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  • Question 1 - A 23-year-old man who is currently on fluoxetine for depression was anaesthetized two...

    Correct

    • A 23-year-old man who is currently on fluoxetine for depression was anaesthetized two hours ago for knee arthroscopy. He seems agitated, confused, with a heart rate of 120 beats per minute, a temperature of 38.2oC, and developed difficulty moving his limbs.
      He is on paracetamol and tramadol for analgesia. Which of the following is the most likely cause for his condition?

      Your Answer: Tramadol

      Explanation:

      Agitation or restlessness, Rapid heart rate, high Blood Pressure, loss of muscle coordination, or twitching muscles is common symptoms of Serotonin Syndrome.

      Tramadol should not be given to patients taking selective serotonin receptor inhibitor (SSRI) therapy because of the risk of serotonin syndrome

      Tramadol is a centrally acting analgesic that is an atypical opioid that relieves pain by opioids as well as additional mechanisms. Its affinity for µ opioid receptor is low, while that for κ and δ is very low. Unlike other opioids, it inhibits the reuptake of Noradrenaline (NA) and 5- Hydroxytryptamine (5-HT), increases 5-HT release, and thus activates monoaminergic spinal inhibition of pain.

      Its analgesic action is only partially reversed by the opioid antagonist naloxone.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 2 - With a cervical dilation of 9 cm, a 23-year-old term primigravida is in...

    Incorrect

    • With a cervical dilation of 9 cm, a 23-year-old term primigravida is in labour. She is otherwise in good health. She's been in labour for 14 hours and counting.
      Early foetal pulse decelerations can be seen on the cardiotocograph, and a recent foetal scalp blood sample revealed a pH of 7.25.
      Which of the following is true about this patient's care and management?

      Your Answer:

      Correct Answer: Monitor for downward trend in fetal scalp blood pH as caesarean section is not indicated at the present time

      Explanation:

      Once the decision to deliver a baby by caesarean section has been made, it should be carried out with a level of urgency commensurate with the risk to the baby and the mother’s safety.

      There are four types of caesarean section urgency:

      Category 1 – Endangering the life of the mother or the foetus
      Category 2 – Maternal or foetal compromise that is not immediately life threatening
      Category 3 – Early delivery is required, but there is no risk to the mother or the foetus.
      Category 4: Elective delivery at a time that is convenient for both the mother and the maternity staff.

      Caesarean sections for categories 1 and 2 should be performed as soon as possible after the decision is made, especially for category 1. For category 1 caesarean sections, a decision to deliver time of 30 minutes is currently used.

      In most cases, Category 2 caesarean sections should be performed within 75 minutes of making the decision.

      The condition of the woman and the unborn baby should be considered when making a decision for a quick delivery, as it may be harmful in some cases.

      There is no evidence of foetal compromise in the example above (early foetal pulse decelerations and a pH of less than 7.25). Early foetal pulse decelerations are most likely caused by the uterus compressing the foetal head. The foetus is not harmed by these. A spinal anaesthetic is preferred over a general anaesthetic whenever possible.

      If the foetal scalp blood pH is greater than 7.25, it’s a good idea to repeat the test later and look for any changes. When a foetus decelerates, the mother should be given oxygen, kept in a left lateral position, and kept hydrated to avoid the need for a caesarean section.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 3 - Regarding renal autoregulation, which of the following best describes its process? ...

    Incorrect

    • Regarding renal autoregulation, which of the following best describes its process?

      Your Answer:

      Correct Answer: Reduces the effect of changes in arterial blood pressure on renal Na+ excretion

      Explanation:

      Two mechanisms are responsible for autoregulation of RBF and GFR: one mechanism that responds to changes in arterial pressure and another that responds to changes in [NaCl] in tubular fluid. Both regulate the tone of the afferent arteriole. The pressure-sensitive mechanism, the so-called myogenic mechanism, is related to an intrinsic property of vascular smooth muscle: the tendency to contract when stretched. Accordingly, when arterial pressure rises and the renal afferent arteriole is stretched, the smooth muscle contracts in response. Because the increase in resistance of the arteriole offsets the increase in pressure, RBF, and therefore GFR, remains constant.

