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  • Question 1 - Which of the following hormones regulates Na+reabsorption in the proximal tubule: ...

    Incorrect

    • Which of the following hormones regulates Na+reabsorption in the proximal tubule:

      Your Answer:

      Correct Answer: Angiotensin II

      Explanation:

      Angiotensin II increases Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters).

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 2 - A 30-year-old man presents with piriformis syndrome pain, tingling, and numbness in her...

    Incorrect

    • A 30-year-old man presents with piriformis syndrome pain, tingling, and numbness in her buttocks. He noted that the pain gets worse upon sitting down. He was seen by a physiotherapist and a diagnosis of piriformis syndrome was made.Which of the following nerves becomes irritated in piriformis syndrome?

      Your Answer:

      Correct Answer: Sciatic nerve

      Explanation:

      Piriformis syndrome is a clinical condition of sciatic nerve entrapment at the level of the ischial tuberosity. While there are multiple factors potentially contributing to piriformis syndrome, the clinical presentation is fairly consistent, with patients often reporting pain in the gluteal/buttock region that may shoot, burn or ache down the back of the leg (i.e. sciatic-like pain). In addition, numbness in the buttocks and tingling sensations along the distribution of the sciatic nerve is not uncommon. The sciatic nerve runs just adjacent to the piriformis muscle, which functions as an external rotator of the hip. Hence, whenever the piriformis muscle is irritated or inflamed, it also affects the sciatic nerve, which then results in sciatica-like pain.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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  • Question 3 - An elderly patient presents to ED following a fall after feeling light headed...

    Incorrect

    • An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:

      Your Answer:

      Correct Answer: Thick ascending limb

      Explanation:

      Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 4 - Antispasmodic drugs are primarily indicated in which of the following conditions: ...

    Incorrect

    • Antispasmodic drugs are primarily indicated in which of the following conditions:

      Your Answer:

      Correct Answer: Irritable bowel syndrome

      Explanation:

      Antispasmodics, such as antimuscarinics, may be used in the management of irritable bowel syndrome. Other antispasmodics used include direct-acting smooth muscle relaxants such as mebeverine, alverine, and peppermint oil. Antispasmodics are contraindicated in bowel obstruction and severe inflammatory bowel disease. Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects. Antimuscarinics are contraindicated in urinary retention.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
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  • Question 5 - External haemorrhoids may cause anal pain. When explaining to your patient why it...

    Incorrect

    • External haemorrhoids may cause anal pain. When explaining to your patient why it does so, which of the following nerves will you point out as being affected?

      Your Answer:

      Correct Answer: Pudendal nerve

      Explanation:

      The pain associated with external haemorrhoids is carried by a branch of the pudendal nerve, specifically the somatic fibres (S2-S4). It innervates the external anal sphincter and most of the skin over the perineum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 6 - Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:...

    Incorrect

    • Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: ITP is classically associated with massive splenomegaly.

      Explanation:

      Chronic ITP is a relatively common disorder. The highest incidence is in women aged 15 – 50 years. It is the most common cause of thrombocytopaenia without anaemia or neutropaenia. It is usually idiopathic but it may been seen in association with other conditions. Platelet autoantibodies (usually IgG) result in the premature removal of platelets from the circulation by macrophages of the reticuloendothelial system. In many causes the antibody is directed against the glycoprotein IIb/IIIa or Ib complex. The normal platelet lifespan of 10 days is reduced to a few hours. Total megakaryocyte mass and platelet turnover are increased to approximately five times normal. Despite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged.  In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 7 - Which of the following best describes the correct administration of adrenaline for a...

    Incorrect

    • Which of the following best describes the correct administration of adrenaline for a shockable rhythm in adult advanced life support?

      Your Answer:

      Correct Answer: Give 1 mg of adrenaline after the third shock and every 3 - 5 minutes thereafter

      Explanation:

      The correct administration of IV adrenaline 1 mg (10 mL of 1:10,000 solution) is that it should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 8 - Regarding endothelin-1, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding endothelin-1, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Endothelin-1 release is inhibited by noradrenaline.

