity.
46.
In the UK, which body produces national, evidence-based clinical guidelines that also consider cost-effectiveness?
a)
General Medical Council (GMC)
b)
British Medical Association (BMA)
c)
National Institute for Health and Care Excellence (NICE)
d)
Royal Colleges
e)
Medicines and Healthcare products Regulatory Agency (MHRA)
47.
A 16-year-old patient attends the clinic alone, requesting confidential advice about contraception. What is the most appropriate initial action?
a)
Refuse to see them without a parent present.
b)
Contact their parents immediately.
c)
Assess their capacity (Gillick competence) to understand the advice.
d)
Prescribe the contraception without any discussion.
e)
Refer them to social services.
48.
The "Sepsis Six" bundle of care, to be delivered within one hour, includes which of the following sets of actions?
a)
Intubation, central line insertion, inotropes, antibiotics, steroids, and ICU referral.
b)
Oxygen, IV fluids, IV antibiotics, take blood cultures, check lactate, measure urine output.
c)
Paracetamol, blood cultures, chest X-ray, urine dipstick, review by senior, and fluid challenge.
d)
CT scan, lumbar puncture, broad-spectrum antibiotics, anticoagulation, and vasopressors.
e)
Airway assessment, breathing assessment, circulation assessment, disability assessment, exposure.
49.
The Glasgow Coma Scale (GCS) assesses which three components?
a)
Pulse, Blood Pressure, Respiratory Rate
b)
Orientation, Memory, Concentration
c)
Eye opening, Verbal response, Motor response
d)
Cranial nerves, Motor strength, Sensory perception
e)
Reflexes, Coordination, Gait
50.
What is the primary purpose of the START Back Tool in the management of low back pain?
a)
To diagnose the specific cause of back pain.
b)
To stratify patients into risk groups for persistent disabling pain.
c)
To determine if surgery is required.
d)
To assess for red flag symptoms.
e)
To measure the range of motion of the spine.
51.
A 75-year-old woman with osteoporosis trips and falls, sustaining a fracture. Which of the following is the most common type of fragility fracture?
a)
Skull fracture
b)
Humeral shaft fracture
c)
Hip fracture
d)
Clavicle fracture
e)
Rib fracture
52.
During a vasovagal syncopal episode, a patient becomes bradycardic and hypotensive. This is best classified as which type of shock?
a)
Hypovolaemic
b)
Cardiogenic
c)
Obstructive
d)
Distributive
e)
Septic
53.
A patient with a history of total hip replacement presents with fever, pain, and a warm, erythematous joint. Aspiration reveals pus. The most likely causative organism is:
a)
Streptococcus pneumoniae
b)
Neisseria gonorrhoeae
c)
Staphylococcus epidermidis
d)
Escherichia coli
e)
Mycobacterium tuberculosis
54.
A patient presents with a hot, swollen, and painful right calf. A Homan's sign is positive. What is the most appropriate initial diagnostic test?
a)
MRI scan of the leg
b)
D-dimer blood test
c)
Arterial Doppler ultrasound
d)
Venous Doppler ultrasound (Duplex)
e)
X-ray of the leg
55.
The Ottawa Ankle Rules are a clinical decision tool used to:
a)
Diagnose the type of ankle fracture.
b)
Determine if an ankle X-ray is necessary following an injury.
c)
Guide the management of ankle sprains.
d)
Assess the stability of the ankle joint.
e)
Predict long-term outcomes after an ankle fracture.
56.
A patient with a history of atrial fibrillation not on anticoagulation presents with sudden onset of a dense right-sided hemiplegia and aphasia. What is the most likely mechanism of this stroke?
a)
Intracerebral haemorrhage
b)
Subarachnoid haemorrhage
c)
Lacunar infarction
d)
Cardioembolic ischaemic stroke
e)
Venous sinus thrombosis
57.
Which of the following is a clinical feature of neurogenic shock?
a)
Tachycardia
b)
Warm, dry skin
c)
Hypotension with bradycardia
d)
Hypertension with headache
e)
Fever and rigors
58.
A patient with a history of gout is prescribed allopurinol. What is its mechanism of action?
a)
Uricosuric agent
b)
Xanthine oxidase inhibitor
c)
Uricase enzyme
d)
NSAID
e)
Colchicine analogue
59.
