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  • Question 1 - Which of the following laboratory findings are suggestive of functional hyposplenism: ...

    Correct

    • Which of the following laboratory findings are suggestive of functional hyposplenism:

      Your Answer: Howell-Jolly bodies

      Explanation:

      Functional hyposplenism is characterised by the blood film findings of Howell-Jolly bodies or siderotic granules on iron staining. The most frequent cause is surgical removal of the spleen e.g. after traumatic rupture, but hyposplenism can also occur in sickle cell anaemia, gluten-induced enteropathy, amyloidosis and other conditions.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      4
      Seconds

  • Question 2 - A pheochromocytoma is diagnosed in a 38-year-old female who has had episodes of...

    Incorrect

    • A pheochromocytoma is diagnosed in a 38-year-old female who has had episodes of acute sweating, palpitations, and paroxysmal hypertension.

      Which of the following is the MOST SUITABLE INITIAL TREATMENT?

      Your Answer:

      Correct Answer: Alpha-blocker

      Explanation:

      A phaeochromocytoma is a rare functional tumour that develops in the adrenal medulla from chromaffin cells. Extra-adrenal paragangliomas (extra-adrenal pheochromocytomas) are tumours that arise in the sympathetic nervous system’s ganglia and are closely connected to extra-adrenal paragangliomas (extra-adrenal pheochromocytomas). Catecholamines are secreted by these tumours, which generate a variety of symptoms and indications associated with sympathetic nervous system hyperactivity.
      Hypertension is the most prevalent presenting symptom, which can be continuous or intermittent.

      Symptoms are usually intermittent, occurring anywhere from many times a day to occasionally. The symptoms of the condition tend to grow more severe and frequent as the disease progresses.
      The ultimate therapy of choice is surgical resection, and if full resection is done without metastases, hypertension is typically cured.

      Preoperative medical treatment is critical because it lowers the risk of hypertensive crises during surgery. This is commonly accomplished by combining non-competitive alpha-blockers (such as phenoxybenzamine) with beta-blockers. To allow for blood volume expansion, alpha-blockade should be started at least 7-10 days before surgery. Beta-blockade, which helps to regulate tachycardia and some arrhythmias, can be started after this is accomplished. Hypertensive crises can be triggered if beta-blockade is started too soon.
      There should also be genetic counselling, as well as a search for and management of any linked illnesses.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 3 - A 54-year-old man returns from a recently holiday on a cruise ship with...

    Incorrect

    • A 54-year-old man returns from a recently holiday on a cruise ship with a dry cough and a fever. Today he has also had several episodes of diarrhoea and has developed bilateral pleuritic chest pain. He states that he is short of breath, most notably on exertion. He had been prescribed amoxicillin by the cruise ship doctor a few days earlier but has not seen any improvement.
      Which of the following is the most likely causative organism? Select ONE answer only.

      Your Answer:

      Correct Answer: Legionella pneumophila

      Explanation:

      Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.

      The clinical features of the pneumonic form of Legionnaires’ disease include:
      Mild flu-like prodrome for 1-3 days
      Cough (usually non-productive and occurs in approximately 90%)
      Pleuritic chest pain
      Haemoptysis
      Headache
      Nausea, vomiting and diarrhoea
      Anorexia
      Legionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
      The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
      Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
      Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 4 - When treating diabetic ketoacidosis (DKA), glucose should be given together with insulin as...

    Incorrect

    • When treating diabetic ketoacidosis (DKA), glucose should be given together with insulin as soon as the blood glucose concentration falls below 14 mmol/L in the form of:

      Your Answer:

      Correct Answer: 10% glucose intravenous infusion at a rate of 125 mL/hour

      Explanation:

      In addition to the sodium chloride 0.9 percent infusion, glucose 10% should be given intravenously (into a large vein with a large-gauge needle) at a rate of 125 mL/hour once blood glucose concentration falls below 14 mmol/litre.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
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  • Question 5 - Which of the following best describes the mechanism of action of aspirin: ...

