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  • Question 1 - Myocardial contractility is best correlated with the intracellular concentration of: ...

    Correct

    • Myocardial contractility is best correlated with the intracellular concentration of:

      Your Answer: Ca2+

      Explanation:

      Contractility of myocardial cells depends on the intracellular [Ca2+], which is regulated by Ca2+entry across the cell membrane during the plateau of the action potential and by Ca2+uptake into and release from the sarcoplasmic reticulum (SR).

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      4
      Seconds

  • Question 2 - A patient with abdominal pain, vomiting and bloody diarrhoea develops a low platelet...

    Correct

    • A patient with abdominal pain, vomiting and bloody diarrhoea develops a low platelet count and deranged renal function. A diagnosis of haemolytic uraemic syndrome is made.Which of the following organisms is a recognised cause of haemolytic uraemic syndrome? Select ONE answer only.

      Your Answer: Escherichia coli

      Explanation:

      E.Colistrain 0157 causes enterohaemorrhagic diarrhoea and can be followed by haemolytic uraemic syndrome (renal failure, haemolytic anaemia and thrombocytopenia).

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      5.5
      Seconds

  • Question 3 - You see a patient in the Emergency Department with features consistent with a...

    Incorrect

    • 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: Microalbuminuria

      Correct 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.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      11.8
      Seconds

  • Question 4 - A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler...

    Correct

    • A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.Which of these statements describes the mechanism of action of corticosteroids in asthma?

      Your Answer: Reduction of bronchial inflammation

      Explanation:

      Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      9.5
      Seconds

  • Question 5 - A young female was diagnosed with a urinary tract infection and was sent...

    Incorrect

    • A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute. She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer: Trimethoprim/sulfamethoxazole

      Correct Answer: Fosfomycin

      Explanation:

      The NICE guidelines for women with lower UTIs who are not pregnant are:1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time 2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibioticThe first choice of antibiotics for non-pregnant women aged 16 years and over is:1. Nitrofurantoin100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute2. Trimethoprim 200 mg PO BD for three daysThe second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:1. Nitrofurantoin100 mg modified-release PO BD for three days – if eGFR >45 ml/minute2. Pivmecillinam400 mg PO initial dose, then 200 mg PO TDS for three days3. Fosfomycin 3 g single sachet dose

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      27.9
      Seconds

  • Question 6 - A 32-year-old woman diagnosed with hyperthyroidism has her T 4 levels grossly elevated...

    Incorrect

    • A 32-year-old woman diagnosed with hyperthyroidism has her T 4 levels grossly elevated and she is started on carbimazole.A release of which of the following from the hypothalamus is inhibited by increase in T4 levels?

      Your Answer: Thyroid-stimulating hormone

      Correct Answer: Thyrotropin-releasing hormone

      Explanation:

      A negative feedback mechanism involving the hypothalamic-pituitary-thyroid axis controls the release of T3 and T4 into the bloodstream. When metabolic rate is low or serum T3 and/or T4 levels are decrease, this triggers the secretion of thyrotropin-releasing hormone (TRH) from the hypothalamus.TRH goes to the anterior pituitary gland and stimulates secretion of thyroid-stimulating hormone (TSH). An increased serum level of T3 and T4 inhibits the release of TRH.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      10.4
      Seconds

  • Question 7 - Approximately how long is the duration of a lidocaine block (when given with...

    Incorrect

    • Approximately how long is the duration of a lidocaine block (when given with adrenaline):

      Your Answer: 3 hours

      Correct Answer: 90 minutes

      Explanation:

      Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      6.7
      Seconds

  • Question 8 - Which of the following statements about sickle cell disease is TRUE: ...

    Incorrect

    • Which of the following statements about sickle cell disease is TRUE:

      Your Answer: Aplastic crisis is classically precipitated by cytomegalovirus.

      Correct Answer: Hand-foot syndrome is frequently a first presentation of the disease.

      Explanation:

      Hand-foot syndrome in children is typically the first symptom of the disease, produced by infarction of the metaphysis of small bones. The disease is inherited as an autosomal recessive trait. By adulthood, the spleen has usually infarcted. Infection with the B19 parvovirus is usually followed by an aplastic crisis. Thrombocytopenia is caused by splenic sequestration.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      12.8
      Seconds

  • Question 9 - Regarding hepatitis B, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hepatitis B, which of the following statements is CORRECT:

      Your Answer: Hepatitis B vaccination is not part of routine childhood immunisation.

      Correct Answer: Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months.

