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  • Question 1 - 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: Retro-aortic lymph nodes

      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
      3
      Seconds

  • Question 2 - An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with...

    Incorrect

    • An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with left-sided hemiplegia of the face, tongue, and limbs and right-sided deficits in motor eye activity. A CT scan was ordered and showed a right-sided stroke.

      Branches of which of the following arteries are most likely implicated in the case?

      Your Answer:

      Correct Answer: Basilar artery

      Explanation:

      Weber syndrome is a midbrain stroke characterized by crossed hemiplegia along with oculomotor nerve deficits and it occurs with the occlusion of the median and/or paramedian perforating branches of the basilar artery.

      Typical clinical findings include ipsilateral CN III palsy, ptosis, and mydriasis (such as damage to parasympathetic fibres of CN III) with contralateral hemiplegia.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 3 - One of your patients has been infected by an obligate pathogen and presents...

    Incorrect

    • One of your patients has been infected by an obligate pathogen and presents with features of this condition.

      Which of these is an example of an obligate pathogen?

      Your Answer:

      Correct Answer: Trepenoma pallidum

      Explanation:

      Treponema pallidum is an obligate pathogen. Obligate pathogens are almost always associated with disease and usually cannot survive outside of the body for long periods of time. Examples include and HIV.

      Staphylococcus aureus and Bacteroides fragilis are conditional pathogens. These are pathogens that usually cause disease only if certain conditions are met.

      Pneumocystis jiroveci and Pseudomonas aeruginosa, are opportunistic pathogens. These are pathogens that can only cause disease in an immunocompromised host or under unusual circumstances.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      0
      Seconds

  • Question 4 - 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
      0
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  • Question 5 - C5 - C9 deficiency increases susceptibility to infection with which of the following:...

    Incorrect

    • C5 - C9 deficiency increases susceptibility to infection with which of the following:

      Your Answer:

      Correct Answer: Neisseria spp.

      Explanation:

      If the complement sequence is completed, an active phospholipase (the membrane attack complex, MAC) is produced, which punches holes in the cell membrane and causes cell lysis. Because the MAC appears to be the sole means to destroy the Neisseria family of bacteria, C5 – C9 deficiency increases susceptibility to Neisseria infections.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
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  • Question 6 - After reviewing a child with respiratory distress who presented to the clinic, you...

    Incorrect

    • After reviewing a child with respiratory distress who presented to the clinic, you make a diagnosis of bronchiolitis.

      What is the most common causative organism?

      Your Answer:

      Correct Answer: Respiratory syncitial virus

      Explanation:

      Bronchiolitis is a common respiratory infection that occurs in infancy between the ages of 3-6 months and in the winter months. It is most commonly caused by the respiratory syncytial virus (70% of cases)

      Although it can also be caused by parainfluenza virus, adenovirus, coronavirus, rhinovirus, and influenza virus, these are not the most common causes

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
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  • Question 7 - Eosinophils comprise what percentage of circulating white cells: ...

    Incorrect

    • Eosinophils comprise what percentage of circulating white cells:

      Your Answer:

      Correct Answer: 1 - 3%

      Explanation:

      Eosinophils comprise 1 – 3% of circulating white cells. Eosinophils are similar to neutrophils, except that the cytoplasmic granules are coarser and more deeply red staining, and there are rarely more than three nuclear lobes. They are less motile, but longer lived. They enter inflammatory exudates and have a special role in allergic responses, defence against parasites and removal of fibrin formed during inflammation. Thus they play a role in local immunity and tissue repair.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
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  • Question 8 - Regarding meningococcal meningitis, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding meningococcal meningitis, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Infection occurs most commonly below the age of 5 years.