A 30-year-old man presents with acute monoarthritis of the knee. He has a history of recurrent bouts of arthritis and has tophi on his ears. What is the definitive diagnostic test?
a)
Serum uric acid level
b)
Joint aspiration and microscopy for crystals
c)
Rheumatoid factor
d)
Anti-CCP antibodies
e)
Erythrocyte Sedimentation Rate (ESR)
60.
Which of the following is a key feature of Complex Regional Pain Syndrome (CRPS) Type I?
a)
It only occurs after a confirmed nerve injury.
b)
It is characterised by pain that is disproportionate to the inciting event.
c)
It is easily treated with simple analgesics.
d)
It always resolves completely within 6 months.
e)
It is associated with a specific dermatomal distribution.
61.
The femoral nerve is a branch of which plexus?
a)
Brachial plexus
b)
Cervical plexus
c)
Lumbar plexus
d)
Sacral plexus
e)
Lumbosacral plexus
62.
The anatomical "snuffbox" is bounded by the tendons of which two muscles?
a)
Abductor pollicis longus and extensor pollicis brevis
b)
Extensor pollicis longus and extensor pollicis brevis
c)
Abductor pollicis longus and extensor pollicis longus
d)
Extensor carpi radialis longus and brevis
e)
Flexor carpi radialis and palmaris longus
63.
The motor innervation to the muscles of facial expression is provided by which cranial nerve?
a)
Trigeminal nerve (CN V)
b)
Facial nerve (CN VII)
c)
Glossopharyngeal nerve (CN IX)
d)
Vagus nerve (CN X)
e)
Hypoglossal nerve (CN XII)
64.
The blood supply to the majority of the lateral hemisphere of the cerebral cortex is from which artery?
a)
Anterior cerebral artery
b)
Middle cerebral artery
c)
Posterior cerebral artery
d)
Basilar artery
e)
Vertebral artery
65.
Which structure passes through the foramen ovale in the skull?
a)
Internal carotid artery
b)
Mandibular division of the trigeminal nerve (V3)
c)
Maxillary division of the trigeminal nerve (V2)
d)
Ophthalmic division of the trigeminal nerve (V1)
e)
Facial nerve (CN VII)
66.
The ligament of the knee that is most commonly injured in a valgus force to the partially flexed knee is the:
a)
Anterior cruciate ligament (ACL)
b)
Posterior cruciate ligament (PCL)
c)
Medial collateral ligament (MCL)
d)
Lateral collateral ligament (LCL)
e)
Patellar ligament
67.
The axillary nerve is most vulnerable to injury in which of the following?
a)
Mid-shaft fracture of the humerus
b)
Supracondylar fracture of the humerus
c)
Anterior dislocation of the shoulder
d)
Fracture of the surgical neck of the humerus
e)
Colles' fracture
68.
Which muscle is the most powerful supinator of the forearm?
a)
Supinator
b)
Brachioradialis
c)
Biceps brachii
d)
Pronator teres
e)
Brachialis
69.
The popliteal artery is a direct continuation of which artery?
a)
Femoral artery
b)
Deep femoral artery (Profunda femoris)
c)
Anterior tibial artery
d)
Posterior tibial artery
e)
External iliac artery
70.
The common peroneal (fibular) nerve is most commonly injured by:
a)
A pelvic fracture.
b)
A posterior dislocation of the hip.
c)
Compression at the fibular neck.
d)
A femoral shaft fracture.
e)
Compression in the tarsal tunnel.
71.
The Frank-Starling law of the heart states that:
a)
Heart rate is directly proportional to blood pressure.
b)
The force of ventricular contraction is proportional to the end-diastolic volume.
c)
Cardiac output is the product of heart rate and systemic vascular resistance.
d)
Coronary blood flow occurs primarily during systole.
e)
The left and right ventricles must always eject the same volume of blood.
72.
The primary site of aldosterone action in the nephron is the:
a)
Proximal convoluted tubule
b)
Descending limb of the loop of Henle
c)
Ascending limb of the loop of Henle
d)
Distal convoluted tubule and collecting duct
e)
Glomerulus
73.
