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  • Question 1 - A patient is referred for lung function tests on account of a history...

    Incorrect

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

      Which statement about lung volumes is correct?

      Your Answer: The residual volume is the volume of air in the lungs at the end of a deep inspiration

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

      Explanation:

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

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

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

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

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

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

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      3
      Seconds

  • Question 2 - Which of the following is the most common cause of hyperthyroidism: ...

    Incorrect

    • Which of the following is the most common cause of hyperthyroidism:

      Your Answer:

      Correct Answer: Graves disease

      Explanation:

      Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disease in which autoantibodies against TSH receptors are produced. These antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Therefore, the signs and symptoms of Graves disease are the same as those of hyperthyroidism, reflecting the actions of increased circulating levels of thyroid hormones: increased heat production, weight loss, increased 02 consumption and cardiac output and exophthalmos (bulging eyes, not drooping eyelids). TSH levels will be decreased (not increased) as a result of the negative feedback effect of increased T3 levels on the anterior pituitary.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 3 - All of the following statements are considered true regarding likelihood ratios, except: ...

    Incorrect

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

      Your Answer:

      Correct Answer: If less than one, indicates that the information increases the likelihood of the suspected diagnosis

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 4 - Regarding apoptosis, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.

      Explanation:

      Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
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  • Question 5 - Which of the following statements is correct regarding the lymphatic system? ...

    Incorrect

    • Which of the following statements is correct regarding the lymphatic system?

      Your Answer:

      Correct Answer: Lymphatic vessels contain both smooth muscle and unidirectional valves.

      Explanation:

      Fluid filtration out of the capillaries is usually slightly greater than fluid absorption into the capillaries. About 8 L of fluid per day is filtered by the microcirculation and returns to the circulation by the lymphatic system. Lymphatic capillaries drain into collecting lymphatics, then into larger lymphatic vessels. Both of these containing smooth muscle and unidirectional valves. From this point, lymph is propelled by smooth muscle constriction and vessel compression by body movements into afferent lymphatics. It then goes to the lymph nodes where phagocytes remove bacteria and foreign materials. It is here that most fluid is reabsorbed by capillaries, and the remainder returns to the subclavian veins via efferent lymphatics and the thoracic duct. The lymphatic system has a major role to play in the body’s immune defence and also has a very important role in the absorption and transportation of fats.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 6 - Which of the following problems is associated with Helicobacter pylori infection? ...

    Incorrect

    • Which of the following problems is associated with Helicobacter pylori infection?

      Your Answer:

      Correct Answer: Gastric malignancy

      Explanation:

      Helicobacter pylori is a ubiquitous organism that is present in about 50% of the global population. Chronic infection with H pylori causes atrophic and even metaplastic changes in the stomach, and it has a known association with peptic ulcer disease. The most common route of H pylori infection is either oral-to-oral or faecal-to-oral contact.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 7 - The 'bucket handle' movement of the thoracic wall describes which of the following movements:...

    Incorrect

    • The 'bucket handle' movement of the thoracic wall describes which of the following movements:

      Your Answer:

      Correct Answer: The middles of the shafts of the ribs moving upwards and laterally

      Explanation:

      Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 8 - 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 9 - A patient has suffered a nerve injury that has caused weakness of the...

    Incorrect

    • A patient has suffered a nerve injury that has caused weakness of the pectoralis minor muscle.
      Pectoralis minor receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Medial pectoral nerve

      Explanation:

      Pectoralis minor is a thin, triangular muscle that is situated in the upper chest. It is thinner and smaller than pectoralis major. It is innervated by the medial pectoral nerve.
      The origin of pectoralis minor is the 3rdto the 5thribs, near the costal cartilages. It inserts into the medial border and superior surface of the coracoid process of the scapula.
      The main action of pectoralis minor is to draw the scapula inferiorly and anteriorly against the thoracic wall. This serves to stabilise the scapula.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 10 - Which of the following features of cell damage tends to be reversible: ...

