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Question 1
Incorrect
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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: Glucuronidation
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.
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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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A patient with history of weight loss and diarrhoea was found out to have Giardia lamblia in her stool since returning from a holiday to Nepal.Which of the following statements is considered true regarding the life cycle of Giardia lamblia?
Your Answer: Trophozoites attach to the intestinal wall via a specialised sucking disc
Explanation:Cysts are resistant forms and are responsible for transmission of giardiasis. Both cysts and trophozoites can be found in the faeces (diagnostic stages). The cysts are hardy and can survive several months in cold water. Infection occurs by the ingestion of cysts in contaminated water, food, or by the faecal-oral route (hands or fomites). In the small intestine, excystation releases trophozoites (each cyst produces two trophozoites).Trophozoites multiply by longitudinal binary fission, remaining in the lumen of the proximal small bowel where they can be free or attached to the mucosa by a ventral sucking disk.Encystation occurs as the parasites transit toward the colon. The cyst is the stage found most commonly in non diarrheal faeces.Because the cysts are infectious when passed in the stool or shortly afterward, person-to-person transmission is possible. While animals are infected with Giardia, their importance as a reservoir is unclear.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 3
Correct
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What type of visual field defect are you most likely to see in a lesion of the parietal optic radiation:
Your Answer: Contralateral homonymous inferior quadrantanopia
Explanation:A lesion of the parietal optic radiation will result in a contralateral homonymous inferior quadrantanopia.A lesion of the temporal optic radiation will result in a contralateral homonymous superior quadrantanopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 4
Correct
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A 59-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 abciximab (ReoPro) mechanism of action?
Your Answer: Antagonism of the glycoprotein IIb/IIIa receptor
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.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 5
Incorrect
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The results from the study investigating the accuracy of a new diagnostic test can be displayed in the following format. How is the positive predictive value calculated:Those with diseaseThose without diseaseTotalTest positiveaba+bTest negativecdc+dTotala+cb+dn=a+b+c+d
Your Answer: a/(a+c)
Correct Answer: a/(a+b)
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 6
Correct
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For which of the following class of drugs can neostigmine be used as a reversal agent?
Your Answer: Non-depolarising muscle relaxants
Explanation:Neostigmine is used specifically for reversal of nondepolarizing (competitive) blockade and is anticholinesterase. It acts within one minute of intravenous injection, and the effects last for 20 to 30 minutes. After this time period, a second dose may then be necessary.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 7
Correct
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A 52-year-old woman visits her local pharmacy to get medication to help with mild dyspepsia symptoms. The pharmacist on duty suggests she uses an over-the-counter antacid. She purchases an antacid that contains magnesium carbonate, which relieves her symptoms, but she unfortunately also develops a side effect.Out of the following, which side effect is she MOST likely to develop after using the antacid?
Your Answer: Diarrhoea
Explanation:Magnesium carbonate is an over the counter antacid commonly used to relieve symptoms in ulcer dyspepsia and non-erosive gastro-oesophageal reflux.Antacids containing magnesium also tend to work as a laxative, while the antacids with aluminium may cause constipation. There is no significant increased risk of anaphylaxis, hepatotoxicity or renal impairment.
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 8
Correct
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Dehydration causes a significant increase in the amount of this hormone?
Your Answer: Antidiuretic hormone
Explanation:Antidiuretic hormone induces the kidneys to release less water, resulting in reduced urine production. In the case of dehydration, ADH levels rise, resulting in a considerable decrease in urine output as well as an increase in plasma protein, blood Hct, and serum osmolality.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 9
Incorrect
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A 72-year-old woman presents to your clinic with worsening oedema. She is a known case of ischaemic heart disease and heart failure.You decide to add a loop diuretic to her current drug regime to control the oedema. Of the following, what is a contraindication to using a loop diuretic?
Your Answer: Hypotension
Correct Answer: Anuria
Explanation:Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:FurosemideBumetanideTorsemideEthacrynic AcidLoop diuretics inhibit the Na-K-Cl pump in the ascending loop of Henle, resulting in salt-water excretion. This relieves congestion and reduces oedema. The contra-indications to the use of loop diuretics are:1. Anuria2. Comatose and precomatose states associated with liver cirrhosis3. Renal failure due to nephrotoxic or hepatotoxic drugs4. Severe hypokalaemia5. Severe hyponatremia6. History of hypersensitivity to furosemide, bumetanide, or torsemide (or sulphonamides)The following conditions or states are not contraindications, but loop diuretics needs to be used cautiously in these conditions:1. Diabetes (but hyperglycaemia less likely than with thiazides)2. Gout3. Hypotension (correct before initiation of treatment)4. Hypovolaemia (Correct before initiation of treatment)
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 10
Incorrect
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An elderly female has a bacterial infection and you are asked to prescribe an antibiotic to her. This antibiotic is a nucleic acid synthesis inhibitor.Which of the following antimicrobial drugs will be prescribed to this patient?