Which of the following is a function of the parasympathetic nervous system?
a)
Dilation of the pupils (mydriasis)
b)
Increased heart rate (tachycardia)
c)
Bronchodilation
d)
Stimulation of salivary gland secretion
e)
Inhibition of gastrointestinal motility
74.
The majority of carbon dioxide is transported in the blood in which form?
a)
Dissolved in plasma
b)
Bound to haemoglobin
c)
As bicarbonate ions (HCO3-)
d)
As carbamino compounds
e)
As carbonic acid
75.
The hormone most responsible for the regulation of serum osmolality is:
a)
Aldosterone
b)
Atrial Natriuretic Peptide (ANP)
c)
Antidiuretic Hormone (ADH, Vasopressin)
d)
Cortisol
e)
Renin
76.
The QRS complex on an electrocardiogram represents:
a)
Atrial depolarisation
b)
Atrial repolarisation
c)
Ventricular depolarisation
d)
Ventricular repolarisation
e)
The delay at the AV node
77.
The primary driving force for filtration in the glomerulus is:
a)
Glomerular oncotic pressure
b)
Bowman's capsule hydrostatic pressure
c)
Glomerular hydrostatic pressure
d)
Systemic blood pressure
e)
Afferent arteriolar resistance
78.
Which of the following is a characteristic of a competitive antagonist?
a)
It binds irreversibly to the receptor.
b)
It shifts the dose-response curve of the agonist to the left.
c)
It decreases the maximal efficacy of the agonist.
d)
It can be overcome by increasing the concentration of the agonist.
e)
It requires allosteric binding to the receptor.
79.
The Valsalva manoeuvre primarily causes an initial:
a)
Decrease in heart rate
b)
Increase in venous return
c)
Decrease in systemic blood pressure
d)
Increase in intrathoracic pressure
e)
Release of atrial natriuretic peptide
80.
The primary role of the juxtaglomerular apparatus is to:
a)
Concentrate the urine.
b)
Secrete erythropoietin.
c)
Regulate glomerular filtration rate via the tubuloglomerular feedback mechanism.
d)
Reabsorb glucose from the filtrate.
e)
Synthesize vitamin D.
81.
A patient on warfarin therapy has an INR above the therapeutic range but is not bleeding. What is the most appropriate immediate management?
a)
Administer fresh frozen plasma (FFP).
b)
Administer Vitamin K intravenously.
c)
Administer protamine sulfate.
d)
Omit the next dose of warfarin and reduce subsequent doses.
e)
Transfuse platelets.
82.
Which class of drugs is considered first-line for the treatment of essential hypertension in most patients?
a)
Beta-blockers
b)
Thiazide diuretics
c)
ACE inhibitors
d)
Calcium channel blockers
e)
Alpha-blockers
83.
Metformin's mechanism of action as an anti-diabetic drug is primarily to:
a)
Stimulate insulin secretion from pancreatic beta-cells.
b)
Increase peripheral glucose uptake and decrease hepatic gluconeogenesis.
c)
Delay the absorption of carbohydrates from the gut.
d)
Inhibit the breakdown of incretin hormones.
e)
Increase insulin receptor sensitivity.
84.
The most serious adverse effect associated with the use of clozapine is:
a)
Extrapyramidal symptoms
b)
Agranulocytosis
c)
Tardive dyskinesia
d)
Neuroleptic malignant syndrome
e)
QT prolongation
85.
Statins (e.g., simvastatin) lower cholesterol by inhibiting which enzyme?
a)
HMG-CoA reductase
b)
Cholesterol esterase
c)
Lipoprotein lipase
d)
ACAT (Acyl-CoA cholesterol acyltransferase)
e)
CETP (Cholesteryl ester transfer protein)
86.
A patient is prescribed a course of amoxicillin and develops diarrhoea. A stool test is positive for Clostridium difficile toxin. What is the mechanism of this adverse effect?
a)
Direct irritation of the gastric mucosa.
b)
Allergic reaction in the colon.
c)
Suppression of normal gut flora allowing overgrowth of C. diff.
d)
Inhibition of colonic sodium absorption.
e)
Promotion of bile salt secretion.
87.
Which of the following is a significant drug interaction with SSRIs (Selective Serotonin Reuptake Inhibitors)?
a)
Potentiation of warfarin effect, increasing bleeding risk.
b)
Reduced effect of oral contraceptives.
c)
Antagonism of the effects of beta-blockers.
d)
Increased risk of ototoxicity with loop diuretics.
e)
Decreased absorption of levothyroxine.
