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  • Question 1 - A 57-year-old woman receives vitamin B12 injections following a gastrectomy.Which of the following...

    Correct

    • A 57-year-old woman receives vitamin B12 injections following a gastrectomy.Which of the following cell types, if absent, is responsible for her vitamin B12 deficiency?

      Your Answer: Parietal cells

      Explanation:

      Intrinsic factor, produced by the parietal cells of the stomach, is essential for the absorption of vitamin B12 from the terminal ileum. After a gastrectomy, the absorption of vitamin B12 is markedly reduced, and a deficiency will occur.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      26.3
      Seconds

  • Question 2 - Caseous necrosis is typically seen in which of the following: ...

    Correct

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

      Your Answer: Tuberculosis

      Explanation:

      Caseous necrosis is most commonly seen in tuberculosis. Histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      6.8
      Seconds

  • Question 3 - The patients listed below have had wounds or injuries and were treated as...

    Incorrect

    • The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.Which of the following patients has had adequate tetanus protection?

      Your Answer: 8-year-old UK resident, cut hand on a kitchen knife, had primary course of vaccinations as a baby plus booster at 4 years - receives vaccination

      Correct Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin

      Explanation:

      25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
      78.3
      Seconds

  • Question 4 - You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy...

    Incorrect

    • You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her with Cushing's syndrome.When would her random cortisol level likely be abnormal? 

      Your Answer: 0900 hrs

      Correct Answer: 2400 hrs

      Explanation:

      Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep.The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      55.5
      Seconds

  • Question 5 - 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: It crosses the blood-brain-barrier

      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
      45.4
      Seconds

  • Question 6 - A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been...

    Correct

    • A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been going on for 3 days.Among the following microorganisms, which is considered to be a cause of infectious bloody diarrhoea?

      Your Answer: Entamoeba histolytica

      Explanation:

      The following are organisms that are capable of producing acute, bloody diarrhoea:- Campylobacter jejuni- Escherichia coli O157:H7- Salmonella species- Shigella species- Yersinia species- Entamoeba histolyticaOther E. coli strains, Giardia, Vibrio, and other parasites are associated with watery, but not bloody, diarrhoea.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      22
      Seconds

  • Question 7 - A patient allergic to penicillin and with marked cellulitis presents and you decide...

    Incorrect

    • A patient allergic to penicillin and with marked cellulitis presents and you decide to start him on erythromycin.Which statement about macrolide antibiotics is true?

      Your Answer: They act by binding to the 30S subunit of the bacterial ribosome

      Correct Answer: They are actively concentrated within leukocytes

      Explanation:

      Macrolide antibiotics are bacteriostatic. They act by binding to the 50S subunit of the bacterial ribosome inhibit protein synthesis. Macrolide antibiotics are actively concentrated within leukocytes, because of this, they are transported into the site of infection.Macrolide antibiotics are not effective in meningitis as they do not penetrate the central nervous system well. They are mainly against Gram-positive organisms and can be used as an alternative in patients with penicillin allergy.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      27.5
      Seconds

  • Question 8 - The functional residual capacity (FRC) will be increased in which of the following:...

    Correct

    • The functional residual capacity (FRC) will be increased in which of the following:

      Your Answer: Emphysema

      Explanation:

      Factors increasing FRC:EmphysemaAir trapping in asthmaAgeing (due to loss of elastic properties)Increasing height of patient

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      7.5
      Seconds

  • Question 9 - A 64-year-old lady attends the emergency department with a known brain tumour. Her...

    Correct

    • A 64-year-old lady attends the emergency department with a known brain tumour. Her left eye is directed outwards and downwards, she can't open it, and her pupil is fixed and dilated. The tumour is most likely compressing which of the following structures:

      Your Answer: Oculomotor nerve

      Explanation:

      The oculomotor nerve is the third cranial nerve. It is the main source of innervation to the extraocular muscles and also contains parasympathetic fibres which relay in the ciliary ganglion. Damage to the third cranial nerve may cause diplopia, pupil mydriasis, and/or upper eyelid ptosis. The clinical manifestations of third cranial nerve dysfunction reflect its constituent parts.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      58.2
      Seconds

  • Question 10 - Which patients are particularly susceptible to infection with herpes simplex, those with: ...

