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  • Question 1 - Regarding airway resistance, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding airway resistance, which of the following statements is INCORRECT:

      Your Answer: Airway resistance is primarily determined by the airway radius according to Poiseuille's law.

      Correct Answer: In the lower respiratory tract, airway resistance is mostly determined by the smallest bronchioles.

      Explanation:

      Airway resistance is primarily determined by the airway radius according to Poiseuille’s law, and whether the flow is laminar or turbulent. The major site of airway resistance is the medium-sized bronchi. The smallest airways would seem to offer the highest resistance, but they do not because of their branching parallel arrangement.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      3
      Seconds

  • Question 2 - A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain,...

    Incorrect

    • A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain, and breathlessness. A bedside echocardiogram was performed and revealed a large pericardial effusion. Due to this finding, a pericardiocentesis was to be performed.

      Which of the following statements is considered true regarding pericardiocentesis?

      Your Answer:

      Correct Answer: The needle should be aimed at the midpoint of the left clavicle

      Explanation:

      Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.

      In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle.

      The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 3 - A patients had a left Colles' fracture, which you were able to repair. It...

    Incorrect

    • A patients had a left Colles' fracture, which you were able to repair. It was their second fragility fracture this year, and you'd like to provide them some tips on how to keep their bones healthy.

      What percentage of the calcium in the body is kept in the bones? 
      Only ONE response is acceptable.

      Your Answer:

      Correct Answer: 99%

      Explanation:

      Calcium is stored in bones for nearly all of the body’s calcium, but it is also found in some cells (most notably muscle cells) and the blood. The average adult diet comprises roughly 25 mmol of calcium per day, of which the body absorbs only about 5 mmol.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      0
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  • Question 4 - Which patient group are most commonly associated with infection with Klebsiella spp: ...

    Incorrect

    • Which patient group are most commonly associated with infection with Klebsiella spp:

      Your Answer:

      Correct Answer: Hospitalised patients

      Explanation:

      Klebsiella spp. are facultatively anaerobic Gram-negative rods, found in the normal intestinal and respiratory flora. These organisms are usually opportunistic pathogens that cause nosocomial infections, most commonly pneumonia and UTI.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 5 - For the treatment of his atrial fibrillation, a 67-year-old man is about to...

    Incorrect

    • For the treatment of his atrial fibrillation, a 67-year-old man is about to begin taking warfarin. He also takes a number of other medications.

      Which of the following medications will prevent warfarin from working?

      Your Answer:

      Correct Answer: Phenytoin

      Explanation:

      Many medications, including warfarin, require cytochrome P450 enzymes for their metabolism. When co-prescribing cytochrome p450 enzyme inducers and inhibitors with warfarin, it’s critical to be cautious.

      Inhibitors of the cytochrome p450 enzyme inhibit the effects of warfarin, resulting in a lower INR. To remember the most commonly encountered cytochrome p450 enzyme inducers, use the mnemonic PC BRASS:

      P– Phenytoin
      C– Carbamazepine
      B– Barbiturates
      R– Rifampicin
      A– Alcohol (chronic ingestion)
      S– Sulphonylureas
      S– Smoking

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 6 - A 24-year-old man goes to the emergency department with a fever, headache, and...

    Incorrect

    • A 24-year-old man goes to the emergency department with a fever, headache, and swollen parotid glands that are excruciating. You have a suspicion that it is mumps. Which of the following nerves is causing the discomfort the patient is experiencing:

      Your Answer:

      Correct Answer: Auriculotemporal nerve

      Explanation:

      The auriculotemporal nerve is irritated by mumps, which results in significant discomfort due to inflammation and swelling of the parotid gland, as well as the stretching of its capsule. Compression caused by swallowing or chewing exacerbates pain.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 7 - Bordetella pertussis causes which of the following infectious diseases: ...

    Incorrect

    • Bordetella pertussis causes which of the following infectious diseases:

      Your Answer:

      Correct Answer: Whooping cough

      Explanation:

      Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
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  • Question 8 - A 27 year old woman presents to ED having sustained a deep laceration...

    Incorrect

    • A 27 year old woman presents to ED having sustained a deep laceration to the dorsum of her ring finger whilst cooking. Her proximal interphalangeal joint is fixed in flexion and the distal interphalangeal joint is hyperextended. Which of the following structures in the digit has most likely been injured:

      Your Answer:

      Correct Answer: Insertion of the central slip of the extensor tendon

      Explanation:

      Damage to the central slip of the extensor digitorum tendon would result in loss of extension at the proximal interphalangeal joint resulting in a fixed flexion deformity of this joint, and hyperextension of the distal interphalangeal joint due to a loss of balancing forces. This is called the Boutonniere deformity.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 9 - A 7-year-old girl is admitted to the hospital with a persistently high temperature....

    Incorrect

    • A 7-year-old girl is admitted to the hospital with a persistently high temperature. To help her reduce her fever, you decide to give her paracetamol and ibuprofen.

      What are the effects of paracetamol and ibuprofen on fever?

      Your Answer:

      Correct Answer: Reduction in prostaglandin synthesis

      Explanation:

      Interleukin-1, which is released by leukocytes and acts on the thermoregulatory centre of the hypothalamus, causes fever. Because prostaglandins mediate this process, antipyretics such as NSAIDs, paracetamol, and aspirin reduce prostaglandin levels by inhibiting cyclooxygenase enzymes. Malignant disease secretes interleukins, which cause the B-symptoms seen in lymphoma, for example. Bacterial toxins can also cause interleukins to be produced.

      Pyrexia of unknown origin (PUO) is defined as a fever of greater than 38.3 degrees Celsius that lasts for more than 2-3 weeks with no clear diagnosis despite extensive investigation.

      Investigation necessitates a thorough understanding of the conditions that can cause febrile illness, which may be missed during an initial investigation, as well as a thorough history, examination, and investigation centred on that list.

      Pyrexia of unknown origin has a wide differential diagnosis, which includes:
      Infection
      Bacterial
      Pyogenic abscess
      Tuberculosis
      Infective endocarditis
      Brucellosis
      Lyme disease
      Viral
      HIV
      Epstein Barr Virus
      Cytomegalovirus
      Parasite
      Toxoplasmosis
      Malignancy
      Leukaemia
      Lymphoma
      Renal cell carcinoma
      Hepatocellular carcinoma
      Vasculitides
      Still’s disease
      Granulomatosis with polyangiitis (formerly Wegener’s)
      Systemic lupus erythematosus
      Giant cell arteritis
      Rheumatoid arthritis
      Polymyalgia rheumatica
      Miscellaneous
      Drug induced fevers
      Familial Mediterranean fever
      Thyrotoxicosis
      Inflammatory bowel disease
      Sarcoidosis
      Factitious fever
      Exaggerated normal circadian fluctuation

      The patient might need to be admitted to the hospital for observation and further investigation. Because infection is still a possibility, blood cultures should be repeated on a regular basis, and inflammatory markers should be closely monitored. CT, PET, and MRI imaging have largely replaced diagnostic laparotomy as a diagnostic tool.

    • This question is part of the following fields:

      • Pathology
      • Pathology Of Infections
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  • Question 10 - A 66-year-old female with a history of stroke one year ago presents to...

    Incorrect

    • A 66-year-old female with a history of stroke one year ago presents to the Family Medicine clinic complaining of fatigue, weight loss, and tongue discolouration. On examination, she seems malnourished, her tongue is beefy red, and an ataxic gait pattern is noticed.

      Which ONE of the following conditions does this patient most likely have?

      Your Answer:

      Correct Answer: Vitamin B12 deficiency

      Explanation:

      A history of stroke and poor nutritional status points towards a nutritional deficiency as the most likely cause of her symptoms. The examination would differentiate between Vitamin B12 and Folic acid deficiency as in the former. The patient has a beefy red tongue and symptoms indicating peripheral nervous system involvement or subacute combined spinal cord degeneration. The patient may also have a lemon-yellow skin colour, loss of proprioception and vibratory sense and oral ulceration.

      Investigations in B12 deficiency can reveal the following:
      1. Macrocytic anaemia
      2. Neutropoenia
      3. Thrombocytopaenia
      4. Blood film: anisocytosis, poikilocytosis
      5. Low serum B12
      6. Raised serum bilirubin (haemolysis)
      7. Intrinsic factor antibodies
      8. Positive Schilling test

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 11 - Regarding hypertensive crises, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hypertensive crises, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: In a hypertensive emergency, blood pressure should be reduced by 20 - 25% within 2 hours.

      Explanation:

      A hypertensive emergency is defined as severe hypertension (blood pressure ≥ 180/110 mmHg) with acute damage to the target organs. Prompt treatment with intravenous antihypertensive therapy is generally required; over the first few minutes or within 2 hours, blood pressure should be reduced by 20 – 25%. Severe hypertension without acute target organ damage is defined as hypertensive urgency.; blood pressure should be reduced gradually over 24 – 48 hours with oral antihypertensive therapy. If blood pressure is reduced too quickly in the management of hypertensive crises, there is a risk of reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, and myocardial ischaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 12 - All of the following statements are considered true regarding likelihood ratios, except: ...

