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  • Question 1 - A 6-year-old child is scheduled for general anaesthesia day surgery. You decide to...

    Incorrect

    • A 6-year-old child is scheduled for general anaesthesia day surgery. You decide to perform an inhalational induction because he is otherwise medically fit. Which of the following is the most important factor in deciding which volatile anaesthetic agents to use?

      Your Answer: The more pleasant smell of halothane

      Correct Answer: The low blood:gas solubility of sevoflurane

      Explanation:

      The ideal volatile agent for a day case surgery inhalational induction should have the following characteristics:

      It has a pleasant scent that is not overpowering.
      Breathing difficulties, coughing, or laryngeal spasm are not caused by this substance.
      The action has a quick onset and a quick reversal.

      The blood:gas partition coefficient is a physicochemical property of a volatile agent that determines the onset and offset of anaesthesia. The greater an agent’s insolubility in plasma, the faster its alveolar concentration rises.

      The blood gas partition coefficients of the most commonly used volatile anaesthetic agents are as follows:
      Halothane 2.3
      Desflurane 0.45
      Sevoflurane 0.6
      Nitrous oxide 0.47
      Isoflurane 1.4

      Although halothane has a pleasant odour, it has a slower offset than sevoflurane.

      Sevoflurane also has a pleasant odour and is less likely than desflurane to cause airway irritation and breath-holding.

      The choice of agent for inhalational induction is unaffected by potency/lipid solubility measures such as the oil: gas partition coefficient and MAC.

      In this case, an agent’s saturated vapour pressure is irrelevant.

    • This question is part of the following fields:

      • Pharmacology
      15.6
      Seconds
  • Question 2 - Which of the following molecule is closely related to the structure of Oxytocin?...

    Incorrect

    • Which of the following molecule is closely related to the structure of Oxytocin?

      Your Answer: Thyroxine

      Correct Answer: ADH

      Explanation:

      Oxytocin is structurally similar to Antidiuretic Hormone (ADH) and thus oxytocin cause water intoxication (due to ADH like action)

      Oxytocin is secreted by the posterior pituitary along with ADH. It increases the uterine contractions with complete relaxation in between. It increases the contraction of the upper segment (fundus and body) of the uterus whereas the lower segment is relaxed facilitating the expulsion of the foetus

      Antidiuretic hormone (ADH) also called vasopressin is released from the posterior pituitary in response to hypertonicity and increases fluid reabsorption from the kidney.

    • This question is part of the following fields:

      • Pharmacology
      21.6
      Seconds
  • Question 3 - Regarding amide local anaesthetics, which one factor has the most significant effect on...

    Incorrect

    • Regarding amide local anaesthetics, which one factor has the most significant effect on its duration of action?

      Your Answer: Lipid solubility

      Correct Answer: Protein binding

      Explanation:

      When drugs are bound to proteins, drugs cannot cross membranes and exert their effect. Only the free (unbound) drug can be absorbed, distributed, metabolized, excreted and exert pharmacologic effect. Thus, when amide local anaesthetics are bound to α1-glycoproteins, their duration of action are reduced.

      The potency of local anaesthetics are affected by lipid solubility. Solubility influences the concentration of the drug in the extracellular fluid surrounding blood vessels. The brain, which is high in lipid content, will dissolve high concentration of lipid soluble drugs. When drugs are non-ionized and non-polarized, they are more lipid-soluble and undergo more extensive distribution. Hence allowing these drugs to penetrate the membrane of the target cells and exert their effect.

      Tissue pKa and pH will determine the degree of ionization.

    • This question is part of the following fields:

      • Physiology
      9.6
      Seconds
  • Question 4 - What makes the ultrasound nebulizer efficient? ...

    Correct

    • What makes the ultrasound nebulizer efficient?

      Your Answer: Reduction in gas flow resistance

      Explanation:

      Smallest drops reach not only the upper but also the lower respiratory tracks. As a result, the ultrasonic nebulizer is most efficient for the therapy of pulmonary diseases and stands out as a robust and reliable support within the clinical setting.

    • This question is part of the following fields:

      • Basic Physics
      26
      Seconds
  • Question 5 - All of the following are responses to massive haemorrhage except which of the...

    Incorrect

    • All of the following are responses to massive haemorrhage except which of the following?

      Your Answer: Fluid moves into the intravascular space due to decreased capillary hydrostatic pressure

      Correct Answer: Decreased cardiac output by increased direct parasympathetic stimulation

      Explanation:

      With regards to compensatory response to blood loss, the following sequence of events take place:

      1. Decrease in venous return, right atrial pressure and cardiac output
      2. Baroreceptor reflexes (carotid sinus and aortic arch) are immediately activated
      3. There is decreased afferent input to the cardiovascular centre in medulla. This inhibits parasympathetic reflexes and increases sympathetic response
      4. This results in an increased cardiac output and increased SVR by direct sympathetic stimulation. There is increased circulating catecholamines and local tissue mediators (adenosine, potassium, NO2)
      5. Fluid moves into the intravascular space as a result of decreased capillary hydrostatic pressure absorbing interstitial fluid.

