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  • Question 1 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Correct

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm. IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm. For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      20.6
      Seconds
  • Question 2 - A 72 year old man is brought to ED by ambulance with sudden...

    Correct

    • A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:

      Your Answer: Synchronised DC cardioversion

      Explanation:

      All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      9.3
      Seconds
  • Question 3 - Adenosine is primarily indicated for which of the following: ...

    Correct

    • Adenosine is primarily indicated for which of the following:

      Your Answer: Paroxysmal supraventricular tachycardia

      Explanation:

      Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia including those associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      9.7
      Seconds
  • Question 4 - A patient has a cardiac output of 4.8 L/min and a heart rate...

    Incorrect

    • A patient has a cardiac output of 4.8 L/min and a heart rate of 80 bpm, therefore their stroke volume is:

      Your Answer: 40 mL

      Correct Answer: 60 mL

      Explanation:

      Cardiac output (CO) = Stroke volume (SV) x Heart rate (HR). Therefore SV = CO/HR = 4.8/80 = 0.06 L = 60 mL.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      12.4
      Seconds
  • Question 5 - Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms: ...

    Correct

    • Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms:

      Your Answer: Binds to beta1-receptors and causes increased Ca2+ entry via L-type channels during the action potential

      Explanation:

      Noradrenaline (the sympathetic neurotransmitter) is a positive inotrope; it binds to β1-adrenoceptors on the membrane and causes increased Ca2+entry via L-type channels during the AP and thus increases Ca2+release from the SR. Noradrenaline also increases Ca2+sequestration into the SR and thus more Ca2+is available for the next contraction. Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump which generates the Na+gradient required for driving the export of Ca2+; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction. Acidosis is negatively inotropic, largely because H+competes for Ca2+binding sites.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      12.7
      Seconds
  • Question 6 - Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:

      Your Answer: Increasing heart rate has a negative effect on contractility.

      Correct Answer: In relaxation, Ca 2+ is transported out of the cell using energy from a Na + gradient.

      Explanation:

      During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane which pumps one Ca2+ion out in exchange for three Na+ions in, using the Na+electrochemical gradient as an energy source. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Factors that affect intracellular [Ca2+] and hence cardiac contractility are called inotropes.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      17.1
      Seconds
  • Question 7 - What is the primary mode of action of Enoxaparin? ...

    Incorrect

    • What is the primary mode of action of Enoxaparin?

      Your Answer: Blocks GPIIb/IIIa receptor sites

      Correct Answer: Inhibits factor Xa

      Explanation:

      Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      6.9
      Seconds
  • Question 8 - Which of the following is NOT a pharmacological effect of beta-blockers: ...

    Correct

    • Which of the following is NOT a pharmacological effect of beta-blockers:

      Your Answer: Reduced AV conduction time

      Explanation:

      Effects of beta-blockers:Cardiovascular system: Reduce blood pressureReduce heart rate, contractility and cardiac outputIncrease AV conduction time, refractoriness and suppress automaticityEye:Reduce intraocular pressureRespiratory system:Cause bronchoconstriction

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      14
      Seconds
  • Question 9 - Digoxin exhibits its positive inotropic effect by which of the following mechanisms: ...

    Correct

    • Digoxin exhibits its positive inotropic effect by which of the following mechanisms:

      Your Answer: Inhibits the Na+/K+ pump on the myocyte membrane

      Explanation:

      Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump (Na+/K+ATPase) which generates the Na+gradient required for driving the export of Ca2+by Na+/Ca2+exchange; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      8.8
      Seconds
  • Question 10 - Blood flows from the left atrium into the left ventricle via: ...

    Correct

    • Blood flows from the left atrium into the left ventricle via:

      Your Answer: The mitral valve

      Explanation:

      Blood flows from the right atrium into the right ventricle via the tricuspid atrioventricular valve and from the left atrium into the left ventricle via the mitral atrioventricular valve. Blood is ejected from the right ventricle through the pulmonary semilunar valve into the pulmonary artery and from the left ventricle via the aortic semilunar valve into the aorta.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      17
      Seconds
  • Question 11 - As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction...

    Incorrect

    • As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction by activating which receptor?

      Your Answer: Alpha2

      Correct Answer: Alpha1

      Explanation:

      The rate of baroreceptor firing slows down when blood pressure falls too low. This causes an increase in sympathetic stimulation of the heart, resulting in an increase in cardiac output. It also causes vasoconstriction by activating alpha 1 receptors in smooth muscle, which causes sympathetic stimulation of peripheral vessels. Alpha2 receptors can be found in both the brain and the peripheral nervous system. They control sympathetic outflow in the brain stem. Beta1 receptors, which are found on the cell membrane of cardiac muscle cells, stimulate heart rate and myocardial contractility. The smooth muscle cell membrane contains beta2 receptors, which promote smooth muscle relaxation in the lungs causing bronchodilation, GI tract, and peripheral blood vessels.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      10.3
      Seconds
  • Question 12 - In ventricular myocytes, the plateau phase of the action potential comes about through which...

