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Question 1
Correct
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A 6 year old boy is brought into the ED by his mom with a rash that is associated with Koplik's spots and a diagnosis of measles is made. What advice should be given about returning to school?
Your Answer: 4 days from the onset of the rash
Explanation:Prevention of spread of measles is extremely important and infected patients should be isolated. The infectious stage is from 3 days before the rash emerges and patients are advised to stay away from school/nursery/work for 4 days from onset of the rash.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 2
Incorrect
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Following an injury sustained during a rugby match, a 16-year-old boy is brought to the Emergency Department by his mother. His forearm appears to be deformed, and you believe he has a distal radius fracture. A numerical rating scale is used to assess his pain, and the triage nurse informs you that he is in moderate pain.'The RCEM guidance recommends which of the following analgesics for the treatment of moderate pain in a child of this age?
Your Answer: Oral paracetamol 10 mg/kg
Correct Answer: Oral codeine phosphate 1 mg/kg
Explanation:According to a 2018 audit conducted by the Royal College of Emergency Medicine (RCEM), the standard of care for children presenting to EDs with fractured limbs has deteriorated, with most patients waiting longer than ever before for pain relief. More than one-tenth of the children who came in with significant pain from a limb fracture received no pain relief at all.For all patients, including children, the Agency for Health Care Policy and Research (AHCPR) in the United States recommends using the ABCs of pain management:A – Ask about pain regularly. Assess pain systematically.B – Believe the patient and family in their reports of pain and what relieves it.C – Choose pain control options appropriate for the patient, family, and setting.D – Deliver interventions in a timely, logical, coordinated fashion.E – Empower patients and their families. Enable patients to control their course to the greatest extent possible.The RCEM guidelines recommend assessing a child’s pain within 15 minutes of arrival. This is a fundamental requirement. For the assessment of pain in children, a variety of rating scales are available; which one is used depends on the child’s age and ability to use the scale. These are some of them:Faces of Wong-Baker Scale for assessing painScale of numerical evaluationThe behavioural scale is a scale that measures how people behave.The RCEM has provided the following visual guide:The RCEM has established the following guidelines for when patients in severe pain should receive appropriate analgesia:100% within 60 minutes of arrival or triage, whichever is earliest75% within 30 minutes of arrival or triage, whichever is earliest50% within 20 minutes of arrival or triage, whichever is earliest
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 3
Correct
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A 59-year-old man presents to the emergency room with chest pain. The cardiology team recently discharged him. He underwent a procedure and was given several medications, including abciximab, during his stay. Which of the following statements about abciximab is correct?
Your Answer: The platelet count should be checked 2-4 hours after starting treatment
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.It’s approved for use as a supplement to heparin and aspirin in high-risk patients undergoing percutaneous transluminal coronary intervention to prevent ischaemic complications. Only one dose of abciximab should be given (to avoid additional risk of thrombocytopenia).
Before using, it is recommended that baseline prothrombin time, activated clotting time, activated partial thromboplastin time, platelet count, haemoglobin, and haematocrit be measured. 12 and 24 hours after starting treatment, haemoglobin and haematocrit should be measured again, as should platelet count 2-4 hours and 24 hours after starting treatment.
When used for high-risk patients undergoing angioplasty, the EPIC trial found that abciximab reduced the risk of death, myocardial infarction, repeat angioplasty, bypass surgery, and balloon pump insertion.The use of abciximab is contraindicated in the following situations:
Internal bleeding is present.
Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
Stroke in the previous two yearsIntracranial tumour
Aneurysm or arteriovenous malformation
Haemorrhagic diathesis
Vasculitis
Retinopathy caused by hypertension
The following are some of the most common abciximab side effects:
Manifestations of bleeding
Bradycardia
Back ache
Pain in the chest
Vomiting and nausea
Pain at the puncture site
Thrombocytopenia
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 4
Correct
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Salbutamol should be used with caution in patients with which of the following:
Your Answer: Susceptibility to QT-interval prolongation
Explanation:Beta-2 agonists should be used with caution in people with: Cardiovascular disease, including arrhythmias and hypertension (beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate)Diabetes(risk of hyperglycaemia and ketoacidosis, especially with intravenous use)Hyperthyroidism(beta-2 agonists may stimulate thyroid activity)Hypokalaemia(potentially serious hypokalaemia may result from beta-2 agonist therapy; this effect may be potentiated in severe asthma by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia)Susceptibility to QT-interval prolongationConvulsive disorders
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 5
Incorrect
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About what percentage of filtered Na+is reabsorbed in the loop of Henle:
Your Answer: 5 - 10%
Correct Answer: 25%
Explanation:About 25% of filtered sodium is reabsorbed in the the loop of Henle.
Water-impermeable ascending loop of Henle plays a central role in maintaining salt-water balance by creating the cortico-medullary osmotic gradient to set up urinary concentrating ability and reabsorbing approximately 25% of the filtered NaCl load.
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This question is part of the following fields:
- Physiology
- Renal
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Question 6
Incorrect
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The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian man is 152/96 mmHg (ABPM).The first-line drug treatment for this patient would be which of the following? Please only choose ONE answer.
Your Answer: Ramipril
Correct Answer: Amlodipine
Explanation:An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 59-year-old Caucasian man.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 7
Incorrect
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How does an action potential in the motor end plate rapidly spread to the central portions of the muscle cells?
Your Answer: Sarcoplasmic reticulum
Correct Answer: Transverse tubules
Explanation:When the concentration of intracellular Ca2+rises, muscle contraction occurs. The pathway of an action potential is down tube-shaped invaginations of the sarcolemma called T-tubules (transverse tubules). These penetrate throughout the muscle fibre and lie adjacent to the terminal cisternae of the sarcoplasmic reticulum. The voltage changes in the T-tubules result in the opening of sarcoplasmic reticulum Ca2+channels and there is there is release of stored Ca2+into the sarcoplasm. Thus muscle contraction occurs via excitation-contraction coupling (ECC) mechanism.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 8
Correct
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A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination. The brachial pulse can be best palpated at ?
Your Answer: In the antecubital fossa, medial to the tendon of the biceps brachii
Explanation:The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 9
Correct
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Which of the following anatomic structures will gallstones most likely lodge into, and cause cholestasis?
Your Answer: Hartmann’s pouch
Explanation:Hartmann’s pouch is a diverticulum that can occur at the neck of the gallbladder. It is one of the rarest congenital anomalies of the gallbladder. Hartmann’s gallbladder pouch is a frequent but inconsistent feature of normal and pathologic human gallbladders. It is caused by adhesions between the cystic duct and the neck of the gallbladder. As a result, it is classified as a morphologic rather than an anatomic entity.There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 10
Correct
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Regarding protein digestion, which of the following statements is CORRECT:
Your Answer: Oligopeptides are broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on the brush border.
Explanation:Digestion of dietary protein begins in the stomach where pepsin hydrolyses protein to polypeptides, and continues in the duodenum where pancreatic proteases (trypsin and chymotrypsin) continue the process of hydrolysis forming oligopeptides. These are further broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on luminal membrane epithelial cells. Free amino acids are absorbed across the apical membrane by secondary active transport coupled with Na+transport into the cell. Amino acids cross the basal membrane into the capillaries by facilitated diffusion.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 11
Correct
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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: 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.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 12
Correct
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Regarding an avulsion fracture, a sudden contraction of which muscle may lead to fracture of the head of the fibula?
Your Answer: Biceps femoris
Explanation:Avulsion fractures of the fibular head are rare and are so-called the arcuate signal. The “arcuate signal” is used to describe an avulsed bone fragment related to the insertion site of the tendon of the biceps femoris associated with the arcuate complex, which consists of the fabellofibular, popliteofibular, and arcuate ligaments. Such lesions are typically observed in direct trauma to the knee with excessive varus and internal rotation forces or indirect trauma with the same direction of the force.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Incorrect
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A young boy is carried by his friends to the Emergency Department in an unconscious state. He is quickly moved into the resuscitation room. He was at a party with friends and has injected heroin. On examination, his GCS is 6/15, and he has bilateral pinpoint pupils and a very low respiratory rate of 6 breaths per minute. Which of the following is the first-line treatment for this patient?
Your Answer: Naloxone 0.2 mg IM
Correct Answer: Naloxone 0.8 mg IV
Explanation:Heroin is injected into the veins and is the most commonly abused drug. Acute intoxication with opioid overuse is the most common cause of death by drug overdose. The clinical features of opioid overdose are:1. Decreased respiratory rate2. Reduced conscious level or coma3. Decreased bowel sounds4. Miotic (constricted) pupils5. Cyanosis6. Hypotension7. Seizures8. Non-cardiogenic pulmonary oedema (with IV heroin usage)The main cause of death secondary to opioid overdose is respiratory depression, which usually occurs within 1 hour of the overdose. Vomiting is also common, and aspiration can occur.Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity. It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.Naloxone has a shorter duration of action (6-24 hours) than most opioids, and so close monitoring according to the respiratory rate and depth of coma with repeated injections is necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg. If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 14
Correct
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Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:
Your Answer: 75% of cases occur before the age of 6 years.
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. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. There is great variation in the chance of individual patients achieving a long-term cure based on a number of biological variables. Approximately 25% of children relapse after first-line therapy and need further treatment but overall 90% of children can expect to be cured. The cure rate in adults drops significantly to less than 5% over the age of 70 years.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Correct
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Which of the following increases the tendency for oedema to occur?
Your Answer: Increased venous pressure
Explanation:When more fluid is filtered out of the capillaries than can be returned to the circulation by the lymphatics, oedema occurs. Changes that increase capillary hydrostatic pressure or decrease plasma oncotic pressure will increase filtration. Arteriolar constriction reduces hydrostatic capillary pressure and transiently increase absorption of fluid. Dehydration increases plasma protein concentration and therefore increases plasma oncotic pressure and absorption. Capillary hydrostatic pressure and filtration are increased when there is increased venous pressure.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 16
Correct
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Question 17
Correct
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Osteoclasts are a type of bone cell that are critical in the maintenance, repair and remodelling of bones.Which of the following inhibits osteoclast activity? Select ONE answer only.
Your Answer: Calcitonin
Explanation:Osteoclasts are a type of bone cell that breaks down bone tissue. This is a critical function in the maintenance, repair and remodelling of bones. The osteoclast disassembles and digests the composite of hydrated protein and minerals at a molecular level by secreting acid and collagenase. This process is known as bone resorption and also helps to regulate the plasma calcium concentration.Osteoclastic activity is controlled by a number of hormones:1,25-dihydroxycholecalciferol increases osteoclastic activityParathyroid hormone increases osteoclastic activityCalcitonin inhibits osteoclastic activityBisphosphonates are a class of drug that slow down and prevent bone damage. They are osteoclast inhibitors.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 18
Correct
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Which of the following neurotransmitter and receptor combinations is present at the neuromuscular junction:
Your Answer: Acetylcholine acting at nicotinic receptors
Explanation:At the neuromuscular junction, acetylcholine is released from the prejunctional membrane which acts on cholinergic nicotinic receptors on the postjunctional membrane.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 19
Incorrect
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Continuous capillaries are typically found where in the body:
Your Answer: Reticuloendothelial system
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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 20
Correct
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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: 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
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 21
Correct
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Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.Which of the following statements about aspirin's mechanism of action is correct?
Your Answer: Inhibition of cyclo-oxygenase
Explanation:Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 22
Correct
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In the United Kingdom, which of the following is the most often used intravenous aesthetic:
Your Answer: Propofol
Explanation:In the United Kingdom, propofol is the most widely used intravenous anaesthetic. In adults and children, it can be used to induce or maintain anaesthesia, although it is not commonly used in newborns. It can also be used to sedate individuals in intensive care and for sedation during operations.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 23
Correct
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A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?
Your Answer: None of the other options
Explanation:Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:Coronary artery disease (CAD) Coronary artery disease (CAD) Second stage of labourHypertension that is uncontrolledSevere Ventricular arrhythmias
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 24
Incorrect
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A patient suffers an injury to his thigh that damages the nerve that innervates pectineus.Which of the following nerves has been damaged in this case? Select ONE answer only.
Your Answer: Inferior gluteal nerve
Correct Answer: Femoral nerve
Explanation:Pectineus is innervated by the femoral nerve. It may also receive a branch from the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 25
Incorrect
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A 68-year-old man with BPH presents to the emergency department in significant pain secondary to urinary retention. What is the location of the neuronal cell bodies that are responsible for urinary bladder discomfort sensation?