      Explanation:

      About half of meningococcal disease occurs in children aged less than five years, and babies are at the highest risk because their immune systems have not yet fully developed. There is a second, smaller increase in risk for older adolescents, mainly for social and behavioural reasons. Infection is most common in winter months. Antibiotics should be given as soon as the diagnosis is suspected (ideally cultures should be performed first but this should not delay treatment), and ceftriaxone/cefuroxime is the first line antibiotic. Only healthcare workers who have been directly exposed to large particle droplets/secretions from the respiratory tract of the index case should receive prophylaxis.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 9 - Which of the following statements is true regarding the extensor pollicis longus? ...

    Incorrect

    • Which of the following statements is true regarding the extensor pollicis longus?

      Your Answer:

      Correct Answer: It is innervated by the posterior interosseous nerve

      Explanation:

      Extensor pollicis longus is part of the deep extensors of the forearm together with extensor pollicis brevis, abductor pollicis longus, extensor indicis and supinator muscles. It is located on the posterior aspect of forearm, extending from the middle third of the ulna, and adjacent interosseous membrane, to the distal phalanx of the thumb.

      Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).

      Extensor pollicis brevis receives its blood supply from the posterior interosseous artery and perforating branches of the anterior interosseous artery.

      The main action of extensor pollicis longus is extension of the thumb at the metacarpophalangeal and interphalangeal joints. Extension at the metacarpophalangeal joint occurs in synergy with extensor pollicis brevis muscle. When the thumb reaches the full extension or abduction, extensor pollicis longus can also assist in adduction of the thumb.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
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  • Question 10 - You are going to prescribe a NSAID to a 50-year-old male patient for...

    Incorrect

    • You are going to prescribe a NSAID to a 50-year-old male patient for his back pain. Which of the following NSAIDs is least likely to cause gastrointestinal side effects:

      Your Answer:

      Correct Answer: Ibuprofen

      Explanation:

      NSAIDs are associated with serious gastrointestinal irritation and drug-induced ulcers.

      Among the NSAIDs included in the choices, ibuprofen has the lowest risk.

      Piroxicam, ketoprofen, and ketorolac trometamol are associated with the highest risk of serious upper gastrointestinal side effects.

      Indomethacin, diclofenac, and naproxen are associated with an intermediate risk of serious upper gastrointestinal side effects.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
      0
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  • Question 11 - When a child has chickenpox, how long should he or she be off...

    Incorrect

    • When a child has chickenpox, how long should he or she be off from school?

      Your Answer:

      Correct Answer: Until all vesicles have crusted over

      Explanation:

      To avoid the spread of infection, infected patients should be isolated. All lesions should be crusted over before children return to nursery or school, even if the standard exclusion time is 5 days.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
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  • Question 12 - Which of the following is characterised by passive carrier-mediated transport down a chemical...

    Incorrect

    • Which of the following is characterised by passive carrier-mediated transport down a chemical concentration gradient:

      Your Answer:

      Correct Answer: Facilitated diffusion

      Explanation:

      Facilitated diffusion is the process of spontaneous passive transport of molecules or ions down their concentration gradient across a cell membrane via specific transmembrane transporter (carrier) proteins. The energy required for conformational changes in the transporter protein is provided by the concentration gradient rather than by metabolic activity.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
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  • Question 13 - A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a...

    Incorrect

    • A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.

      Which statement about ipratropium bromide is true?

      Your Answer:

      Correct Answer: It can trigger acute closed-angle glaucoma

      Explanation:

      Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD.

      It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.

      The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists.

      It can trigger acute closed-angle glaucoma in patients that are susceptible.

      First-line treatment for moderate asthma attacks is short-acting β2agonists.

      The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.

      Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      0
      Seconds

  • Question 14 - Regarding the brachioradialis muscle, which of the following statements is true? ...

    Incorrect

    • Regarding the brachioradialis muscle, which of the following statements is true?

      Your Answer:

      Correct Answer: It assists with supination of the forearm at the radioulnar joints

      Explanation:

      Brachioradialis is a fusiform muscle located in the lateral part of the posterior forearm. Along with extensor carpi radialis brevis and extensor carpi radialis longus, it comprises the radial group of forearm muscles, which belong to the superficial layer of posterior forearm muscles. Although anatomically part of the posterior forearm muscles, which are known to be forearm extensors, brachioradialis’ fibre orientation enables it to rather flex the forearm, and aids in supination of the forearm at the radioulnar joint.