    Incorrect

    • Which of the following features of cell damage tends to be reversible:

      Your Answer:

      Correct Answer: Swelling of endoplasmic reticulum and some mitochondria

      Explanation:

      Features of cell damage that tend to be reversible include: swelling of endoplasmic reticulum and some mitochondrialoss of ribosomescell stress response
      Features of cell damage that tend to be irreversible include: loss of nucleolus, no ribosomes, swelling of all mitochondria, nuclear condensation, membrane blebs and holes, lysosome rupture, fragmentation of all inner membranes, nuclear breakup

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
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  • Question 11 - A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago....

    Incorrect

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

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

      Your Answer:

      Correct Answer: N-hydroxylation

      Explanation:

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

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

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 12 - Regarding Gaussian sample distribution, which of the following statements is false? ...

    Incorrect

    • Regarding Gaussian sample distribution, which of the following statements is false?

      Your Answer:

      Correct Answer: It can be skewed left or right

      Explanation:

      Gaussian distribution, also known as normal distribution, is the most important probability distribution in statistics because it fits many natural phenomena. The normal distribution is a probability function that describes how the values of a variable are distributed. Below are its characteristics:

      (1) Bell-shaped and symmetrical about the mean
      (2) The mean, median, mode are all equal
      (3) The total area under the curve and above the x-axis is equal to 1
      (4) It has long tapering tails extending infinitely but never touching the x-axis
      (5) It is determined by its parameters: its mean and standard deviation
      (6) The standard deviation becomes a more meaningful quality than merely being a measure of dispersion

      The mean is the most common measure of central tendency. It is the sum of all observed values divided by the number of observation, and is also known as the ‘average’.

      The median is the value that falls in the middle position when the observations are ranked in order from the smallest to the largest. If the number of observations is odd, the median is the middle number. If it is even, the median is the average of the two middle numbers.

      The mode is the value that occurs with the greatest frequency in a set of observations, and is commonly used in public health statistics, such as the top 10 causes of mortality.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 13 - A 34-year-old male is brought into the Emergency Department by the paramedics after...

    Incorrect

    • A 34-year-old male is brought into the Emergency Department by the paramedics after a road traffic accident. After a quick triage, you establish that he will need to be intubated, and you ask for some ketamine to be prepared.

      Which one of the following options regarding this drug is true?

      Your Answer:

      Correct Answer: It is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties

      Explanation:

      Ketamine is a dissociative anaesthetic with analgesic, amnesic, and hypnotic effects. It is the only anaesthetic agent which causes all three of these effects.

      Ketamine exerts its action by non-competitive antagonism at the NMDA (N-methyl-D-aspartate) receptor. Due to its analgesic property, Ketamine is given so that patients do not retain memories of short term procedures. Ketamine is used for the induction and maintenance of anaesthesia in general surgery and for treating burn wounds, battlefield injuries, and children who cannot tolerate other anaesthetic or analgesic agents.

      It can be given by both intravenous and intramuscular routes. Ketamine causes cardiac stimulation by increasing the sympathetic tone. The major side effect is increased intracranial pressure as an increase in the sympathetic tone causes vasoconstriction and an increase in the MAP.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 14 - A patient presents with a cough, productive of green sputum and fever. He...

    Incorrect

    • A patient presents with a cough, productive of green sputum and fever. He was commenced on antibiotics 4 days earlier, but his condition has worsened. There is a documented history of penicillin allergy, and the GP prescribed erythromycin.

      Erythromycin exert its pharmacological effect by binding to?

      Your Answer:

      Correct Answer: The 50S subunit of the bacterial ribosome

      Explanation:

      Macrolides are bacteriostatic antibiotics. They act by binding to the 50S subunit of the bacterial ribosome and inhibit translocation, therefore, inhibiting protein synthesis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 15 - You examine a 72-year-old man who has recently begun bumetanide treatment for worsening...

    Incorrect

    • You examine a 72-year-old man who has recently begun bumetanide treatment for worsening heart failure.

      Which of these statements about bumetanide is correct?