      Explanation:

      Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months. Hepatitis B has a long incubation period of about 2 – 6 months. Hepatitis B vaccine has recently been introduced to the routine childhood immunisation schedule – given at 2, 3 and 4 months. It is also given to babies born to hepatitis B infected mothers at birth, four weeks and 12 months old. Treatment of acute hepatitis is supportive. Treatment with antivirals should be considered in chronic infection as responders have a reduced risk of liver damage and liver cancer in the long term.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      71.3
      Seconds

  • Question 10 - The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the...

    Incorrect

    • The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the postsynaptic cell responds to the neurotransmitter.Which of the following enzymes catalyses the breakdown of noradrenaline?

      Your Answer: Acetylcholinesterase (ACh)

      Correct Answer: Catechol-O-methyltransferase (COMT)

      Explanation:

      The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the post-synaptic cell responds to the neurotransmitter. This can be accomplished in a variety of ways:Re-uptakeBreakdownDiffusionSerotonin is an example of a neurotransmitter that is uptake. Serotonin is absorbed back into the presynaptic neuron via the serotonin transporter (SERT), which is found in the presynaptic membrane. Re-uptake neurotransmitters are either recycled by repackaging into vesicles or broken down by enzymes.Specific enzymes found in the synaptic cleft can also break down neurotransmitters. The following enzymes are examples of these enzymes:Acetylcholinesterase (AChE) catalyses the acetylcholine breakdown (ACh)The enzyme catechol-O-methyltransferase (COMT) catalyses the breakdown of catecholamines like adrenaline , dopamine and noradrenaline. The breakdown of catecholamines, as well as other monoamines like serotonin, tyramine, and tryptamine, is catalysed by monoamine oxidases (MOA).Diffusion of neurotransmitters into nearby locations can also be used to eliminate them.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      12.6
      Seconds

  • Question 11 - Which of the following is NOT an advantage of a cohort study used...

    Incorrect

    • Which of the following is NOT an advantage of a cohort study used to investigate the relationship between exposure to a risk factor and a future outcome:

      Your Answer: Can measure absolute and relative risk directly

      Correct Answer: Particularly suitable for rare diseases

      Explanation:

      Advantages: ideal for studying associations between an exposure and an outcome when the exposure is uncommon, the time sequence of events can be assessed, they can provide information on a wide range of disease outcomes, the absolute and relative risk of disease can be measured directly, they can give a direct estimation of disease incidence ratesDisadvantages: costly and can take long periods of time if the outcome is delayed, subject to subject-selection and loss to follow-up bias, large sample size required for rare outcome of interest so it is not useful for rare diseases, prone to confounding

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      17.6
      Seconds

  • Question 12 - Which of the following occurs at the transverse thoracic plane: ...

    Incorrect

    • Which of the following occurs at the transverse thoracic plane:

      Your Answer: Azygos vein drains into subclavian vein

      Correct Answer: Bifurcation of the trachea

      Explanation:

      A way to help remember the structures transected by the transverse thoracic plane is CLAPTRAP:C: cardiac plexusL: ligamentum arteriosumA: aortic arch (inner concavity)P: pulmonary trunkT: tracheal bifurcation (carina)R: right-to-left movement of the thoracic duct (posterior to the oesophagus)A: azygos vein drains into superior vena cavaP: pre-vertebral fascia and pre-tracheal fascia end

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      3.2
      Seconds

  • Question 13 - In relation to ketamine, which of the following statements is TRUE: ...

    Incorrect

    • In relation to ketamine, which of the following statements is TRUE:

      Your Answer:

      Correct Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.

      Explanation:

      Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 14 - A blood culture was performed from a sample taken from a patient. It...

    Incorrect

    • A blood culture was performed from a sample taken from a patient. It was noted that a Gram-positive coccus organism was grown.Among the following microorganisms, which is considered an example of a Gram-positive coccus?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Bacillus cereus = Gram-positive bacillusNeisseria meningitidis = Gram-negative coccusSalmonella enterica & Escherichia coli = Gram-negative bacilliIn Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative. The Staphylococci that are associated with infections in humans are colonizers of various skin and mucosal surfaces. Because the carrier state is common among the human population, infections are frequently acquired when the colonizing strain gains entrance to a normally sterile site as a result of trauma or abrasion to the skin or mucosal surface.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      0
      Seconds

  • Question 15 - Which of the following best describes the order in which blood passes through...

    Incorrect

    • Which of the following best describes the order in which blood passes through the nephron? 

      Your Answer:

      Correct Answer: Afferent arteriole→Glomerular capillary→Efferent arteriole→Peritubular capillary→Vasa recta

      Explanation:

      The nephron’s blood flow is as follows:Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa recta – Afferent arteriole – Glomerular capillary – Efferent arteriole – Peritubular capillary – Vasa rectaThe kidney is the only vascular network in the body with two capillary beds. With arterioles supplying and draining the glomerular capillaries, higher hydrostatic pressures at the glomerulus are maintained, allowing for better filtration. A second capillary network at the tubules enables for secretion and absorption in the tubules, as well as concentrating urine.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      0
      Seconds

  • Question 16 - Regarding the factor V Leiden gene mutation, which of the following best describes...