      The brachioradialis muscle originates from the upper two-thirds of the lateral supracondylar ridge of humerus and the anterior surface of the lateral intermuscular septum of the arm. It slides over the lateral surface of the elbow joint, entering the anterolateral cubital area. The muscle fibres course inferiorly down the radial part of the anterior forearm, forming a thick tendon in approximately the middle of the forearm. This tendon then traverses the remainder of the forearm, inserting near the wrist, just proximal to the styloid process of radius.

      Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus. Blood supply to the brachioradialis muscle comes from branches of the radial artery, radial recurrent artery and the radial collateral branch of the deep brachial artery.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
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  • Question 15 - A 59-year-old woman presents with a history of tiredness and weight gain and...

    Incorrect

    • A 59-year-old woman presents with a history of tiredness and weight gain and a diagnosis of hypothyroidism is suspected.

      Which of these changes is likely to appear first in primary hypothyroidism?

      Your Answer:

      Correct Answer: Increased thyroid-stimulating hormone (TSH)

      Explanation:

      The earliest biochemical change seen in hypothyroidism is an increase in thyroid-stimulating hormone (TSH) levels.

      Triiodothyronine (T3) and thyroxine (T4) levels are normal in the early stages.

      TBG levels are generally unchanged in primary hypothyroidism.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 16 - You are seeing a child with known mitochondrial disease who has presented breathlessness...

    Incorrect

    • You are seeing a child with known mitochondrial disease who has presented breathlessness and cough. Which of the following best describes the function of mitochondria:

      Your Answer:

      Correct Answer: Energy production

      Explanation:

      Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.
      Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.
      Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
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  • Question 17 - A 66-year-old male was admitted from the Emergency Department due to severe pain...

    Incorrect

    • A 66-year-old male was admitted from the Emergency Department due to severe pain in the left forearm and hand, refractory to pain medication along with pallor and hypothermia of the affected limb. Ultrasound doppler showed an arterial embolism. Circulation was restored after vascular surgery, but there was extensive, irreversible muscle damage.

      How will the muscle heal from an injury of this type?

      Your Answer:

      Correct Answer: Diffuse formation of fibrous tissue

      Explanation:

      Once muscle tissue is damaged, there will be healing via diffuse formation of fibrous tissue, especially due to the widespread ischemia.

      Callus formation takes place in the healing of bone, not muscle.

      Organised scar formation occurs when a lacerated wound is approximated by sutures so that primary intention wound healing can occur.

      Liquefaction degeneration occurs following ischemia in the brain.

      Volkmann’s ischemic contracture may occur, but it is not the primary type of healing that will take place but rather the effect of the fibrous scar formation.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 18 - Which of the following movements does the iliacus muscle produce? ...

    Incorrect

    • Which of the following movements does the iliacus muscle produce?

      Your Answer:

      Correct Answer: Flexion of the thigh at the hip joint

      Explanation:

      The iliacus flexes the thigh at the hip joint when the trunk is stabilised. It flexes the trunk against gravity when the body is supine.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
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  • Question 19 - When there is the presence of distended and engorged veins in the umbilical...

    Incorrect

    • When there is the presence of distended and engorged veins in the umbilical area, which of the following portosystemic anastomoses has most likely occurred?

      Your Answer:

      Correct Answer: Para-umbilical veins and inferior epigastric vein

      Explanation:

      Caput medusae is a condition that consists of collateral veins radiating from the umbilicus and results from recanalization of the umbilical vein.

      Under normal conditions, the portal venous blood traverses the liver and drains into the inferior vena cava of the systemic venous circulation by way of the hepatic veins. This is the direct route. However, other, smaller communications exist between the portal and systemic systems, and they become important when the direct route becomes blocked. These communications are as follows:

      At the lower third of the oesophagus, the oesophageal branches of the left gastric vein (portal tributary) anastomose with the oesophageal veins draining the middle third of the oesophagus into the azygos veins (systemic tributary).

      Halfway down the anal canal, the superior rectal veins (portal tributary) draining the upper half of the anal canal anastomosis with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.

      The paraumbilical veins connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall (systemic tributaries). The paraumbilical veins travel in the falciform ligament and accompany the ligamentum teres.

      The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries).

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      0
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  • Question 20 - A 20-year-old male patient lives in a travelling community and has never...

    Incorrect

    • A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.

      Which of these statements concerning indications and contraindications for vaccination is TRUE?

      Your Answer:

      Correct Answer: Inactivated vaccines are safe in pregnancy

      Explanation:

      All vaccines are contraindicated in individuals with: A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.
      A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycin

      There is no evidence that vaccinating pregnant women with inactivated vaccine or toxoids harms the woman or foetus.

      The current protocol is that a child with history of egg allergy can be safely vaccinated with Fluenz tetra. However, if they had a previous severe anaphylaxis to egg requiring intensive care, then Flenz tetra is contraindicated.

      BCG, yellow fever or oral typhoid vaccinations are not safe in HIV positive patients.

      The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should not be implemented.

      Concurrent antibiotic therapy is not a contraindication to vaccination.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
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  • Question 21 - In the Kaplan-Meier plot, which of the following labels should be applied to...

    Incorrect

    • In the Kaplan-Meier plot, which of the following labels should be applied to the X-axis?

      Your Answer:

      Correct Answer: Time in years

      Explanation:

      Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death, is called as survival time and the analysis of group data as survival analysis.

      The graph plotted between estimated survival probabilities/estimated survival percentages (on Y axis) and time past after entry into the study (on X axis) consists of horizontal and vertical lines.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 22 - Regarding the abductor digiti minimi, which of the following statements is false? ...

    Incorrect

    • Regarding the abductor digiti minimi, which of the following statements is false?

      Your Answer:

      Correct Answer: It assists with flexion of the fifth finger at the middle phalanx

      Explanation:

      Abductor digiti minimi is a short intrinsic muscle of the hand. It belongs to the group of muscles collectively called hypothenar muscles due to their acting on the 5th finger. Besides abductor digiti minimi, other hypothenar muscles include flexor digiti minimi brevis and opponens digiti minimi.

      The main function of abductor digiti minimi involves abduction of the 5th finger, as well as flexion of its proximal phalanx. Along with other hypothenar muscles, this muscle forms the hypothenar eminence on the medial side of the palm.

      Like other hypothenar muscles, abductor digiti minimi receives nervous supply from the deep branch of the ulnar nerve, derived from root values C8 and T1.

      Abductor digiti minimi receives arterial blood supply from the palmar branch of ulnar artery, palmar digital artery, as well as branches of the ulnar side of the superficial palmar arch. The venous blood from the muscle is drained via the venous networks of the palm into the deep veins of the arm (vv. ulnares).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 23 - A patient is referred to the Medicine Department for complaints of unilateral hearing...

    Incorrect

    • A patient is referred to the Medicine Department for complaints of unilateral hearing loss, tinnitus and facial numbness. Upon further investigation, an acoustic neuroma is given as the final diagnosis.

      Which of the following nerves is least likely to be affected in acoustic neuroma?

      Your Answer:

      Correct Answer: Trochlear nerve

      Explanation:

      Acoustic neuroma is also called vestibular schwannoma (VS), acoustic neuroma, vestibular neuroma or acoustic neurofibroma. These are tumours that evolve from the Schwann cell sheath and can be either intracranial or extra-axial. They usually occur adjacent to the cochlear and vestibular nerves and most often arise from the inferior division of the latter. Anatomically, acoustic neuroma tends to occupy the cerebellopontine angle. About 5-10% of cerebellopontine angle (CPA) tumours are meningiomas and may occur elsewhere in the brain. Bilateral acoustic neuromas tend to be exclusively found in individuals with type 2 neurofibromatosis.