      A slower response is mounted by the hypothalamus-pituitary-adrenal axis.
      6. Reduced renal blood flow is sensed by the intra renal baroreceptors and this stimulates release of renin by the juxta-glomerular apparatus.
      7. There is cleavage of circulating Angiotensinogen to Angiotensin I, which is converted to Angiotensin II in the lungs (by Angiotensin Converting Enzyme ACE)

      Angiotensin II is a powerful vasoconstrictor that sets off other endocrine pathways.
      8. The adrenal cortex releases Aldosterone
      9. There is antidiuretic hormone release from posterior pituitary (also in response to hypovolaemia being sensed by atrial stretch receptors)
      10. This leads to sodium and water retention in the distal convoluted renal tubule to conserve fluid
      Fluid conservation is also aided by an increased amount of cortisol which is secreted in response to the increase in circulating catecholamines and sympathetic stimulation.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      506.8
      Seconds
  • Question 6 - Which of the following intravenous induction agents is best for the patient with...

    Incorrect

    • Which of the following intravenous induction agents is best for the patient with acute intermittent porphyria requiring rapid sequence induction for emergency surgery?

      Your Answer: Thiopentone

      Correct Answer: Propofol

      Explanation:

      Propofol is considered a safe drug to use in porphyria because even if causes mild elevation of porphyrins inpatient, it does not cause any symptoms.

      Since barbiturates are inducers of ALA synthetase, they are contraindicated in porphyria patients. So, thiopentone most not be used.

      Etomidate is a potent inhibitor of adrenal 11 beta-hydroxylase and 17 alpha-hydroxylase reducing cortisol and aldosterone synthesis in the adrenal cortex and has been associated with exacerbations of porphyria in animal studies and it is advisable not to use it in this condition.

      Ketamine should be reserved for the hemodynamically unstable patient, however, it is a safe drug.

      Diazepam is safe in porphyria but is not usually used for a rapid sequence induction.

    • This question is part of the following fields:

      • Pharmacology
      16
      Seconds
  • Question 7 - A healthy 27-year old male who weighs 70kg has appendicitis. He is currently...

    Correct

    • A healthy 27-year old male who weighs 70kg has appendicitis. He is currently in the operating room and is being positioned to have a rapid sequence induction. Prior to preoxygenation, the compartment likely to have the best oxygen reserve is:

      Your Answer: Red blood cells

      Explanation:

      The following table shows the compartments and their relative oxygen reserve:
      Compartment Factors Room air (mL) 100% O2 (mL)
      Lung FAO2, FRC 630 2850
      Plasma PaO2, DF, PV 7 45
      Red blood cells Hb, TGV, SaO2 788 805
      Myoglobin 200 200
      Interstitial space 25 160

      Oxygen reserves in the body, with room air and after oxygenation.

      FAO2-alveolar fraction of oxygen rises to 95% after administration of 100% oxygen (CO2 = 5%)
      FRC- Functional residual capacity – (the most important store of oxygen in the body) – 2,500-3,000 mL in medium sized adults
      PaO2-partial pressure of oxygen dissolved in arterial blood (80 mmHg breathing room air and 500 mmHg breathing 100% oxygen)
      DF -dissolved form (0.3%)
      PV-plasma volume (3L)
      TG-total globular volume (5L)
      Hb-haemoglobin concentration
      SaO2-arterial oxygen concentration (98% breathing air and 100% when preoxygenated)

    • This question is part of the following fields:

      • Physiology
      57.6
      Seconds
  • Question 8 - A 33-year old man was referred to you because of difficulty moving his...

    Incorrect

    • A 33-year old man was referred to you because of difficulty moving his limbs. History revealed that he was placed under anaesthesia for a major surgery 12 hours prior to the referral. Other symptoms were noted such as anxiousness, agitation, and fever of 38°C. Upon physical examination, he was tachycardic at 119 beats per minute. Moreover, his medical history showed that he was on Fluoxetine for clinical depression. The nurses reported that, because of his frequent complaints of axillary pain, he was given tramadol with paracetamol. Which of the following is responsible for his clinical features?

      Your Answer: Neuroleptic malignant syndrome

      Correct Answer: Tramadol

      Explanation:

      Tramadol is weak agonist at the mu receptor. It inhibits the neuronal reuptake of serotonin and norepinephrine, and inhibits pain neurotransmission. It is given for moderate pain, chronic pain syndromes, and neuropathic pain.

      Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It inhibits the neuronal reuptake of serotonin by inhibiting the serotonin transporter (SERT). It is the drug of choice for major depressive disorder, and is given for other psychiatric disorders such as anxiety, obsessive-compulsive, post-traumatic stress, and phobias.

      When tramadol is given with SSRIs, serotonin syndrome may occur. Serotonin syndrome is characterized by fever, agitation, tremors, clonus, hyperreflexia and diaphoresis. The onset of symptoms may occur within a few hours, and the first-line treatment is sedation, paralysis, intubation and ventilation.

    • This question is part of the following fields:

      • Pharmacology
      13.9
      Seconds
  • Question 9 - When there is a relation between two variables due to the existence of...

    Correct

    • When there is a relation between two variables due to the existence of a confounding factor, this association is termed as:

      Your Answer: Indirect

      Explanation:

      When the association among any two classes of object is defined by the presence of a third entity it is termed as indirect association. For an instance, the age of the employee may affect the rate of pay, which would have implications on job satisfaction. So, in this example, an indirect relationship between age and job satisfaction exists due to a third party i.e. rate of pay.

    • This question is part of the following fields:

      • Statistical Methods
      11.9
      Seconds
  • Question 10 - All of the following are causes of hypalbuminaemia except: ...

    Incorrect

    • All of the following are causes of hypalbuminaemia except:

      Your Answer: Renal failure

      Correct Answer: Starvation

      Explanation:

      Major surgery induces the systemic inflammatory response and this causes endothelial leakage and a low albumin level.

      Albumin is a single polypeptide which is made but not stored in the liver. Therefore, levels are a reflection of synthetic activity. It is negatively charged and very soluble.

      Only 40% of albumin is intravascular, and the rest in the in interstitial compartment.

      If there was normal liver function during starvation, albumin will be maintained and proteolysis will occur elsewhere.
      It is not catabolised during starvation.
      Starvation and malnutrition may, however, present as part of other disease processes that are associated with hypalbuminaemia.

      Causes of low albumin are

      1. Decreased production (hepatic dysfunction)
      2. Increased loss (renal dysfunction)
      3. Redistribution (endothelial leak/damage)
      4. Increased catabolism (very rare)

    • This question is part of the following fields:

      • Physiology And Biochemistry
      16
      Seconds
  • Question 11 - A 25 year-old female came to the out-patient department with complaints of vaginal...

    Incorrect

    • A 25 year-old female came to the out-patient department with complaints of vaginal discharge with a distinct fishy odour. She was later diagnosed with bacterial vaginosis and was prescribed to take metronidazole. The mechanism of action of metronidazole is?

      Your Answer: Interferes with bacterial RNA synthesis

      Correct Answer: Interferes with bacterial DNA synthesis

      Explanation:

      Metronidazole is a nitroimidazole antiprotozoal drug that is selectively absorbed by anaerobic bacteria and sensitive protozoa. Once taken up be anaerobes, it is nonenzymatically reduced by reacting with reduced ferredoxin. This reduction results in products that accumulate in and are toxic to anaerobic cells. The metabolites of metronidazole are taken up into bacterial DNA, forming unstable molecules. This action occurs only when metronidazole is partially reduced, and, because this reduction usually happens only in anaerobic cells, it has relatively little effect on human cells or aerobic bacteria.

    • This question is part of the following fields:

      • Pharmacology
      16.4
      Seconds
  • Question 12 - A new study is being carried out on the measurement of a new...

    Incorrect

    • A new study is being carried out on the measurement of a new cardiovascular disease biomarker, and its applications in preoperative screening. The data for this study is expected to be normally distributed. Which of the following statements is true about normal distributions?

      Your Answer: 95% of observations lie within the mean and 1 standard deviation

      Correct Answer: The mean, median and mode are the same value

      Explanation:

      The correct answer is the mean, median and mode of normally distributed data are the same value. This is as a result of the bell shaped curve which is equal on both sides.

      The bell-shape indicates that values around the mean are more frequent in occurrence than the values farther away.

      In a normal distribution:
      1) +/- one standard deviation of the mean accounts for 68% of the data.
      2) +/- two standard deviations of the mean accounts for 95% of the data.
      3) +/- three standard deviations of the mean accounts for 99.7% of the data.

    • This question is part of the following fields:

      • Statistical Methods
      25.5
      Seconds
  • Question 13 - Which of the following options is correct regarding the coagulation pathway? ...

    Incorrect

    • Which of the following options is correct regarding the coagulation pathway?

      Your Answer: Thrombin converts plasminogen to plasmin

      Correct Answer: Tissue factor released by damaged tissue initiates the extrinsic pathway

      Explanation:

      The extrinsic pathway is considered as the main pathway of coagulation cascade.

      Heparin is known to inhibit the activation of coagulation factors 2,9,10, and 11.

      The extrinsic and intrinsic pathways meet at the activation of coagulation factor 10.