    Incorrect

    • All of the following statements are considered true regarding likelihood ratios, except:

      Your Answer:

      Correct Answer: A likelihood ratio less than 1 indicates that the result is associated with the presence of the disease

      Explanation:

      The Likelihood Ratio (LR) is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.

      The LR is used to assess how good a diagnostic test is and to help in selecting an appropriate diagnostic tests or sequence of tests. They have advantages over sensitivity and specificity because they are less likely to change with the prevalence of the disorder, they can be calculated for several levels of the symptom/sign or test, they can be used to combine the results of multiple diagnostic test and they can be used to calculate post-test probability for a target disorder.

      A LR greater than 1 produces a post-test probability which is higher than the pre-test probability. An LR less than 1 produces a post-test probability which is lower than the pre-test probability. When the pre-test probability lies between 30 and 70 per cent, test results with a very high LR (say, above 10) rule in disease. An LR below 1 produces a post-test probability les than the pre-test probability. A very low LR (say, below 0.1) virtually rules out the chance that the patient has the disease.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 13 - The most common complication of paracetamol overdose is: ...

    Incorrect

    • The most common complication of paracetamol overdose is:

      Your Answer:

      Correct Answer: Hepatic failure

      Explanation:

      The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 14 - An analytical cohort study aimed to determine a relationship between intake of dietary...

    Incorrect

    • An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:

      No. of post-menopausal women who took Calcium: 500
      No. of post-menopausal women who took Calcium and suffered a hip fracture: 10

      No. of post-menopausal women who took placebo: 500
      No. of post-menopausal women who took placebo and suffered a hip fracture: 25

      Compute for the risk ratio of a hip fracture.

      Your Answer:

      Correct Answer: 0.4

      Explanation:

      Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.

      RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).

      RR = ART/ARC
      RR = (10/500) / (25/500)
      RR = 0.4

      Recall that:

      If RR < 1, then the intervention reduces the risk of the outcome.
      If RR = 1, then the treatment has no effect on the outcome.
      If RR > 1, then the intervention increases the risk of the outcome.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 15 - Which of the following is NOT a typical side effect of opioid analgesics:...

    Incorrect

    • Which of the following is NOT a typical side effect of opioid analgesics:

      Your Answer:

      Correct Answer: Diarrhoea

      Explanation:

      All opioids have the potential to cause:
      Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
      Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
      Cardiovascular effects – Peripheral vasodilation, postural hypotension
      Dependence and tolerance

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 16 - Mannitol is primarily indicated for which of the following: ...

    Incorrect

    • Mannitol is primarily indicated for which of the following:

      Your Answer:

      Correct Answer: Cerebral oedema

      Explanation:

      Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. Mannitol is a low molecular weight compound and is, therefore, freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain-barrier (BBB).

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 17 - Which of the following is the most abundant immunoglobulin in plasma: ...

    Incorrect

    • Which of the following is the most abundant immunoglobulin in plasma:

      Your Answer:

      Correct Answer: IgG

      Explanation:

      IgA is the major Ig in secretions, particularly from the gastrointestinal tract (but also in saliva, tears, sweat and breast milk).
      IgE is important for mast cell degranulation in allergic and antiparasitic response. In the allergic response, the plasma cell produces IgE-antibodies, which, like antibodies of other immunoglobulin isotypes, are capable of binding a specific allergen via its Fab portion.
      IgG is the most abundant in plasma (comprising 80% of normal serum immunoglobulin) and the main circulatory Ig for the secondary immune response.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 18 - A 4-year-old girl is rushed to the Emergency Department by her grandparents after...

    Incorrect

    • A 4-year-old girl is rushed to the Emergency Department by her grandparents after swallowing some of her grandfather's Warfarin tablets. On further questioning, it turns out that she took 5 of his 3 mg tablets which he needs to take due to a history of atrial fibrillation. The child appears healthy well-oriented in time, place and person, and has normal vitals.

      What is the threshold dose of Warfarin that needs to be ingested for there to be a risk of anticoagulation?

      Your Answer:

      Correct Answer: 0.5 mg/kg

      Explanation:

      The clinical effects of Warfarin occur after a dose of greater than 0.5 mg/kg, and they will be observable 8-10 hours after consumption of the drug. The antidote used for Warfarin is Vitamin K.

      1. In low-risk cases with no apparent bleeding:
      an oral dose of 10 mg vitamin K

      2. If there is clinically significant bleeding
      an intravenous dose of 250-300 mcg/kg

      Activated charcoal:
      in cases of warfarin ingestion
      binds to it and reduces the absorption of warfarin
      the ingestion must have occurred within the last hour
      There is, however, rarely a need for the use of activated charcoal because vitamin K is such as safe and effective antidote.