      The second mechanism responsible for autoregulation of GFR and RBF is the [NaCl]-dependent mechanism known as tubuloglomerular feedback. This mechanism involves a feedback loop in which a change in GFR leads to alteration in the concentration of NaCl in tubular fluid, which is sensed by the macula densa of the juxtaglomerular apparatus and converted into signals that affect afferent arteriolar resistance and thus the GFR (Fig. 33.19). For example, when the GFR increases and causes [NaCl] in tubular fluid in the loop of Henle to rise, more NaCl enters the macula densa cells in this segment (Fig. 33.20). This leads to an increase in formation and release of adenosine triphosphate (ATP) and adenosine (a metabolite of ATP) by macula densa cells, which causes vasoconstriction of the afferent arteriole and normalization of GFR. In contrast, when GFR and [NaCl] in tubule fluid decrease, less NaCl enters the macula densa cells, and both ATP and adenosine production and release decline. The fall in [ATP] and [adenosine] results in afferent arteriolar vasodilation, which returns GFR to normal. NO, a vasodilator produced by the macula densa, attenuates tubuloglomerular feedback, whereas angiotensin II enhances tubuloglomerular feedback. Thus the macula densa may release both vasoconstrictors (e.g., ATP and adenosine) and a vasodilator (e.g., NO) that oppose each other’s action at the level of the afferent arteriole. Production plus release of either vasoconstrictors or vasodilators ensures exquisite control over tubuloglomerular feedback.

      Renal autoregulation, thus, reduces the effect of changes in arterial blood pressure on renal sodium excretion.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 4 - Regarding bilirubin, which one of the following statement is true? ...

    Incorrect

    • Regarding bilirubin, which one of the following statement is true?

      Your Answer:

      Correct Answer: Conjugated bilirubin is stored in the gall bladder

      Explanation:

      Bilirubin is the tetrapyrrole and a catabolic product of heme. 70-90% of bilirubin is end product of haemoglobin degradation in the liver.

      Bilirubin circulates in the blood in 2 forms; unconjugated and conjugated bilirubin.

      Unconjugated bilirubin is insoluble in water. It travels through the bloodstream to the liver, where it changes from insoluble into a soluble form (i.e.; unconjugated into conjugated form).

      This conjugated bilirubin travels from the liver into the small intestine and the gut bacteria convert bilirubin into urobilinogen and then into urobilin (not urobilin to urobilinogen). A very small amount passes into the kidneys and is excreted in urine.

    • This question is part of the following fields:

      • Physiology
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  • Question 5 - Which of the following is true regarding the mechanism of action of daptomycin?...

    Incorrect

    • Which of the following is true regarding the mechanism of action of daptomycin?

      Your Answer:

      Correct Answer: Interferes with the outer membrane of gram positive bacteria resulting in cell death

      Explanation:

      Daptomycin alters the curvature of the membrane, which creates holes that leak ions. This causes rapid depolarization, resulting in loss of membrane potential. Thus it interferes with the outer membrane of gram-positive bacteria resulting in cell death.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 6 - Following a traumatic head injury, you are summoned to the emergency department to...

    Incorrect

    • Following a traumatic head injury, you are summoned to the emergency department to transfer a patient to the CT scanner. With a Glasgow coma score of 3, he has already been intubated and ventilated.
      It is important to ensure that cerebral protection strategies are implemented during the transfer.
      Which of the following methods is the most effective for reducing venous obstruction?

      Your Answer:

      Correct Answer: Position with a head-up tilt of 30°

      Explanation:

      ICP is significant because it influences cerebral perfusion pressure and cerebral blood flow. The normal ICP ranges from 5 to 13 mmHg.

      The components within the skull include the brain (80%/1400 ml), blood (10%/150 ml), and cerebrospinal fluid (CSF) (10%/150 ml).

      Because the skull is a rigid box, if one of the three components increases in volume, one or more of the remaining components must decrease in volume to compensate, or the ICP will rise (Monroe-Kellie hypothesis).

      Primary brain injury occurs as a result of a head injury and is unavoidable unless precautions are taken to reduce the risk of head injury. A reduction in oxygen delivery due to hypoxemia (low arterial PaO2) or anaemia, a reduction in cerebral blood flow due to hypotension or reduced cardiac output, and factors that cause a raised ICP and reduced CPP are all causes of secondary brain injury. Secondary brain injury can be avoided with proper management.

