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Question 1
Incorrect
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The triage nurse asks if you will prescribe a dose of codeine phosphate for a patient who is in a lot of pain. You discover that you are unable to prescribe it due to a contra-indication after evaluating the patient.The use of codeine phosphate is contraindicated in which of the following situations?
Your Answer: Irritable bowel syndrome
Correct Answer: Age under 12 years
Explanation:Codeine phosphate is a mild opiate that can be used to treat mild to moderate pain when other pain relievers like paracetamol or ibuprofen have failed. It can also be used to treat diarrhoea and coughs that are dry or painful.The use of all opioids is contraindicated for the following reasons:Respiratory depression (acute)Patients who are comatoseHead injury (opioid analgesics impair pupillary responses, which are crucial for neurological evaluation)Intracranial pressure has risen (opioid analgesics interfere with pupillary responses vital for neurological assessment)There’s a chance you’ll get paralytic ileus.The use of codeine phosphate is contraindicated in the following situations:Because of the significant risk of respiratory side effects in children under the age of 12, it is not recommended for children under the age of 12.Patients of any age who have been identified as ultra-rapid codeine metabolizers (CYP2D6 ultra-rapid metabolizers)Because codeine can pass through breast milk to the baby and because mothers’ ability to metabolise codeine varies greatly, it is especially dangerous in breastfeeding mothers.If other painkillers, such as paracetamol or ibuprofen, fail to relieve acute moderate pain in children over the age of 12, codeine should be used. In children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy, a significant risk of serious and life-threatening adverse reactions has been identified.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 2
Correct
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Low levels of which of the following arterial blood gas parameters stimulate the peripheral chemoreceptors?
Your Answer: Arterial pO 2
Explanation:Chemoreceptors are activated when the chemical composition of their immediate surroundings changes. Peripheral chemoreceptors, together with central chemoreceptors, regulate respiratory functions. They detect changes in arterial blood oxygen levels. Decreased arterial Po2 (partial pressure of oxygen) reflexly stimulates peripheral chemoreceptors. When peripheral chemoreceptors detect changes in arterial blood oxygen, they will trigger cardiorespiratory changes such as an increase in breathing and blood pressure. These reflexes are important for maintaining homeostasis during hypoxemia.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 3
Incorrect
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At the start of the cardiac cycle, towards the end of diastole, all of the following statements are true EXCEPT for:
Your Answer: The atrial pressure is greater than the ventricular pressure.
Correct Answer: The semilunar valves are open.
Explanation:At the start of the cardiac cycle, towards the end of diastole, the whole of the heart is relaxed. The atrioventricular (AV) valves are open because the atrial pressure is still slightly greater than the ventricular pressure. The semilunar valves are closed, as the pressure in the pulmonary artery and aorta is greater than the ventricular pressures. The cycle starts when the sinoatrial node (SAN) initiates atrial systole.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 4
Incorrect
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When a child has chickenpox, how long should he or she be off from school?
Your Answer: 48 hours after rash has resolved
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.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
Correct
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A 7-days-old neonate is taken to the emergency department. She's pyretic, lethargic, and unresponsive, and her fontanelle has bulged. Antibiotics are started, and a lumbar puncture reveals Gram-negative rods. Which pathogen is most likely to be the cause:
Your Answer: Escherichia coli
Explanation:Among neonates, group B streptococci (GBS) are the most commonly identified causes of bacterial meningitis, implicated in roughly 50% of all cases. Escherichia coli(Gram-negative rods) accounts for another 20%. Thus, the identification and treatment of maternal genitourinary infections is an important prevention strategy.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 6
Incorrect
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A 52-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.Which of the following is NOT a contraindication to abciximab (ReoPro) treatment?
Your Answer: Stroke within the last 2 years
Correct Answer: Major surgery within the last 6 months
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.The use of abciximab is contraindicated in the following situations:Internal bleeding is present.Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.Stroke in the previous two yearsIntracranial tumourAneurysm or arteriovenous malformationHaemorrhagic diathesis is a type of haemorrhagic diathesis.VasculitisRetinopathy caused by hypertension
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 7
Correct
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A 43 year old lady suffering with idiopathic thrombocytopenic purpura has a splenectomy. She is advised to get the Pneumococcal vaccine booster every 5 - 10 years as Streptococcus pneumoniae has which of the following properties that make her prone to infection to this organism?
Your Answer: It is encapsulated
Explanation:There is a lifelong susceptibility to increased risk of infection from a variety of organisms in patients with hyposplenism, especially in children under 5 years and those with sickle cell anaemia. Patients are most susceptible is to the encapsulated bacteria Streptococcus pneumoniae, Haemophilus influenzae type B and Neisseria meningitidis. Streptococcus pneumoniae is particular concerning as it can cause rapid and fulminant disease, which can be fatal. Malaria and animal bites that become infected also tend to be more severe.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 8
Incorrect
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An 11-year-old presented to a GP with a history of headache, neck stiffness and photophobia. On examination, HR is 122, BP is 87/42, RR is 28, SaO 2 is 95%, temperature is 39.4 o C. There is a recent petechial rash on legs and arms. The GP administered a dose of antibiotics in the prehospital setting before transferring to the Emergency Department.Which of these would the GP have administered?
Your Answer: IM benzylpenicillin 1.2 g
Correct Answer: IM benzylpenicillin 600 mg
Explanation:General Practitioners are advised to give a single injection of benzylpenicillin by intravenous or intramuscular injection before transferring the patient urgently to the ED when bacterial meningitis is suspected.The recommended doses are:Infants under 1 year: 300 mgChildren ages 1 to 9 years: 600 mgChildren aged 10 years and over: 1.2gAdults: 1.2g
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 9
Incorrect
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Regarding flow through a tube, which of the following statements is CORRECT:
Your Answer: Poiseuille's law states that flow is dependent on the pressure difference across the ends of a tube and the resistance provided by the tube.