88.
The therapeutic effect of loop diuretics like furosemide is due to their action on which part of the nephron?
a)
Proximal convoluted tubule
b)
Descending limb of the loop of Henle
c)
Thick ascending limb of the loop of Henle
d)
Distal convoluted tubule
e)
Collecting duct
89.
A patient with Parkinson's disease is treated with levodopa. Why is it almost always co-administered with carbidopa?
a)
Carbidopa is a dopamine agonist that synergises with levodopa.
b)
Carbidopa inhibits peripheral dopa decarboxylase, allowing more levodopa to reach the brain.
c)
Carbidopa prevents the on-off phenomenon.
d)
Carbidopa is an MAO-B inhibitor that prolongs the action of dopamine.
e)
Carbidopa reduces the gastrointestinal side effects of dopamine.
90.
The narrow therapeutic index of digoxin means that:
a)
It is only effective for a short period of time.
b)
There is a small difference between a therapeutic dose and a toxic dose.
c)
It has a very short half-life.
d)
It is only effective in a small subset of patients.
e)
It requires administration via a narrow-gauge needle.
91.
A 25-year-old woman presents with a butterfly-shaped rash on her face, arthralgia, and photosensitivity. Which autoantibody is most specific for her likely condition?
a)
Rheumatoid Factor (RF)
b)
Anti-nuclear antibody (ANA)
c)
Anti-double stranded DNA (anti-dsDNA)
d)
Anti-Sm antibody
e)
Anti-CCP antibody
92.
A 50-year-old man with a history of alcohol dependency presents with confusion, ataxia, and ophthalmoplegia. This triad is characteristic of which condition?
a)
Korsakoff's syndrome
b)
Wernicke's encephalopathy
c)
Delirium tremens
d)
Hepatic encephalopathy
e)
Cerebellar degeneration
93.
Which tumour marker is most commonly associated with testicular cancer?
a)
Carcinoembryonic Antigen (CEA)
b)
Alpha-fetoprotein (AFP)
c)
Cancer Antigen 125 (CA-125)
d)
Prostate-Specific Antigen (PSA)
e)
Beta-Human Chorionic Gonadotropin (β-hCG)
94.
A 60-year-old smoker presents with haemoptysis, weight loss, and a persistent cough. A chest X-ray shows a central hilar mass. What is the most likely cell type?
a)
Adenocarcinoma
b)
Squamous cell carcinoma
c)
Large cell carcinoma
d)
Small cell lung cancer
e)
Bronchoalveolar carcinoma
95.
The most common cause of community-acquired pneumonia in adults is:
a)
Haemophilus influenzae
b)
Mycoplasma pneumoniae
c)
Streptococcus pneumoniae
d)
Staphylococcus aureus
e)
Legionella pneumophila
96.
A 70-year-old man has a painless, progressive jaundice with palpable gall bladder but no tenderness (Courvoisier's law). This suggests a diagnosis of:
a)
Choledocholithiasis (gallstones)
b)
Alcoholic hepatitis
c)
Carcinoma of the head of the pancreas
d)
Acute cholecystitis
e)
Viral hepatitis
97.
Which of the following is a feature of a left-sided heart failure?
a)
Peripheral oedema
b)
Hepatosplenomegaly
c)
Ascites
d)
Pulmonary oedema
e)
Jugular venous distension
98.
A patient with type 2 diabetes is found to have microalbuminuria. What does this signify?
a)
A urinary tract infection
b)
Early diabetic nephropathy
c)
End-stage renal failure
d)
Diabetic retinopathy
e)
A side effect of metformin
99.
The most common cause of hyperthyroidism in the UK is:
a)
Toxic multinodular goitre
b)
Graves' disease
c)
Thyroiditis
d)
Toxic adenoma
e)
Iodine deficiency
100.
A 40-year-old woman presents with colicky right upper quadrant pain that radiates to the scapula, triggered by fatty meals. What is the most likely diagnosis?
a)
Acute pancreatitis
b)
Peptic ulcer disease
c)
Biliary colic due to gallstones
d)
Appendicitis
e)
Hepatitis
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