      Fibrinogen is converted into Fibrin in the presence of Thrombin. Plasminogen is converted into plasmin during fibrinolysis to breakdown fibrin clot.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      21.1
      Seconds
  • Question 14 - Which of the following is incorrect with regards to atrial natriuretic peptide? ...

    Correct

    • Which of the following is incorrect with regards to atrial natriuretic peptide?

      Your Answer: Secreted mainly by the left atrium

      Explanation:

      Atrial natriuretic peptide (ANP) is secreted mainly from myocytes of right atrium and ventricle in response to increased blood volume.
      It is secreted by both the right and left atria (right >> left).

      It is a 28 amino acid peptide hormone, which acts via cGMP
      degraded by endopeptidases.

      It serves to promote the excretion of sodium, lowers blood pressure, and antagonise the actions of angiotensin II and aldosterone.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      18.6
      Seconds
  • Question 15 - A 42 year old lady has acute onset of painless weakness on her...

    Incorrect

    • A 42 year old lady has acute onset of painless weakness on her left side of the face with a drooping mouth and difficulty speaking. With no significant past medical history and after relevant investigations, you rule out stroke as a possible cause. The lady is suspected to have suffered Bell's palsy, an idiopathic paralysis of the facial nerve. What symptoms are you most likely to find on examination in a patient with Bell's palsy?

      Your Answer: Normal corneal reflex

      Correct Answer: Taste impairment of the anterior tongue

      Explanation:

      Bell’s palsy is facial muscle weakness or paralysis that arises from idiopathic damage to the facial nerve. It can occur at any age but is commonly associated with some conditions:
      1. pregnancy
      2. diabetes
      3. upper respiratory ailment
      4. GBS
      5. Toxins

      The common symptoms of Bell’s palsy are:
      1. Abnormal corneal reflex as the facial nerve controls the motor aspect of the corneal reflex.
      2. The loss of control of facial muscles and eyelids leads to decreased tear production.
      3. mild weakness to total paralysis on one side of the face, occurring within hours to days.
      4. Bell’s palsy is a lower motor neuron lesion that usually spares the forehead while the upper motor near lesions, like stroke, involves the entire face.
      5. The anterior two-thirds of the tongue is supplied by the chorda tympani branch of the facial nerve, thus resulting in loss of taste.
      6. Ptosis can be a feature of Bell’s palsy but Bell’s palsy would typically show unilateral symptoms rather than bilateral.

    • This question is part of the following fields:

      • Anatomy
      21.2
      Seconds
  • Question 16 - A 66-year-old man with a haemorrhagic stroke is admitted to the medical admissions...

    Correct

    • A 66-year-old man with a haemorrhagic stroke is admitted to the medical admissions unit. He has been taking warfarin for a long time because of atrial fibrillation. His INR at the time of admission was 9.1. Which of the following treatment options is the most effective in managing his condition?

      Your Answer: Prothrombin complex concentrate

      Explanation:

      Haemorrhage, including intracranial bleeding, is a common and potentially fatal side effect of warfarin therapy, and reversing anticoagulation quickly and completely can save lives. When complete and immediate correction of the coagulation defect is required in orally anticoagulated patients with life-threatening haemorrhage, clotting factor concentrates are the only viable option.

      For rapid reversal of vitamin K anticoagulants, prothrombin complex concentrates (PCC) are recommended. They contain the vitamin K-dependent clotting factors II, VII, IX, and X and are derived from human plasma. They can be used as an adjunctive therapy in patients with major bleeding because they normalise vitamin K dependent clotting factors and restore haemostasis.

      The most common treatments are fresh frozen plasma (FFP) and vitamin K. The efficacy of this approach is questioned due to the variable content of vitamin K-dependent clotting factors in FFP and the effects of dilution. Significant intravascular volume challenge, as well as the possibility of rare complications like transfusion-associated lung injury or blood-borne infection, are all potential issues.

      To avoid anaphylactic reactions, vitamin K should be given as a slow intravenous infusion over 30 minutes. Regardless of the route of administration, the reversal of INRs with vitamin K can take up to 24 hours to reach its maximum effect.

      Reversal of anticoagulation in patients with warfarin-associated intracranial haemorrhage may be considered with factor VIIa (recombinant), but its use is controversial. There are concerns about thromboembolic events following treatment, as well as questions about assessing efficacy in changes in the INR. If the drug is to be administered, patients should be screened for an increased risk of thrombosis before the drug is given.

    • This question is part of the following fields:

      • Pathophysiology
      21
      Seconds
  • Question 17 - The renal glomerulus is able to filter 180 litres of blood per day,...

    Incorrect

    • The renal glomerulus is able to filter 180 litres of blood per day, as determined by the starling forces present in the glomerulus. Ninety-nine percent of which is reabsorbed thereafter. Water is reabsorbed in the highest proportion in which segment of the nephron?