      Your Answer:

      Correct Answer: It has better intestinal absorption than furosemide

      Explanation:

      Bumetanide is a loop diuretic that is used to treat congestive heart failure. It is frequently used in patients who have failed to respond to high doses of furosemide.

      It has a potency of about 40 times that of furosemide, with a 1 mg dose being roughly equivalent to a 40 mg dose of furosemide.
      Seizures are not known to be triggered by bumetanide. In fact, it lowers the concentration of neuronal chloride, making GABA’s action more depolarizing, and it’s currently being tested as an antiepileptic in the neonatal period.

      It takes effect after 1 hour of oral administration, and diuresis takes 6 hours to complete.

      Bumetanide absorbs much better in the intestine than furosemide. Because it has a higher bioavailability than furosemide, it is commonly used in patients with gut oedema.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 16 - You're examining a 58-year-old male who has cellulitis in his left leg. Because...

    Incorrect

    • You're examining a 58-year-old male who has cellulitis in his left leg. Because he is allergic to penicillin, you start him on erythromycin.

      Which of the following statements about erythromycin is correct?

      Your Answer:

      Correct Answer: It can be used to treat Legionnaire’s disease

      Explanation:

      Bacteriostatic antibiotics include erythromycin and other macrolide antibiotics. They work by attaching to the bacterial ribosome’s 50S subunit, preventing translocation and thereby protein synthesis. Macrolide antibiotics are actively concentrated inside leukocytes and delivered to the infection site as a result.

      Erythromycin is an orally active antibiotic that can also be given intravenously. It is metabolized in the liver and eliminated in the bile and has a biological half-life of 1.5 hours.

      It has a similar antibacterial spectrum to benzylpenicillin (i.e., a narrow spectrum, primarily against Gram-positive pathogens) and can be used as a penicillin substitute in people who are allergic to penicillin.
      Erythromycin is unsuccessful in the treatment of meningitis because it does not penetrate the central nervous system well enough. It is efficient against a variety of unusual pathogens, unlike penicillin.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 17 - A blood culture was performed from a sample taken from a patient. It...

    Incorrect

    • A blood culture was performed from a sample taken from a patient. It was noted that a Gram-negative coccus organism was grown.

      Among the following microorganisms, which is considered an example of a Gram-negative coccus?

      Your Answer:

      Correct Answer: Neisseria menigitidis

      Explanation:

      Staphylococcus aureus = Gram-positive coccus
      Bacillus cereus = Gram-positive bacillus
      Campylobacter jejuni = Gram-negative bacillus
      Escherichia coli = Gram-negative bacillus

      In Gram staining, crystal violet is a purple stain that is used to stain the bacteria first. The stained bacteria are decolorized and then stained with a red stain, which is safranin. Bacteria with thick cell walls keep the purple stain and are called Gram-positive. Thin-walled bacteria are easily decolorized so when safranin, the red stain, is placed on the organisms, they become red or Gram-negative.
      Neisseria species appear as Gram-negative diplococci because they form pairs and their adjacent ends are flattened that is why they are also described to have a coffee-bean or kidney-bean shape.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
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  • Question 18 - Continuous capillaries are typically found where in the body: ...

    Incorrect

    • Continuous capillaries are typically found where in the body:

      Your Answer:

      Correct Answer: Blood-brain barrier

      Explanation:

      Continuous capillaries, found in the skin, lungs, muscles and CNS, are the most selective with low permeability, as junctions between the endothelial cells are very tight, restricting the flow of molecules with MW > 10,000.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 19 - Which of the following pathogens is most commonly implicated in croup: ...

    Incorrect

    • Which of the following pathogens is most commonly implicated in croup:

      Your Answer:

      Correct Answer: Parainfluenza

      Explanation:

      Parainfluenza virus is the most commonly implicated infectious agent in croup.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 20 - You investigated a patient with a chest infection and want to start antibiotics right...

    Incorrect

    • You investigated a patient with a chest infection and want to start antibiotics right away. The patient says they she can't take cephalosporins when you ask about allergies.