      The following nerves may be affected due to nerve compression:

      Facial nerve: usually minimal with late presentation except for very large tumours. Depending on the degree of engagement of the nerve, the symptoms may include twitching, increased lacrimation and facial weakness.

      Trigeminal Nerve: paraesthesia in the trigeminal distribution, tingling of the tongue, impairment of the corneal reflex, and less commonly pain which may mimic typical trigeminal neuralgia.

      Glossopharyngeal and Vagus nerves: palatal paresis, hoarseness of voice and dysphagia

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 24 - Clostridium difficile primarily causes which of the following infectious diseases: ...

    Incorrect

    • Clostridium difficile primarily causes which of the following infectious diseases:

      Your Answer:

      Correct Answer: Pseudomembranous colitis

      Explanation:

      Clostridium difficile causes pseudomembranous colitis, an acute inflammatory diarrhoeal disease and an important cause of morbidity and mortality in hospitals. Gas gangrene is primarily caused by Clostridium perfringens. Tetanus is caused by Clostridium tetani. Toxic shock syndrome may be caused by Staphylococcus aureus or Streptococcus pyogenes. Necrotising fasciitis is most commonly caused by Streptococcus pyogenes but has a multitude of causes.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 25 - A 34-year-old man arrives at the department befuddled. He has a history of...

    Incorrect

    • A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.

      Which of the following statements about antipsychotic drug side effects is correct?

      Your Answer:

      Correct Answer: Haloperidol is the most common causative antipsychotic drug

      Explanation:

      Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.

      Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.

      Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.

      An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.

      Renal impairment causes increased cerebral sensitivity, so lower doses should be used.

      In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.

      The following are some of the antipsychotic drugs’ contraindications:
      Reduced level of consciousness/coma
      Depression of the central nervous system
      Phaeochromocytoma

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 26 - The patients listed below have had wounds or injuries and were treated as...

    Incorrect

    • The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.

      Which of the following patients has had adequate tetanus protection?

      Your Answer:

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

      Explanation:

      25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.

      Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.

      8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:
      The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.

      80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:
      A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.

      A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:
      In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.

      30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:
      Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
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  • Question 27 - Regarding benzodiazepines, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Diazepam is a short-acting benzodiazepine.

      Explanation:

      Diazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration. Midazolam is a water-soluble benzodiazepine that is often used in preference to intravenous diazepam; recovery is faster than from diazepam, but may be significantly longer in the elderly, in patients with a low cardiac output, or after repeated dosing. Midazolam is associated with profound sedation when high doses are given intravenously or when it is used with certain other drugs.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 28 - Compliance is decreased by all but which one of the following: ...

    Incorrect

    • Compliance is decreased by all but which one of the following:

      Your Answer:

      Correct Answer: Aging

      Explanation:

      Factors increasing compliance:
      Old age
      Emphysema

      Factors decreasing compliance:
      Pulmonary fibrosis
      Pulmonary oedema
      Atelectasis
      Extremes of lung volumes (at higher lung volumes the compliance of the lung becomes less as the lung becomes stiffer)

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds

  • Question 29 - The results from the study investigating the accuracy of a new diagnostic test can be...

    Incorrect

    • The results from the study investigating the accuracy of a new diagnostic test can be displayed in the following format. How is the negative predictive value calculated:







      Those with disease

      Those without disease

      Total



      Test positive

      a

      b

      a+b



      Test negative

      c

      d

      c+d



      Total

      a+c

      b+d

      n=a+b+c+d

      Your Answer:

      Correct Answer: d/(c+d)

      Explanation:

      Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.
      NPV = d/(c+d)

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      0
      Seconds

  • Question 30 - 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
      0
      Seconds

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