      Your Answer: Descending loop of Henle

      Correct Answer: Proximal convoluted tubule

      Explanation:

      Sixty-seven percent of filtered water is reabsorbed in the proximal tubule. The driving force for water reabsorption is a transtubular osmotic gradient established by reabsorption of solutes (e.g., NaCl, Na+-glucose).

      Henle’s loop reabsorbs approximately 25% of filtered NaCl and 15% of filtered water. The thin ascending limb reabsorbs NaCl by a passive mechanism, and is impermeable to water. Reabsorption of water, but not NaCl, in the descending thin limb increases the concentration of NaCl in the tubule fluid entering the ascending thin limb. As the NaCl-rich fluid moves toward the cortex, NaCl diffuses out of the tubule lumen across the ascending thin limb and into the medullary interstitial fluid, down a concentration gradient as directed from the tubule fluid to the interstitium. This mechanism is known as the counter current multiplier.

      The distal tubule and collecting duct reabsorb approximately 8% of filtered NaCl, secrete variable amounts of K+ and H+, and reabsorb a variable amount of water (approximately 8%-17%).

    • This question is part of the following fields:

      • Physiology
      19.5
      Seconds
  • Question 18 - Which among the given choices can be used to describe a persistent and...

    Incorrect

    • Which among the given choices can be used to describe a persistent and expected level of disease in a particular population?

      Your Answer: Prosodemic

      Correct Answer: Endemic

      Explanation:

      Phase 0 trials assist the scientists in studying the behaviour of drugs in humans by micro dosing patients. They are used to speed up the developmental process. They have no measurable therapeutic effect and efficiency.

    • This question is part of the following fields:

      • Statistical Methods
      16.5
      Seconds
  • Question 19 - A 74-year-old with a VVI pacemaker is undergoing a hip replacement. Which of...

    Correct

    • A 74-year-old with a VVI pacemaker is undergoing a hip replacement. Which of the following is most likely to predispose him to an electrical hazard?

      Your Answer: Use of cutting unipolar diathermy

      Explanation:

      A single chamber pacemaker was implanted in the patient. In VVI mode, a pacemaker paces and senses the ventricle while being inhibited by a perceived ventricular event. The most likely electrical hazard from diathermy is electromagnetic interference (EMI).

      EMI has the potential to cause the following: Inhibition of pacing
      Asynchronous pacing
      Reset to backup mode
      Myocardial burns, and
      Trigger VF.

      Diathermy entails the implementation of high-frequency electrical currents to produce heat and either make incisions or induce coagulation. Monopolar cautery involves disposable cautery pencils and electrosurgical diathermy units. In typical monopolar cautery, an electrical plate is placed on the patient’s skin and acts as an electrode, while the current passes between the instrument and the plate. Monopolar diathermy can therefore interfere with implanted metal devices and pacemaker function.

      Bipolar diathermy, where the current passes between the forceps tips and not through the patient and is less likely to generate EMI.

      Whilst the presence of a CVP line may in theory predispose the patient to microshock, the use of prerequisite CF electrical equipment makes this very unlikely. The presence of a CVP line and pacemaker does not therefore unduly increase the risk of an electrical hazard.

      Isolating transformers are used to protect secondary circuits and individuals from electrical shocks. There is no step-up or step-down voltage (i.e. there is a ratio of 1 to 1 between the primary and secondary windings).

      A ground (or earth) wire is normally connected to the metal case of an operating table to protect patients from accidental electrocution. In the event that a fault allows a live wire to make contact with the metal table (broken cable, loose connection etc.) it becomes live. The earth will provide an immediate path for current to safely flow through and so the table remains safe to touch. Being a low resistance path, the earth lets a large current flow through it when the fault occurs ensuring that the fuse or RCD will quickly blow. Without an operating table earth, the patient is not at more risk of an electrical hazard because of the pacemaker.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      12.1
      Seconds
  • Question 20 - Which of the following antibiotics inhibits protein synthesis in bacteria? ...

    Correct

    • Which of the following antibiotics inhibits protein synthesis in bacteria?

      Your Answer: Erythromycin

      Explanation:

      Erythromycin binds to the 50s subunit of bacterial rRNA complex and inhibits protein synthesis.

      Vancomycin binds to the acyl-D-ala-D-ala portion of the growing cell wall in a susceptible gram-positive bacterium. After binding, it prevents the cell wall from forming the cross-linking.

      Trimethoprim binds to dihydrofolate reductase and inhibits the reduction of dihydrofolic acid to tetrahydrofolic acid. Tetrahydrofolic acid is an essential precursor in the thymidine synthesis pathway and interference with this pathway inhibits bacterial DNA synthesis.