    Correct

    • In ventricular myocytes, the plateau phase of the action potential comes about through which of the following:

      Your Answer: Opening of voltage-gated Ca 2+ channels

      Explanation:

      After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      92.9
      Seconds
  • Question 13 - Discontinuous capillaries are typically found where in the body: ...

    Incorrect

    • Discontinuous capillaries are typically found where in the body:

      Your Answer: Renal glomeruli

      Correct Answer: Reticuloendothelial system

      Explanation:

      Discontinuous capillaries, found in the reticuloendothelial system (bone marrow, liver and spleen), have large gaps between endothelial cells and are permeable to red blood cells.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      6.3
      Seconds
  • Question 14 - All of the following are indications for beta-blockers EXCEPT for: ...

    Correct

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer: Raynaud's disease

      Explanation:

      Beta-blockers are contraindicated in Raynaud’s syndrome. Beta-blockers may be indicated in:HypertensionPheochromocytoma (only with an alpha-blocker)AnginaSecondary prevention after ACSArrhythmias including atrial fibrillationHeart failureThyrotoxicosisAnxietyProphylaxis of migraineEssential tremorGlaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      15
      Seconds
  • Question 15 - Which of the following drugs is first line treatment for a stable regular...

    Correct

    • Which of the following drugs is first line treatment for a stable regular broad-complex tachycardia:

      Your Answer: Amiodarone

      Explanation:

      A regular broad-complex tachycardia is likely to be ventricular tachycardia or a regular supraventricular rhythm with bundle branch block. A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours. If previously confirmed as SVT with bundle branch block, the patient should be treated as for narrow-complex tachycardia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      49.6
      Seconds
  • Question 16 - Which of the following represents ventricular repolarisation on the ECG: ...

    Incorrect

    • Which of the following represents ventricular repolarisation on the ECG:

      Your Answer: ST segment

      Correct Answer: T wave

      Explanation:

      P wave = Atrial depolarisationQRS complex = Ventricular depolarisationT wave = Ventricular repolarisation

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      7
      Seconds
  • Question 17 - Mannitol is primarily indicated for which of the following: ...

    Incorrect

    • Mannitol is primarily indicated for which of the following:

      Your Answer: Hypertension

      Correct Answer: Cerebral oedema

      Explanation:

      Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intraocular pressure. Mannitol is a low molecular weight compound and is, therefore, freely filtered at the glomerulus and is not reabsorbed. It, therefore, 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).

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      38.7
      Seconds
  • Question 18 - An elderly patient presents to ED following a fall after feeling light headed...

    Incorrect

    • An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:

      Your Answer: Thin ascending limb

      Correct Answer: Thick ascending limb

      Explanation:

      Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      18.7
      Seconds
  • Question 19 - Regarding postural hypotension, which of the following statements is INCORRECT: ...

    Correct

    • Regarding postural hypotension, which of the following statements is INCORRECT:

      Your Answer: Postural hypotension usually causes a reflex bradycardia.

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      50.1
      Seconds
  • Question 20 - 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: The lymphatic system empties into the thoracic duct, which in turn empties into the jugular vein.

      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
      179.7
      Seconds
  • Question 21 - All of the statements regarding vascular tone are correct except: ...

    Correct

    • All of the statements regarding vascular tone are correct except:

      Your Answer: Most endogenous vasodilators act by decreasing levels of cAMP or cGMP.

      Explanation:

      Most vasoconstrictors bind to G-protein coupled receptors. These mediate elevation in intracellular [Ca2+] which leads to vascular smooth muscle contraction. Important vasoconstrictors include noradrenaline, endothelin-1 and angiotensin II. Increased intracellular Ca2+ is as a result of the release of Ca2+from the sarcoplasmic reticulum and depolarisation and entry of Ca2+via L-type voltage-gated Ca2+channels. Most types of vascular smooth muscle do not generate action potentials – instead, the depolarisation is graded, which allows graded entry of Ca2+.sequestration by the sarcoplasmic reticulum Ca2+ATPase, removal from the cell by a plasma membrane Ca2+ATPase and Na+/Ca2+exchange decreases intracellular Ca2+, resulting in vasodilation. Relaxation is a result of most endogenous vasodilators when there is an increase in cyclic guanosine monophosphate (cGMP) like nitric oxide) or cyclic adenosine monophosphate (cAMP) like prostacyclin and beta-adrenergic receptor agonists. These activate protein kinases causing substrate level phosphorylation. Clinically effective vasodilators are L-type Ca2+channel blocker drugs.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      123.3
      Seconds
  • Question 22 - Which of the following causes the first heart sound? ...