    Incorrect

    • Regarding the factor V Leiden gene mutation, which of the following best describes the clinical effect:

      Your Answer:

      Correct Answer: It results in increased levels of activated factor V.

      Explanation:

      Factor V Leiden gene mutation is the most common inherited cause of an increased risk of venous thrombosis. Activated protein C normally breaks down activated factor V and so should slow the clotting reaction and prolong the APTT, but a mutation in the factor V gene makes factor V less susceptible to cleavage by activated protein C, resulting in increased levels of activated factor V.Heterozygotes for factor V Leiden are at an approximately five- to eight- fold increased risk of venous thrombosis compared to the general population (but only 10% of carriers will develop thrombosis in their lifetime). Homozygotes have a 30 – 140-fold increased risk. The incidence of factor V Leiden in patients with venous thrombosis is approximately 20 – 40%. It does not increase the risk of arterial thrombosis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 17 - Aside from the inability to extend the leg above the knee, which of...

    Incorrect

    • Aside from the inability to extend the leg above the knee, which of the following clinical symptoms should you anticipate seeing in a patient who had a pelvic and right leg injury as well as femoral nerve damage?

      Your Answer:

      Correct Answer: Loss of sensation over the anterior thigh

      Explanation:

      The femoral nerve runs down the front of the leg from the pelvis. It gives the front of the thigh and a portion of the lower leg sensation. Extension of the leg at the knee joint, flexion of the thigh at the hip are produced by muscles that is primarily innervated by the femoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 18 - Which of the following organelles form lysosomes? ...

    Incorrect

    • Which of the following organelles form lysosomes?

      Your Answer:

      Correct Answer: The Golgi apparatus

      Explanation:

      Lysosomes are formed by the Golgi apparatus or the endoplasmic reticulum. Lysosome releases its enzymes and digests the cell when the cell dies.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      0
      Seconds

  • Question 19 - A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood...

    Incorrect

    • A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?

      Your Answer:

      Correct Answer: Cranial diabetes insipidus

      Explanation:

      Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes. The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus. By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone. Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output. Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      0
      Seconds

  • Question 20 - The enzyme protein gastric lipase is responsible for the breakdown of lipids in...

    Incorrect

    • The enzyme protein gastric lipase is responsible for the breakdown of lipids in the stomach.Which of the following cell types secretes gastric lipase? 

      Your Answer:

      Correct Answer: Chief cells

      Explanation:

      Gastric lipase, commonly known as LIPF, is an acidic lipase released by gastric chief cells, which are found deep within the stomach lining’s mucosal layer. It’s an enzymatic protein that’s in charge of fat digestion in the stomach.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      0
      Seconds

  • Question 21 - A possible diagnosis of Cushing's illness is being investigated in an overweight patient...

    Incorrect

    • A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.Which of the following statements about corticotropin-releasing hormone is correct? 

      Your Answer:

      Correct Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus

      Explanation:

      Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      0
      Seconds

  • Question 22 - Which of the following is NOT a typical effect of cortisol: ...

    Incorrect

    • Which of the following is NOT a typical effect of cortisol:

      Your Answer:

      Correct Answer: Decreased protein catabolism

      Explanation:

      Cortisol is a steroid hormone produced in the zona fasciculata of the adrenal cortex. It is released in response to stress and low blood glucose concentrations.Cortisol acts to: raise plasma glucose by stimulating glycolysis and gluconeogenesis in the liver and inhibiting peripheral glucose uptake into storage tissues, increase protein breakdown in skeletal muscle, skin and bone to release amino acids, increase lipolysis from adipose tissues to release fatty acidsand at higher levels and mimic the actions of aldosterone on the kidney to retain Na+ and water and lose K+ ionssuppress the action of immune cells

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
      Seconds

  • Question 23 - Action potentials are transmitted from myocyte to myocyte via which of the following:...

    Incorrect

    • Action potentials are transmitted from myocyte to myocyte via which of the following:

      Your Answer:

      Correct Answer: Gap junctions

      Explanation:

      Action potentials are transmitted to adjacent myocytes via gap junctions.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 24 - Nitrous oxide is associated with which of the following adverse effects: ...

    Incorrect

    • Nitrous oxide is associated with which of the following adverse effects:

      Your Answer:

      Correct Answer: Megaloblastic anaemia

      Explanation:

      Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 25 - Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: The Treppe effect refers to an increase in contractility secondary to an increase in heart rate.

