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Question 1
Correct
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A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.At the moment, he is completely symptom-free. When it comes to this type of overdose, how long does it usually take for symptoms to appear?
Your Answer: 1-2 hours
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.>10 tablets of verapamil (160 mg or 240 mg immediate or sustained-release capsules) or diltiazem can cause serious toxicity (180 mg, 240 mg or 360 mg immediate or sustained-release capsules)In children, 1-2 tablets of verapamil or diltiazem (immediate or sustained-release)Symptoms usually appear within 1-2 hours of ingestion with standard preparations. However, with slow-release preparations, significant toxicity may take 12-16 hours to manifest, with peak effects occurring after 24 hours.The following are the main clinical features of calcium-channel blocker overdose:Nausea and vomitingHypotensionBradycardia and first-degree heart blockMyocardial ischaemia and strokeRenal failurePulmonary oedemaHyperglycaemiaThe following are some of the most important bedside investigations to conduct:Blood glucoseECGArterial blood gasOther investigations that can be helpful includeUrea & electrolytesChest X-ray (pulmonary oedema)Echocardiography
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 2
Correct
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In a VF arrest, a 6-year-old child is brought to your Emergency Department resuscitation area. He weighs 16 kilogrammes. He's had three DC shocks, but he's still in VF and doesn't have an output.What amiodarone dose should he get now, according to the most recent APLS guidelines?
Your Answer: 80 mg
Explanation:In a shockable (Vf/pVT) paediatric cardiac arrest, amiodarone should be administered after the third and fifth shocks. The dose is 5 mg/kg (maximum 300 mg) and should be administered over a three-minute period. If at all possible, administration via a central line is recommended.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 3
Incorrect
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A 19-year-old woman presents with dysuria and vaginal discharge. A swab was taken for culture. Culture results showed the presence of Neisseria gonorrhoeae infection. Treatment of azithromycin and doxycycline was started.Which of the following statements is considered correct regarding Neisseria gonorrhoeae?
Your Answer: Vaginal discharge is present in around 90% of infected women
Correct Answer: Throat swabs can be used for diagnosis
Explanation:Neisseria gonorrhoeae is a Gram-negative diplococcus that causes gonorrhoea. Gonorrhoea is an acute pyogenic infection of nonciliated columnar and transitional epithelium; infection can be established at any site where these cells are found. Gonococcal infections are primarily acquired by sexual contact and occur primarily in the urethra, endocervix, anal canal, pharynx, and conjunctiva.In men, acute urethritis, usually resulting in purulent discharge and dysuria (painful urination), is the most common manifestation. The endocervix is the most common site of infection in women. Symptoms of infection, when present, include dysuria, cervical discharge, and lower abdominal pain. Some cases in women may be asymptomatic leading to complications such as pelvic inflammatory disease. Blood-borne dissemination occurs in less than 1% of all infections, resulting in purulent arthritis and rarely septicaemia. Fever and a rash on the extremities can also be present. Other conditions associated with N. gonorrhoeae include anorectal and oropharyngeal infections. Infections in these sites are more common in men who have sex with men but can also occur in women. Pharyngitis is the chief complaint in symptomatic oropharyngeal infections, whereas discharge, rectal pain, or bloody stools may be seen in rectal gonorrhoea. Approximately 30% to 60% of women with genital gonorrhoea have concurrent rectal infection. Newborns can acquire ophthalmia neonatorum, a gonococcal eye infection, during vaginal delivery through an infected birth canal. Specimens collected for the recovery of N. gonorrhoeae may come from genital sources or from other sites, such as the rectum, pharynx, and jointfluid. According to the 2010 STD Treatment guidelines, cephalosporins (e.g., ceftriaxone, cefixime) are currently recommended treatments.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 4
Correct
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A 78-year-old male presents to the Orthopaedic clinic with lower back pain for the past month. His past medical history reveals a history of cancer. After examination, you diagnose Metastatic Spinal Cord Compression (MSCC). Which one of the following cancers is this patient most likely to have had?
Your Answer: Prostate cancer
Explanation:Compression of the thecal sac causes metastatic Spinal Cord Compression (MSCC) due to a Metastatic tumour and its components. It can cause symptoms of limb weakness, sensory disturbances and back pain depending on the extent and level of Compression. The most common source of a tumour causing MSCC is a prostate carcinoma that metastasized to the spinal cord via the vertebral venous plexus.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 5
Correct
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A 24-year-old athlete drinks a 500 ml hypertonic sports drink before an endurance event he participates in.Which of the following effects will this cause?
Your Answer: The interstitial fluid becomes more concentrated
Explanation:Osmosis is the passive movement of water across a semipermeable membrane from a region of low solute concentration to a region of higher solute concentration.When hypertonic fluid is ingested:The plasma becomes CONCENTRATED. The cells lose water and shrinkThe intracellular fluid becomes more concentrated.Water and ions move freely from the plasma into the interstitial fluid and the interstitial fluid becomes more concentrated. The increased osmotic potential draws water out of the cells.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 6
Incorrect
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A 56-year-old female presents at the hospital with a diabetic foot ulcer that has become infected. She has a longstanding history of type 2 diabetes mellitus and diabetic polyneuropathy. She has trouble controlling her blood sugar levels, and recently, she was converted to a new insulin regimen that includes intermediate-acting insulin.Out of the following, which one is the intermediate-acting insulin?
Your Answer: Insulin degludec
Correct Answer: Isophane insulin
Explanation:Insulin is used mainly in type 1 diabetes, where the pancreas makes no insulin and can sometimes be prescribed in type 1 diabetes. There are different types of insulin categorized by their onset of action:1. Intermediate-acting insulins (isophane insulin NPH): – intermediate duration of action, designed to mimic the effect of endogenous basal insulin- starts their action in 1 to 4 hours- peaks in 4 to 8 hours – dosing is usually twice a day and helps maintain blood sugar throughout the day- Isophane insulin is a suspension of insulin with protamine2. Short-acting insulins (regular insulin)- starts the action in 30 to 40 minutes- peaks in 90 to 120 minutes- duration of action is 6 to 8 hours- taken before meals, and food is necessary within 30 minutes after its administration to avoid hypoglycaemia3. Long-acting insulins (glargine, detemir, degludec)- start action in 1 to 2 hours- plateau effect over 12 to 24 hours- Dosing is usually during the night-time after meals. Their long duration of action helps in reducing the frequency of dosing throughout the day. 4. Rapid-acting insulins (lispro, aspart, glulisine) – start their action in 5 to 15 minutes- peak in 30 minutes- The duration of action is 3 to 5 hours- generally used before meals and always used along with short-acting or long-acting insulins to control sugar levels throughout the day.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 7
Incorrect
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All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:
Your Answer: Glossopharyngeal nerve
Correct Answer: Hypoglossal nerve
Explanation:All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 8
Incorrect
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Which of the following statements concerning hepatitis D is TRUE:
Your Answer: It can only be transmitted with, or to somebody who is infected with, Hepatitis C.
Correct Answer: It can only be transmitted with, or to somebody who is infected with, Hepatitis B.
Explanation:Hepatitis D virus (HDV) is an RNA virus that was discovered in 1977 and is structurally unrelated to the hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV) viruses. HDV causes a unique infection that requires the assistance of HBV viral particles to replicate and infect hepatocytes. Its clinical course is varied and ranges from acute, self-limited infection to acute, fulminant liver failure. Chronic liver infection can lead to end-stage liver disease and associated complications (including accelerated fibrosis, liver decompensation, and hepatocellular carcinoma).
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 9
Incorrect
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You are about to perform an emergency pericardiocentesis on a 26-year-old male who was involved in a car accident and is suspected of having cardiac tamponade due to signs of hypotension, muffled heart sounds, and distended neck veins. Where should you insert the needle to relieve tamponade?
Your Answer: Medial left sixth intercostal space
Correct Answer: Inferior and to the left of the xiphochondral junction
Explanation:Pericardiocentesis is a procedure that removes excess fluid from the pericardium. As a result, it’s used in cases of cardiac tamponade, which occurs when there’s too much fluid in the space around the heart. During the procedure, a needle and a small catheter are inserted 1 to 2 cm inferior and to the left of the xiphochondral junction into the pericardial cavity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 10
Correct
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Where is angiotensin I primarily converted to angiotensin II:
Your Answer: Lungs
Explanation:Angiotensin I is converted to angiotensin II by the removal of two C-terminal residues by the enzyme angiotensin-converting enzyme (ACE). This primarily occurs in the lungs, although it does also occur to a lesser degree in endothelial cells and renal epithelial cells.The main actions of angiotensin II are:Vasoconstriction of vascular smooth muscle (resulting in increased blood pressure)Vasoconstriction of the efferent arteriole of the glomerulus (resulting in an increased filtration fraction and preserved glomerular filtration rate)Stimulation of aldosterone release from the zona glomerulosa of the adrenal cortexStimulation of anti-diuretic hormone (vasopressin) release from the posterior pituitaryStimulation of thirst via the hypothalamusActs on the Na+/H+ exchanger in the proximal tubule of the kidney to stimulate Na+reabsorption and H+excretion
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This question is part of the following fields:
- Physiology
- Renal
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Question 11
Correct
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Which of the following increases the tendency for oedema to occur?
Your Answer: Increased venous pressure
Explanation:When more fluid is filtered out of the capillaries than can be returned to the circulation by the lymphatics, oedema occurs. Changes that increase capillary hydrostatic pressure or decrease plasma oncotic pressure will increase filtration. Arteriolar constriction reduces hydrostatic capillary pressure and transiently increase absorption of fluid. Dehydration increases plasma protein concentration and therefore increases plasma oncotic pressure and absorption. Capillary hydrostatic pressure and filtration are increased when there is increased venous pressure.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 12
Incorrect
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Which of the following nerves is responsible for the symptoms of a patient with history of recurrent herpes simplex outbreaks on his face and presents with ophthalmic herpes zoster and a painful vesicle on the tip of his nose?
Your Answer: Infraorbital nerve
Correct Answer: Nasociliary nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve. The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 13
Correct
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A 29 year old patient with known inflammatory bowel disease presents to ED with surgical complications following his recent ileocaecal resection. Removal of the terminal ileum may result in the malabsorption of which of the following:
Your Answer: Vitamin B12
Explanation:On ingestion, vitamin B12 is bound to R protein found in saliva and gastric secretions, which protects it from digestion in the stomach. Intrinsic factor is secreted by gastric parietal cells. Receptors for the IF-B12 complex are present in the membrane of epithelial cells of the terminal ileum, which bind the complex and allow uptake of vitamin B12 across the apical membrane by endocytosis. Vitamin B12 is then transported across the basal membrane into the portal blood where it is bound to transcobalamin II and processed by the liver. In pernicious anaemia, there are autoantibodies against gastric parietal cells and intrinsic factor, resulting in vitamin B12 deficiency anaemia.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 14
Correct
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You are giving a teaching session to a group of final year medical students regarding lower limb neurology. Which of the following clinical features would be expected in an obturator nerve palsy:
Your Answer: Weakness of hip adduction
Explanation:Damage to the obturator nerve results in weak adduction of the hip with lateral swinging of the limb during walking due to unopposed abduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 15
Incorrect
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A 45-year-old African American male presents to your clinic complaining of swelling of his feet for the past six months. On examination, there is periorbital and pedal oedema. A 24-hour urine collection is ordered, which shows 8 g of protein. The serum cholesterol is ten mmol/L. You order a renal biopsy to confirm the diagnosis. Which one of the following findings are you most likely to see in this patient's biopsy?
Your Answer: Membranous glomerulonephritis
Correct Answer: Focal segmental glomerulosclerosis
Explanation:This patient has Nephrotic Syndrome confirmed by the presence of 1. Heavy proteinuria (greater than 3-3.5 g/24 hours)2. Hypoalbuminemia (serum albumin < 25 g/L)3. Generalised oedema (often with periorbital involvement)4. Severe hyperlipidaemia (total cholesterol is often > 10 mmol/L). Focal Segmental Glomerulosclerosis will be the most likely answer as it is the most common cause of Nephrotic Syndrome in African American adults. Minimal change disease is the most common cause of nephrotic syndrome in children. Membranous glomerulonephritis is the most common cause of Nephrotic Syndrome in Caucasian adults. In IgA nephropathy, patients will complain of cola-coloured urine. Mesangiocapillary glomerulonephritis presents with features of Nephritic Syndrome.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 16
Correct
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A 28-year-old known intravenous drug user has a history of persistent high-fever. On examination you hear a harsh systolic murmur and the patient says a murmur has never been heard before in previous hospital visits. A diagnosis of endocarditis is suspect.Which of these antibacterial agents would be most appropriate to prescribe in this case?
Your Answer: Flucloxacillin and gentamicin
Explanation:Endocarditis is infective or non infective inflammation (marantic endocarditis) of the inner layer of the heart and it often involves the heart valves.Risk factors include:Prosthetic heart valvesCongenital heart defectsPrior history of endocarditisRheumatic feverIllicit intravenous drug useIn the presentation of endocarditis, the following triad is often quoted:Persistent feverEmbolic phenomenaNew or changing murmurFlucloxacillin and gentamicin are current recommended by NICE and the BNF for the initial ‘blind’ therapy in endocarditis.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 17
Correct
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You review a 34-year-old man with lower back pain and plan to prescribe him ibuprofen and codeine phosphate. His only past medical history of note is depression, for which he takes fluoxetine.Which of the following scenarios would prompt you to consider the co-prescription of a PPI for gastro-protection? Select ONE answer only.
Your Answer: Co-prescription of fluoxetine
Explanation:Patients at risk of gastro-intestinal ulceration (including the elderly) who need NSAID treatment should receive gastroprotective treatment. The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:Using maximum recommended dose of an NSAIDAged 65 or olderHistory of peptic ulcer or GI bleedingConcomitant use of medications that increase risk:Low dose aspirinAnticoagulantsCorticosteroidsAnti-depressants including SSRIs and SNRIsRequirements for prolonged NSAID usage:Patients with OA or RA at any ageLong-term back pain if older than 45It is suggested that if required, either omeprazole 20 mg daily or lansoprazole 15-30 mg daily should be the PPIs of choice.This patient is on 400 mg of ibuprofen TDS, but the maximum recommended dose of ibuprofen is 2.4 g daily. Co-prescription of codeine, raised BMI, and a family history of peptic ulceration would also not prompt gastro-protection.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 18
Correct
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You have been asked to give a tutorial on common upper limb neurology to a group of medical students. You use the example of a man falling from a balcony onto spiked fencing, sustaining a puncture wound to the axilla. This results in an injury to the musculocutaneous nerve. Which of the following clinical features would you LEAST expect to see in this patient:
Your Answer: Weakness of forearm pronation
Explanation:Flexion of the arm and flexion and supination of the forearm are weakened but not lost entirely due to the actions of the pectoralis major and deltoid, the brachioradialis and the supinator muscles respectively. There is loss of sensation over the lateral aspect of the forearm. Forearm pronation would not be affected as this is primarily produced by the pronator quadratus and pronator teres muscles, innervated by the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Correct
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Which of these drugs may reduce the efficacy of contraception?
Your Answer: Carbamazepine
Explanation:Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 20
Correct
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You see a 30-year-old man who has come to the department with a very tender right elbow. On examination, the elbow is very hot and red, and appears to be acutely inflamed.Which SINGLE statement regarding acute inflammation is FALSE?
Your Answer: Reduced extravascular osmotic pressure leads to oedema
Explanation:Inflammation can be divided intoacute inflammation, which occurs over seconds, minutes, hours, and days, andchronic inflammation, which occurs over longer periods.Acute inflammationcommences within seconds or minutes following the injury of tissues. There are numerous potential stimuli for an acute inflammatory response including infections (bacterial, viral, fungal, parasitic), tissue necrosis, foreign bodies, and Immune reactions (hypersensitivity reactions). The chief cell type of acute inflammation is the neutrophil.There are three main processesthat occur in the acute inflammatory response:Increased blood flowIncreased capillary permeabilityNeutrophil migration1. Increased blood flow:Vasoactive mediators are released, such as nitric oxide, histamine, bradykinins, and prostaglandin E2. These mediators cause vasodilatation and increased blood flow to the area (causing redness and heat).2. Increased capillary permeability:The vasoactive mediators also cause increased capillary permeability by causing endothelial cell contraction that widens the intercellular gaps of venules. This allows an outpouring of protein-rich fluid (exudate) into the extracellular tissues that results in a reduction of intravascular osmotic pressure and an increase in extravascular/interstitial pressure. The increased interstitial osmotic pressure leads to oedema.3. Neutrophil migration:Neutrophils leave the vasculature through the following sequence of events:Margination and rolling: neutrophils flow nearer the vessel wall, rather than in the axial stream, which is referred to as margination. Following margination the neutrophils begin rolling along the surface of the vascular endothelium.Activation and adhesion: then as a result of interaction with endothelial cell adhesion molecules (CAMs) that is mediated by selectins, the neutrophils are activated and adhere to the endothelium.Transmigration: once bound to the endothelium, neutrophils squeeze through gaps between adjacent endothelial cells into the interstitial fluid, in a process calleddiapedesis.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 21
Incorrect
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Which of these is NOT a naturally occurring anticoagulant:
Your Answer: Tissue plasminogen activator
Correct Answer: Factor V Leiden
Explanation:It’s crucial that thrombin’s impact is restricted to the injured site. Tissue factor pathway inhibitor (TFPI), which is produced by endothelial cells and found in plasma and platelets, is the first inhibitor to function. It accumulates near the site of harm induced by local platelet activation. Xa and VIIa, as well as tissue factor, are inhibited by TFPI. Other circulating inhibitors, the most potent of which is antithrombin, can also inactivate thrombin and other protease factors directly. Coagulation cofactors V and VIII are inhibited by protein C and protein S. Tissue plasminogen activator (TPA) from endothelial cells facilitates fibrinolysis by promoting the conversion of plasminogen to plasmin.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 22
Correct
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A 68-year-old man with multiple myeloma presents with complaints of abdominal pain and malaise. A series of blood tests is done and his calcium level is 2.96 mmol/l.What effect will this blood test result have on gastric secretions?
Your Answer: Stimulate the release of gastrin
Explanation:Hypercalcaemia stimulates the release of gastrin from the G-cells in the pyloric antrum of the stomach, the duodenum and the pancreas.Gastrin is also released in response to:Stomach distensionVagal stimulationThe presence of amino acids.Gastrin release is inhibited by the presence of acid and somatostatin.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 23
Correct
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A 34-year-old man presented to the emergency room after being involved in a road traffic accident. Upon observation and examination, it was noted that he was hypotensive and has muffled heart sounds. It was suspected that he has pericardial effusion, so an emergency pericardiocentesis was to be performed.In performing pericardiocentesis for suspected pericardial effusion, which of the following anatomical sites are at risk of being punctured?
Your Answer: 1 cm below the left xiphocostal angle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 24
Incorrect
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You examine a 78-year-old man who has been diagnosed with chronic lymphocytic leukaemia (CLL).What is the MAIN contributory factor in this condition's immunodeficiency?
Your Answer: Lymphopenia
Correct Answer: Hypogammaglobulinemia
Explanation:Immunodeficiency is present in all patients with chronic lymphocytic leukaemia (CLL), though it is often mild and not clinically significant. Infections are the leading cause of death in 25-50 percent of CLL patients, with respiratory tract, skin, and urinary tract infections being the most common.Hypogammaglobulinemia is the most common cause of immunodeficiency in CLL patients, accounting for about 85 percent of all cases.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 25
Incorrect
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During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was prematurely born with cyanosis and ashen grey coloured skin as a result of this. Other symptoms were hypotonia, low blood pressure, and poor feeding.From the  following antibiotics, which one is most likely to cause this side effect?Â
Your Answer: Tetracycline
Correct Answer: Chloramphenicol
Explanation:Grey baby syndrome is a rare but causes significant adverse effect caused by the build-up of chloramphenicol in neonates (particularly preterm babies).The following are the main characteristics of ‘grey baby syndrome’:Skin that is ashy grey in colour.Feeding problemsVomitingCyanosisHypotensionHypothermiaHypotoniaCollapse of the cardiovascular systemDistension of the abdomentrouble breathing
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 26
Correct
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Which of the following nerves is responsible for the symptoms of a patient who presented with ophthalmic herpes zoster and a few vesicles on the nose?
Your Answer: Trigeminal nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve. The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 27
Incorrect
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Regarding flucloxacillin, which of the following statements is CORRECT:
Your Answer: It is used first line for localised impetigo infection.
Correct Answer: It is resistant to bacterial beta-lactamases.
Explanation:Flucloxacillin is unique in that it is beta-lactamase stable and it can be used in infections caused by beta-lactamase producing staphylococci e.g. S. aureus. It is acid-stable and can therefore be given by mouth as well as by injection. It is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. The most common adverse effects of flucloxacillin include nausea, vomiting, skin rash, and diarrhoea. Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. First line treatment of animal and human bites is co-amoxiclav.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 28
Incorrect
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Anatomical barriers to infection include all of the following EXCEPT:
Your Answer: Commensal flora in the genitourinary tract
Correct Answer: Mucociliary escalator in the gastrointestinal tract
Explanation:Anatomical barriers to infection include:tight junctions between cells of the skin and mucosal membranesthe flushing action of tears, saliva and urinethe mucociliary escalator in the respiratory tract (together with the actions of coughing and sneezing)the acidic pH of gastric and vaginal secretionsthe acidic pH of the skin (maintained by lactic acid and fatty acids in sebum)enzymes such as lysozyme found in saliva, sweat and tearspepsin present in the stomachbiological commensal flora formed on the skin and the respiratory, gastrointestinal and genitourinary tracts which protect the host by competing with pathogenic bacteria for nutrients and attachment sites and by producing antibacterial substances
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This question is part of the following fields:
- Microbiology
- Principles
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Question 29
Correct
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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
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 30
Incorrect
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A 50-year-old man from Russia presents with a history of cough with blood-stained sputum, fever, night sweats, and weight loss. Suspecting tuberculosis, you begin investigations.All the following statements regarding tuberculosis (TB) are true EXCEPT?
Your Answer: Mycobacterium tuberculosis fluoresces with auramine staining
Correct Answer: Corticosteroid use is not a risk factor for developing TB
Explanation:Immunosuppressants like corticosteroids may be an important risk factor for developing tuberculosis. All of the other statements are true.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 31
Correct
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Which of the following side effects has limited the use of etomidate as an intravenous induction agent:
Your 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.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 32
Incorrect
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Which of the following best describes the positive predictive value of a diagnostic test:
Your Answer: The ratio of the chance of a positive result if the patient has the disease to the chance of a positive result if they do not have the disease
Correct Answer: The proportion of individuals with a positive test result who have the disease
Explanation:Positive predictive value (PPV) is the proportion of individuals with a positive test result who actually have the disease.PPV = a/(a+b)
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 33
Incorrect
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Which coronary artery is mostly likely affected if an ECG shows ST segment elevation in leads II, III and aVF, and ST segment depression in V1-V3?
Your Answer: Left circumflex artery
Correct Answer: Right coronary artery
Explanation:A posterior wall MI occurs when posterior myocardial tissue (now termed inferobasilar), usually supplied by the posterior descending artery — a branch of the right coronary artery in 80% of individuals — acutely loses blood supply due to intracoronary thrombosis in that vessel. This frequently coincides with an inferior wall MI due to the shared blood supply.The ECG findings of an acute posterior wall MI include the following:1. ST segment depression (not elevation) in the septal and anterior precordial leads (V1-V4). This occurs because these ECG leads will see the MI backwards; the leads are placed anteriorly, but the myocardial injury is posterior.2. A R/S wave ratio greater than 1 in leads V1 or V2.3. ST elevation in the posterior leads of a posterior ECG (leads V7-V9). Suspicion for a posterior MI must remain high, especially if inferior ST segment elevation is also present.4. ST segment elevation in the inferior leads (II, III and aVF) if an inferior MI is also present.The following ECG leads determine the location and vessels involved in myocardial infarction:ECG Leads Location Vessel involvedV1-V2 Septal wall Left anterior descendingV3-V4 Anterior wall Left anterior descendingV5-V6 Lateral wall Left circumflex arteryII, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)I, aVL High lateral wall Left circumflex arteryV1, V4R Right ventricle Right coronary arteryV7-V9 Posterior wall Right coronary artery
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 34
Incorrect
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An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:
Your Answer: Loss of sensation over the lateral arm
Correct Answer: Weakness of medial rotation of the arm
Explanation:Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus. The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 35
Correct
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A dermatological examination on a patient presenting with a lump shows a solid, well circumscribed, lump measuring 0.8 cm in diameter.Which one of these best describes the lump you have found on examination?
Your Answer: Nodule
Explanation:A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter. 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.A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.A plaque is a palpable skin lesion that is elevated and measures >1cm in diameter
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 36
Correct
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Question 37
Correct
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Which of the following best describes digoxin:
Your Answer: A positive inotrope and negative chronotrope
Explanation:Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 38
Correct
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Fibrinoid necrosis is typically seen in which of the following:
Your Answer: Malignant hypertension
Explanation:Fibrinoid necrosis occurs in malignant hypertension where increased arterial pressure results in necrosis of smooth muscle wall. Eosinophilic and fibrinous deposits are seen.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 39
Incorrect
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A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen on the way to hospital. What percentage of patients with anaphylactic reaction suffer a biphasic response?.
Your Answer: 50%
Correct Answer: 20%
Explanation:About 20% of patients that suffer an anaphylactic reaction suffer a biphasic response 4-6 hours after the initial response (sometimes up to 72 hours after).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 40
Correct
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Depolarisation of a neuron begins with which of the following:
Your Answer: Opening of ligand-gated Na + channels
Explanation:Action potentials are initiated in nerves by activation of ligand-gated Na+channels by neurotransmitters. Opening of these Na+channels results in a small influx of sodium and depolarisation of the negative resting membrane potential (-70 mV). If the stimulus is sufficiently strong, the resting membrane depolarises enough to reach threshold potential (generally around -55 mV), at which point an action potential can occur. Voltage-gated Na+channels open, causing further depolarisation and activating more voltage-gated Na+channels and there is a sudden and massive sodium influx, driving the cell membrane potential to about +40 mV.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 41
Incorrect
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A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs. Which one is a nucleic acid synthesis inhibitor?
Your Answer: Gentamicin
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.The following is a summary of the many modes of action of various types of antimicrobial agents:Action Mechanisms-Â Examples:Cell wall production is inhibitedVancomycinVancomycinCephalosporinsThe function of the cell membrane is disrupted NystatinPolymyxinsAmphotericin BÂ Inhibition of protein synthesisChloramphenicolMacrolidesAminoglycosidesTetracyclinesNucleic acid synthesis inhibitionQuinolonesTrimethoprimRifampicin5-nitroimidazolesSulphonamidesAnti-metabolic activityIsoniazid
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 42
Correct
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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: 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
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 43
Correct
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The Frank-Starling curve is shifted downhill in heart failure due to which of the following?
Your Answer: Decrease in contractility
Explanation:The Frank–Starling mechanism states that the left ventricle can increase its force of contraction and hence stroke volume in response to increases in venous return and thus preload. Changes in afterload or inotropy cause the Frank–Starling curve to rise or fall. In heart failure, the Frank–Starling curve is shifted downward (flattened), requiring higher venous return and filling pressure to enhance contractility and stroke volume.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 44
Incorrect
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Which of the following study designs is considered the most appropriate to safely determine whether an association exists between a well-established, commonly used, anti-hypertensive medication and causing type II diabetes mellitus?
Your Answer: A cohort study
Correct Answer: A meta-analysis
Explanation:Evidence-based medicine may be defined as the systematic, quantitative, preferentially experimental approach to obtaining and using medical information. Therefore, meta-analysis, a statistical procedure that integrates the results of several independent studies, plays a central role in evidence-based medicine.Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 45
Correct
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You are seeing a child with known mitochondrial disease who has presented breathlessness and cough. Which of the following best describes the function of mitochondria:
Your Answer: Energy production
Explanation:Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 46
Incorrect
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Regarding bile acids, which of the following statements is INCORRECT:
Your Answer: Bile acids form micelles in aqueous solutions.
Correct Answer: The main primary bile acids are deoxycholic acid and lithocholic acid.
Explanation:Bile acids have a hydrophobic and a hydrophilic end and in aqueous solution, bile salts orient themselves around droplets of lipid forming micelles to keep the lipid droplets dispersed. The principal primary bile acids are cholic acid and chenodeoxycholic acid. They are made more soluble by conjugation with taurine or glycine in the liver. Of the bile acids excreted into the intestine, about 95% are reabsorbed into the portal circulation by active transport mechanisms in the distal ileum and recycled by the liver.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 47
Correct
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Diagnosis of HIV is predominantly made through which of the following:
Your Answer: Antibody detection
Explanation:Diagnosis of HIV is predominantly made through detection of HIV antibody and p24 antigen. Viral load (viral PCR) and CD4 count are used to monitor progression of disease.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 48
Correct
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Which of the following is NOT a common effect of etomidate:
Your Answer: Significant hypotension
Explanation:Etomidate causes less hypotension than thiopental sodium and propofol during induction. However, it is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Pain on injection is common and there is a high rate of thrombophlebitis in the postoperative period. Postoperative nausea and vomiting commonly occur. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 49
Correct
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Mannitol is primarily indicated for which of the following:
Your Answer: Cerebral oedema
Explanation:Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. 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).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 50
Correct
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What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer: Beta1-receptor agonist
Explanation:Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
