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  • Question 1 - Regarding haemophilia A, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: Haemophilia A is caused by a deficiency of factor VIII.

      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 2 - A 7-year-old presented to a GP with a history of headache, neck stiffness...

    Incorrect

    • A 7-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent non-blanching rash on legs and arms. The GP administered a dose of antibiotics before transferring child to the Emergency Department.

      Which of these is the most appropriate antibiotic to administer in this scenario from the choices available?

      Your Answer:

      Correct Answer: Give IM benzylpenicillin 600 mg

      Explanation:

      Meningococcal septicaemia should be suspected in a child with a non-blanching rash especially in the presence of:
      An ill-looking child
      Neck stiffness
      Lesions larger than 2 mm in diameter (purpura)
      Capillary refill time of>3 seconds

      The index child is very sick and shows signs of septic shock. In the prehospital setting, a single dose of benzylpenicillin should be given immediately. The correct dose for this childs age is IM benzylpenicillin 600 mg.

      The recommended doses of benzylpenicillin according to age are:
      Infants <1 year of age: IM or IV benzylpenicillin 300 mg
      Children 1 to 9 years of age: IM or IV benzylpenicillin 600mg
      Children and adults 10 years or older: IM or IV benzylpenicillin 1.2g

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 3 - A 79-year-old male had a humeral shaft fracture during a road traffic accident...

    Incorrect

    • A 79-year-old male had a humeral shaft fracture during a road traffic accident and is being followed up in a fracture clinic. He complains of inability to use the limb 6 months after the injury. X-rays of that arm shows non union of his fracture.

      All the following are responsible for this non-union EXCEPT?

      Your Answer:

      Correct Answer: Osteoporosis

      Explanation:

      An imbalance between bone resorption and formation is Osteoporosis. In normal bone, formation and resorption are roughly equal, and the density of bone matrix remains constant but there is more resorption in osteoporosis and the matrix density reduces and bones become weaker. Fractures are more likely to occur but healing is unaffected.

      Non-union of a fracture occurs when the two sides of a fracture fail to unite after 6 months. Causes include: infection, movement at the fracture site, avascular necrosis, tissue interposed between the fracture and gross misalignment.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 4 - Regarding haemoglobin, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: In degradation of haemoglobin, the haem group is split from the haemoglobin and converted to biliverdin and ultimately to bilirubin.

      Explanation:

      Haemoglobin is composed of four polypeptide globin chains each with its own iron containing haem molecule. Haem synthesis occurs largely in the mitochondria by a series of biochemical reactions commencing with the condensation of glycine and succinyl coenzyme A under the action of the key rate-limiting enzyme delta-aminolevulinic acid (ALA) synthase. The globin chains are synthesised by ribosomes in the cytosol. Haemoglobin synthesis only occurs in immature red blood cells.
      There are three types of haemoglobin in normal adult blood: haemoglobin A, A2 and F:
      – Normal adult haemoglobin (HbA) makes up about 96 – 98 % of total adult haemoglobin, and consists of two alpha (α) and two beta (β) globin chains. 
      – Haemoglobin A2 (HbA2), a normal variant of adult haemoglobin, makes up about 1.5 – 3.5 % of total adult haemoglobin and consists of two α and two delta (δ) globin chains.
      – Foetal haemoglobin is the main Hb in the later two-thirds of foetal life and in the newborn until approximately 12 weeks of age. Foetal haemoglobin has a higher affinity for oxygen than adult haemoglobin. 
      Red cells are destroyed by macrophages in the liver and spleen after , 120 days. The haem group is split from the haemoglobin and converted to biliverdin and then bilirubin. The iron is conserved and recycled to plasma via transferrin or stored in macrophages as ferritin and haemosiderin. An increased rate of haemoglobin breakdown results in excess bilirubin and jaundice.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 5 - A patient presents to your clinic with fever of unknown origin. His...

    Incorrect

    • A patient presents to your clinic with fever of unknown origin. His blood results shows a markedly elevated C-Reactive Protein (CRP) level.

      Which of these is responsible for mediating the release of CRP?