    Incorrect

    • Which of the following best describes the mechanism of action of aspirin:

      Your Answer:

      Correct Answer: Cyclo-oxygenase (COX) inhibitor

      Explanation:

      Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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  • Question 6 - A 50-year-old woman has an anaphylactic reaction following accidental ingestion peanuts at a...

    Incorrect

    • A 50-year-old woman has an anaphylactic reaction following accidental ingestion peanuts at a restaurant. She is a known hypertensive on atenolol 50 mg daily and BP is well controlled. She is also on amlodipine 5 mg daily. Two doses of IM adrenaline has been given without improvement.

      Which medication may prove helpful in this patient?

      Your Answer:

      Correct Answer: IM Glucagon

      Explanation:

      Resistant to the effects of adrenaline in anaphylaxis is seen in patients taking beta-blockers.

      Glucagon can be used to overcome the effects of the beta-blockade if initial doses of adrenaline are unsuccessful in patients taking beta-blockers.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      0
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  • Question 7 - On reviewing the ECG of a patient with a history of intermittent palpitations,...

    Incorrect

    • On reviewing the ECG of a patient with a history of intermittent palpitations, you observe prolonged QT interval.

      Which of these can cause prolongation of the QT interval on the ECG?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      Syncope and sudden death due to ventricular tachycardia, particularly Torsades-des-pointes is seen in prolongation of the QT interval.

      The causes of a prolonged QT interval include:
      Erythromycin
      Amiodarone
      Quinidine
      Methadone
      Procainamide
      Sotalol
      Terfenadine
      Tricyclic antidepressants
      Jervell-Lange-Nielsen syndrome (autosomal dominant)
      Romano Ward syndrome (autosomal recessive)
      Hypothyroidism
      Hypocalcaemia
      Hypokalaemia
      Hypomagnesaemia
      Hypothermia
      Rheumatic carditis
      Mitral valve prolapse
      Ischaemic heart disease

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      0
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  • Question 8 - Which of the following statements regarding forest plots is true? Select ONE answer...

    Incorrect

    • Which of the following statements regarding forest plots is true? Select ONE answer only.
      Which of the following statements regarding forest plots is true? Select ONE answer only.

      Your Answer:

      Correct Answer: Larger studies are associated with smaller horizontal lines

      Explanation:

      Forest plots are graphical displays designed to illustrate the relative strength of treatment effects in multiple individual studies addressing the same question.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 9 - A 32-year-old woman suffers a deep wound to her thigh while she was...

    Incorrect

    • A 32-year-old woman suffers a deep wound to her thigh while she was climbing over a barbed wire fence. As a consequence of her injury, the nerve that was severed innervates the gracilis muscle.

      In which of the following nerves is the gracilis muscle innervated by?

      Your Answer:

      Correct Answer: Anterior branch of the obturator nerve

      Explanation:

      The gracilis muscles is innervated by the anterior branch of the obturator nerve (L2-L4).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
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  • Question 10 - 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 11 - Which of the following statements about vitamin B12 absorption is TRUE: ...

    Incorrect

    • Which of the following statements about vitamin B12 absorption is TRUE:

      Your Answer:

      Correct Answer: On ingestion, vitamin B12 is bound to R protein which protects it from digestion in the stomach.

      Explanation:

      The substance intrinsic factor,
      essential for absorption of vitamin B12 in the ileum, is
      secreted by the parietal cells along with the secretion of
      hydrochloric acid. When the acid-producing parietal
      cells of the stomach are destroyed, which frequently
      occurs in chronic gastritis, the person develops not only
      achlorhydria (lack of stomach acid secretion) but often
      also pernicious anaemia because of failure of maturation
      of the red blood cells in the absence of vitamin B12 stimulation of the bone marrow.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 12 - Which of the following is NOT a feature characteristic of intravascular haemolysis: ...

    Incorrect

    • Which of the following is NOT a feature characteristic of intravascular haemolysis:

      Your Answer:

      Correct Answer: Bilirubinuria

      Explanation:

      Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
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  • Question 13 - You're in resus with a 69-year-old woman who is very sick. You decide...