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.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 10
Incorrect
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A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer: Superior cerebellar artery
Correct Answer: Basilar artery
Explanation:The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 11
Incorrect
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Regarding cross-sectional studies, which of the following statements is CORRECT:
Your Answer: They are useful for considering trends over time.
Correct Answer: They are particularly suitable for estimating point prevalence.
Explanation:Cross-sectional studies aim to provide data about population health, normal ranges of biological parameters, and disease prevalence or severity by observing the entire population, or a representative subset, at a single point in time. Cross-sectional studies are relatively simple and quick to perform and can be used to study multiple outcomes, but are subject to confounding and recall bias and are not suitable for studying rare diseases. Cross-sectional studies cannot be used to assess causation or to consider trends over time.
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 12
Correct
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A 32-year-old asthmatic patient on theophylline as part of her asthma management presents to the Emergency Department with an unrelated medical condition.Which of these drugs should be avoided?
Your Answer: Clarithromycin
Explanation:Macrolide antibiotics (e.g. clarithromycin and erythromycin) are cytochrome P450 enzyme inhibitors. They increase blood levels of theophylline leading to hypokalaemia, and potentially increasing the risk of Torsades de pointes when they are prescribed together. Co-prescription with theophylline should be avoided.Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin. Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 13
Correct
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Fusidic acid is primarily indicated for infections caused by which of the following microorganisms:
Your Answer: Staphylococcal infections
Explanation:Fusidic acid is a narrow spectrum antibiotic used for staphylococcal infections, primarily topically for minor staphylococcal skin (impetigo) or eye infection. It is sometimes used orally for penicillin-resistant staphylococcal infection, including osteomyelitis or endocarditis, in combination with other antibacterials.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 14
Correct
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Approximately how long is the duration of a lidocaine block (when given with adrenaline):
Your Answer: 90 minutes
Explanation:Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 15
Incorrect
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Which of the following is NOT a typical complication associated with mumps:
Your Answer: Meningitis
Correct Answer: Subacute sclerosing panencephalitis
Explanation:Complications of mumps include meningitis, post meningitis deafness, encephalitis, pancreatitis, orchitis and oophoritis. Subacute sclerosing panencephalitis is a complication typically associated with measles infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 16
Incorrect
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A patient with a central line in situ for the past 10 days now has erythema surrounding the catheter insertion site and shows signs of sepsis. You suspect line sepsis.Which of these antibacterial agents would be most appropriate to prescribe for this patient?
Your Answer: Co-amoxiclav
Correct Answer: Vancomycin
Explanation:The current recommendation by NICE and the BNF is to use vancomycin as first-line in treatment of septicaemia related to vascular catheter. A broad-spectrum antipseudomonal beta-lactam antibiotic should be added to vancomycin if a Gram-negative sepsis is suspected especially in an immunocompromised patient.In any patient that has had a central venous catheter in situ for a period longer than a week, it should be suspected as the source of sepsis.The features suggesting the vascular catheter as the source of infection include:Presence of the catheter before onset of fever.The absence of another identifiable source of infection.Presence of inflammation or purulent material at the insertion site or along the tunnel.An immunocompetent patient without any underlying disease developing bacteraemia (or fungaemia).
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 17
Incorrect
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Lidocaine's antiarrhythmic mode of action is as follows:
Your Answer: Blocks open Na+ channels
Correct Answer: Blocks inactivated Na+ channels
Explanation:Lidocaine is a class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity. However, in ischaemic areas, where anoxia causes depolarisation and arrhythmogenic activity, many Na+ channels are inactivated and therefore susceptible to lidocaine.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 18
Incorrect
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Which of the following best describes the positive predictive value of a diagnostic test:
Your Answer:
Correct Answer: The proportion of individuals with a positive test result who have the disease
Explanation:Positive predictive value (PPV) is the proportion of individuals with a positive test result who actually have the disease.PPV = a/(a+b)
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 19
Incorrect
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The hypothalamus produces antidiuretic hormone (ADH), also known as vasopressin, which is a peptide hormone. It is important for maintaining water and electrolyte balance, as well helping control arterial pressure.To have an effect on blood arteries, ADH binds to which of the following receptors?
Your Answer:
Correct Answer: V 1 receptor
Explanation:ADH, or antidiuretic hormone, is a hormone that regulates water and electrolyte balance. It is released in response to a variety of events, the most important of which are higher plasma osmolality or lower blood pressure. ADH increases plasma volume and blood pressure via acting on the kidneys and peripheral vasculature.It causes vasoconstriction by binding to peripheral V1 Receptors on vascular smooth muscle via the IP3 signal transduction and Rho-kinase pathways. The systemic vascular resistance and arterial pressure rise as a result. High levels of ADH appear to be required for this to have a major impact on arterial pressure, such as in hypovolaemic shock.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 20
Incorrect
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The fracture of the medial epicondyle will cause damage to the ulnar nerve. Which of the following motions would be impaired by this type of injury?
Your Answer:
Correct Answer: Adduction of the thumb
Explanation:Fracture of the medial epicondyle is most likely to result in damage to the ulnar nerve. The three hypothenar muscles, two medial lumbricals, seven interossei, the adductor pollicis, and the deep head of the flexor pollicis brevis are all innervated by the deep branch of the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY
