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  • Question 1 - A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago....

    Incorrect

    • A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago. The boy is healthy and has no known comorbid or drug history.

      Out of the following metabolic pathways, which one is primarily responsible for the toxic effects of paracetamol?

      Your Answer: Glucuronidation

      Correct Answer: N-hydroxylation

      Explanation:

      Paracetamol is predominantly metabolized in the liver by three main metabolic pathways:
      1. Glucuronidation (45-55%)
      2. Sulphate conjugation (30-35%)
      3. N-hydroxylation via the hepatic cytochrome P450 enzyme system (10-15%)

      Cytochrome P450 enzymes catalyse the oxidation of acetaminophen to the reactive metabolite N-acetyl-p-benzoquinoneimine (NAPQI). NAPQI primarily contributes to the toxic effects of acetaminophen. NAPQI is an intermediate metabolite that is further metabolized by fast conjugation with glutathione. The conjugated metabolite is then excreted in the urine as mercapturic acid. High doses of acetaminophen (overdoses) can lead to hepatic necrosis due to depleting glutathione and high binding levels of reactive metabolite (NAPQI) to important parts of liver cells.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      2
      Seconds
  • Question 2 - Which anatomical structure is divided following an emergency department anterolateral thoracotomy? ...

    Incorrect

    • Which anatomical structure is divided following an emergency department anterolateral thoracotomy?

      Your Answer:

      Correct Answer: Latissimus dorsi

      Explanation:

      Thoracotomy describes an incision made in the chest wall to access the contents of the thoracic cavity. Thoracotomies typically can be divided into two categories; anterolateral thoracotomies and posterolateral thoracotomies. These can be further subdivided into supra-mammary and infra-mammary and, of course, further divided into the right or left chest. Each type of incision has its utility given certain circumstances.

      A scalpel is used to sharply divide the skin along the inframammary crease overlying the fifth rib. Electrocautery is then used to divide the pectoralis major muscle and serratus anterior muscle. Visualization of the proper operative field can be achieved with the division and retraction of the latissimus dorsi. Either the fourth or fifth intercostal space is then entered after the division of intercostal muscles above the rib to ensure the preservation of the neurovascular bundle. Once the patient is properly secured to the operating table, the ipsilateral arm is raised and positioned anteriorly and cephalad to rest above the head. The incision is started along the inframammary crease and extended posterolaterally below the tip of the scapula. It is then extended superiorly between the spine and the edge of the scapula, a short distance. The trapezius muscle and the subcutaneous tissues are divided with electrocautery. The serratus anterior and latissimus dorsi muscles are identified and can be retracted. The intercostal muscles are then divided along the superior border of the ribs, and the thoracic cavity is accessed.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds
  • Question 3 - Antidiuretic hormone (ADH) is synthesised by which of the following: ...

    Incorrect

    • Antidiuretic hormone (ADH) is synthesised by which of the following:

      Your Answer:

      Correct Answer: Hypothalamus

      Explanation:

      Antidiuretic hormone is synthesised in the hypothalamus and transported to the posterior pituitary within nerve fibres where it is stored in secretory granules. ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, raising cAMP levels and causing intracellular vesicles to fuse with the apical membrane. In their membrane these vesicles have water channels called aquaporins, which increase the water permeability allowing greater water reabsorption and concentration of urine. Excess levels of ADH results in syndrome of inappropriate ADH secretion (SIADH) characterised by hyponatremia with concomitant hypo-osmolality and high urine osmolality.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
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  • Question 4 - Stimulation of J receptors located on alveolar and bronchial walls results in all...

    Incorrect

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

      Your Answer:

      Correct Answer: Tachycardia

      Explanation:

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

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
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  • Question 5 - A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the...

    Incorrect

    • A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the resuscitation area of the Emergency Department. A loading dose of IV aminophylline is administered and her symptoms begin to improve. You are asked to check her theophylline levels after an appropriate time period.

      How long should you wait before taking her blood sample be taken?

      Your Answer:

      Correct Answer: 4-6 hours

      Explanation:

      Plasma theophylline concentration is usually measured five days after starting oral treatment and three days after each dose adjustment.

      A blood sample to check theophylline concentration should usually be taken after 4-6 hours if an IV dose of aminophylline was given.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 6 - Regarding fat digestion, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding fat digestion, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Chylomicrons consist of a cholesterol and triglyceride core with a phospholipid coat studded with apolipoproteins.

      Explanation:

      Dietary fat is chiefly composed of triglycerides. In the duodenum fat is emulsified by bile acids, a process where larger lipid droplets are broken down into much smaller droplets providing a greater surface area for enzymatic digestion. Once inside the epithelial cell, lipid is taken into the smooth endoplasmic reticulum where much of it is re esterified. Dietary and synthesised lipids are then incorporated into chylomicrons in the Golgi body, which are exocytosed from the basolateral membrane to enter lacteals. Chylomicrons consist mainly of triglyceride with small amounts of cholesterol and cholesteryl esters in the centre with a phospholipid coat studded with apolipoproteins. Fat-soluble are absorbed into enterocytes from micelles by simple diffusion together with the products of fat digestion.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 7 - Regarding haemophilia A, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      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
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  • Question 8 - What kind of function loss do you anticipate in a 22-year-old guy who...

    Incorrect

    • What kind of function loss do you anticipate in a 22-year-old guy who had a laceration to his arm, resulting in nerve damage in the antecubital fossa?

      Your Answer:

      Correct Answer: Opposition of thumb

      Explanation:

      The symptoms of median nerve injury include tingling or numbness in the forearm, thumb, and three adjacent fingers, as well as gripping weakness and the inability to move the thumb across the palm.

      Because the thenar muscles and the flexor pollicis longus are paralyzed, flexion, abduction, and opposition of the thumb at the MCPJ and IPJ are gone.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 9 - A 22-year-old presents with acute severe asthma. He takes a drug prescribed by...

    Incorrect

    • A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.

      Which drug is least likely to have caused his hypokalaemia?

      Your Answer:

      Correct Answer: Spironolactone

      Explanation:

      Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.

      Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 10 - Regarding alteplase, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Alteplase is commonly associated with hypotensive effects.

      Explanation:

      Alteplase is a recombinant tissue-type plasminogen activator (tPA), a naturally occurring fibrin-specific enzyme that has selectivity for activation of fibrin-bound plasminogen. It has a short half-life of 3 – 4  minutes and must be given by continuous intravenous infusion but is not associated with antigenic or hypotensive effects, and can be used in patients when recent streptococcal infections or recent use of streptokinase contraindicates the use of streptokinase.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 11 - Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms: ...

    Incorrect

    • Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms:

      Your Answer:

      Correct Answer: Binds to beta1-receptors and causes increased Ca2+ entry via L-type channels during the action potential

      Explanation:

      Noradrenaline (the sympathetic neurotransmitter) is a positive inotrope; it binds to β1-adrenoceptors on the membrane and causes increased Ca2+entry via L-type channels during the AP and thus increases Ca2+release from the SR. Noradrenaline also increases Ca2+sequestration into the SR and thus more Ca2+is available for the next contraction. Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump which generates the Na+gradient required for driving the export of Ca2+; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction. Acidosis is negatively inotropic, largely because H+competes for Ca2+binding sites.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 12 - A young female was diagnosed with a urinary tract infection and was sent...

    Incorrect

    • A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.

      She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer:

      Correct Answer: Fosfomycin

      Explanation:

      The NICE guidelines for women with lower UTIs who are not pregnant are:
      1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
      2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibiotic

      The first choice of antibiotics for non-pregnant women aged 16 years and over is:
      1. Nitrofurantoin
      100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
      2. Trimethoprim
      200 mg PO BD for three days

      The second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
      1. Nitrofurantoin
      100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
      2. Pivmecillinam
      400 mg PO initial dose, then 200 mg PO TDS for three days
      3. Fosfomycin 3 g single sachet dose

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 13 - Gentamicin is contraindicated in which of the following: ...

    Incorrect

    • Gentamicin is contraindicated in which of the following:

      Your Answer:

      Correct Answer: Myasthenia gravis

      Explanation:

      Gentamicin is the aminoglycoside of choice in the UK and is used widely for the treatment of serious infections. It has a broad spectrum but is inactive against anaerobes and has poor activity against haemolytic streptococci and pneumococci. When used for the blind therapy of undiagnosed serious infections it is usually given in conjunction with a penicillin or metronidazole (or both). The main toxic effects are nephrotoxicity and ototoxicity due to damage to the vestibulocochlear nerve (CN VIII).

      Gentamicin is contraindicated in myasthenia gravis and should be used with caution in renal disease which may result in accumulation and a greater risk of toxic side effects.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 14 - A 62-year-old man complains of chest pain and goes to the emergency room....

    Incorrect

    • A 62-year-old man complains of chest pain and goes to the emergency room. You diagnose him with an acute coronary syndrome and prescribe enoxaparin as part of his treatment plan.

      Enoxaparin inactivates which of the following?

      Your Answer:

      Correct Answer: Thrombin

      Explanation:

      Enoxaparin is a low molecular weight heparin (LMWH) that works in the same way as heparin by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin by forming a 1:1 complex with it. Factor Xa and a few other clotting proteases are also inhibited by the heparin-antithrombin III complex.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 15 - What is the main mechanism of action of cyclizine: ...

    Incorrect

    • What is the main mechanism of action of cyclizine:

      Your Answer:

      Correct Answer: Histamine-H1 antagonist

      Explanation:

      Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 16 - Which of the following is NOT an effect of benzodiazepines: ...

    Incorrect

    • Which of the following is NOT an effect of benzodiazepines:

      Your Answer:

      Correct Answer: Analgesic effect

      Explanation:

      Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists which enhance inhibitory synaptic transmission throughout the central nervous system, with sedative, hypnotic, anxiolytic, anticonvulsant, amnesic and muscle relaxant properties.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 17 - A patient is referred for lung function tests on account of a history...

    Incorrect

    • A patient is referred for lung function tests on account of a history of breathlessness and cough.

      Which statement about lung volumes is correct?

      Your Answer:

      Correct Answer: The tidal volume is the volume of air drawn in and out of the lungs during normal breathing

      Explanation:

      The tidal volume(TV) is the amount of air that moves in and out of the lungs with each respiratory cycle. In a healthy male, the usual volume is 0.5 L (,7 ml/kg body mass).

      The vital capacity(VC) is the maximum amount of air that can be exhaled following maximal inspiration. The usual volume in a healthy male is 4.5 L.

      The residual volume(RV) is the amount of air remaining in the lungs after maximum expiration. The usual volume in a healthy male is 1.0 L.

      The inspiratory reserve volume(IRV) is the maximum amount of air that can be breathed in forcibly after normal inspiration. The usual volume in a healthy male is 3.0 L.

      The expiratory reserve volume(ERV) is the volume of air that can be breathed out forcibly after normal expiration. The usual volume in a healthy male is 1.0 L.

      Total lung capacity(TLC) is the volume of air the lungs can accommodate. TLC = RV+VC. The usual volume in a healthy male is 5.5 L.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
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  • Question 18 - Regarding folate requirements, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding folate requirements, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Dietary folate is found particularly in leafy green vegetables and liver.

      Explanation:

      Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
      Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 19 - Which of these drugs may reduce the efficacy of contraception? ...

    Incorrect

    • Which of these drugs may reduce the efficacy of contraception?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 20 - Epigastric pain and haematemesis present in a 67-year-old man. In the emergency room,...

    Incorrect

    • Epigastric pain and haematemesis present in a 67-year-old man. In the emergency room, he is stabilised and referred to the on-call medical team. He has been scheduled for an endoscopy in the morning due to a suspected peptic ulcer. Before transferring him to the ward, you consider giving him a proton pump inhibitor (PPI).

      Which of the following doses and routes are the best?

      Your Answer:

      Correct Answer: A PPI should not be prescribed

      Explanation:

      PPIs should not be used prior to endoscopic therapy when an early endoscopic examination is performed within 24 hours of admission, according to current recommendations.
      High-dose PPI therapy reduces the risk of rebleeding and surgery after endoscopic treatment of severe peptic ulcer bleeding. Both oral and intravenous PPIs produce similar results, and there is no discernible benefit to using the intravenous formulation in patients who can tolerate oral medication.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
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  • Question 21 - Which of the following pathogens causes tetanus: ...

    Incorrect

    • Which of the following pathogens causes tetanus:

      Your Answer:

      Correct Answer: Clostridium tetani

      Explanation:

      Tetanus is caused by Clostridium tetani, a bacterium. Tetanus can cause mild spasms to severe whole-body contractions, suffocation, and heart attack.

      Gas gangrene and food poisoning are both caused by Clostridium perfringens.

      Pseudomembranous colitis is caused by Clostridium difficile.

      Urinary tract infections, respiratory infections, dermatitis, soft tissue infections, bacteraemia, bone and joint infections, gastrointestinal infections, and a variety of systemic infections are all caused by Pseudomonas aeruginosa.

      Pharyngitis, skin infections, acute rheumatic fever, scarlet fever, poststreptococcal glomerulonephritis, toxic shock–like syndrome, and necrotizing fasciitis can all be caused by Streptococcus pyogenes infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 22 - You review a patient with urinary sepsis and decide to start her...

    Incorrect

    • You review a patient with urinary sepsis and decide to start her on gentamicin.

      Which statement about gentamicin is true?

      Your Answer:

      Correct Answer: Ototoxicity is a dose-related effect

      Explanation:

      Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.

      Gentamicin is given by injection because it is NOT absorbed orally.

      It is excreted in the kidneys by glomerular filtration

      Gentamicin is not to be used for the treatment of Neisseria meningitidis, Neisseria gonorrhoea, or Legionella pneumophila.There is a risk of patient going into shock from lipid A endotoxin release.

      Two of its most notable side effects are hearing loss reversible nephrotoxicity and which are both dose-related and levels should be monitored in patients.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 23 - What is the earliest physiological effect that causes postural hypotension: ...

    Incorrect

    • What is the earliest physiological effect that causes postural hypotension:

      Your Answer:

      Correct Answer: A fall in central venous pressure

      Explanation:

      When autonomic reflexes are impaired or intravascular volume is markedly depleted, a significant reduction in blood pressure occurs upon standing, a phenomenon termed Postural Hypotension (orthostatic hypotension). Orthostatic hypotension can cause dizziness, syncope, and even angina or stroke. When autonomic reflexes are impaired, blood pressure falls progressively after standing because the gravitational pooling of blood in the legs cannot be compensated by sympathetic vasoconstriction.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 24 - A patient suffered from a chest injury while working out in the gym....

    Incorrect

    • A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.

      Which of the following statements regarding the pectoralis minor muscle is considered correct?

      Your Answer:

      Correct Answer: It stabilises the scapula

      Explanation:

      The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.

      Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 25 - The correct statement regarding the parasympathetic nervous system is which of the following?...

    Incorrect

    • The correct statement regarding the parasympathetic nervous system is which of the following?

      Your Answer:

      Correct Answer: Parasympathetic preganglionic neurones run in cranial nerves III, VII, IX and X.

      Explanation:

      The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2 molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 26 - Which statement regarding skeletal muscle is true?
    ...

    Incorrect

    • Which statement regarding skeletal muscle is true?

      Your Answer:

      Correct Answer: Myosin is the major constituent of the thick filament

      Explanation:

      Myosin is the major constituent of the thick filament.

      Actin is the major constituent of the THIN filament.

      Thin filaments consist of actin, tropomyosin and troponin in the ratio 7:1:1.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 27 - A 70-year-old woman presents with exacerbation of her chronic obstructive pulmonary disease (COPD),...

    Incorrect

    • A 70-year-old woman presents with exacerbation of her chronic obstructive pulmonary disease (COPD), increased cough, wheeze and chest tightness. On examination, she is tachypnoeic and oxygen saturation is 86%. You plan to administer supplemental oxygen.

      Which oxygen delivery system is most appropriate to use initially?

      Your Answer:

      Correct Answer: Venturi mask

      Explanation:

      In life-threatening emergencies, oxygen should be started immediately otherwise, it should be prescribed like any other drug. The prescription should include a target saturation range.

      Until blood gases can be measured, initial oxygen should be administered using a controlled concentration of 24% or 28%.
      The ideal mask is a Venturi mask.

      The other mask are not ideal for initial use

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 28 - A 31-year-old man with sickle-cell disease receives a blood transfusion for symptomatic anaemia....

    Incorrect

    • A 31-year-old man with sickle-cell disease receives a blood transfusion for symptomatic anaemia. He presents to the Emergency Department three weeks later with a rash, fever, and diarrhoea. He has pancytopenia and abnormal liver function results on blood tests.

      Which of the transfusion reactions is most likely to have happened?

      Your Answer:

      Correct Answer: Graft-vs-host disease

      Explanation:

      Blood transfusion can be a life-saving treatment with significant clinical benefits, but it also comes with a number of risks and potential complications, including:
      Immunological side effects
      Errors in administration (episodes of ‘wrong blood’)
      Viruses and Infections (bacterial, viral, possibly prion)
      Immunodilution

      A culture of better safety procedures as well as steps to reduce the use of transfusion has emerged as a result of growing awareness of avoidable risk and improved reporting systems. Transfusion errors, on the other hand, continue to occur, and some serious adverse reactions go unreported.

      Transfusion-associated graft-vs-host disease (TA-GVHD) is a rare blood transfusion complication that causes fever, rash, and diarrhoea 1-4 weeks after the transfusion. Pancytopenia and liver function abnormalities are common laboratory findings.

      TA-GVHD, unlike GVHD following allogeneic marrow transplantation, causes profound marrow aplasia with a mortality rate of >90%. Survival is uncommon, with death occurring within 1-3 weeks of the onset of symptoms.