      The most important initial management task is to make certain that:

      There is protection of the airway and the cervical spine
      There is proper ventilation and oxygenation
      Blood pressure and cerebral perfusion pressure are both adequate (CPP).

      Following the implementation of these management principles, additional strategies to reduce ICP and preserve cerebral perfusion are required. The volume of one or more of the contents of the skull can be reduced using techniques that can be used to reduce ICP.

      Reduce the volume of brain tissue
      Blood volume should be reduced.
      CSF volume should be reduced.

      The following are some methods for reducing the volume of brain tissue:
      Abscess removal or tumour resection
      Steroids (especially dexamethasone) are used to treat oedema in the brain.
      To reduce intracellular volume, use mannitol/furosemide or hypertonic saline.
      To increase intracranial volume, a decompressive craniectomy is performed.

      The following are some methods for reducing blood volume:

      Haematomas must be evacuated.
      Barbiturate coma reduces cerebral metabolic rate and oxygen consumption, lowering cerebral blood volume as a result.
      Hypoxemia, hypercarbia, hyperthermia, vasodilator drugs, and hypotension should all be avoided in the arterial system.
      PEEP/airway obstruction/CVP lines in neck: patient positioning with 30° head up, avoid neck compression with ties/excessive rotation, avoid PEEP/airway obstruction/CVP lines in neck

      The following are some methods for reducing CSF volume:

      To reduce CSF volume, an external ventricular drain or a ventriculoperitoneal shunt is inserted (although more a long term measure).

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 7 - What statement about endotoxins is true? ...

    Incorrect

    • What statement about endotoxins is true?

      Your Answer:

      Correct Answer: Can often survive autoclaving

      Explanation:

      Endotoxins are the lipopolysaccharides found in the outer cell wall of Gram-negative bacteria. They are responsible for providing the structure and stability of the cell wall.

      They cannot be destroyed by normal sterilisation as they are heat stable molecules. They require the use of certain sterilant such as superoxide, peroxide and hypochlorite to be neutralised.

      They stimulate strong immune responses, but can only be destroyed partially by specific antibodies. Repeat infections occur as memory T cells cannot be formed.

      It can cause septicaemia and associated symptoms such as fever, shock, hypotension and nausea.

      It activates the alternative complement pathway and the coagulation pathway using secreted cytokines.

      It is not involved in botulism as clostridium botulinum, the responsible organism, secretes a neurotoxic exotoxin.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 8 - Which of the following drugs would cause the most clinical concern if accidentally...

    Incorrect

    • Which of the following drugs would cause the most clinical concern if accidentally administered intravenously to a 4-year-old boy?

      Your Answer:

      Correct Answer: 20 mg codeine

      Explanation:

      To begin, one must determine the child’s approximate weight. There are a variety of formulas to choose from. It is acceptable to use the advanced paediatric life support formula:

      (age + 4) 2 = weight

      A 5-year-old child will weigh around 18 kilogrammes.

      The following are the appropriate doses of the drugs listed above:

      Gentamicin (once daily) – 5-7 mg/kg = 90-126 mg and subsequent dose modified according to plasma levels
      Ondansetron – 0.1 mg/kg, but a maximum of 4 mg as a single dose = 1.8 mg
      Codeine should be administered orally at a dose of 1 mg/kg rather than intravenously, as the latter can cause ‘dangerous’ hypotension due to histamine release.
      15 mg/kg paracetamol = 270 mg orally or intravenously (a loading dose of 20 mg/kg, or 360 mg, is sometimes recommended, which is not far short of the doses listed above).
      Cefuroxime – the initial intravenous dose is 20 mg/kg (360 mg) depending on the indication (again, similar to the dose given in the answer options above).

    • This question is part of the following fields:

      • Pharmacology
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  • Question 9 - About the mechanism of action of bendroflumethiazide, Which of the following is correct?...

    Incorrect

    • About the mechanism of action of bendroflumethiazide, Which of the following is correct?

      Your Answer:

      Correct Answer: Sodium-chloride symporter inhibitor

      Explanation:

      Sodium-chloride symporter inhibitor.

      The thiazide sensitive sodium chloride symporter is inhibited by thiazides at the proximal portion of the distal convoluted tubule leading to increased sodium and water excretion. Increased delivery of sodium to the distal portion of the distal convoluted tubule promotes potassium loss. This is why thiazides are associated with hyponatraemia and hypokalaemia.

      Carbonic anhydrase inhibitors are used mainly in the treatment of glaucoma. They act on the proximal convoluted tubule to promote bicarbonate, sodium and potassium loss.

      Sodium potassium chloride symporter is inhibited by Loop diuretics.
      Epithelial sodium channels are inhibited by Amiloride.
      Drugs which lead to nephrogenic diabetes insipidus such as lithium and demeclocycline, are Inhibitors of vasopressin.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 10 - If a patient is to be placed under general anaesthesia using total intravenous...

    Incorrect

    • If a patient is to be placed under general anaesthesia using total intravenous technique with target-controlled infusions of propofol and remifentanil, what safety precaution is the most vital in this a scenario?

      Your Answer:

      Correct Answer: Cannula access site clearly visible and regularly checked

      Explanation:

      According to the Safe Anaesthesia Liaison Group, the most important factor to consider the cannula access, and if the patient is properly receiving the total intravenous anaesthesia. The cannula access must be regularly checked for kinks, leaks and disconnections.

      Below are the safety precautions and policies to be followed for total intravenous anaesthesia among children and adults:

      When administering TIVA, a non-return valve must be used on any intravenous fluid line;
      When using equipment, it is essential that clinical staff know its limitations and uses;
      Sites of intravenous infusions should be visible so they may be monitored for disconnection, leaks or perivenous infusion into the subcutaneous tissues; and,
      Organisations must give preference to clearly labelled intravenous connectors and valves.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 11 - Regarding pre-eclampsia with warning signs, which of the following laboratory tests is the...

    Incorrect

    • Regarding pre-eclampsia with warning signs, which of the following laboratory tests is the most appropriate to establish a platelet dysfunction or disorder?

      Your Answer:

      Correct Answer: Platelet count

      Explanation:

      Decreased platelet concentrations with eclampsia were described as early as 1922 by Stancke. The platelet count is routinely measured in women with any form of gestational hypertension. The frequency and intensity of thrombocytopenia vary and are dependent on the severity and duration of the preeclampsia syndrome and the frequency with which platelet counts are performed.

      Overt thrombocytopenia defined by a platelet count < 100,000/microliter - indicates severe disease. In general, the lower the platelet count, the higher the rates of maternal and fetal morbidity and mortality. In most cases, delivery is advisable because thrombocytopenia usually continues to worsen. After delivery, the platelet count may continue to decline for the first day or so. It then usually increases progressively to reach a normal level within 3-5 days. In some instances with HELLP syndrome, the platelet count continues to fall after delivery. If these do not reach a nadir until 48 to 72 hours, then preeclampsia syndrome may be incorrectly attributed to one of the thrombotic microangiopathies. The following are other severe features associated with preeclampsia: Proteinuria: >/= 300 mg/24 hours; or urine protein: creatinine ratio >/= 0.3; or dipstick 1+

      Renal insufficiency: serum creatinine > 1.1 mg/dL or doubling of creatinine in the absence of other renal disease

      Impaired liver function: two times elevated AST/ALT or unexplained right upper quadrant pain or epigastric pain unresponsive to medications

      Pulmonary oedema

      Cerebral or visual symptoms: headache, visual disturbances.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 12 - Very small SI units are easily expressed using mathematical prefixes.
    One femtolitre is...

    Incorrect

    • Very small SI units are easily expressed using mathematical prefixes.
      One femtolitre is equal to which of the following volumes?

      Your Answer:

      Correct Answer: 0.000, 000, 000, 000, 001 L

      Explanation:

      Small measurement units are denoted by the following SI mathematical prefixes:

      1 deci = 0.1
      1 milli = 0.001
      1 micro = 0.000001
      1 nano = 0.000000001
      1 pico = 0.000000000001
      1 femto = 0.000000000000001 (used to measure red blood cell volume)
      1 atto = 0.000000000000000001.

    • This question is part of the following fields:

      • Basic Physics
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  • Question 13 - Ondansetron is serotonin antagonist indicated for post-operative nausea and vomiting.
    In which of...

    Incorrect

    • Ondansetron is serotonin antagonist indicated for post-operative nausea and vomiting.
      In which of the following anatomic structures does ondansetron produce its effects?

      Your Answer:

      Correct Answer: Nucleus tractus solitarius

      Explanation:

      Ondansetron is a serotonin antagonist at the 5HT3 receptor. 5HT3 receptors in the gastrointestinal tract and in the vomiting centre of the medulla participate in the vomiting reflex. They are particularly important in vomiting caused by chemical triggers such as cancer chemotherapy drugs.

      The nucleus solitarius is the recipient of all visceral afferents, and an essential part of the regulatory centres of the internal homeostasis, through its multiple projections with cardiorespiratory and gastrointestinal regulatory centres. It participates in the reflexes of the nerves innervating the nucleus, so it mediates cough reflex, carotid sinus reflex, gag reflex, and vomiting reflex.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 14 - With regards to the repolarisation phase of the myocardial action potential, which of...

    Incorrect

    • With regards to the repolarisation phase of the myocardial action potential, which of the following is responsible?

      Your Answer:

      Correct Answer: Efflux of potassium

      Explanation:

      Cardiac conduction

      Phase 0 – Rapid depolarization. Opening of fast sodium channels with large influx of sodium

      Phase 1 – Rapid partial depolarization. Opening of potassium channels and efflux of potassium ions. Sodium channels close and influx of sodium ions stop

      Phase 2 – Plateau phase with large influx of calcium ions. Offsets action of potassium channels. The absolute refractory period

      Phase 3 – Repolarization due to potassium efflux after calcium channels close. Relative refractory period

      Phase 4 – Repolarization continues as sodium/potassium pump restores the ionic gradient by pumping out 3 sodium ions in exchange for 2 potassium ions coming into the cell. Relative refractory period

    • This question is part of the following fields:

      • Physiology And Biochemistry
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  • Question 15 - Desflurane has which of the following characteristics when compared with halothane? ...

    Incorrect

    • Desflurane has which of the following characteristics when compared with halothane?

      Your Answer:

      Correct Answer: Less biodegradation

      Explanation:

      Approximately 20% of halothane and 0.02% desflurane undergo hepatic biotransformation. Desflurane, halothane, and isoflurane are metabolised in the liver by cytochrome p450 to trifluoroacetate. Through an immunological mechanism involving trifluoroacetyl hapten formation, trifluoroacetate is thought to be responsible for hepatotoxicity.

      Potency of inhaled anaesthetic agents is measured using the minimal alveolar concentration (MAC). The MAC of halothane is 0.74% while that of desflurane is 6.3%. The potency can also be compared using the oil: gas partition coefficient (224 and 18.7 for halothane and desflurane respectively).

      Onset of action of volatile agents depends on the blood:gas partition coefficient. A lower blood:gas partition coefficient and insolubility in blood means faster onset and offset of action. The blood gas coefficient for halothane is 2.4 while that of desflurane is 0.42. Desflurane is less soluble than halothane in blood. Halothane has a pungent smell that can irritate the airway which limits its use for a gaseous induction especially in paediatric anaesthesia. desflurane is not pungent.

      Desfluranes boiling point is only slightly above normal room temperature (22.8°C) making it extremely volatile while the boiling point of halothane is approximately 50.2°C.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 16 - A 72-year-old woman with a medical history of ischaemic heart disease, hypertension, and...

    Incorrect

    • A 72-year-old woman with a medical history of ischaemic heart disease, hypertension, and hypothyroidism was brought to ER with a change in her mental state over the past few hours. Medications used by her were hydrochlorothiazide, aspirin, ramipril, and levothyroxine.
      On physical examination, decreased skin turgor, orthostatic hypotension, and disorientation of time and place were found. There were no significant neurological signs.
      Initial biochemical tests are as follows:
      Na: 111 mmol/L (135-145),
      K: 4.1 mmol/L (3.5-5.1),
      Cl: 105 mmol/L (99-101),
      Bic: 29 mmol/L (22-29),
      Urea: 16.4 mmol/L (1.7-8.3),
      Creatinine: 320µmol/L (44-80),
      Glucose: 13.5mmol/L (3.5-5.5),
      Plasma osmolality: 278mOsm/kg,
      Urinary osmolality: 450mOsm/kg,
      TSH: 6.2 miu/L (0.1-6.0),
      Free T4: 10.1 pmol/L (10-25),
      Free T3: 1.4nm/L (1.0-2.5),
      Which of the following is most likely cause for this condition of the patient?