    Incorrect

    • You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.

      Which of the following statements about dobutamine is correct?

      Your Answer:

      Correct Answer: It may be infused via a peripheral line

      Explanation:

      Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.

      Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.

      It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.

      At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:
      Nausea and vomiting
      Tachycardia
      Dysrhythmias
      Angina
      Hypertension
      Headache

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
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  • Question 14 - C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:...

    Incorrect

    • C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:

      Your Answer:

      Correct Answer: IL-6

      Explanation:

      Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      0
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  • Question 15 - Which type of collagen is initially laid down in early wound healing: ...

    Incorrect

    • Which type of collagen is initially laid down in early wound healing:

      Your Answer:

      Correct Answer: III

      Explanation:

      Fibroblasts migrate to the wound (about 2 – 5 days after wounding), proliferate and secrete extracellular matrix comprising mainly collagen (type III) and fibronectin to plug the gap.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
      0
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  • Question 16 - Regarding amoxicillin, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: It is used first line for bacterial tonsillitis.

      Explanation:

      Amoxicillin is a derivative of ampicillin and has a similar antibacterial spectrum. It is better absorbed than ampicillin when given orally, producing higher plasma and tissue concentrations; unlike ampicillin, absorption is not affected by the presence of food in the stomach.

      The adverse effects of amoxicillin are mainly gastrointestinal and mild and include nausea, vomiting and diarrhoea. 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).

      Penicillin V is used first line for bacterial tonsillitis; amoxicillin should be avoided in blind treatment of a sore throat as there is a high risk of a rash if glandular fever is present.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 17 - You have been called to review a patient and his management in the...

    Incorrect

    • You have been called to review a patient and his management in the resuscitation room. A very sick patient has been started on mannitol in his treatment protocol.

      Out of the following, what is NOT an FDA-recognized indication for the use of mannitol?

      Your Answer:

      Correct Answer: Congestive cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      Mannitol has four FDA approved uses clinically:
      1. Reduction of intracranial pressure and brain mass
      2. reduce intraocular pressure if this is not achievable by other means
      3. promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage
      4. promote diuresis to promote the excretion of toxic substances, materials, and metabolites

      It can be used in rhabdomyolysis-induced renal failure, especially in crush injuries. Mannitol reduces osmotic swelling and oedema in the injured muscle cells and helps restore skeletal muscle function.

      It is a low molecular weight compound and can be freely filtered at the glomerulus and not reabsorbed. This way 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).

      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:

      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 18 - Regarding flow through a tube, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding flow through a tube, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Polycythaemia will decrease the rate of blood flow through a vessel.

      Explanation:

      Darcy’s law states that flow through a tube is dependent on the pressure differences across the ends of the tube (P1 – P2) and the resistance to flow provided by the tube (R). Resistance is due to frictional forces and is determined by the length of the tube (L), the radius of the tube (r) and the viscosity of the fluid flowing down that tube (V). The radius of the tube has the largest effect on resistance and therefore flow – this explains why smaller gauge cannulas with larger diameters have a faster rate of flow. Increased viscosity, as seen in polycythemia, will slow the rate of blood flow through a vessel.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 19 - A 38-year-old woman is investigated for Addison's disease. She had low blood pressure,...

    Incorrect

    • A 38-year-old woman is investigated for Addison's disease. She had low blood pressure, weakness, weight loss, and skin discoloration. An adrenocorticotropic hormone (ACTH) stimulation test is scheduled as part of her treatment.

      Which of the following statements about ACTH is correct? 

      Your Answer:

      Correct Answer: It is released in response to the release of CRH

      Explanation:

      The anterior pituitary gland produces and secretes a peptide hormone called adrenocorticotropic hormone (ACTH) (adenohypophysis). It is secreted in response to the hypothalamus’s secretion of the hormone corticotropin-releasing hormone (CRH).