    • This question is part of the following fields:

      • Pharmacology
      278.6
      Seconds
  • Question 21 - A 58-year-old man, visits his general practitioner complaining of a lump in his...

    Correct

    • A 58-year-old man, visits his general practitioner complaining of a lump in his groin. He explains he is otherwise well and reports no other symptoms. The lump is examined and is found to be soft, and can be reduced without causing the patient pain. The GP diagnoses an inguinal hernia. To determine the nature of the hernia, the GP reduced the lump and applies pressure on the deep inguinal ring. The deep inguinal ring has what anatomical landmark?

      Your Answer: Superior to the midpoint of the inguinal ligament

      Explanation:

      The deep inguinal ring lies approximately 1.5-2cm above the midpoint of the inguinal ligament, the halfway point between the anterior superior iliac spine and the pubic tubercle, next to the epigastric vessels.

      It is an important point in determining the nature of an inguinal hernia (direct or indirect). The patient is asked to cough after the hernia is reduced, with pressure applied to the deep inguinal ring. The hernia reappearing indicates it is direct, moving through the posterior wall of the inguinal canal.

      Inferior and lateral to the pubic tubercle is the normal anatomical position of the neck of a femoral hernia.

      Superior and medial to the pubic tubercle is the site of the superficial inguinal ring, and the normal anatomical position of the neck of an inguinal hernia.

      The mid-inguinal point is located halways between the pubic symphysis and the anterior superior iliac spine. It is the surface marking for taking the femoral pulse.

    • This question is part of the following fields:

      • Anatomy
      24.1
      Seconds
  • Question 22 - A 50-year-old female, known case of diabetes, has come in for a check-up...

    Correct

    • A 50-year-old female, known case of diabetes, has come in for a check-up at the diabetic foot clinic. The pulses of her feet are examined. The posterior tibial pulse and dorsalis pedis pulses are palpated. Which of the following artery continues as the dorsalis pedis artery?

      Your Answer: Anterior tibial artery

      Explanation:

      At the ankle joint, midway between the malleoli, the anterior tibial artery changes names, becoming the dorsalis pedis artery (dorsal artery of the foot).

      The dorsalis pedis artery is palpated against the underlying tarsals, immediately lateral to the tendon of extensor hallucis longus, from the midpoint between the malleoli to the proximal end of the first intermetatarsal space.

      The popliteal artery forms the anterior tibial artery.
      The tibioperoneal trunk is a branch of the popliteal artery.
      The peroneal artery (also known as the fibular artery) supplies the lateral compartment of the leg.
      The external iliac artery is formed from the common iliac artery at the level of the pelvis.

    • This question is part of the following fields:

      • Anatomy
      21.3
      Seconds
  • Question 23 - A 20-year-old female presents to the emergency department. She complains of increased shortness...

    Incorrect

    • A 20-year-old female presents to the emergency department. She complains of increased shortness of breath and wheezing over the last 48 hours. On examination, she is found to have tachycardia, tachypnoea, and oxygen saturation at 91% on air. She admits to a previous medical history of asthma, diagnosed 4 years ago. She requires further investigations for diagnosis. Which of the following is true about the assessment of a patient with symptomatic asthma?

      Your Answer: A peak expiratory flow rate (PEFR) of 45% best or predicted suggests moderate asthma exacerbation

      Correct Answer: Oxygen saturations of 91% on air would be an indication for performing arterial blood gases

      Explanation:

      A patient presenting with symptomatic asthma should be assessed for severity to determine appropriate management options. Indications of acute severe asthma are:

      Peak expiratory flow rate (PEFR): 33-50% best/predicted
      Respiratory rate: ‰¥25/min
      Heart rate: ‰¥110/min
      Inability to finish a complete sentence in a single breath.

      Oxygen saturation should be measured. Any measurement of an oxygen saturation of 92% or less, either on air or on oxygen, indicates severe, life threatening asthma, and requires an arterial blood gas (ABG) to detect normo- or hypercarbia.

      A chest x-ray would not be routine as it will not provide any relevant information. It is only required in specific cases, including:
      Diagnosis of a subcutaneous emphysema
      Indications of a unilateral pneumothorax
      Indications of a lobar collapse of consolidation
      Treatment-resistance life-threatening asthma
      If mechanical ventilation is indicated

      A peak expiratory flow rate (PEFR) can provide relevant information to help distinguish between acute, moderate, severe and life threatening asthma. However, it is not necessary as other parameters exist that can also help make the same distinction.

      An ECG is indicated in this case as the patient has tachycardia and tachypnoea which are indicative of acute severe asthma. The ECG would indicate if arrhythmia is also present which would suggest life-threatening asthma.

    • This question is part of the following fields:

      • Clinical Measurement
      26.1
      Seconds
  • Question 24 - In a normal healthy adult breathing 100 percent oxygen, which of the following...