      Explanation:

      Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane. When more action potentials occur per unit time, more Ca2+enters the cell during the AP plateau, more Ca2+is stored in the SR, more Ca2+is released from the SR and thus more Ca2+is left inside the cell and greater tension is produced during contraction. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Cardiac glycosides such as digoxin have a positive inotropic effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 26 - Which of the following nerves supply the superficial head of the flexor pollicis...

    Incorrect

    • Which of the following nerves supply the superficial head of the flexor pollicis brevis muscle?

      Your Answer:

      Correct Answer: The recurrent branch of the median nerve

      Explanation:

      The two heads of the flexor pollicis brevis usually differ in their innervation. The superficial head of flexor pollicis muscle receives nervous supply from the recurrent branch of the median nerve, whereas the deep head receives innervation from the deep branch of the ulnar nerve, derived from spinal roots C8 and T1.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 27 - Which of the following does NOT typically cause a neutrophil leucocytosis: ...

    Incorrect

    • Which of the following does NOT typically cause a neutrophil leucocytosis:

      Your Answer:

      Correct Answer: Glandular fever

      Explanation:

      Causes of neutrophil leucocytosis:Bacterial infectionInflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)PregnancyAcute haemorrhage or haemolysisNeoplasms of all typesDrugs (e.g. corticosteroid therapy, lithium, tetracyclines)AspleniaMyeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)Rare inherited disorders

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 28 - Angiotensin II acts to cause all but which one of the following effects:...

    Incorrect

    • Angiotensin II acts to cause all but which one of the following effects:

      Your Answer:

      Correct Answer: Inhibit release of ADH from the posterior pituitary gland

      Explanation:

      Angiotensin II acts to:Stimulate release of aldosterone from the zona glomerulosa of the adrenal cortex (which in turn acts to increase sodium reabsorption)Cause systemic vasoconstrictionCause vasoconstriction of the renal arterioles (predominant efferent effect thus intraglomerular pressure is stable or increased, thereby tending to maintain or even raise the GFR)Directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters)Stimulate synthesis and release of ADH from the hypothalamus and posterior pituitary respectivelyStimulate the sensation of thirstPotentiate sympathetic activity (positive feedback)Inhibit renin production by granular cells (negative feedback)

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

  • Question 29 - When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle'...

    Incorrect

    • When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle' should be identified. Which of the following forms the inferior border of the 'safe triangle'?

      Your Answer:

      Correct Answer: 5 th intercostal space

      Explanation:

      Care and management of the thoracostomy tubes (chest tubes) are subject to the direction and practice pattern of the responsible physician. Therefore, it is difficult to make a “one size fits all” set of instructions about the specific management recommendations for all chest tubes. It is recommended to discuss specific expectations for management with the patient’s attending physician. Facility specific Clinical Practice Guidelines (CPGs) may provide further guidance for one’s practice.Placement of the appropriately sized chest tube is performed on the affected side. The typical landmark for placement is the 4th or 5th intercostal space (nipple line for males, inframammary fold for females) at the anterior axillary line. The space above the 5th intercostal space and below the base of the axilla that is bordered posteriorly by the trapezius and anteriorly by the pectoralis muscle has recently been described as the safe triangle. Tubes are positioned anteriorly for pneumothoraces and posteriorly for fluid processes.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 30 - You review a sick patient in resus who has been prescribed mannitol as...

    Incorrect

    • You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.Which SINGLE statement regarding mannitol is true?

      Your Answer:

      Correct Answer: It is irritant to veins and causes phlebitis

      Explanation:

      Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:Decreasing the rate of CSF formation,and;Withdrawing extracellular fluid from the brain across the BBBOther uses of mannitol include:Short-term management of glaucomaTreatment of rhabdomyolysisPreserve renal function in peri-operative jaundiced patientsTo initiate diuresis in transplanted kidneysBowel preparation prior to colorectal proceduresThe recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:AnuriaIntracranial bleeding (except during craniotomy)Severe cardiac failureSevere dehydrationSevere pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 31 - A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis....

    Incorrect

    • A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?

      Your Answer:

      Correct Answer: ORT is sugar-free

      Explanation:

      One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status. Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries. Some characteristics of Oral rehydration solutions are:- slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.- contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia. – also contains essential mineral saltsCurrent NICE guidance recommends that 50 ml/kg is given over 4 hours to treat mild dehydration.Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pharmacology
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  • Question 32 - You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced...

    Incorrect

    • You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.Which of the following anti-D statements is correct?

      Your Answer:

      Correct Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks

      Explanation:

      Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly. The following are examples of potentially sensitising events:BirthHaemorrhage during pregnancyMiscarriageEctopic pregnancyDeath within the wombAmniocentesisChorionic villus samplingTrauma to the abdomenThe sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
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  • Question 33 - Which of the following is most likely to cause a homonymous hemianopia: ...