      ACTH promotes cortisol secretion via binding to cell surface ACTH receptors in the zona fasciculata of the adrenal cortex.

      ACTH also promotes the production of beta-endorphin, which is a precursor to melanocyte-releasing hormone (MRH).

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 20 - Identify the type of graph described below:

    A graph that consists of a vertical...

    Incorrect

    • Identify the type of graph described below:

      A graph that consists of a vertical bar graph in which values are plotted in decreasing order of relative frequency from left to right. The independent variables on the chart are shown on the horizontal axis and the dependent variables are portrayed as the heights of bars.

      Your Answer:

      Correct Answer: Pareto diagram

      Explanation:

      A pareto diagram, or pareto chart, consists of a vertical bar graph in which values are plotted in decreasing order of relative frequency from left to right. The independent variables on the chart are shown on the horizontal axis and the dependent variables are portrayed as the heights of bars.

      A point-to-point graph, which shows the cumulative relative frequency, may be superimposed on the bar.

      Because the values of the statistical variables are placed in order of relative frequency, the graph clearly reveals which factors have the greatest impact and where attention is likely to yield the greatest benefit. It is extremely useful for analysing what problems need attention first, because the taller bars on the chart clearly illustrate which variable have the greatest cumulative effect on a given system.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 21 - Which of the following nerves is most likely associated with an anterior shoulder...

    Incorrect

    • Which of the following nerves is most likely associated with an anterior shoulder dislocation?

      Your Answer:

      Correct Answer: Axillary nerve

      Explanation:

      In an anterior dislocation, the arm is an abducted and externally rotated position. In the externally rotated position, the posterosuperior aspect of the humeral head abuts and drives through the anteroinferior aspect of the glenoid rim. This can damage the humeral head, glenoid labrum, or both. An associated humeral head compression fracture is described as a Hill Sach’s lesion. If large enough, it can lead to locked dislocations that may require open reduction. The glenoid labrum is a fibrocartilaginous structure that rings the circumference of the glenoid fossa. Bankart lesions are injuries to the anteroinferior glenoid labrum complex and the most common capsulolabral injury. A bony Bankart lesion refers to an associated fracture of the glenoid rim. These capsulolabral lesions are risk factors for recurrent dislocation.

      Axillary nerve injury is identified in about 42% of acute anterior shoulder dislocations. Nerve transection is rare, and traction injuries are more common. Arterial injury has also been described. The subclavian artery becomes the axillary artery after passing the first rib. The distal portion of the axillary artery is anatomically fixed and, therefore, susceptible to injury in anterior dislocations. Ischemic injury, including pseudoaneurysm and arterial laceration, is rare but carries marked morbidity if not quickly identified.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 22 - A 40-year-old woman presents with a fever and headache upon returning from an...

    Incorrect

    • A 40-year-old woman presents with a fever and headache upon returning from an overseas business trip. Upon further investigation, a diagnosis of Plasmodium falciparum malaria was made.

      All of the following statements is considered true regarding Plasmodium falciparum malaria, except:

      Your Answer:

      Correct Answer: It is commonly the result of travel in the Indian subcontinent

      Explanation:

      The mean incubation period for P. falciparum is 12 days.

      WHO World Malaria Report 2019 states that an estimated 228 million cases of malaria occurred worldwide in 2018, and reports steadily decreasing the number of cases since 2010. In 2018, nineteen sub-Saharan African countries and India carried approximately 85% of the global malaria burden. The most prevalent and pathogenic malaria parasite, most commonly associated with severe illness and death, especially in the WHO African region, accounting for 99.7% malaria cases, is P. falciparum.

      The vector for Plasmodium spp. is a female Anopheles mosquito that inoculates sporozoites contained in her salivary glands into the puncture wound when feeding. Sporozoites enter peripheral bloodstream and are uptake by hepatocytes, where they undergo an asexual pre-erythrocytic liver-stage as liver schizonts lasting up to 2 weeks before the onset of the blood stage.