    Correct

    • Which patients are particularly susceptible to infection with herpes simplex, those with:

      Your Answer: T-cell deficiency

      Explanation:

      Cell-mediated immunity, especially the action of cytotoxic T-cells, is essential in the control of herpesvirus infections and patients with T-cell deficiency are at particular risk of reactivation and severe infection. T-cell deficiency may follow HIV infection, chemotherapy, corticosteroid therapy or organ transplantation.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      15.6
      Seconds

  • Question 11 - C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:...

    Incorrect

    • C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:

      Your Answer: IL-5

      Correct Answer: IL-6

      Explanation:

      Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      13.7
      Seconds

  • Question 12 - Which of the following laboratory findings is NOT typical of Hodgkin lymphoma: ...

    Incorrect

    • Which of the following laboratory findings is NOT typical of Hodgkin lymphoma:

      Your Answer: Neutrophilia

      Correct Answer: Basophilia

      Explanation:

      Features may include:Normochromic normocytic anaemia is most common; bone marrow failure involvement is unusual in early disease, but if it occurs bone marrow failure may develop with leucoerythroblastic anaemiaOne-third of patients have a neutrophilia; eosinophilia is frequentAdvanced disease is associated with lymphopenia and loss of cell-mediated immunityPlatelet count is normal or increased in early disease and reduced in later stagesESR and CRP are usually raised (ESR is useful in monitoring disease progress)Serum LDH is raised initially in 30-40% of casesDiagnosis is made by histological examination of an excised lymph nodeThe distinctive multinucleate polypoid RS cell is central to the diagnosis of the four classic types of HL (95% of cases)

    • This question is part of the following fields:

      • Haematology
      • Pathology
      8.5
      Seconds

  • Question 13 - Regarding bile, which of the following statements is CORRECT: ...

    Correct

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

      Your Answer: Bile passes into the duodenum through the ampulla of Vater.

      Explanation:

      Bile is synthesised in the liver. Bile functions to eliminate endogenous and exogenous substances from the liver, to neutralise gastric acid in the small intestine, and to emulsify fats in the small intestine and facilitate their digestion and absorption. Bile is stored and concentrated in the gallbladder. Bile passes out of the gallbladder via the cystic duct. Bile passes into the duodenum through the ampulla of Vater regulated by the sphincter of Oddi.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      37.4
      Seconds

  • Question 14 - Regarding haemophilia A, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding haemophilia A, which of the following statements is INCORRECT:

      Your Answer: Haemophilia A is the most common of the hereditary clotting factor deficiencies.

      Correct Answer: In haemophilia both the APTT and PT are prolonged.

      Explanation:

      Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives. The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      22.4
      Seconds

  • Question 15 - At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts...

    Incorrect

    • At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts for around 50% of body weight. This can increase to nearly 80% of cardiac output during exercise. Skeletal muscle circulation is highly controlled and has a number of specialized adaptations as a result of this high degree of disparity during exercise, in combination with the diversity in the size of skeletal muscle around the body.What is the primary mechanism for boosting skeletal muscle blood flow during exercise?

      Your Answer: Sympathetic stimulation

      Correct Answer: Metabolic hyperaemia

      Explanation:

      In skeletal muscle, blood flow is closely related to metabolic rate. Due to the contraction of precapillary sphincters, most capillaries are blocked off from the rest of the circulation at rest and are not perfused. This causes an increase in vascular tone and vessel constriction. As metabolic activity rises, this develops redundancy in the system, allowing it to cope with greater demand. During exercise, metabolic hyperaemia, which is induced by the release of K+, CO2, and adenosine, recruits capillaries. Sympathetic vasoconstriction in the active muscles is overridden by this. Simultaneously, blood flow in non-working muscles is restricted, preserving cardiac output. During exercise, muscle contractions pump blood through the venous system, raising the pressure differential between arterioles and venules and boosting blood flow via capillaries.Capillary angiogenesis is evident when muscles are used repeatedly (e.g. endurance training). It is a long-term effect, not a quick fix for increased blood flow.The local partial pressure of alveolar oxygen is the primary intrinsic control of pulmonary blood flow (pAO2). Low pAO2 promotes arteriole vasoconstriction and vice versa. The hypoxic pulmonary vasoconstriction (HPV) reflex allows blood flow to be diverted away from poorly ventilated alveoli and towards well-ventilated alveoli in order to maximize gaseous exchange.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      1091.1
      Seconds

  • Question 16 - Regarding diuretics, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer: Loop diuretics act on the thin descending limb.

      Correct Answer: Carbonic anhydrase inhibitors have their effect by inhibiting bicarbonate reabsorption.

      Explanation:

      Carbonic anhydrase inhibitors e.g. acetazolamide block the reaction of carbon dioxide and water and so prevent Na+/H+exchange and bicarbonate reabsorption. The increased bicarbonate levels in the filtrate oppose water reabsorption. Proximal tubule sodium reabsorption is also reduced because it is partly dependent on bicarbonate reabsorption.

    • This question is part of the following fields:

      • Physiology
      • Renal
      48.3
      Seconds

  • Question 17 - While on morning rounds in the medical ward, the attending physician asks a...

    Incorrect

    • While on morning rounds in the medical ward, the attending physician asks a medical student about the differences between transudates and exudates and their causes. The student explains that a transudate is an excess fluid that leaks out of an intravascular compartment due to an imbalance between oncotic and hydrostatic pressures. Which ONE of the following conditions will he mention as the cause of a transudate?

      Your Answer: Rheumatoid arthritis

      Correct Answer: Meig’s syndrome

      Explanation:

      Transudative effusions are caused due to systemic causes leading to increased hydrostatic pressure or decreased oncotic pressure. These include:1) Meig’s Syndrome (Ovarian tumour causing ascites and pleural effusion)2) Congestive heart failure3) Nephrotic Syndrome4) Myxoedema5) Cirrhosis6) SarcoidosisAn exudate is caused by local inflammation and results from increased vascular permeability. Causes include:1) Rheumatoid arthritis2) Pneumonia leading to empyema3) Malignancies4) Pericarditis

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      35
      Seconds

  • Question 18 - The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A...

    Incorrect

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

      Your Answer: Sodium nitroprusside

      Correct Answer: Labetalol

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      125.5
      Seconds

  • Question 19 - Which of the following is NOT a characteristic of megaloblastic anaemia? ...

    Incorrect

    • Which of the following is NOT a characteristic of megaloblastic anaemia?

      Your Answer: Decreased platelet count

      Correct Answer: Raised reticulocyte count

      Explanation:

      The LDH level is usually markedly increased in severe megaloblastic anaemia. Reticulocyte counts are inappropriately low, representing a lack of production of RBCs due to massive intramedullary haemolysis. These findings are characteristics of ineffective haematopoiesis that occurs in megaloblastic anaemia as well as in other disorders such as thalassemia major.The common feature in megaloblastosis is a defect in DNA synthesis in rapidly dividing cells. To a lesser extent, RNA and protein synthesis are impaired. Unbalanced cell growth and impaired cell division occur since nuclear maturation is arrested. More mature RBC precursors are destroyed in the bone marrow prior to entering the bloodstream (intramedullary haemolysis).

    • This question is part of the following fields:

      • Haematology
      • Pathology
      15.5
      Seconds

  • Question 20 - Reed-Sternberg cells are characteristic of which of the following malignancies: ...

    Correct

    • Reed-Sternberg cells are characteristic of which of the following malignancies:

      Your Answer: Hodgkin lymphoma

      Explanation:

      Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      5.8
      Seconds

  • Question 21 - Which of these is NOT a lithium side effect: ...