    Incorrect

    • Which of the following causes the first heart sound?

      Your Answer: Opening of the semilunar valves

      Correct Answer: Closing of the atrioventricular valves

      Explanation:

      The heart sounds are as a result of the various parts of the cardiac cycle.Heart Sound – Phase of Cardiac Cycle – Mechanical Event:1st heart sound – Systole starts – there is closure of the atrioventricular (mitral & tricuspid) valves2nd heart sound – Systole ends – there is closure of the semilunar (aortic and pulmonary) valves3rd heart sound – Early diastole – this is caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase4th heart sound – Late diastole – this is caused by filling of an abnormally stiff ventricle in atrial systole

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      35.6
      Seconds
  • Question 23 - What is the mechanism of action of captopril: ...

    Correct

    • What is the mechanism of action of captopril:

      Your Answer: Angiotensin-converting enzyme inhibitor

      Explanation:

      Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      10.6
      Seconds
  • Question 24 - What is the direct mechanism of action of digoxin as a positive inotrope:...

    Correct

    • What is the direct mechanism of action of digoxin as a positive inotrope:

      Your Answer: Inhibition of Na+/K+ ATPase pump

      Explanation:

      Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      5.3
      Seconds
  • Question 25 - Adenosine has a half-life of approximately: ...

    Incorrect

    • Adenosine has a half-life of approximately:

      Your Answer: 30 minutes

      Correct Answer: 8 - 10 seconds

      Explanation:

      Adenosine stimulates A1-adenosine receptors and opens acetylcholine sensitive K+ channels, increasing K+ efflux. This hyperpolarises the cell membrane in the atrioventricular node and, by inhibiting the calcium channels, slows conduction in the AVN. As it has a very short duration of action (half-life only about 8 – 10 seconds), most side effects are short lived.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      6.5
      Seconds
  • Question 26 - Myocardial contractility is best correlated with the intracellular concentration of: ...

    Correct

    • Myocardial contractility is best correlated with the intracellular concentration of:

      Your Answer: Ca2+

      Explanation:

      Contractility of myocardial cells depends on the intracellular [Ca2+], which is regulated by Ca2+entry across the cell membrane during the plateau of the action potential and by Ca2+uptake into and release from the sarcoplasmic reticulum (SR).

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      3.3
      Seconds
  • Question 27 - 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: It has a lower associated risk of heparin-induced thrombocytopenia.

      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
      38.3
      Seconds
  • Question 28 - Cardiac myocytes are connected to each other by which of the following: ...

    Incorrect

    • Cardiac myocytes are connected to each other by which of the following:

      Your Answer: Microglia

      Correct Answer: Intercalated discs

      Explanation:

      Adjacent cardiac myocytes are connected to each other by intercalated discs. The intercalated discs provide both a structural attachment by ‘glueing’ cells together at desmosomes and an electrical contact made up of proteins called connexons, called a gap junction, which essentially creates a low-resistance pathway between cells.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      10.3
      Seconds
  • Question 29 - Regarding calcium channel blockers, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding calcium channel blockers, which of the following statements is CORRECT:

      Your Answer: In cases of refractory hypertension, verapamil can be used in combination with a beta-blocker.

      Correct Answer: Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle causing vasodilation.

      Explanation:

      Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle, causing relaxation and vasodilation (reduction in peripheral vascular resistance). They also block calcium channels within the myocardium and conducting tissues of the heart which produces a negative inotropic effect by reducing calcium influx during the plateau phase of the action potential. They have a variety of uses, including:HypertensionAnginaAtrial fibrillationMigraineCalcium channel blockers have been found to be moderately useful in the prevention of migraines. The best evidence is for this is with verapamil. This may be due to the prevention of the arteriolar constriction that is associated with migraine. They are commonly used for this elsewhere in the world but are not currently licensed for this use in the UK.The following are common side effects of all calcium-channel blockers:Abdominal painDizzinessDrowsinessFlushingHeadacheNausea and vomitingPalpitationsPeripheral oedemaSkin reactionsTachycardiaVerapamil is highly negatively inotropic and reduces cardiac output, slows the heart rate and may impair atrioventricular conduction. It may precipitate heart failure, exacerbate conduction disorders, and cause hypotension at high doses and should not be used with beta-blockers. Nifedipine has less myocardial effects than verapamil and has no antiarrhythmic properties but has more influence on the vessels. Nimodipine is used solely for the prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      153.1
      Seconds
  • Question 30 - Regarding fibrinolytics, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: Tenecteplase has a longer half-life than alteplase allowing for bolus administration.

      Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.

      Explanation:

      Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      22.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (15/30) 50%
Pharmacology (8/15) 53%
Physiology (7/15) 47%
Passmed