      Intravenous or intramuscular artesunate is the first-line treatment in all patients worldwide and should be used for at least 24 hours and until the oral medication is tolerated.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 23 - A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms...

    Incorrect

    • A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms have been steadily deteriorating, with no intervals of remission in sight.

      Which of the following aspects of nerve conduction is disrupted by multiple sclerosis?

      Your Answer:

      Correct Answer: Saltatory conduction

      Explanation:

      Local currents propagate action potentials down the axons of neurons. This local current flow following depolarisation results in the depolarisation of the neighbouring axonal membrane, and when this region approaches the threshold, more action potentials are generated and so forth. Due to the refractory period, portions of the membrane that have recently depolarized will not depolarize again, resulting in the action potential only being able to go in one direction.

      The square root of axonal diameter determines the velocity of the action potential; the axons with the biggest diameter have the quickest conduction velocities. When a neuron is myelinated, the speed of the action potential rises as well.
      The myelin sheath is an insulating coating that surrounds certain neural axons. By increasing membrane resistance and decreasing membrane capacitance, the myelin sheath improves conduction. This enables faster electrical signal transmission via a neuron, making them more energy-efficient than non-myelinated neuronal axons.
      Electrical impulses are quickly transmitted from one node to the next, causing depolarization of the membrane above the threshold and triggering another action potential, which is then transmitted to the next node. An action potential is rapidly conducted down a neuron in this manner. Saltatory conduction is the term for this.
      Multiple sclerosis is an example of a clinical disorder in which the myelin sheath is affected. It is an immune-mediated disorder in which certain nerve cells in the brain and spinal cord become demyelinated. The ability of some areas of the nervous system to properly transmit action potentials is disrupted by demyelination, resulting in a variety of neurological symptoms and indications.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 24 - Which of the following is NOT a benefit of low molecular weight heparin...

    Incorrect

    • Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:

      Your Answer:

      Correct Answer: Its effects can be rapidly and completely reversed with protamine sulfate.

      Explanation:

      Advantages of LMWHGreater ability to inhibit factor Xa directly, interacting less with platelets and so may have a lesser tendency to cause bleedingGreater bioavailability and longer half-life in plasma making once daily subcutaneous administration possibleMore predictable dose response avoiding the need for routine anticoagulant monitoringLower associated risk of heparin-induced thrombocytopenia or of osteoporosis

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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  • Question 25 - Regarding anaemia, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Anaemia is usually associated with a decrease in red cell 2,3 - DPG.

      Explanation:

      Anaemia is defined as a reduction in haemoglobin concentration below the normal range for the age and sex of the individual. Children tend to have lower haemoglobin than adults, and women tend to have lower haemoglobin than men. Anaemia may occur from an actual reduction in total circulating haemoglobin mass, or with an increase in plasma volume e.g. in pregnancy, causing a dilutional anaemia. After acute major blood loss, anaemia is not immediately apparent because total blood volume is reduced and it takes up to a day for plasma volume to be replaced and hence the degree of anaemia to become apparent. The initial clinical features in acute haemorrhage are therefore a result of reduction in blood volume rather than that of anaemia. When anaemia develops slowly, the associated symptoms are often very mild as the body has time to adapt to the fall in haemoglobin. This involves mechanisms such as an increase in red cell 2,3 -diphosphoglycerate (2,3 – DPG), which shifts the oxygen dissociation curve to the right, allowing enhanced delivery of O2 to the tissues, and an increase in stroke volume and heart rate.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 26 - After collapsing in his nursing home, a 70-year-old man is brought into the...

    Incorrect

    • After collapsing in his nursing home, a 70-year-old man is brought into the ER. He has diabetes mellitus and is on medication for it. An RBS of 2.0 mmol/L (3.9-5.5 mmol/L) is recorded in the ER.

      Out of the following, which medication for diabetes mellitus is LEAST likely responsible for his hypoglycaemic episode?