    Correct

    • Which of these is NOT a lithium side effect:

      Your Answer: Peptic ulcer disease

      Explanation:

      Adverse Effects of lithium IncludeLeucocytosis (most patients)Polyuria/polydipsia (30-50%)Dry mouth (20-50%)Hand tremor (45% initially, 10% after 1 year of treatment)Confusion (40%)Decreased memory (40%)Headache (40%)Muscle weakness (30% initially, 1% after 1 year of treatment)Electrocardiographic (ECG) changes (20-30%)Nausea, vomiting, diarrhoea (10-30% initially, 1-10% after 1-2 years of treatment)Hyperreflexia (15%)Muscle twitch (15%)Vertigo (15%)Extrapyramidal symptoms, goitre (5%)Hypothyroidism (1-4%)Acne (1%)Hair thinning (1%)

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      15.6
      Seconds

  • Question 22 - Which of these statements about experimental studies is true? ...

    Correct

    • Which of these statements about experimental studies is true?

      Your Answer: Randomisation serves to remove potential bias

      Explanation:

      In experimental studies, the researcher introduces an intervention and studies the effect. The study subjects are allocated into different groups by the investigator through the use of randomisation. Randomisation serves to remove any potential bias.A cohort study is a form of longitudinal, observational study that follows a group of patients (the cohort) over a period of time to monitor the effects of exposure to a proposed aetiological factor upon them.A case-control study is a type observational study. Here, patients who have developed a disease are identified and compared on the basis of proposed causative factors that occurred in the past, to a control group.Clinical trials are experimental studies. Examples include: double blind, single blind, and unblinded studies(both patient and researcher are aware of the treatment they receive)

    • This question is part of the following fields:

      • Evidence Based Medicine
      8.2
      Seconds

  • Question 23 - 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: Stimulate release of aldosterone from the zona glomerulosa

      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
      77.5
      Seconds

  • Question 24 - A 57-year-old woman has presented with cough and shortness of breath. Her GP...

    Incorrect

    • A 57-year-old woman has presented with cough and shortness of breath. Her GP had done some blood tests recently and told her that she had a positive ANA result.Which of these statements is true about anti-nuclear antibodies (ANAs)? Select only ONE answer.

      Your Answer: ELISA testing is the most accurate means of testing for ANAs.

      Correct Answer: The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome

      Explanation:

      Anti-nuclear antibodies are auto-antibodies directed against a variety of nuclear antigens. There are different staining patterns and each pattern is suggestive of a different disorder.Speckled staining is suggestive of mixed connective tissue disease.Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.Anti-double stranded DNA is suggestive of SLE while anti-histone antibodies are suggestive of drug-induced lupus.ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most accurate.The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome. Felty’s syndrome is characterized by a combination of rheumatoid arthritis, splenomegaly and neutropenia.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      35.7
      Seconds

  • Question 25 - A 30-year-old female presented to the Emergency Department after a fall during a...

    Incorrect

    • A 30-year-old female presented to the Emergency Department after a fall during a hiking expedition caused severe pain in her left arm and wrist drop. An X-ray revealed a mid-shaft fracture of the humerus, which most likely damaged the radial nerve. Which one of the following statements best describes the healing process of peripheral nerves?

      Your Answer: Schwann cells are associated only with myelinated nerve fibres

      Correct Answer: Peripheral nerve fibres regenerate at around 1mm per day

      Explanation:

      Peripheral nerves are nerves that lie outside the brain and spinal cord. Peripheral nerves readily regenerate, while central nervous system axonal injury does not spontaneously regenerate. If there is damage to the axons of peripheral nerves, the nerves will regenerate at a slow rate of 1 mm per day. The slow regeneration process may lead to muscle atrophy before regeneration is complete. Each peripheral nerve has a single cell body that supplies nutrients to the growing nerve fibre. The cell body does not undergo mitosis; only the axon is regenerated.Schwann cells of the peripheral nervous system provide support for this process, while the analogous oligodendrocytes of the central nervous system do not. Schwann cells themselves do not cause regeneration. Schwann cells provide myelin for myelinated fibres and surround non-myelinated fibres with their cytoplasm. If an axon is completely severed, as in the case of amputation, the axonal fibres regenerating from the cell body may never find their original route back to the muscle. Instead, they may form a traumatic neuroma, a painful collection of nerve fibres and myelin.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      158.4
      Seconds

  • Question 26 - After what time period should intravenous phenytoin be used as second-line treatment of...

    Incorrect

    • After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?

      Your Answer: 1 hour

      Correct Answer: 25 minutes

      Explanation:

      If seizures recur or fail to respond after initial treatment with benzodiazepines within 25 minutes of onset, phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium should be used.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      18.3
      Seconds

  • Question 27 - A 76-year-old man presents with complaints of double vision. Upon physical examination, it...

    Correct

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

      Your Answer: Basilar artery

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      51.5
      Seconds

  • Question 28 - You're called to a cardiac arrest in your Emergency Department resuscitation area. The...

    Incorrect

    • You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available.In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines?

      Your Answer: Procainamide

      Correct Answer: Lidocaine

      Explanation:

      If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      35.1
      Seconds

  • Question 29 - A 74-year-old woman with a history of ischaemic heart disease and heart failure...

    Incorrect

    • A 74-year-old woman with a history of ischaemic heart disease and heart failure is complaining of worsening oedema, bloating, and a loss of appetite. She has ascites and peripheral oedema on examination. Her oedema is being controlled by an oral diuretic, but it appears that this is no longer enough. You discuss her care with the on-call cardiology registrar, who believes she is very likely to have significant gut oedema that is interfering with her diuretic absorption and that she will need to change her medication.Which of the following oral diuretics is most likely to help you overcome this problem?

      Your Answer: Mannitol

      Correct Answer: Bumetanide

      Explanation:

      Bumetanide is primarily used in patients with heart failure who have failed to respond to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency. In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. As a result, when it has a better bioavailability than furosemide, it is commonly used in patients with gut oedema.When taken alone, Bendroflumethiazide is a moderately potent diuretic that is unlikely to control her oedema.Mannitol is a type of osmotic diuretic used to treat cerebral oedema and high intracranial pressure.Acetazolamide is a weak diuretic that inhibits carbonic anhydrase. It’s a rare occurrence.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      97.8
      Seconds

  • Question 30 - The primary mechanism of action of ketamine is: ...

    Incorrect

    • The primary mechanism of action of ketamine is:

      Your Answer: Gamma-aminobutyric acid (GABA)-receptor agonist

      Correct Answer: N-methyl-D-aspartate (NMDA)-receptor antagonist

      Explanation:

      Ketamine is a non-competitive antagonist of the calcium-ion channel in the NMDA (N-methyl-D-aspartate) receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).Overdose may lead to panic attacks and aggressive behaviour; rarely seizures, increased ICP, and cardiac arrestVery similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      14.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastrointestinal Physiology (1/1) 100%
Physiology (3/7) 43%
Inflammatory Responses (1/2) 50%
Pathology (2/9) 22%
Immunological Products & Vaccines (0/1) 0%
Pharmacology (1/9) 11%
Endocrine Physiology (0/1) 0%
Cardiovascular Pharmacology (0/4) 0%
Microbiology (2/2) 100%
Specific Pathogen Groups (1/1) 100%
Infections (0/1) 0%
Respiratory (1/1) 100%
Anatomy (2/2) 100%
Cranial Nerve Lesions (1/1) 100%
Pathogens (1/1) 100%
Haematology (1/4) 25%
Gastrointestinal (1/1) 100%
Cardiovascular Physiology (0/1) 0%
Renal (0/2) 0%
General Pathology (0/3) 0%
Central Nervous System (2/3) 67%
Evidence Based Medicine (1/1) 100%
Anaesthesia (0/1) 0%
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