      Choose the 'second-generation' cephalosporin from the following choices? 

      Your Answer:

      Correct Answer: Cefuroxime

      Explanation:

      Cephalosporins of the first generation  include cephalexin, cefradine, and cefadroxil. Urinary tract infections, respiratory tract infections, otitis media, and skin and soft-tissue infections are all treated with them.

      Second-generation cephalosporins include cefuroxime, cefaclor, and cefoxitin. These cephalosporins are less vulnerable to beta-lactamase inactivation than the ‘first-generation’ cephalosporins. As a result, they’re effective against germs that are resistant to other antibiotics, and they’re especially effective against Haemophilus influenzae.

      Cephalosporins of the third generation include cefotaxime, ceftazidime, and ceftriaxone. They are more effective against Gram-negative bacteria than second generation’ cephalosporins. They are, however, less effective against Gram-positive bacteria such Staphylococcus aureus than second-generation cephalosporins.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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  • Question 21 - Which of the following medications can block the effect of adrenaline? ...

    Incorrect

    • Which of the following medications can block the effect of adrenaline?

      Your Answer:

      Correct Answer: Beta-blockers

      Explanation:

      Beta-blockers may reduce the response to adrenaline in the treatment of anaphylactic reactions.

      Noncardioselective beta-blockers in particular can antagonize the broncho dilating and cardio stimulatory effects of adrenaline by blocking beta-2 adrenergic receptors in the smooth muscles of the bronchial tree and in the heart muscles.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 22 - If the null hypothesis is wrongly rejected when it is actually true, this...

    Incorrect

    • If the null hypothesis is wrongly rejected when it is actually true, this is an example of:

      Your Answer:

      Correct Answer: A test with a type I error

      Explanation:

      A type I error occurs when the null hypothesis is wrongly rejected when it is actually true and we conclude that there is a difference of effect when in reality there is none (a false positive result).

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
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  • Question 23 - After collapsing at home, a 75-year-old man is transported in an ambulance. He...

    Incorrect

    • After collapsing at home, a 75-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is transported to resuscitation and placed on a cardiac monitor, which indicates that he is in VT. An amiodarone infusion is set up.

      Which of the following statements about amiodarone side effects is correct?

      Your Answer:

      Correct Answer: It can cause jaundice

      Explanation:

      Amiodarone has a lot of potential toxic side effects, so it’s important to get a full clinical evaluation before starting treatment with it.

      The following are some of the most common amiodarone side effects:

      Arrhythmias
      Corneal microdeposits
      Hepatic disorders
      Hyperthyroidism
      Hypothyroidism
      Hepatic disorders and jaundice
      Nausea
      Peripheral neuropathy
      Respiratory disorders (including lung fibrosis)
      Sleep disturbance
      Skin reactions
      QT prolongation

      Amiodarone can cause optic neuritis, which is a very rare side effect. If this happens, the amiodarone should be stopped right away because it poses a risk of blindness.

      Most people who take amiodarone develop corneal microdeposits, which go away once the medication is stopped and rarely cause vision problems.

      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 24 - The flow of ions across a cell membrane causes electrical activity in biological...

    Incorrect

    • The flow of ions across a cell membrane causes electrical activity in biological tissues. Excitable tissues are specialized tissues that may generate a significant electrical signal called an action potential, which is followed by a refractory period.

      Which set of ion channels is responsible for the refractory period? 

      Your Answer:

      Correct Answer: Sodium channels

      Explanation:

      A refractory period follows each action potential. The absolute refractory time and the relative refractory period are two divisions of refractory periods. Because the sodium channels seal after an AP, they enter an inactive state during which they cannot be reopened regardless of membrane potential, this time occurs.

      The sodium channels slowly come out of inactivation during the relative refractory period that follows. During this time, a stronger stimulus than that required to initiate an action potential can excite the cell. The strength of the stimulus required early in the relative refractory period is relatively high, and it steadily decreases as more sodium channels recover from the inactivation of the refractory period.

