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  • Question 1 - The only statement that is correct regarding diffusion is which of the following?...

    Incorrect

    • The only statement that is correct regarding diffusion is which of the following?

      Your Answer: The rate of diffusion across a membrane is described by Darcy's law.

      Correct Answer: The permeability of a membrane is related to the membrane thickness and composition.

      Explanation:

      Passive diffusion is a process that describes the movement down a concentration gradient. This process accounts for movement across small distances like within the cytosol or across membranes. Factors that affect the diffusion of a substance across a membrane are the permeability (p) of the membrane, a difference in concentration across the membrane and the membrane area over which diffusion occurs. The membrane thickness and composition, and the diffusion coefficient of the substance also affects the permeability. Fick’s law describes the rate of diffusion of a substance within a solution, which can be modified to describe the rate of diffusion across a membrane.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      96.7
      Seconds
  • Question 2 - What is the average healing time for a femoral shaft fracture under normal...

    Incorrect

    • What is the average healing time for a femoral shaft fracture under normal circumstances? Choose ONE answer.

      Your Answer: 16 weeks

      Correct Answer: 12 weeks

      Explanation:

      The process of fracture healing occurs naturally after traumatic bone disruption and begins with haemorrhage, then progresses through Inflammatory, reparative, and remodelling stagesAverage healing times of common fractures are:Femoral shaft: 12 weeksTibia: 10 weeksPhalanges: 3 weeksMetacarpals: 4-6 weeksDistal radius: 4-6 weeksHumerus: 6-8 weeks

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      85.6
      Seconds
  • Question 3 - Which of the following statements about neutrophils is TRUE: ...

    Correct

    • Which of the following statements about neutrophils is TRUE:

      Your Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.

      Explanation:

      Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      12.9
      Seconds
  • Question 4 - Identify the type of graph described below:This graph has been used to create...

    Correct

    • Identify the type of graph described below:This graph has been used to create visual representations to communicate the risks and benefits of treatments using 4 face categories.

      Your Answer: Cates plot

      Explanation:

      Cates Plot, since 1999, has been used to create visual representations to communicate the risks and benefits of treatments. The essence of Cates Plot is the use of 4 face categories to visually indicate the following:People not affected by a treatment (green faces for those with a good outcome and red for those with a bad outcome)People for which treatment changes their category from a bad outcome to a good outcome (yellow faces)People for which treatment causes an adverse event and changes their category from a good outcome to a bad outcome (crossed out green faces)

    • This question is part of the following fields:

      • Evidence Based Medicine
      11.9
      Seconds
  • Question 5 - The renal team is currently prescribing erythropoietin to a patient with chronic kidney...

    Incorrect

    • The renal team is currently prescribing erythropoietin to a patient with chronic kidney disease.Which of the following statements about erythropoietin is correct?

      Your Answer: It increases oxygen affinity

      Correct Answer: It protects red blood cell progenitors from apoptosis

      Explanation:

      Erythropoietin is a glycoprotein hormone that regulates the formation of red blood cells (red cell production). It is mostly produced by interstitial fibroblasts in the kidney, which are located near the PCT. It is also produced in the liver’s perisinusoidal cells, however this is more common during the foetal and perinatal periods.The kidneys produce and secrete erythropoietin in response to hypoxia. On red blood cells, erythropoietin has two main effects:- It encourages stem cells in the bone marrow to produce more red blood cells.- It protects red blood cell progenitors and precursors from apoptosis by targeting them in the bone marrow.As a result of the increased red cell mass, the oxygen-carrying capacity and oxygen delivery increase.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      10.9
      Seconds
  • Question 6 - The common bile duct drains into the duodenum in which of the following...

    Correct

    • The common bile duct drains into the duodenum in which of the following regions:

      Your Answer: Second part of the duodenum

      Explanation:

      As the common bile duct descends, it passes posterior to the first part of the duodenum before joining with the pancreatic duct from the pancreas, forming the hepatopancreatic ampulla (ampulla of Vater) at the major duodenal papilla, located in the second part of the duodenum. Surrounding the ampulla is the sphincter of Oddi, a collection of smooth muscle which can open to allow bile and pancreatic fluid to empty into the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      35.9
      Seconds
  • Question 7 - A 30-year-old man bought into the ED with increased thirst, confusion, abdominal pain...

    Correct

    • A 30-year-old man bought into the ED with increased thirst, confusion, abdominal pain and constipation is suspected to have hypercalcaemia.What is the commonest cause of hypercalcaemia in the UK?

      Your Answer: Primary hyperparathyroidism

      Explanation:

      The commonest cause of hypercalcaemia in the UK is primary hyperparathyroidism, which accounts for around 70-80% of cases. It is commoner in younger patients and in community setting.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      253.1
      Seconds
  • Question 8 - Which of the following represents ventricular repolarisation on the ECG: ...

    Incorrect

    • Which of the following represents ventricular repolarisation on the ECG:

      Your Answer: QRS complex

      Correct Answer: T wave

      Explanation:

      P wave = Atrial depolarisationQRS complex = Ventricular depolarisationT wave = Ventricular repolarisation

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      3.7
      Seconds
  • Question 9 - A patient presents with a rash for dermatological examination. A large area of...

    Incorrect

    • A patient presents with a rash for dermatological examination. A large area of purplish discolouration of the skin that measures 2 cm in diameter and does not blanch when pressure is applied is seen .What is the best description of this rash that you have found on examination?

      Your Answer: Purpura

      Correct Answer: Ecchymoses

      Explanation:

      Ecchymosis are discolouration of the skin or mucous membranes caused by extravasation of blood. They are usually red or purple in colour and measure greater than 1 cm in diameter and do not blanch on applying pressure. A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin. Petechiae are discolouration of the skin measuring less than 3 mm in diameterPurpura are discolouration of the skin measuring between 0.3 cm and 1 cm in diameter.Erythema is redness of the skin or mucous membranes caused by hyperaemia of superficial capillaries caused by skin injury, infection or inflammation. Erythema blanches when pressure is applied whereas ecchymosis, purpura and petechiae do not.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      12.3
      Seconds
  • Question 10 - The most common complication of paracetamol overdose is: ...

    Incorrect

    • The most common complication of paracetamol overdose is:

      Your Answer: Lactic acidosis

      Correct Answer: Hepatic failure

      Explanation:

      The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      5.7
      Seconds
  • Question 11 - A 76-year-old man presents with complaints of double vision. Upon physical examination, it...

    Correct

    • A 76-year-old man presents with complaints of double vision. Upon physical examination, it was observed that he exhibits left-sided hemiplegia and left-sided loss of joint position sense, vibratory sense and discriminatory touch. In addition, he has the inability to abduct his right eye and is holding his head towards the right side. A CT scan was ordered and showed that he has suffered a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?

      Your Answer: Basilar artery

      Explanation:

      Inferior medial pontine syndrome, also known as Foville syndrome, is one of the brainstem stroke syndromes which occurs when there is infarction of the medial inferior aspect of the pons due to occlusion of the paramedian branches of the basilar artery.It is characterized by ipsilateral sixth nerve palsy, facial palsy, contralateral hemiparesis, contralateral loss of proprioception and vibration, ipsilateral ataxia, ipsilateral facial weakness, and lateral gaze paralysis and diplopia.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      123.3
      Seconds
  • Question 12 - Which of the following is an action of glucagon: ...

    Correct

    • Which of the following is an action of glucagon:

      Your Answer: Stimulates glycogenolysis

      Explanation:

      Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline. Glucagon then causes:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      6.2
      Seconds
  • Question 13 - An 11-year-old presented to a GP with a history of headache, neck stiffness...

    Correct

    • An 11-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent petechial rash on legs and arms. The GP administered a dose of antibiotics in the prehospital setting before transferring to the Emergency Department.Which of these would the GP have administered?

      Your Answer: IM benzylpenicillin 1.2 g

      Explanation:

      General Practitioners are advised to give a single injection of benzylpenicillin by intravenous or intramuscular injection before transferring the patient urgently to the ED when bacterial meningitis is suspected.The recommended doses are:Infants under 1 year: 300 mgChildren ages 1 to 9 years: 600 mgChildren aged 10 years and over: 1.2gAdults: 1.2g

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      11.4
      Seconds
  • Question 14 - A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense,...

    Incorrect

    • A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke. Which of the following is considered the best diagnosis for the case presented above?

      Your Answer: Medial pontine syndrome

      Correct Answer: Medial medullary syndrome

      Explanation:

      Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      1.7
      Seconds
  • Question 15 - Coagulative necrosis is typically seen in which of the following: ...

    Correct

    • Coagulative necrosis is typically seen in which of the following:

      Your Answer: Myocardial infarction

      Explanation:

      Coagulative necrosis is the most common form of necrosis characterised by the loss of cell nuclei, but with general preservation of the underlying architecture. Dead tissue is macroscopically pale and firm. This is the classic pattern seen in myocardial infarction.Liquefactive necrosis leads to complete loss of cellular structure and conversion into a soft, semi-solid mass. This is typically seen in the brain following cerebral infarction.Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.Gangrenous necrosis is necrosis with putrefaction of tissues due to exposure to air (dry gangrene) or infection (wet gangrene).

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      42.4
      Seconds
  • Question 16 - Which of the following side effects has limited the use of etomidate as...

    Incorrect

    • Which of the following side effects has limited the use of etomidate as an intravenous induction agent:

      Your Answer: Profound hypotension

      Correct Answer: Adrenocortical suppression

      Explanation:

      Etomidate causes the least cardiovascular depression of the intravenous induction agents, with only a small reduction in the cardiac output and blood pressure. In the past, etomidate was widely used to induce anaesthesia in the shocked, elderly or cardiovascularly unstable patient. However, more recently it has become less popular as a single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4 – 8 hours, and up to 24 hours in elderly and debilitated patients. Although no increase in mortality has been identified following a single dose during induction of anaesthesia, the use of etomidate has declined due to a perceived potential morbidity.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      11.3
      Seconds
  • Question 17 - Which of the following does NOT affect the rate of flow of a...

    Incorrect

    • Which of the following does NOT affect the rate of flow of a liquid through a tube:

      Your Answer: Length of the tube

      Correct Answer: Surface tension

      Explanation:

      Flow through a tube is dependent upon:The pressure difference across the ends of the tube (P1– P2)The resistance to flow provided by the tube (R)This is Darcy’s law, which is analogous to Ohm’s law in electronics:Flow = (P1– P2) / RResistance in the tube is defined by Poiseuille’s law, which is determined by the diameter of the tube and the viscosity of the fluid. Poiseuille’s law is as follows:Resistance = (8VL) / (πR4)Where:V = The viscosity of the fluidL = The length of the tubeR = The radius of the tubeTherefore, in simple terms, resistance is directly proportional to the viscosity of the fluid and the length of the tube and inversely proportional to the radius of the tube. Of these three factors, the most important quantitatively and physiologically is vessel radius.It can be seen that small changes in the radius can have a dramatic effect on the flow of the fluid. For example, the constriction of an artery by 20% will decrease the flow by approximately 60%.Another important and frequently quoted example of this inverse relationship is that of the radius of an intravenous cannula. Doubling the diameter of a cannula increases the flow rate by 16-fold (r4). This is the reason the diameter of an intravenous cannula in resuscitation scenarios is so important.*Please note that knowledge of the detail of Poiseuille’s law is not a requirement of the RCEM Basic Sciences Curriculum.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      4.5
      Seconds
  • Question 18 - You review a patient with a history of Addison’s disease. He takes 100...

    Correct

    • You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.

      Your Answer: 25 mg

      Explanation:

      Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:CorticosteroidPotency relative to hydrocortisonePrednisolone4 times more potentTriamcinolone5 times more potentMethylprednisolone5 times more potentDexamethasone25 times more potent

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      8.2
      Seconds
  • Question 19 - What is the main mechanism of action of metoclopramide: ...

    Incorrect

    • What is the main mechanism of action of metoclopramide:

      Your Answer: Serotonin-5HT3 antagonist

      Correct Answer: Dopamine antagonist

      Explanation:

      Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      6.1
      Seconds
  • Question 20 - Lidocaine's mechanism of action as a local aesthetic is as follows: ...

    Correct

    • Lidocaine's mechanism of action as a local aesthetic is as follows:

      Your Answer: Blocks influx of Na+ through voltage-gated Na+ channels

      Explanation:

      Local anaesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      8.9
      Seconds
  • Question 21 - Which of the following statements is false regarding the biceps brachii muscle? ...

    Incorrect

    • Which of the following statements is false regarding the biceps brachii muscle?

      Your Answer: It has two heads

      Correct Answer: It pronates the radioulnar joint in the forearm

      Explanation:

      The biceps brachii muscle is one of the chief muscles of the arm. The origin at the scapula and the insertion into the radius of the biceps brachii means it can act on both the shoulder joint and the elbow joint, which is why this muscle participates in a few movements of the arm. It derives its name from its two heads which merge in one unique distal body, defining the unusual structure of the muscle.The biceps brachii muscle is supplied by the musculocutaneous nerve (C5-C6), a branch of the brachial plexus.Arterial supply to the biceps brachii muscle varies considerably, coming from up to eight vessels originating from the brachial artery in the middle third of the arm.In the shoulder joint both muscle heads partially enforce opposite movements. The long head pulls the arm away from the trunk (abduction) and turns it inwards (inward rotation) whereas the short head pulls the arm back towards the trunk (adduction). When both heads contract simultaneously it leads to an arm bend (flexion). In the elbow joint the muscle bends the forearm (flexion) and rotates it outwards (supination). The supination is most powerful in a flexed elbow. In addition to the movement functions, the biceps has the important task to support the humeral head within the shoulder joint. Its antagonist is the triceps brachii in the posterior compartment of the arm.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      3.8
      Seconds
  • Question 22 - How does abciximab mediate its antiplatelet effect: ...

    Incorrect

    • How does abciximab mediate its antiplatelet effect:

      Your Answer: It is a vitamin K antagonist.

      Correct Answer: It is a GPIIb/IIIa inhibitor.

      Explanation:

      Abciximab, eptifibatide and tirofiban are GPIIb/IIIa inhibitors, inhibiting platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor and other adhesive molecules.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      8.2
      Seconds
  • Question 23 - A 55 year old man presents to ED complaining of leg weakness. Your...

    Incorrect

    • A 55 year old man presents to ED complaining of leg weakness. Your colleague has examined the patient and suspects femoral nerve palsy. Which of the following clinical features would you LEAST expect to see on examination of this patient:

      Your Answer: Weakness of knee extension

      Correct Answer: Weakness of hip extension

      Explanation:

      Damage to the femoral nerve results in weakness of hip flexion and knee extension and loss of sensation over the anterior thigh and the anteromedial knee, medial leg and medial foot.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      9.8
      Seconds
  • Question 24 - Glomerular filtration rate can be calculated using any substance that: ...

    Incorrect

    • Glomerular filtration rate can be calculated using any substance that:

      Your Answer: is freely filtered and secreted by the nephron

      Correct Answer: is freely filtered and neither reabsorbed nor secreted by the nephron

      Explanation:

      Clearance of a substance can provide an accurate estimate of the glomerular filtration rate (GFR) provided that the substance is:freely filterednot reabsorbed in the nephronnot secreted in the nephronnot synthesised or metabolised by the kidney

    • This question is part of the following fields:

      • Physiology
      • Renal
      5.4
      Seconds
  • Question 25 - Regarding carbohydrate, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding carbohydrate, which of the following statements is INCORRECT:

      Your Answer: Carbohydrates provide 4 kcal of energy per gram.

      Correct Answer: Most dietary carbohydrate is in the form of disaccharides.

      Explanation:

      Carbohydrates are the main energy source of most diets. They provide 17 kJ (4 kcal) of energy per gram. Most dietary carbohydrate is in the form of polysaccharides. The principal ingested polysaccharides are starch which is derived from plant sources and glycogen which is derived from animal sources. Dietary fibre consists of indigestible carbohydrate (found in plant foods) such as cellulose, lignin and pectin.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      13.8
      Seconds
  • Question 26 - The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A...

    Correct

    • The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A CT head scan is performed, and the diagnosis of an ischaemic stroke is confirmed. Her blood pressure is currently very high, with the most recent measurement being 196/124 mmHg, according to the nurse in charge. While you wait for the stroke team to review her, she asks you to prescribe something to help lower the patient's blood pressure.Which of the following is the best drug treatment for this patient's BP reduction?

      Your Answer: Labetalol

      Explanation:

      End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.In the setting of a stroke syndrome (i.e., in the presence of focal neurological deficits), hypertensive emergencies usually necessitate a slower and more controlled blood pressure reduction than in other situations. Rapid reduction of MAP in the presence of an ischaemic stroke can compromise blood flow, leading to further ischaemia and worsening of the neurological deficit. In this situation, intravenous labetalol is the drug of choice for lowering blood pressure.Significantly elevated blood pressure (>185/110 mmHg) is a contraindication to thrombolysis, but there is some evidence for controlling blood pressure before thrombolysis in exceptional circumstances, when it is only slightly above this threshold.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      8.9
      Seconds
  • Question 27 - A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a...

    Incorrect

    • A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.Which statement about ipratropium bromide is true?

      Your Answer: It is a muscarinic agonist

      Correct Answer: It can trigger acute closed-angle glaucoma

      Explanation:

      Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD. It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists. It can trigger acute closed-angle glaucoma in patients that are susceptible. First-line treatment for moderate asthma attacks is short-acting β2agonists.The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      407.6
      Seconds
  • Question 28 - Which of the following causes the first heart sound? ...

    Incorrect

    • Which of the following causes the first heart sound?

      Your Answer: Closing of the aortic valve

      Correct Answer: Closing of the atrioventricular valves

      Explanation:

      The heart sounds are as a result of the various parts of the cardiac cycle.Heart Sound – Phase of Cardiac Cycle – Mechanical Event:1st heart sound – Systole starts – there is closure of the atrioventricular (mitral & tricuspid) valves2nd heart sound – Systole ends – there is closure of the semilunar (aortic and pulmonary) valves3rd heart sound – Early diastole – this is caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase4th heart sound – Late diastole – this is caused by filling of an abnormally stiff ventricle in atrial systole

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      5.3
      Seconds
  • Question 29 - You review a 37-year-old man with a history of intravenous drug abuse who...

    Incorrect

    • You review a 37-year-old man with a history of intravenous drug abuse who admits to sharing needles in the past. He has a flu-like illness and a rash. Concerned he may be experiencing an HIV seroconversion illness, you order a test.Which of these tests is most reliably used to diagnose HIV at this stage?

      Your Answer: CD4 count

      Correct Answer: p24 antigen test

      Explanation:

      Serum concentrations of the p24 antigen are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection. P24 is the viral protein that makes up most of the core of the HIV.ELISA and other antibody tests, though a very sensitive way of detecting the presence of HIV, cannot be used in the early stages of the disease. This is because of the window period of 6-12 weeks before antibodies are produced. These tests will be negative during a seroconversion illness.The ‘rapid HIV test’ is an HIV antibody test. It will also be negative during the ‘window period’ since it takes time for antibodies to be produced. It is called the ‘rapid test’ as it can detect antibodies in blood or saliva much quicker than the other antibody tests and results are often back within 20 minutes.CD4 and CD8 counts are usually normal in the early stages of the HIV infection and cannot be used in this case.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      4.3
      Seconds
  • Question 30 - A patient presents with an adducted eye at rest which cannot abduct past...

    Correct

    • A patient presents with an adducted eye at rest which cannot abduct past the midline, which of the following cranial nerves is most likely to be affected:

      Your Answer: Abducens nerve

      Explanation:

      Abducens nerve palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      6.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Cellular (0/2) 0%
Physiology (1/8) 13%
General Pathology (0/2) 0%
Pathology (2/5) 40%
Immune Responses (1/1) 100%
Evidence Based Medicine (1/1) 100%
Renal Physiology (0/1) 0%
Abdomen (1/1) 100%
Anatomy (3/6) 50%
Endocrine Physiology (1/1) 100%
Cardiovascular (0/2) 0%
Central Nervous System (1/4) 25%
Pharmacology (5/9) 56%
Endocrine (1/1) 100%
Infections (1/1) 100%
Inflammatory Responses (1/1) 100%
Anaesthesia (1/2) 50%
Endocrine Pharmacology (1/1) 100%
Upper Limb (0/1) 0%
Haematology (0/1) 0%
Lower Limb (0/1) 0%
Renal (0/1) 0%
Gastrointestinal (0/1) 0%
Cardiovascular Pharmacology (1/1) 100%
Respiratory Pharmacology (0/1) 0%
Microbiology (0/1) 0%
Specific Pathogen Groups (0/1) 0%
Cranial Nerve Lesions (1/1) 100%
Passmed