      Your Answer:

      Correct Answer: IL-6

      Explanation:

      C-reactive protein (CRP) is an acute phase protein produced by the liver hepatocytes. Its production is regulated by cytokines, particularly interleukin 6 (IL-6) and it can be measured in the serum as a nonspecific marker of inflammation.

      Although a high CRP suggest an acute infection or inflammation, it does not identify the cause or location of infection.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 6 - The only statement that is correct regarding diffusion is which of the following?...

    Incorrect

    • The only statement that is correct regarding diffusion is which of the following?

      Your Answer:

      Correct Answer: The permeability of a membrane is related to the membrane thickness and composition.

      Explanation:

      Passive diffusion is a process that describes the movement down a concentration gradient. This process accounts for movement across small distances like within the cytosol or across membranes. Factors that affect the diffusion of a substance across a membrane are the permeability (p) of the membrane, a difference in concentration across the membrane and the membrane area over which diffusion occurs. The membrane thickness and composition, and the diffusion coefficient of the substance also affects the permeability. Fick’s law describes the rate of diffusion of a substance within a solution, which can be modified to describe the rate of diffusion across a membrane.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 7 - Following the administration of a medication for a heart condition, a 69-year-old man...

    Incorrect

    • Following the administration of a medication for a heart condition, a 69-year-old man develops hypothyroidism.

      Which of the following drugs is most likely to be the cause?

      Your Answer:

      Correct Answer: Amiodarone

      Explanation:

      Amiodarone has a chemical structure that is similar to that of thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, though hypothyroidism is far more common, with 5-10% of patients suffering from it.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 8 - The transport of oxygen from maternal to fetal circulation is made possible by...

    Incorrect

    • The transport of oxygen from maternal to fetal circulation is made possible by fetal haemoglobin. Which of the statements about fetal haemoglobin (HbF) is also correct?

      Your Answer:

      Correct Answer: The oxygen dissociation curve for foetal haemoglobin is shifted to the left of that of adult haemoglobin

      Explanation:

      Fetal haemoglobin is the most common type of haemoglobin found in the foetus during pregnancy. It transports oxygen from the maternal circulation to the fetal circulation. It can easily bind to oxygen from the maternal circulation because it has a high affinity for oxygen. From 10 to 12 weeks of pregnancy to the first six months after birth, the erythroid precursor cells produce fetal haemoglobin. In comparison to adult haemoglobin, fetal haemoglobin has two alpha and two gamma subunits, whereas adult haemoglobin has two alpha and two beta subunits in its major form.

      And, unlike adult haemoglobin, the oxygen dissociation curve of fetal haemoglobin is left-shifted. Myoglobin is an oxygen storage molecule with a very high affinity for oxygen. Only when the partial pressure of oxygen is exceeded does it release oxygen.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
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  • Question 9 - A possible diagnosis of Cushing's illness is being investigated in an overweight patient...

    Incorrect

    • A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.

      Which of the following statements about corticotropin-releasing hormone is correct? 

      Your Answer:

      Correct Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus

      Explanation:

      Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.

      The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.

      Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 10 - A 72-year-old woman presents to your clinic with worsening oedema. She is a...

    Incorrect

    • A 72-year-old woman presents to your clinic with worsening oedema. She is a known case of ischaemic heart disease and heart failure.

      You decide to add a loop diuretic to her current drug regime to control the oedema.

      Of the following, what is a contraindication to using a loop diuretic?

      Your Answer:

      Correct Answer: Anuria

      Explanation:

      Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
      Furosemide
      Bumetanide
      Torsemide
      Ethacrynic Acid

      Loop diuretics inhibit the Na-K-Cl pump in the ascending loop of Henle, resulting in salt-water excretion. This relieves congestion and reduces oedema.

      The contra-indications to the use of loop diuretics are:
      1. Anuria
      2. Comatose and precomatose states associated with liver cirrhosis
      3. Renal failure due to nephrotoxic or hepatotoxic drugs
      4. Severe hypokalaemia
      5. Severe hyponatremia
      6. History of hypersensitivity to furosemide, bumetanide, or torsemide (or sulphonamides)

      The following conditions or states are not contraindications, but loop diuretics needs to be used cautiously in these conditions:
      1. Diabetes (but hyperglycaemia less likely than with thiazides)
      2. Gout
      3. Hypotension (correct before initiation of treatment)
      4. Hypovolaemia (Correct before initiation of treatment)

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 11 - A 35 year old patient presents to ED having sustained an injury to...

    Incorrect

    • A 35 year old patient presents to ED having sustained an injury to her right hand whilst playing cricket. She is unable to fully straighten her right middle finger as the distal phalanx remains flexed. A picture of her hand is shown below. Which of the following structures within the digit was most likely injured:





      By Howcheng (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0), via Wikimedia Commons

      Your Answer:

      Correct Answer: Insertion of terminal extensor digitorum tendon

      Explanation:

      Damage to the insertion of the terminal extensor digitorum tendon would result in loss of extension at the distal interphalangeal joint causing a fixed flexion deformity, called the Mallet deformity.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 12 - Which of the following is true regarding respiration? ...

    Incorrect

    • Which of the following is true regarding respiration?

      Your Answer:

      Correct Answer: The diaphragm is responsible for abdominal breathing

      Explanation:

      The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.

      Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.

      In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.

      Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 13 - Which of the following ABO blood groups is the universal recipient: ...

    Incorrect

    • Which of the following ABO blood groups is the universal recipient:

      Your Answer:

      Correct Answer: AB

      Explanation:

      Blood group AB has both A and B antigens but no antibodies and thus is the universal recipient.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 14 - Which of the following microbes attaches to host cells by its haemagglutinin antigen:...

    Incorrect

    • Which of the following microbes attaches to host cells by its haemagglutinin antigen:

      Your Answer:

      Correct Answer: Influenza virus

      Explanation:

      Hemagglutinin (HA) or Haemagglutinin (BE) is an antigenic glycoprotein found on the surface of the influenza viruses. It is responsible for binding the virus to the cell that is being infected. The name hemagglutinin comes from the protein’s ability to cause red blood cells (erythrocytes) to clump together (agglutinate) in vitro.

    • This question is part of the following fields:

      • Microbiology
      • Principles
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  • Question 15 - A 65-year-old female presents to the Emergency Department with complaints of chest pain...

    Incorrect

    • A 65-year-old female presents to the Emergency Department with complaints of chest pain pointing to angina. A dose of glyceryl trinitrate (GTN) was administered, rapidly resolving her symptoms. Unfortunately, she develops a side-effect of the drug.

      Which one of the following is the side effect she is most likely to have developed?

      Your Answer:

      Correct Answer: Flushing

      Explanation:

      Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.

      Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
      1. Glyceryl trinitrate
      2. Isosorbide dinitrate

      Side effects to nitrate therapy are common especially
      The most common side effects are:
      1. Headaches
      2. Feeling dizzy, weak, or tired
      3. Nausea
      4. Flushing

      The serious but less likely to occur side effects are:
      1. Methemoglobinemia (rare)
      2. Syncope
      3. Prolonged bleeding time
      4. Exfoliative dermatitis
      5. Unstable angina
      6. Rebound hypertension
      7. Thrombocytopenia

      Dry eyes, bradycardia, and metabolic acidosis have not been reported.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 16 - A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler...

    Incorrect

    • A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.

      Which of these statements describes the mechanism of action of corticosteroids in asthma?

      Your Answer:

      Correct Answer: Reduction of bronchial inflammation

      Explanation:

      Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.
      They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.
      Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 17 - Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:...

    Incorrect

    • Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:

      Your Answer:

      Correct Answer: Ca 2+ release from sarcoplasmic reticulum

      Explanation:

      Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). APs travel down invaginations of the sarcolemma called T-tubules, which are close to, but do not touch, the terminal cisternae of the SR. During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. The amount of Ca2+released is dependent on how much is stored, and on the size of the initial Ca2+influx during the AP.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 18 - A 69-year-old man with a history of chronic anaemia is transfused. He takes...

    Incorrect

    • A 69-year-old man with a history of chronic anaemia is transfused. He takes bisoprolol and furosemide for his cardiac failure, and his most recent BNP was 123 pmol/l. He developed shortness of breath and his pre-existing peripheral oedema became worse 5 hours after transfusion was commenced. His BP rises to 170/105 mmHg and a repeat measurement of his BNP is 192 pmol/l.

      What is the most likely transfusion reaction to have occurred?

      Your Answer:

      Correct Answer: TACO

      Explanation:

      Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Typical clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.

      Febrile transfusion reaction presents with a 1 degree rise in temperature from baseline during transfusion. Patient may have chills and malaise. It is the most common transfusion reaction (1 in 8 transfusions) and is usually caused by cytokines released from leukocytes in transfused red cell or platelet components.

      TRALI (Transfusion Related Acute Lung Injury) is a clinical syndrome with abrupt onset of non-cardiogenic pulmonary oedema within 6 hours of transfusion not explained by another risk factor. Associated with the presence of antibodies in the donor blood to recipient leukocyte antigens. patients present with dyspnoea, hypertension, hypotension, acute leukopenia.

      Graft versus host disease(GVHD) is an immune mediated condition that arises from a complex interaction between donor and recipients adaptive immunity. It presents as dermatitis, hepatitis and enteritis developing within 100 days after stem cell or bone marrow transplant.

      Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 19 - Cryptococcus neoformans is primarily implicated in which of the following conditions: ...

    Incorrect

    • Cryptococcus neoformans is primarily implicated in which of the following conditions:

      Your Answer:

      Correct Answer: Chronic lymphocytic meningitis

      Explanation:

      Cryptococcus neoformans typically causes a chronic lymphocytic meningitis in immunosuppressed patients or those with intense exposure e.g. pigeon fanciers.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 20 - The most common cause of anaemia worldwide is which of the following? ...

    Incorrect

    • The most common cause of anaemia worldwide is which of the following?

      Your Answer:

      Correct Answer: Iron deficiency anaemia

      Explanation:

      The most common cause of microcytic anaemia and of any anaemia worldwide is iron deficiency anaemia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 21 - Which of the following is a contraindication for aspirin? ...

    Incorrect

    • Which of the following is a contraindication for aspirin?

      Your Answer:

      Correct Answer: Children under 16 years

      Explanation:

      Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.
      There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 22 - A 30-year old male is brought to the emergency room after a terrible...

    Incorrect

    • A 30-year old male is brought to the emergency room after a terrible fall during a photoshoot. The patient reported falling on his right forearm. There is evident swelling and tenderness on the affected area, with notable weakness of the flexor pollicis longus muscle. Radiographic imaging showed a fracture on the midshaft of the right radius.

      Which of the following nerves is most likely injured in the case above?

      Your Answer:

      Correct Answer: The anterior interosseous nerve

      Explanation:

      Flexor pollicis longus receives nervous supply from the anterior interosseous branch of median nerve, derived from spinal roots C7 and C8.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 23 - Following a bee sting, a 12-year old boy was transported to resus with...

    Incorrect

    • Following a bee sting, a 12-year old boy was transported to resus with symptoms and signs of an anaphylactic reaction. You decide to administer adrenaline IM stat.

      What is the recommended dose of intramuscular adrenaline?

      Your Answer:

      Correct Answer: 0.3 mL of 1:1000

      Explanation:

      Anaphylaxis is a type I hypersensitivity reaction that is severe and life-threatening. It is marked by the fast onset of life-threatening airway and/or circulatory issues, which are generally accompanied by skin and mucosal abnormalities. When an antigen attaches to specific IgE immunoglobulins on mast cells, degranulation and the release of inflammatory mediators takes place (e.g. histamine, prostaglandins, and leukotrienes).

      The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.

      In anaphylaxis, age-related dosages of IM adrenaline are:
      150 mcg (0.15 mL of 1:1000) for a child under 6 years
      300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years
      500 mcg (0.5 mL of 1:1000) for children aged 12 and above
      500 mcg for adults (0.5 mL of 1:1000)

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 24 - You are attending to a patient that has presented with a severe headache...

    Incorrect

    • You are attending to a patient that has presented with a severe headache in the Emergency Department. The patient has signs of cerebral oedema and raised intracranial pressure.

      You discuss the case with the on-call neurology registrar and decide to prescribe Mannitol. The nurse assisting you asks you to reconsider this management plan as she suspects the patient has a contraindication to Mannitol.

      Out of the following, what is a contraindication to mannitol?