    Correct

    • In a normal healthy adult breathing 100 percent oxygen, which of the following is the most likely cause of an alveolar-arterial (A-a) oxygen difference of 30 kPa?

      Your Answer: Atelectasis

      Explanation:

      The ‘ideal’ alveolar PO2 minus arterial PO2 is the alveolar-arterial (A-a) oxygen difference.

      The ‘ideal’ alveolar PO2 is derived from the alveolar air equation and is the PO2 that the lung would have if there was no ventilation-perfusion (V/Q) inequality and it was exchanging gas at the same respiratory exchange ratio as real lung.

      The amount of oxygen in the blood is measured directly in the arteries.

      The A-a oxygen difference (or gradient) is a useful measure of shunt and V/Q mismatch, and it is less than 2 kPa in normal adults breathing air (15 mmHg). Because the shunt component is not corrected, the A-a difference increases when breathing 100 percent oxygen, and it can be up to 15 kPa (115 mmHg).

      An abnormally low or abnormally high V/Q ratio within the lung can cause an increased A-a difference, though the former is more common. Atelectasis, which results in a low V/Q ratio, is the most likely cause of an A-a difference in a healthy adult breathing 100 percent oxygen.

      Hypoventilation may cause an increase in alveolar (and thus arterial) CO2, lowering alveolar PO2 according to the alveolar air equation.

      The alveolar PO2 is also reduced at high altitude.

      Healthy people are unlikely to have a right-to-left shunt or an oxygen transport diffusion defect.

    • This question is part of the following fields:

      • Physiology
      9
      Seconds
  • Question 25 - Which of the following drugs can have significant clinical effects on neonates when...

    Correct

    • Which of the following drugs can have significant clinical effects on neonates when used in appropriate doses for a caesarean section?

      Your Answer: Alfentanil

      Explanation:

      Opioid should be avoided in the caesarean section as it crosses the placental membrane and causes respiratory depression.

      Even though inhalational and intravenous anaesthetic agents readily cross the placenta, they do not have significant effects on APGAR score when used in clinical doses.

      Vecuronium and suxamethonium are highly polar molecules and thus do not cross the placenta in significant amounts.

    • This question is part of the following fields:

      • Pharmacology
      6.4
      Seconds
  • Question 26 - A 30-year-old woman with a BMI of 24 kg/m2 consumes four glasses of...

    Correct

    • A 30-year-old woman with a BMI of 24 kg/m2 consumes four glasses of wine on an empty stomach. Her serum alcohol are levels measured over the following five hours. The serum alcohol level of 30-year-old man with the same BMI and alcohol consumption is also measured over the same duration. The peak concentration of alcohol is found to be greater in the woman than in the man. Which of these offers best explanation for this observation?

      Your Answer: Lower volume of distribution

      Explanation:

      The blood alcohol concentration depends on:

      -The rate of alcohol absorption from the gastrointestinal tract
      -The volume of distribution of alcohol in the body, and
      -The rate of elimination of alcohol from the body.

      Total body water is approximately 50% in a female as compared to 60% in a typical male. This means that the volume of distribution of alcohol is lower in female compared with men. This is the principal reason for higher peak in alcohol levels.

      About 4% of ingested alcohol is metabolised by the liver accounting for first pass metabolism and 0.4% is metabolised by gastric alcohol dehydrogenase (ADH). The absorbed alcohol is NOT distributed to fat cells but it is distributed throughout the water compartments (plasma, interstitial and intracellular) of the body. Women have very little gastric ADH, which further influences this exaggerated rise.

      85-98% of the alcohol is oxidised by the liver to acetaldehyde and then to acetate. The metabolic pathway initially observes first order kinetics and then saturation or zero order kinetics leading to peaks in alcohol levels.

      Clearance of ethanol per unit lean body mass is lower in male. The calculated alcohol elimination rate and liver volume per kilogram of lean body mass were 33% and 38% higher in women than in men, respectively.

      Available evidence in the literature about the relationship of alcohol metabolism to the phases of the menstrual cycle is conflicting.

    • This question is part of the following fields:

      • Pathophysiology
      35.4
      Seconds
  • Question 27 - Using a negative feedback loop, Haem production is controlled by which of these...

    Incorrect

    • Using a negative feedback loop, Haem production is controlled by which of these enzymes?

      Your Answer: Protoporphyrinogen oxidase

      Correct Answer: ALA synthetase

      Explanation:

      Heme a exists in cytochrome a and heme c in cytochrome c; they are both involved in the process of oxidative phosphorylation. 5′-Aminolevulinic acid synthase (ALA-S) is the regulated enzyme for heme synthesis in the liver and erythroid cells.

      There are two forms of ALA Synthase, ALAS1, and ALAS2.

    • This question is part of the following fields:

      • Physiology
      7.3
      Seconds
  • Question 28 - A 40 year old female is planned for an critical appendicectomy. A fast...