      Nodes of Ranvier are periodic holes in a myelinate axon when there is no myelin and the axonal membrane is exposed. There are no gated ion channels in the portion of the axon covered by the myelin sheath, but there is a high density of ion channels in the Nodes of Ranvier. Action potentials can only occur at the nodes as a result of this.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
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  • Question 25 - The first line drug for oral candidiasis is: ...

    Incorrect

    • The first line drug for oral candidiasis is:

      Your Answer:

      Correct Answer: Nystatin

      Explanation:

      Treatment for oral candidiasis is with nystatin mouthwash. In unresponsive cases, oral fluconazole is used

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 26 - Which of the following is NOT a typical feature of benzodiazepine toxicity: ...

    Incorrect

    • Which of the following is NOT a typical feature of benzodiazepine toxicity:

      Your Answer:

      Correct Answer: Hyperventilation

      Explanation:

      Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 27 - Glucagon may be used as an antidote for overdose with which of the...

    Incorrect

    • Glucagon may be used as an antidote for overdose with which of the following:

      Your Answer:

      Correct Answer: Beta blockers

      Explanation:

      Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
      Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
      Glucagon then causes:
      Glycogenolysis
      Gluconeogenesis
      Lipolysis in adipose tissue
      The secretion of glucagon is also stimulated by:
      Adrenaline
      Cholecystokinin
      Arginine
      Alanine
      Acetylcholine
      The secretion of glucagon is inhibited by:
      Insulin
      Somatostatin
      Increased free fatty acids
      Increased urea production

      Glycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.

      Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
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  • Question 28 - You review an 18-months-old child who seems to be having a reaction following...

    Incorrect

    • You review an 18-months-old child who seems to be having a reaction following an immunisation she took earlier in the day.

      Which statement concerning immunity and vaccination is true?

      Your Answer:

      Correct Answer: The strongest immunological response is seen with natural immunity

      Explanation:

      Vaccination induces ACTIVE adaptive immunity. Actively acquired immunity involves the development of an immune response either due to vaccination or natural exposure to a pathogen and leads to long-lasting resistance to infection.

      Immediate protection is achieved with injection of immunoglobulin. The protection is transient lasting only a few weeks and is useful as post-exposure prophylaxis.

      Passively acquired immunity usually leads to short-lasting resistance to infection because it does not involve a host immune response.

      With inactivated bacteria, a series of primary vaccinations is usually required to induce an adequate immune response. In most cases, boosters are required to sustain adequate immunity.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 29 - A 34-year-old male presents to the Emergency Department with the complaint of palpitations...

    Incorrect

    • A 34-year-old male presents to the Emergency Department with the complaint of palpitations and difficulty breathing, which started suddenly half an hour ago. His ECG shows findings of supraventricular tachycardia. You attempt vagal manoeuvres but cannot convert them back to sinus rhythm. Therefore, drug therapy is necessary to terminate the arrhythmia. Adenosine cannot be used in this patient because of a contra-indication listed in his medical record.

      Which one of the conditions listed below would be a contraindication in this case?

      Your Answer:

      Correct Answer: Asthma

      Explanation:

      Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor.

      It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour.

      Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 30 - An 11-year-old girl presents with a 5-day history of persistent fever despite regular...

    Incorrect

    • An 11-year-old girl presents with a 5-day history of persistent fever despite regular paracetamol, throbbing left ear pain, ear discharge and deafness. Her parents have observed that she is not her usual self, not eating well, and has been lethargic. On examination there is a tender swelling in the post auricular region on the left hand side.

      What is the most likely causative organism?

      Your Answer:

      Correct Answer: Streptococcus pneumonia

      Explanation:

      Acute mastoiditis is a complication (rare) of acute otitis media (AOM) and the commonest causative organism is Streptococcus pneumoniae.

      Generally, acute mastoiditis presents with:
      Pyrexia
      Recent history of AOM
      Mastoid swelling and erythema
      Otalgia
      Otorrhoea and perforation of tympanic membrane
      Post-auricular pain
      Protrusion of the ears

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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