      Because of immunodeficiency, severe immunosuppression, or shared HLA antigens, viable T lymphocytes in blood components are transfused, engraft, and react against the recipient’s tissues, and the recipient is unable to reject the donor lymphocytes.
      The following is a list of the most common transfusion reactions and complications:

      1) Reaction to a febrile transfusion
      The temperature rises by one degree from the baseline. Chills and malaise are also possible symptoms.
      The most common response (1 in 8 transfusions).
      Cytokines from leukocytes in transfused red cell or platelet components are usually to blame.
      Only supportive. The use of paracetamol is beneficial.

      2) Acute haemolytic reaction is a type of haemolytic reaction that occurs when the
      Fever, chills, pain at the transfusion site, nausea, vomiting, and dark urine are all symptoms of a transfusion reaction.
      Early on, many people report a sense of ‘impending doom.’
      The most serious reaction. ABO incompatibility is frequently caused by a clerical error.
      STOP THE TRANSFUSION OF INFORMATION. IV fluids should be given. It’s possible that diuretics will be required.

      3) Haemolytic reaction that is delayed
      It usually happens 4 to 8 days after a blood transfusion.
      Fever, anaemia, jaundice, and haemoglobinuria are all symptoms that the patient has.
      Positive Coombs test for direct antiglobulin.
      Because of the low titre antibody, it is difficult to detect in a cross-match, and it is unable to cause lysis at the time of transfusion.
      The majority of delayed haemolytic reactions are harmless and do not require treatment.
      Anaemia and renal function should be monitored and treated as needed.

      4) Reaction to allergens
      Foreign plasma proteins are usually to blame, but anti-IgA could also be to blame.
      Urticaria, pruritus, and hives are typical allergic reactions. It’s possible that it’s linked to laryngeal oedema or bronchospasm.
      Anaphylaxis is a rare occurrence.
      Antihistamines can be used to treat allergic reactions symptomatically. It is not necessary to stop transfusions.
      If the patient develops anaphylaxis, the transfusion should be stopped and the patient should be given adrenaline and treated according to the ALS protocol.

      5) TRALI (Transfusion Related Acute Lung Injury)
      Within 6 hours of transfusion, there was a sudden onset of non-cardiogenic pulmonary oedema.
      It’s linked to the presence of antibodies to recipient leukocyte antigens in the donor blood.
      The most common cause of death from transfusion reactions is this.
      STOP THE TRANSFUSION OF INFORMATION. Oxygen should be given to the patient. Around 75% of patients will require aggressive respiratory support.
      The use of diuretics should be avoided.

      6) TACO (Transfusion Associated Circulatory Overload)
      Acute or worsening respiratory distress within 6 hours of a large blood transfusion. Fluid overload and pulmonary and peripheral oedema can be seen. Rapid blood pressure rises are common. BNP is usually 1.5 times higher than it was before the transfusion. It is most common in the elderly and those who have chronic anaemia.

      Blood transfusions should be given slowly, over the course of 3-4 hours.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 29 - Which of the following decreases activation of vitamin D: ...

    Incorrect

    • Which of the following decreases activation of vitamin D:

      Your Answer:

      Correct Answer: Chronic renal failure

      Explanation:

      Calcium deficiency (low Ca2+ diet or hypocalcemia) activates 1-alpha-hydroxylase in the cells of the renal proximal tubule which catalyses the conversion of vitamin D to its active form, 1,25-dihydroxycholecalciferol. Increased parathyroid hormone (PTH) and hypophosphatemia also stimulate the enzyme. Chronic renal failure is associated with a constellation of bone diseases, including osteomalacia caused by failure of the diseased renal tissue to produce the active form of vitamin D.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 30 - Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is...

    Incorrect

    • Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is an increase in metabolic rate, the production of vasoactive metabolites increases. These metabolites act locally on the surrounding arterioles, causes vasodilation and an increase blood supply.

      Which of these metabolites is the most potent vasodilator in skeletal muscle?

      Your Answer:

      Correct Answer: K +

      Explanation:

      Hyperaemia is the process where the body adjusts blood flow to meet the metabolic needs of different tissues in health and disease. Vasoactive mediators that take part in this process include K+, adenosine, CO2, H+, phosphates and H2O2. Although the mechanism is not clear, all these mediators likely contribute to some extent at different points.

      Specific organs are more sensitive to specific metabolites:
      K+ and adenosine are the most potent vasodilators in skeletal muscles

      CO2 and K+ are the most potent vasodilators in cerebral circulation.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
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