      Your Answer:

      Correct Answer: Drug idiosyncrasy

      Explanation:

      Based on the laboratory reports, the patient is suffering from significant hyponatremia. The symptoms of hyponatremia are mainly neurological and depend on the severity and rapidity of onset of hyponatremia.

      Patient symptom according to the hyponatremia level is correlated below:

      125 – 130mmol/L – Nausea and malaise
      115 – 125mmol/L – Headache, lethargy, seizures, and coma
      <120mmol/L - Up to 11% present with coma.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 17 - Which of the following options is correct regarding the coagulation pathway? ...

    Incorrect

    • Which of the following options is correct regarding the coagulation pathway?

      Your Answer:

      Correct Answer: Tissue factor released by damaged tissue initiates the extrinsic pathway

      Explanation:

      The extrinsic pathway is considered as the main pathway of coagulation cascade.

      Heparin is known to inhibit the activation of coagulation factors 2,9,10, and 11.

      The extrinsic and intrinsic pathways meet at the activation of coagulation factor 10.

      Fibrinogen is converted into Fibrin in the presence of Thrombin. Plasminogen is converted into plasmin during fibrinolysis to breakdown fibrin clot.

    • This question is part of the following fields:

      • Physiology And Biochemistry
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  • Question 18 - Which of the following is incorrect with regards to atrial natriuretic peptide? ...

    Incorrect

    • Which of the following is incorrect with regards to atrial natriuretic peptide?

      Your Answer:

      Correct Answer: Secreted mainly by the left atrium

      Explanation:

      Atrial natriuretic peptide (ANP) is secreted mainly from myocytes of right atrium and ventricle in response to increased blood volume.
      It is secreted by both the right and left atria (right >> left).

      It is a 28 amino acid peptide hormone, which acts via cGMP
      degraded by endopeptidases.

      It serves to promote the excretion of sodium, lowers blood pressure, and antagonise the actions of angiotensin II and aldosterone.

    • This question is part of the following fields:

      • Physiology And Biochemistry
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  • Question 19 - Which of the following closely estimates the interstitial oncotic pressure acting on a...

    Incorrect

    • Which of the following closely estimates the interstitial oncotic pressure acting on a pulmonary capillary?

      Your Answer:

      Correct Answer: 17 mmHg

      Explanation:

      The starling forces operate to maintain a homeostatic flow across the pulmonary capillary bed.

      The outward driving force comprises of the capillary hydrostatic pressure (13 mmHg), negative interstitial fluid pressure (zero to slightly negative), and interstitial colloid osmotic pressure (17 mmHg). The inward driving force is controlled by the plasma colloid osmotic pressure (25 mmHg).

    • This question is part of the following fields:

      • Basic Physics
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  • Question 20 - The following are the pharmacodynamic properties of a neuromuscular blocking agent:
    Effective dose...

    Incorrect

    • The following are the pharmacodynamic properties of a neuromuscular blocking agent:
      Effective dose 95 (ED95) - 0.3 mg/kg,
      Time to 95% depression of first twitch of train of four (ToF) - 75 seconds,
      Time to 25% recovery of first twitch of train of four (ToF) - 33 minutes.
      Which of the following statements about this neuromuscular blocking agent is the most accurate?

      Your Answer:

      Correct Answer: Can be reversed by a modified gamma-cyclodextrin

      Explanation:

      The aminosteroid rocuronium is the neuromuscular blocking agent in question.

      0.3 mg/kg is the effective dose 95 (ED95) (the dose required to depress the twitch height by 95 percent )
      The dose for intubation is 0.6 mg/kg.
      75 seconds is the time it takes to reach 95 percent depression of the first twitch of the train of four (ToF) or the onset time.
      The clinical duration or time to 25% recovery of the first twitch of the train of four (ToF) is 33 minutes.

      A modified cyclodextrin can quickly reverse both rocuronium and vecuronium (sugammadex).

      It is more fat-soluble than vecuronium, with the liver absorbing the majority of the drug and excreting it in the bile. The only metabolite found in the blood (17-desacetylrocuronium) is 20 times less potent than the parent drug and is unlikely to cause neuromuscular block.

      Despite its quick onset of action (60-90 seconds), suxamethonium arguably is still the neuromuscular blocker of choice for a quick sequence induction. Rocuronium is becoming increasingly popular for this purpose.

    • This question is part of the following fields:

      • Pharmacology
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