      Explanation:

      Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 9 - A 35-year-old man suffered a severe road traffic accident and has been brought...

    Incorrect

    • A 35-year-old man suffered a severe road traffic accident and has been brought to the hospital. As part of his treatment, he requires a blood transfusion and experiences a transfusion reaction.The most common type of transfusion reaction is which of the following?

      Your Answer:

      Correct Answer: Febrile transfusion reaction

      Explanation:

      During or shortly after transfusion, febrile transfusion reactions, also known as non-haemolytic transfusion reactions, present with an unexpected temperature rise (38oC or 1oC above baseline, if baseline is 37oC). This is usually a one-off occurrence. The fever is sometimes accompanied by chills.The most common type of transfusion reaction is febrile transfusion reactions, which occur in about 1 in every 8 transfusions.The most common event leading to symptoms of febrile transfusion reactions is cytokine accumulation during storage of cellular components (especially platelet units). White cells secrete cytokines, and pre-storage leucodepletion has reduced this risk.Recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leukocyte antigen (HLA) or other antigens can also cause febrile transfusion reactions. Donor lymphocytes, granulocytes, and platelets all contain these antigens.Treatment is reassuring. Other causes should be ruled out, and antipyretics like paracetamol can help with fever relief. If another cause of fever is suspected, the transfusion should be stopped; however, if other causes of fever have been ruled out, it can be restarted at a slower rate.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 10 - Polyuria and polydipsia develop in a patient with a history of affective disorders...

    Incorrect

    • Polyuria and polydipsia develop in a patient with a history of affective disorders illness who has been on long-term lithium. She has a fluid deprivation test because she is suspected of having nephrogenic diabetic insipidus.Which of the following urine osmolality findings would be the most reliable in confirming the diagnosis? 

      Your Answer:

      Correct Answer: After fluid deprivation <300 mosmol/kg, after IM desmopressin <300 mosmol/kg

      Explanation:

      The inability to produce concentrated urine is a symptom of diabetes insipidus. Excessive thirst, polyuria, and polydipsia are all symptoms of this condition. There are two forms of diabetes insipidus: Nephrogenic diabetes insipidus and cranial (central) diabetes insipidus.A lack of ADH causes cranial diabetic insipidus. Patients with cranial diabetes insipidus can have a urine output of up to 10-15 litres per 24 hours, however most patients can maintain normonatraemia with proper fluid consumption. Thirty percent of cases are idiopathic, while another thirty percent are caused by head injuries. Neurosurgery, brain tumours, meningitis, granulomatous disease (e.g. sarcoidosis), and medicines like naloxone and phenytoin are among the other reasons. There is also a very rare hereditary type that is linked to diabetes, optic atrophy, nerve deafness, and bladder atonia.Renal resistance to the action of ADH causes nephrogenic diabetes insipidus. Urine output is significantly increased, as it is in cranial diabetes insipidus. Secondary polydipsia can keep serum sodium levels stable or raise them. Chronic renal dysfunction, metabolic diseases (e.g., hypercalcaemia and hypokalaemia), and medications, such as long-term lithium use and demeclocycline, are all causes of nephrogenic diabetes insipidus.The best test to establish if a patient has diabetes insipidus vs another cause of polydipsia is the water deprivation test, commonly known as the fluid deprivation test. It also aids in the distinction between cranial and nephrogenic diabetes insipidus. Weight, urine volume, urine osmolality, and serum osmolality are all measured after patients are denied water for up to 8 hours. At the end of the 8-hour period, 2 micrograms of IM desmopressin is given, and measures are taken again at 16 hours.The following are the way results are interpreted:Urine osmolality after fluid deprivation : Urine osmolality after IM desmopressinCranial diabetes insipidus800 mosmol/kgNephrogenic diabetes insipidus<300 mosmol/kg : 800 mosmol/kg : >800 mosmol/kg

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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