    Incorrect

    • A 40 year old female is planned for an critical appendicectomy. A fast arrangements inductance is organized. The patient has had a preoperative respiratory tract evaluation and there are no adverse features. The patient is ideally positioned and preoxygenated. The anaesthetic applied cricoid pressure of 10 N. Acceptance of anaesthesia is at that point carried out with 250 mg thiopentone and 100 mg suxamethonium with 30 N of cricoid pressure. Initial laryngoscopy shows a review of grade 4. Three endeavours are made at putting a estimate 7 mm ID tracheal tube; two with a standard laryngoscope and one with a McCoy edge and bougie. Then one advance attempt is made employing a video laryngoscope. At this point the suxamethonium is starts to wear off. Oxygen immersion is 95%. Which one of the following treatment option is the another most suitable arrange of action?

      Your Answer: Insert a 2 generation supraglottic airway

      Correct Answer: Maintain oxygenation and anaesthesia and declare a failed intubation

      Explanation:

      Firstly, always call for an early help. This understanding is at hazard of gastro-oesophageal reflux, the reason a fast arrangement acceptance has been picked for within the first place. The patient isn’t pregnant and the critical surgery isn’t immediate.

      The scheme A is to perform a fast arrangement acceptance under ideal conditions and effectively secure the respiratory tract with a tracheal tube.

      Whilst no more than three attempts with coordinate laryngoscope (+ 1 endeavour with video laryngoscope) ought to be made to intubate the trachea, the reality is that the suxamethonium is wearing off ought to be borne in mind. One step is to make certain satisfactory neuromuscular blockade at this level, if oxygenation can be kept up by bag-mask ventilation, this might involve the administration of a non-depolarising relaxant. As the surgery isn’t prompt there should be a baseline to stop scheme A at intubation and resort to scheme B.

      An elective procedure can be planned at that time.

      The first most vital step is to report a failed intubation as this will halt you from continuing to intubate and notify your collaborator that scheme A has failed. Keeping up oxygenation and anaesthesia is additionally critical earlier to the initiation of scheme B.

      Do not administer another dose of suxamethonium. If there’s collapse of oxygenation and failure to preserve satisfactory ventilation, then insert a supraglottic airway. Plan D takes after the affirmation of a CICO.

    • This question is part of the following fields:

      • Pharmacology
      130.2
      Seconds
  • Question 29 - When nitrous oxide is stored in cylinders at room temperature, it is a...

    Incorrect

    • When nitrous oxide is stored in cylinders at room temperature, it is a gas. Which of its property is responsible for this?

      Your Answer: Molecular weight

      Correct Answer: Critical temperature

      Explanation:

      The temperature above which a gas cannot be liquefied no matter how much pressure is applied is its critical temperature. The critical temperature of nitrous oxide is 36.5°C

      The minimum pressure that causes liquefaction is the critical pressure of that gas.

      The Poynting effect refers to the phenomenon where mixing of liquid nitrous oxide at low pressure with oxygen at high pressure (in Entonox) leads to formation of gas of nitrous oxide.

      There is no relevance of molecular weight to this question. it does not change with phase of a substance.

    • This question is part of the following fields:

      • Pharmacology
      15.7
      Seconds
  • Question 30 - Arrythmias can develop from abnormal conduction, which may be as a result of...

    Correct

    • Arrythmias can develop from abnormal conduction, which may be as a result of impaired blood flow in the coronary arteries which causes hypoxia. Phase 0 depolarisation can be slowed, and this leads to slower conduction speeds. Rapid depolarisation in the cardiac action potential is caused by which movement of ions?

      Your Answer: Sodium influx

      Explanation:

      Cardiac conduction

      Phase 0 – Rapid depolarization. Opening of fast sodium channels with large influx of sodium

      Phase 1 – Rapid partial depolarization. Opening of potassium channels and efflux of potassium ions. Sodium channels close and influx of sodium ions stop

      Phase 2 – Plateau phase with large influx of calcium ions. Offsets action of potassium channels. The absolute refractory period

      Phase 3 – Repolarization due to potassium efflux after calcium channels close. Relative refractory period

      Phase 4 – Repolarization continues as sodium/potassium pump restores the ionic gradient by pumping out 3 sodium ions in exchange for 2 potassium ions coming into the cell. Relative refractory period

    • This question is part of the following fields:

      • Physiology And Biochemistry
      9.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Pharmacology (2/9) 22%
Physiology (2/5) 40%
Basic Physics (1/1) 100%
Physiology And Biochemistry (2/5) 40%
Statistical Methods (1/3) 33%
Anatomy (2/3) 67%
Pathophysiology (2/2) 100%
Anaesthesia Related Apparatus (1/1) 100%
Clinical Measurement (0/1) 0%
Passmed