Your Answer: Erythromycin
Correct Answer: Metronidazole
Explanation:Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA. Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors. Erythromycin inhibits protein synthesis and blocks translocation by binding to the 23S rRNA of the 50S ribosomal subunit.Chloramphenicol blocks peptidyl transferase at 50S ribosomal subunit.Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA and thus preventing initiation of protein synthesis.An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:1. Inhibition of cell wall synthesis- Penicillins- Cephalosporins- Vancomycin2. Disruption of cell membrane function- Polymyxins- Nystatin- Amphotericin B3. Inhibition of protein synthesis- Macrolides- Aminoglycosides- Tetracyclines- Chloramphenicol4. Inhibition of nucleic acid synthesis- Quinolones- Trimethoprim- 5-nitroimidazoles- Rifampicin5. Anti-metabolic activity- Sulphonamides- Isoniazid
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 11
Correct
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A 19-year-old student that has presented with a headache and a petechial rash is diagnosed with meningitis caused by Neisseria meningitidis.Which SINGLE statement regarding Neisseria meningitidis is true?
Your Answer: Lipo-oligosaccharide activates complement activation and cytokine release
Explanation:Neisseria meningitidisis is a Gram-negative diplococcusc that can cause meningococcal meningitis.Carriage of Neisseria meningitidisis very common and it exists in the normal flora in the nasopharynx in 5 – 15% of adults. Actual disease only develops in a very small percentage of individuals. Infection is most common in the winter months and epidemics tend to occur about once every 10 years.Most invasive infections are caused by serotypes A, B or C. In the UK, most cases of meningococcal septicaemia are caused byNeisseria meningitidisgroup B. The vaccination programme forNeisseria meningitidisgroup C has made this type much less common. A vaccine for group B disease has now been initiated in children.The main determinant of the pathogenicity of Neisseria meningitidisis the antiphagocytic polysaccharide capsule. Meningococci cross mucosal epithelium by endocytosis and the capsule allows survival in the bloodstream. Lipo-oligosaccharide activates complement activation and cytokine release, resulting in shock and disseminated intravascular coagulation (DIC).Theclinical featuresof meningococcal meningitis include:Non-blanching rashNeck stiffnessHeadachePhotophobiaAltered mental state (drowsiness, confusion)Focal neurological deficitsSeizuresSeptic shockThe diagnosis is usually made clinically and confirmed by culture of blood, aspirate from the rash and CSF. Rapid antigen detection or nucleic acid amplification testing (NAAT) on blood and CSF are both sensitive and reliable.Due to the potentially life-threatening nature of the disease treatment should not wait for laboratory confirmation and antibiotics should be started immediately. In the hospital setting IV ceftriaxone (2 g adult; 80 mg/kg child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the preferred agents. IM benzylpenicillin can be given as an alternative in the pre-hospital setting and chloramphenicol is a suitable alternative if there is a history of anaphylaxis to cephalosporins. Treatment does not eradicate carriage and the patient should be given ‘prophylaxis’ following recovery.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 12
Correct
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Langhans giant cells, seen in granulomatous inflammation. are:
Your Answer: Multinucleated cells formed from fusion of epithelioid cells
Explanation:A granuloma is a collection of five or more epithelioid macrophages, with or without attendant lymphocytes and fibroblasts; epithelioid macrophages are altered macrophages which have turned themselves over to becoming giant phagocytosing and killing machines, they often fuse to become multinucleate (Langhans) giant cells.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 13
Correct
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Intravenous glucose solutions are typically used in the treatment of all of the following situations except:
Your Answer: Hypokalaemia
Explanation:In hypokalaemia, initial potassium replacement therapy should not involve glucose infusions, as glucose may cause a further decrease in the plasma-potassium concentration. Glucose infusions are used for the other indications like diabetic ketoacidosis, hypoglycaemia, routine fluid maintenance in patients who are nil by mouth (very important in children), and in hyperkalaemia.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 14
Incorrect
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Salivary glands produce saliva which is mostly water, but it also contains a range of essential chemicals such as mucus, electrolytes, antibiotic agents, and enzymes.Which of the following is a carbohydrate-digesting enzyme found in saliva?