Your Answer: Dorsal root ganglia of spinal cord levels L4 and L5
Correct Answer: Dorsal root ganglia of spinal cord levels S2, S3 and S4
Explanation:The activation of stretch receptors with visceral afferents relayed through the pelvic nerve plexus and into the pelvic splanchnic nerves causes bladder pain. The sensory fibres of spinal nerves S2 – S4 enter the dorsal root ganglia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 26
Incorrect
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A 28-year-old asthmatic patient is seen in the Emergency Department following an acute exacerbation. His symptoms start to improve when your consultant gives him a high dose of IV aminophylline.Which of the following is correct mechanism of action of aminophylline ?
Your Answer: Muscarinic receptor antagonism
Correct Answer: Inhibition of phosphodiesterase
Explanation:Aminophylline has the following properties:Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 27
Correct
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What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your Answer: 10 ml of 1 in 10,000 adrenaline solution
Explanation:Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm. IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm. For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 28
Incorrect
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In all of the following conditions, lymphocytosis typically occurs except for:
Your Answer: Infectious mononucleosis
Correct Answer: Corticosteroid therapy
Explanation:In infants and young children, lymphocytosis often occurs in response to infections that would normally produce a neutrophil reaction in adults.Lymphocytosis occurs in:1. Viral infections (e.g. infectious mononucleosis, HIV, rubella, mumps, viral hepatitis, cytomegalovirus, herpes simplex or zoster)2. Bacterial infections (e.g. pertussis, tuberculosis, toxoplasmosis, syphilis)3. Chronic lymphoid leukaemias4. Acute lymphoblastic leukaemias5. Non-Hodgkin lymphoma6. Thyrotoxicosis
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 29
Correct
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A 60-year-old man presents with marked breathlessness. He has with a history of ischaemic heart disease. On examination, there is coarse bibasal crackles, marked peripheral oedema and chest X-ray taken is consistent with severe pulmonary oedema. RR is 28 per minute. Which receptor is responsible for detecting pulmonary oedema and the subsequent increase in respiratory rate?
Your Answer: Juxtacapillary receptors
Explanation:Pulmonary oedema causes stimulation of the Juxtacapillary receptors (J receptors) leading to a reflex increase in breathing rate. These receptors are also thought to be involved in the sensation of dyspnoea. The J receptors are sensory cells and are located within the alveolar walls in juxtaposition to the pulmonary capillaries.Aortic baroreceptor are involved in detecting blood pressureCentral chemoreceptors detect changes in CO2 and hydrogen ion within the brainAtrial volume receptors regulate plasma volume
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 30
Correct
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A patient noticed ankle swelling and has passed very little urine over the past 24 hours. He also has nausea and vomiting, reduced urine output and his blood results reveal a sudden rise in his creatinine levels over the past 48 hours. You make a diagnosis of acute kidney injury (AKI).Which one of these is a prerenal cause of AKI?
Your Answer: Cardiac failure
Explanation:The causes of AKI can be divided into pre-renal, intrinsic renal and post-renal causes. Majority of AKI developing in the community is due to a pre-renal causes (90% of cases).Pre-renal causes: Haemorrhage, severe vomiting or diarrhoea, burns, cardiac failure, liver cirrhosis, nephrotic syndrome, hypotension, severe cardiac failure, NSAIDs, COX-2 inhibitors, ACE inhibitors or ARBs, Abdominal aortic aneurysm, renal artery stenosis, hepatorenal syndrome, Intrinsic (renal) causes:Eclampsia, glomerulonephritis, thrombosis, haemolytic-uraemic syndrome, acute tubular necrosis (ATN), acute interstitial nephritis, drugs ( NSAIDs), infection or autoimmune diseases, vasculitis, polyarteritis nodosa, thrombotic microangiopathy, cholesterol emboli, renal vein thrombosis, malignant hypertensionPost-renal causes: Renal stones, Blood clot, Papillary necrosis, Urethral stricture, Prostatic hypertrophy or malignancy, Bladder tumour, Radiation fibrosis, Pelvic malignancy, Retroperitoneal fibrosis
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This question is part of the following fields:
- General Pathology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