      Clotting studies, including an INR, can be performed, but small children who have ingested warfarin do not require INRs or follow up if they have been treated with 10 mg vitamin K. This dose of vitamin will completely reverse the anticoagulative effects of warfarin.

      Perform INR if any of the following are present:
      1. Delayed presentation (>6 hours)
      2. Patients with symptoms or signs of anticoagulation
      3. Possible massive ingestion

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 19 - Which of the following is NOT mainly characterised by intravascular haemolysis: ...

    Incorrect

    • Which of the following is NOT mainly characterised by intravascular haemolysis:

      Your Answer:

      Correct Answer: Beta-Thalassaemia

      Explanation:

      Causes of intravascular haemolysis:
      Haemolytic transfusion reactions
      G6PD deficiency
      Red cell fragmentation syndromes
      Some severe autoimmune haemolytic anaemias
      Some drug-and infection-induced haemolytic anaemias
      Paroxysmal nocturnal haemoglobinuria

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 20 - Amoxicillin is used first line for all of the following infections EXCEPT for:...

    Incorrect

    • Amoxicillin is used first line for all of the following infections EXCEPT for:

      Your Answer:

      Correct Answer: Cellulitis

      Explanation:

      Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI). Flucloxacillin is used first line for acute cellulitis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 21 - Which of the following statements about lithium treatment is FALSE: ...

    Incorrect

    • Which of the following statements about lithium treatment is FALSE:

      Your Answer:

      Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.

      Explanation:

      Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.
      Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 22 - Which of the following statements is considered correct regarding Klebsiella infections? ...

    Incorrect

    • Which of the following statements is considered correct regarding Klebsiella infections?

      Your Answer:

      Correct Answer: Klebsiella spp. are non-motile

      Explanation:

      Klebsiella is a Gram-negative, rod-shaped, non-motile bacteria. The absence of motility distinguishes Klebsiella spp. from most other members of the family Enterobacteriaceae.

      K. pneumoniae is the most commonly isolated species and has the distinct feature of possessing a large polysaccharide capsule. The capsule offers the organism protection against phagocytosis and antimicrobial absorption,
      contributing to its virulence.

      Colonization of gram-negative bacilli in the respiratory tracts of hospitalized patients, particularly by K. pneumoniae, increases with the length of hospital stay. It is a frequent cause of lower respiratory tract infections among hospitalized patients and in immunocompromised hosts such as newborns,
      elderly patients, and seriously ill patients on respirators.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 23 - Regarding antihistamines, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Elderly patients and children are more susceptible to side effects.

      Explanation:

      Elderly patients and children are more susceptible to side effects. Antihistamines are competitive inhibitors at the H1-receptor. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent. Antihistamines are used as a second line adjunct to adrenaline in anaphylaxis.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 24 - You've been summoned to your Emergency Department resuscitation area to see a patient....

    Incorrect

    • You've been summoned to your Emergency Department resuscitation area to see a patient. You consider giving him an atropine shot because he is severely bradycardic.

      Which of the following statements about the use of atropine is correct?

      Your Answer:

      Correct Answer: It blocks the effects of the vagus nerve on both the SA and AV nodes

      Explanation:

      At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.

      At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.

      The most common cause of asystole during cardiac arrest is primary myocardial pathology, not excessive vagal tone, and there is no evidence that atropine is helpful in the treatment of asystole or PEA. As a result, it is no longer included in the ALS algorithm’s non-shockable section. Atropine is most commonly used in the peri-arrest period. It is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.

      If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of 500 mcg IV:
      Shock
      Syncope
      Myocardial ischaemia
      Heart failure

      Atropine is also used for the following purposes:
      Topically as a cycloplegic and mydriatic to the eyes
      To cut down on secretions (e.g. in anaesthesia)
      Organophosphate poisoning is treated with
      Atropine’s side effects are dose-dependent and include:
      Mouth is parched
      Vomiting and nausea
      Vision is hazy
      Retention of urine
      Tachyarrhythmias
      It can also cause severe confusion and hallucinations in patients, especially the elderly.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 25 - Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed...

    Incorrect

    • Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed with psittacosis based on his symptoms and history of being a pigeon enthusiast. Which of the following is the causative bacteria of psittacosis?

      Your Answer:

      Correct Answer: Chlamydia psittaci

      Explanation:

      Chlamydia psittaci is a microorganism that is commonly found in birds.

      These bacteria can infect people and cause psittacosis. Psittacosis is an infectious disease that may cause high fever and pneumonia associated with headaches, altered mental state, and hepatosplenomegaly.

    • This question is part of the following fields:

      • Infections
      • Microbiology
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  • Question 26 - Bordetella pertussis is spread via which of the following routes: ...

    Incorrect

    • Bordetella pertussis is spread via which of the following routes:

      Your Answer:

      Correct Answer: Respiratory droplet route

      Explanation:

      Bordetella pertussis is a Gram negative coccobacillus that causes whooping cough. B. pertussis is spread via the respiratory droplet route and expresses fimbriae that aid their adhesion to the ciliated epithelium of the upper respiratory tract, and produce a number of exotoxins, causing the characteristic thickened bronchial secretions, paralysis of cilia and lymphocytosis.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 27 - A 61-year-old woman returns to get the results of recent blood tests she...

    Incorrect

    • A 61-year-old woman returns to get the results of recent blood tests she had done for non-specific malaise, lethargy, and weight loss.

      The only abnormality discovered during the blood tests was a 580 x 10 9 /l increase in platelets. Her platelets were also elevated on a blood test taken 6 months earlier, according to her previous results. You're aware of the recent emergence of elevated platelet levels as a cancer risk marker and decide to look into it.

      Which of the following cancers is most likely to cause isolated thrombocytosis?

      Your Answer:

      Correct Answer: Colorectal cancer

      Explanation:

      Raised platelet levels have emerged as a cancer risk marker, according to a large population-based study published in 2017(link is external). According to the study, 12 percent of men and 6% of women with thrombocytosis were diagnosed with cancer within a year. These figures increased to 18% in men and 10% in women if a second platelet count was taken within 6 months of the first and showed an increased or stable elevated platelet count.

      The researchers discovered that thrombocytosis linked to cancer is most common in colorectal and lung cancers, and it is linked to a worse prognosis. Furthermore, one-third of the cancer patients in the study had no other symptoms that would have prompted an immediate cancer referral.

      The exact mechanism by which these cancers cause thrombocytosis is unknown, but one theory proposes the existence of pathogenic feedback loops between malignant cells and platelets, with a reciprocal interaction between tumour growth and metastasis, as well as thrombocytosis and platelet activation. Another hypothesis is that thrombocytosis occurs independently of cancer but aids in its spread and progression.

      The findings show that routinely testing for thrombocytosis could cut the time it takes to diagnose colorectal and lung cancer by at least two months. In the UK, this could result in around 5500 earlier cancer diagnoses per year.

      Because the positive predictive value of thrombocytosis in middle age for cancer (10%) is higher than the positive predictive value for a woman in her 50s presenting with a new breast lump (8.5%), this is clearly an important research paper that should be used to adjust future clinical practise. The current NICE guidelines predate these new research findings, so we’ll have to wait and see how they affect cancer referral guidelines in the UK.

      Because there are so many possible cancers associated with thrombocytosis, the treating clinician should take a thorough history and perform a thorough clinical examination if a patient is diagnosed with it. Further investigation and the most appropriate referral route should be aided by this information.

      It’s worth noting that the patients in the study had their blood tests done for a medical reason rather than as a random screening test.

      If there are no other symptoms to guide investigation and referral (one-third of the patients in the study had no other symptoms), keep in mind that the two most common cancers encountered were colorectal and lung cancer, so a chest X-ray and a faecal immunochemical test (FIT) for faecal blood may be reasonable initial investigations.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 28 - An ambulance transports a 23-year-old woman who has taken a witnessed overdose of...

    Incorrect

    • An ambulance transports a 23-year-old woman who has taken a witnessed overdose of her mother's diazepam tablets. She has no significant medical history and does not take any medications on a regular basis.

      In this case, what is the SINGLE MOST APPROPRIATE FIRST DRUG TREATMENT?

      Your Answer:

      Correct Answer: Flumazenil IV 200 μg

      Explanation:

      Flumazenil is a benzodiazepine antagonist that can be helpful in some overdose situations. It works quickly (in less than a minute), but the effects are fleeting, lasting less than an hour. The dose is 200 micrograms every 1-2 minutes with a maximum dose of 3 milligrams per hour.

      Flumazenil should be avoided by patients who are addicted to benzodiazepines or who take tricyclic antidepressants because it can cause withdrawal symptoms. It can cause seizures or cardiac arrest in these situations.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 29 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Incorrect

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer:

      Correct Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.

      For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 30 - In ventricular myocytes, the plateau phase of the action potential comes about through which...

    Incorrect

    • In ventricular myocytes, the plateau phase of the action potential comes about through which of the following:

      Your Answer:

      Correct Answer: Opening of voltage-gated Ca 2+ channels

      Explanation:

      After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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