    Incorrect

    • Which of the following is most likely to cause a homonymous hemianopia:

      Your Answer:

      Correct Answer: Posterior cerebral artery stroke

      Explanation:

      A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 34 - The flow of ions across a cell membrane causes electrical activity in biological...

    Incorrect

    • The flow of ions across a cell membrane causes electrical activity in biological tissues. Excitable tissues are specialized tissues that may generate a significant electrical signal called an action potential, which is followed by a refractory period.Which set of ion channels is responsible for the refractory period? 

      Your Answer:

      Correct Answer: Sodium channels

      Explanation:

      A refractory period follows each action potential. The absolute refractory time and the relative refractory period are two divisions of refractory periods. Because the sodium channels seal after an AP, they enter an inactive state during which they cannot be reopened regardless of membrane potential, this time occurs.The sodium channels slowly come out of inactivation during the relative refractory period that follows. During this time, a stronger stimulus than that required to initiate an action potential can excite the cell. The strength of the stimulus required early in the relative refractory period is relatively high, and it steadily decreases as more sodium channels recover from the inactivation of the refractory period.Nodes of Ranvier are periodic holes in a myelinate axon when there is no myelin and the axonal membrane is exposed. There are no gated ion channels in the portion of the axon covered by the myelin sheath, but there is a high density of ion channels in the Nodes of Ranvier. Action potentials can only occur at the nodes as a result of this.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 35 - A patient complains of stomach ache. You see a midline scar in the...

    Incorrect

    • A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The gastric ECL cells secrete which of the following substances?

      Your Answer:

      Correct Answer: Histamine

      Explanation:

      Enterochromaffin-like cells (ECL cells) are a type of neuroendocrine cell located beneath the epithelium in the stomach glands. They’re most typically located near the parietal cells of the stomach. The ECL cells’ primary role is to produce histamine, which stimulates the formation of stomach acid by the parietal cells.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
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  • Question 36 - A 20-year-old male patient lives in a travelling community and has never received...

    Incorrect

    • A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.Which of these statements concerning indications and contraindications for vaccination is FALSE?

      Your Answer:

      Correct Answer: Premature infants should have the their immunisation schedule adjusted for gestational age

      Explanation:

      All vaccines are contraindicated in individuals with:A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycinLive attenuated vaccines are contraindicated in pregnancy except in cases where risk of infection is more than the risks of vaccination.During times of acute febrile illness, vaccination should be avoided.12 weeks should elapse after a dose of human immunoglobulin before a live vaccine is administered.The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should NOT be implemented.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
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  • Question 37 - Regarding Clostridium perfringens, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding Clostridium perfringens, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: It can cause exotoxin-mediated food poisoning.

      Explanation:

      Clostridium perfringens is an obligate anaerobe and has exotoxin mediated effects. It is the most common cause of gas gangrene. C. perfringens is also implicated in food poisoning, cellulitis, enteritis necrotican (life-threatening infection involving ischaemic necrosis of the jejunum), and rarely, CNS infections such as meningitis and encephalitis.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 38 - Regarding myeloma, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding myeloma, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Myeloma is associated with marked rouleaux formation on blood film.

      Explanation:

      98% of cases of myeloma occur over the age of 40 years with a peak incidence between 65 and 70 years. The disease is twice as common in black individuals compared to those of white or Asian origin. Laboratory findings include presence of a paraprotein in serum/urine (the paraprotein is IgG in 60% of cases, IgA in 20% and light chain only in almost all the rest) and marked Rouleaux formation on blood film. There is no cure for myeloma. The overall median survival is now 7-10 years and in younger (less than 50 years) patients it can be over 10 years.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 39 - A 34-year-old man arrives at the department befuddled. He has a history of...

    Incorrect

    • A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.Which of the following statements about antipsychotic drug side effects is correct?

      Your Answer:

      Correct Answer: Haloperidol is the most common causative antipsychotic drug

      Explanation:

      Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.Renal impairment causes increased cerebral sensitivity, so lower doses should be used.In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.The following are some of the antipsychotic drugs’ contraindications:Reduced level of consciousness/comaDepression of the central nervous systemPhaeochromocytoma

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 40 - 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 41 - What is the approximate lifespan of the mature erythrocyte: ...

    Incorrect

    • What is the approximate lifespan of the mature erythrocyte:

      Your Answer:

      Correct Answer: 120 days

      Explanation:

      Erythrocytes have a normal lifespan of about 120 days. Mature erythrocytes are biconcave discs with no nucleus, ribosomes or mitochondria but with the ability to generate energy as ATP by the anaerobic glycolytic pathway. The red cell membrane consists of a bipolar lipid layer with a membrane skeleton of penetrating and integral proteins anchoring carbohydrate surface antigens. The shape and flexibility of red cells allows them to deform easily and pass through capillaries.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 42 - A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis...