      Your Answer:

      Correct Answer: Severe cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.

      Mannitol has several contraindications and some of them are listed below:
      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 25 - A 70-year-old patient is diagnosed with Cushing's disease. She has a history of...

    Incorrect

    • A 70-year-old patient is diagnosed with Cushing's disease. She has a history of weight gain, hypertension, and easy bruising.

      In this patient, which of the following is the MOST LIKELY UNDERLYING CAUSE?

      Your Answer:

      Correct Answer: Pituitary adenoma

      Explanation:

      Cushing’s syndrome is a collection of symptoms and signs caused by prolonged exposure to elevated levels of either endogenous or exogenous glucocorticoids.

      The most common cause of Cushing’s syndrome is the iatrogenic administration of corticosteroids. The second most common cause of Cushing’s syndrome is Cushing’s disease.

      Cushing’s disease should be distinguished from Cushing’s syndrome and refers to one specific cause of the syndrome, an adenoma of the pituitary gland that secretes large amounts of ACTH and, in turn, elevates cortisol levels. This patient has a diagnosis of Cushing’s disease, and this is, therefore, the underlying cause in this case.

      The endogenous causes of Cushing’s syndrome include:
      Pituitary adenoma (Cushing’s disease)
      Ectopic corticotropin syndrome, e.g. small cell carcinoma of the lung
      Adrenal hyperplasia
      Adrenal adenoma
      Adrenal carcinoma

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 26 - Which of the following microbes is spread by a vector: ...

    Incorrect

    • Which of the following microbes is spread by a vector:

      Your Answer:

      Correct Answer: Plasmodium falciparum

      Explanation:

      The female Anopheles mosquito is the vector for Plasmodium falciparum transmission. Treponema pallidum is transmitted through sexual transmission or direct skin contact. Clostridium perfringens is spread by direct skin contact or through oral-faecal route. The oral-faecal pathway is how Vibrio cholerae spreads. Mycoplasma tuberculosis is spread via the airborne route.

    • This question is part of the following fields:

      • Microbiology
      • Principles
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  • Question 27 - Na+ is reabsorbed via the Na+/K+/2Cl-symporter in which part of the loop of...

    Incorrect

    • Na+ is reabsorbed via the Na+/K+/2Cl-symporter in which part of the loop of Henle?

      Your Answer:

      Correct Answer: Thick ascending limb

      Explanation:

      In the thick ascending limb is the part of the loop of Henle in which there is active reabsorption of Na+and Cl- ions from the tubular fluid. This occurs via the Na+/K+/2Cl-symporter on the apical membrane.
      This mechanism is by:
      1. Na+ions are transported across the basolateral membrane by Na+pumps and the Cl-ions by diffusion.
      2. K+leaks back into the tubular fluid via apical ROMK K+channels which creates a positive charge.
      3. This positive charge drives the reabsorption of cations (Na+, K+, Ca2+, Mg2+) through paracellular pathways.
      4. Due to the thick ascending limb being impermeable to water, the tubular fluid osmolality is reduced by ion reabsorption, the interstitial fluid osmolality is increased, and an osmotic difference is created.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 28 - A 23-year-old male presents to his family physician with the complaint of repeated...

    Incorrect

    • A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia.

      Which one of the following disorders is this patient most likely to have?

      Your Answer:

      Correct Answer: Paroxysmal nocturnal haemoglobinuria

      Explanation:

      Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight.

      Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.

      Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections.

      Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections.

      Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 29 - A 27-year-old man has been diagnosed with testicular cancer and has spread to...

    Incorrect

    • A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes.

      The lymph from the testes will drain to which of the following nodes?

      Your Answer:

      Correct Answer: Para-aortic lymph nodes

      Explanation:

      Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.

      The scrotum is the one which drains into the nearby superficial inguinal nodes.

      The glans penis and clitoris drains into the deep inguinal lymph nodes.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
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  • Question 30 - A 54-year-old man with a long history of poorly controlled hypertension complains of...

    Incorrect

    • A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.

      Which of the following is the patient's preferred drug treatment?

      Your Answer:

      Correct Answer: 25% of the mean arterial pressure over the first hour

      Explanation:

      End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.

      Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.

      Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.

      The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.
      An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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