      Your Answer:

      Correct Answer: Metformin

      Explanation:

      Metformin is a biguanide used as the first-line to treat type 2 diabetes mellitus. It has a good reputation as it has an extremely low risk of causing hypoglycaemia compared to the other agents for diabetes. It does not affect the insulin secreted by the pancreas or increase insulin levels. Toxicity with metformin can, however, cause lactic acidosis with associated hypoglycaemia.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
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  • Question 27 - All of the following statements is considered true regarding Streptococcus pneumoniae, except: ...

    Incorrect

    • All of the following statements is considered true regarding Streptococcus pneumoniae, except:

      Your Answer:

      Correct Answer: It is the commonest cause of erysipelas

      Explanation:

      Erysipelas is a rare infection of the skin and subcutaneous tissues observed frequently in elderly patients. It is characterized by an acute spreading skin lesion that is intensely erythematous with a plainly demarcated but irregular edge. It is most commonly caused by Streptococcus pyogenes or Group A Streptococcus (GAS).

      GAS are susceptible to penicillin, which remains the drug of choice for treatment. For patients allergic to penicillin, erythromycin can be used.

      S. pyogenes colonizes the throat and skin on humans, making these sites the primary sources of transmission. Infections resulting from S. pyogenes include pharyngitis, scarlet fever, skin or pyodermal infections, and other septic infections. In addition, the sequelae rheumatic fever and acute glomerulonephritis can occur as a result of infection with S. pyogenes.

      Agammaglobulinemia is mostly associated with S. pneumoniae.

      The M protein is attached to the peptidoglycan of the cell wall and extends to
      the cell surface. The M protein is essential for virulence. The polysaccharide capsule is characteristic of S. pneumoniae.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 28 - Which of the following laboratory findings are indicative of von Willebrand disease (VWD):...

    Incorrect

    • Which of the following laboratory findings are indicative of von Willebrand disease (VWD):

      Your Answer:

      Correct Answer: Prolonged APTT

      Explanation:

      Laboratory results often show that:
      PFA-100 test results are abnormal.
      Low levels of factor VIII (if a factor VIII/VWF binding assay is conducted)
      APTT is Prolonged (or normal)
      PT is normal
      VWF values are low.
      Defective Platelet aggregation
      The platelet count is normal.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 29 - The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian...

    Incorrect

    • The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian man is 152/96 mmHg (ABPM).

      The first-line drug treatment for this patient would be which of the following? Please only choose ONE answer.

      Your Answer:

      Correct Answer: Amlodipine

      Explanation:

      An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.

      A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 59-year-old Caucasian man.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 30 - A 56-year-old man presents with pneumonia 8 days after being admitted for an...

    Incorrect

    • A 56-year-old man presents with pneumonia 8 days after being admitted for an open fracture of his tibia and fibula. Upon history taking and observation, it was established that he has no known drug allergies, has coarse left basal crackles and evidence of consolidation in the left lower lobe based on his chest X-ray.

      Which of the following antibacterial agents would be the most appropriate to prescribe according to the latest NICE guidelines?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      The current NICE guidelines for hospital-acquired pneumonia are as follow:
      – First-choice oral antibiotic if non‑severe symptoms or signs, and not at higher risk of resistance (guided by microbiological results when available): co-amoxiclav

      – Alternative oral antibiotics if non‑severe symptoms or signs, and not at higher risk of resistance, for penicillin allergy or if co‑amoxiclav unsuitable (based on specialist microbiological advice and local resistance data): doxycycline, cefalexin, co-trimoxazole, levofloxacin

      – First-choice intravenous antibiotics if severe symptoms or signs (for example, symptoms or signs of sepsis) or at higher risk of resistance (based on specialist microbiological advice and local resistance data): piperacillin with tazobactam, ceftazidime, ceftriaxone, cefuroxime, meropenem, ceftazidime with avibactam, levofloxacin

      – Antibiotics to be added if suspected or confirmed methicillin-resistant Staphylococcus aureus infection (dual therapy with a first-choice intravenous antibiotic): vancomycin, teicoplanin, linezolid

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
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