    Incorrect

    • A patient has a diagnosis of acute osteomyelitis. They have no joint prosthesis on indwelling metal work and no known drug allergies. He has had a recent skin swab that has cultured MRSA and MRSA infection is suspected.Which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.

      Your Answer:

      Correct Answer: Vancomycin

      Explanation:

      In the majority of patients the commonest causative organism for osteomyelitis isStaphylococcus aureus.Salmonella spp. are the commonest cause in patients with sickle cell disease.Other bacteria that can cause osteomyelitis include:Enterobacter spp.Group A and B streptococcusHaemophilus influenzaeThe current recommendations by NICE and the BNF on the treatment of osteomyelitis are:Flucloxacillin first-lineConsider adding fusidic acid or rifampicin for initial 2 weeksIf penicillin allergic use clindamycinIf MRSA is suspected use vancomycinSuggested duration of treatment is 6 weeks for acute infection

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 43 - A 29-year-old female with a swollen red finger presents to your clinic and...

    Incorrect

    • A 29-year-old female with a swollen red finger presents to your clinic and you suspect that the underlying process is of acute inflammation. You request for some bloods investigations.Which statement about histamine as a chemical mediator of the acute inflammatory response is TRUE?

      Your Answer:

      Correct Answer: It increases vascular permeability

      Explanation:

      Histamine increases vascular permeability in the acute inflammatory response.Histamine causes vasodilation.It is released from Mast cells and basophils, eosinophils and platelets. Mast cells and basophils are its primary source Nitric oxide (not histamine) is a major factor in endotoxic shock

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 44 - Regarding antacids, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antacids, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Antacids are contraindicated in hypophosphataemia.

      Explanation:

      Antacids are contraindicated in hypophosphataemia. Liquid preparations are more effective than tablet preparations. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are best taken when symptoms occur or are expected, usually between meals and at bedtime. Antacids should preferably not be taken at the same time as other drugs since they may impair absorption.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
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  • Question 45 - 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 46 - A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic...

    Incorrect

    • 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:

      Correct 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

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 47 - A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On...

    Incorrect

    • A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.Which drug is NOT likely to cause cholestatic jaundice out of the following?

      Your Answer:

      Correct Answer: Isoniazid

      Explanation:

      Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.The drugs that cause cholestatic jaundice are the following:1. Nitrofurantoin2. Erythromycin3. Cephalosporins4. Verapamil5. NSAIDs6. ACE inhibitors7. Tricyclic antidepressants8. Phenytoin9. Azathioprine10. Carbamazepine11. Oral contraceptive pills12. Diazepam13. Ketoconazole14. Tamoxifen

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 48 - A 45-year-old woman presents with persistent palpitations for the past two days. She...

    Incorrect

    • A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.Which of the drugs listed below is the best fit for this strategy?

      Your Answer:

      Correct Answer: Bisoprolol

      Explanation:

      In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 49 - A 53 year old women presents to the emergency room with a chronic...

    Incorrect

    • A 53 year old women presents to the emergency room with a chronic cough. The pulmonary receptors likely to be involved in causing her cough are:

      Your Answer:

      Correct Answer: Irritant receptors

      Explanation:

      Throughout the airways, there are irritant receptors which are located between epithelial cells which are made of rapidly adapting afferent myelinated fibres in the vagus nerve. A cough is as a result of receptor stimulation located in the trachea, hyperpnoea is as a result of receptor stimulation in the lower airway. Stimulation may also result in reflex bronchial and laryngeal constriction. Many factors can stimulate irritant receptors. These include irritant gases, smoke and dust, airway deformation, pulmonary congestion, rapid inflation/deflation and inflammation. Deep augmented breaths or sighs seen every 5 – 20 minutes at rest are due to stimulation of these irritant receptors. This reverses the slow lung collapse that occurs in quiet breathing.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 50 - In the emergency room, a patient was diagnosed with acute bacterial tonsillitis. Which...

    Incorrect

    • In the emergency room, a patient was diagnosed with acute bacterial tonsillitis. Which of the following postinfectious complications is most commonly linked to Streptococcus pyogenes:

      Your Answer:

      Correct Answer: Glomerulonephritis

      Explanation:

      Poststreptococcal glomerulonephritis (PSGN) is caused by prior infection with specific nephritogenic strains of group A beta-haemolytic streptococcus. The clinical presentation of PSGN varies from asymptomatic, microscopic haematuria to the full-blown acute nephritic syndrome, characterized by red to brown urine, proteinuria (which can reach the nephrotic range), oedema, hypertension, and acute kidney injury.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 51 - A 28 year old man presents with abdominal pain and constipation, and bloods...

    Incorrect

    • A 28 year old man presents with abdominal pain and constipation, and bloods show hypocalcaemia. Which of the following hormones is increased as a result of hypocalcaemia?

      Your Answer:

      Correct Answer: Parathyroid hormone

      Explanation:

      Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone that is secreted by the parathyroid glands, which lie immediately behind the thyroid gland. In particular, this hormone is made by chief cells. It regulates the serum calcium concentration through its effects on bone, kidney, and intestine. This hormone is primarily released in response to decreasing plasma Ca2+ concentration and it serves to increase plasma calcium levels and decrease plasma phosphate levels.PTH activates Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane and as a result, increases calcium reabsorption in the distal tubule of the nephron. It inhibits reabsorption of phosphate and this increases its excretion by in the proximal tubule of the nephron.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 52 - A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath,...

    Incorrect

    • A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.

      Your Answer:

      Correct Answer: Atelectasis is an example of a perfusion defect

      Explanation:

      Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
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  • Question 53 - A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms...

    Incorrect

    • A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms have been steadily deteriorating, with no intervals of remission in sight.Which of the following aspects of nerve conduction is disrupted by multiple sclerosis?

      Your Answer:

      Correct Answer: Saltatory conduction

      Explanation:

      Local currents propagate action potentials down the axons of neurons. This local current flow following depolarisation results in the depolarisation of the neighbouring axonal membrane, and when this region approaches the threshold, more action potentials are generated and so forth. Due to the refractory period, portions of the membrane that have recently depolarized will not depolarize again, resulting in the action potential only being able to go in one direction.The square root of axonal diameter determines the velocity of the action potential; the axons with the biggest diameter have the quickest conduction velocities. When a neuron is myelinated, the speed of the action potential rises as well.The myelin sheath is an insulating coating that surrounds certain neural axons. By increasing membrane resistance and decreasing membrane capacitance, the myelin sheath improves conduction. This enables faster electrical signal transmission via a neuron, making them more energy-efficient than non-myelinated neuronal axons.Electrical impulses are quickly transmitted from one node to the next, causing depolarization of the membrane above the threshold and triggering another action potential, which is then transmitted to the next node. An action potential is rapidly conducted down a neuron in this manner. Saltatory conduction is the term for this.Multiple sclerosis is an example of a clinical disorder in which the myelin sheath is affected. It is an immune-mediated disorder in which certain nerve cells in the brain and spinal cord become demyelinated. The ability of some areas of the nervous system to properly transmit action potentials is disrupted by demyelination, resulting in a variety of neurological symptoms and indications.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 54 - What is the most common application of Nitrates? ...

    Incorrect

    • What is the most common application of Nitrates?

      Your Answer:

      Correct Answer: Angina

      Explanation:

      In patients with exertional stable angina, nitrates improve exercise tolerance, time to onset of angina, and ST-segment depression during exercise testing. In combination with beta-blockers or calcium channel blockers, nitrates produce greater anti-anginal and anti-ischemic effects.While they act as vasodilators, coronary vasodilators, and modest arteriolar dilators, the primary anti ischemic effect of nitrates is to decrease myocardial oxygen demand by producing systemic vasodilation more than coronary vasodilation. This systemic vasodilation reduces left ventricular systolic wall stress.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 55 - Parasympathetic preganglionic neurons originate in which of the following locations: ...

    Incorrect

    • Parasympathetic preganglionic neurons originate in which of the following locations:

      Your Answer:

      Correct Answer: Brainstem and pelvic splanchnic nerves

      Explanation:

      Parasympathetic preganglionic neurones originate in the brainstem from which they run in cranial nerves III, VII, IX and X and also from the second and third sacral segments of the spinal cord. Parasympathetic preganglionic neurones release acetylcholine into the synapse, which acts on cholinergic nicotinic receptors on the postganglionic fibre. Parasympathetic peripheral ganglia are generally found close to or within their target, whereas sympathetic peripheral ganglia are located largely in two sympathetic chains on either side of the vertebral column (paravertebral ganglia), or in diffuse prevertebral ganglia of the visceral plexuses of the abdomen and pelvis. Parasympathetic postganglionic neurones release acetylcholine, which acts on cholinergic muscarinic receptors.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 56 - The juxtacapillary receptors, or J receptors, are sensory cells that play an important...

    Incorrect

    • The juxtacapillary receptors, or J receptors, are sensory cells that play an important role in the control of respiration.At which of the following anatomical sites are the J receptors located? Select ONE answer only.

      Your Answer:

      Correct Answer: The alveolar walls

      Explanation:

      Juxtacapillary receptors (J receptors) are sensory cells that are located within the alveolar walls in juxtaposition to the pulmonary capillaries of the lung.The J receptors are innervated by the vagus nerve and are activated by physical engorgement of the pulmonary capillaries or increased pulmonary interstitial volume, for example, in the presence of pulmonary oedema, pulmonary embolus, pneumonia and barotraumas. They may also be stimulated by hyperinflation of the lung.Stimulation of the J receptors causes a reflex increase in breathing rate and is also thought to be involved in the sensation of dyspnoea. The reflex response that is produced is apnoea, followed by rapid breathing, bradycardia, and hypotension.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
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  • Question 57 - A patient who is a known case of rheumatoid arthritis presents to the...

    Incorrect

    • A patient who is a known case of rheumatoid arthritis presents to the clinic as his grandson was recently diagnosed with chickenpox. His grandson spent the weekend with her, and he was in close contact with him. He takes 50 mg of prednisolone once daily and has been for the past six months. There is no history of chickenpox.Out of the following, which is TRUE regarding the next plan of action for her care?

      Your Answer:

      Correct Answer: She should receive prophylactic varicella-zoster Immunoglobulin (VZIG)

      Explanation:

      Varicella-zoster immunoglobulin (VZIG) is indicated for post exposure prevention and treatment of varicella. It is recommended as prophylaxis for high-risk patients with no known immunity (i.e. no known previous chickenpox) who have had a significant exposure to varicella-zoster (considered >4 hours close contact).The high-risk groups are:1. Neonates2. Pregnant women3. The immunocompromised (e.g. cancer, immunosuppressive therapies)4. Those on high dose steroids (children on more than 2 mg/kg/day for more than 14 days, or adults on 40 mg/day for more than a week)This patient is at high risk of developing adrenal insufficiency and may need a temporary increase in her steroid dose during infection or stress. It would be inappropriate to stop or wean down her dose of prednisolone and can cause side effects.Since he is on steroids without immunity for chickenpox, he is at risk of developing severe varicella infection, with possible complications including pneumonia, hepatitis and DIC. If he develops a varicella infection, he will need to be admitted and require a specialist review and intravenous Acyclovir.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
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  • Question 58 - The most common source of healthcare-associated bacteraemia is: ...

    Incorrect

    • The most common source of healthcare-associated bacteraemia is:

      Your Answer:

      Correct Answer: Intravenous cannula

      Explanation:

      Healthcare-associated bacteraemia is most commonly caused by intravenous access. Any intravenous device that is left in place for a long time increases the risk of infection. It allows bacteria like Staphylococcus aureus and Staphylococcus epidermidis to enter the body.

    • This question is part of the following fields:

      • Microbiology
      • Principles
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      Seconds

  • Question 59 - Stimulation of J receptors located on alveolar and bronchial walls results in all...

    Incorrect

    • Stimulation of J receptors located on alveolar and bronchial walls results in all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Tachycardia

      Explanation:

      Juxtapulmonary or ‘J’ receptors are located on alveolar and bronchial walls close to the capillaries. Their afferents are small unmyelinated C-fibres or myelinated nerves in the vagus nerve. Activation causes depression of somatic and visceral activity by producing apnoea or rapid shallow breathing, a fall in heart rate and blood pressure, laryngeal constriction and relaxation of skeletal muscles via spinal neurones. J receptors are stimulated by increased alveolar wall fluid, pulmonary congestion and oedema, microembolism and inflammatory mediators. J receptors are thought to be involved in the sensation of dyspnoea in lung disease.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 60 - An analytical study is conducted to compare the risk of stroke between Ticagrelor...

    Incorrect

    • An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:No. of patients who took Ticagrelor: 300No. of patients who took Ticagrelor and suffered a stroke: 30No. of patients who took Warfarin: 500No. of patients who took Warfarin and suffered a stroke: 20Compute for the absolute risk in the Ticagrelor group.

      Your Answer:

      Correct Answer: 0.1

      Explanation:

      The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.AR = 30/300 = 0.1

    • This question is part of the following fields:

      • Evidence Based Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (1/1) 100%
Physiology (1/4) 25%
Microbiology (1/2) 50%
Specific Pathogen Groups (1/1) 100%
Endocrine Physiology (0/2) 0%
Pharmacology (1/4) 25%
Respiratory Pharmacology (1/1) 100%
Infections (0/1) 0%
Anaesthesia (0/2) 0%
Haematology (0/1) 0%
Pathology (0/1) 0%
Pathogens (0/1) 0%
Basic Cellular Physiology (0/1) 0%
Anatomy (0/1) 0%
Thorax (0/1) 0%
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