Your Answer: Carboxypeptidase
Correct Answer: Amylase
Explanation:The acinar cells of the parotid and submandibular glands release amylase. Amylase begins starch digestion before food is even eaten, and it works best at a pH of 7.4.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 15
Incorrect
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Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:
Your Answer: Charles's law
Correct Answer: Dalton's law
Explanation:Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 16
Incorrect
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One of these statements about cohort studies is true:
Your Answer: They look at groups of patients with the disease being studied
Correct Answer: They are longitudinal in nature
Explanation:A cohort study is a longitudinal, observational study. It follows a group of patients (the cohort) forward in time and monitors the effects of the aetiological factor under study upon them.Cohort studies are usually of longer duration and are more expensive than case-control studies. They, however, provide more useful and reliable information.Cohort studies follow a cohort of patients who don’t have a disease and evaluate the absolute and relative risk of contracting the disease after exposure to the aetiological agent.Cross-sectional studies are the best way to determine the prevalence of a disease. while Cohort studies are better at determining the incidence of a disease.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 17
Correct
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Fat necrosis is typically seen in which of the following:
Your Answer: Acute pancreatitis
Explanation:Fat necrosis typically occurs following either direct trauma or from enzymatic lipolysis in acute pancreatitis, where release of triglyceride elicits a rapid inflammatory response and fat is phagocytosed by neutrophils and macrophages with subsequent fibrosis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 18
Incorrect
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The qSOFA score is a bedside prompt designed to identify patients with suspected infection who are at greater risk for a poor outcome outside of the intensive care unit.Which of the following is one of the criteria used in the qSOFA score? Select ONE answer only.
Your Answer: Temperature >38°C
Correct Answer: Respiratory rate >22
Explanation:In February 2016 the Society of Critical Care Medicine published a JAMA article reformatting the definitions of sepsis in an attempt to overcome the shortcomings of the old definitions.The main changes are a new definition of sepsis, the replacement of the SIRS criteria with the quick Sepsis-related Organ Failure Assessment (qSOFA), and the complete removal of “severe sepsis” as an entity.The new definition of sepsis is that it is “life-threatening organ dysfunction caused by a dysregulated host response to infection.”Septic shock is “a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to increase mortality.”In essence this means that septic shock is sepsis plus the following, despite adequate fluid resuscitation:Vasopressors required to maintain a MAP > 65 mmHgSerum lactate > 2 mmol/lThe qSOFA score is a bedside prompt designed to identify patients with suspected infection who are at greater risk for a poor outcome outside of the intensive care unit. It uses the following three criteria:Hypotension (SBP < 100 mmHg)Tachypnoea (RR > 22)Altered mental status (GCS < 15)The presence of 2 or more of the qSOFA criteria near the onset of infection is associated with greater risk of death or a prolonged intensive care unit stay.
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This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 19
Incorrect
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Which of the following is NOT a mineralocorticoid effect of corticosteroids:
Your Answer: Calcium loss
Correct Answer: Hyperglycaemia
Explanation:Mineralocorticoid side effects include:hypertensionsodium retentionwater retention and oedemapotassium losscalcium lossGlucocorticoid side effects include:weight gainhyperglycaemia and diabetesosteoporosis and osteoporotic fracturesmuscle wasting (proximal myopathy)peptic ulceration and perforationpsychiatric reactions
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 20
Correct
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A 28 year old man presents with abdominal pain and constipation, and bloods show hypocalcaemia. Which of the following hormones is increased as a result of hypocalcaemia?
Your Answer: Parathyroid hormone
Explanation:Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone that is secreted by the parathyroid glands, which lie immediately behind the thyroid gland. In particular, this hormone is made by chief cells. It regulates the serum calcium concentration through its effects on bone, kidney, and intestine. This hormone is primarily released in response to decreasing plasma Ca2+ concentration and it serves to increase plasma calcium levels and decrease plasma phosphate levels.PTH activates Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane and as a result, increases calcium reabsorption in the distal tubule of the nephron. It inhibits reabsorption of phosphate and this increases its excretion by in the proximal tubule of the nephron.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 21
Correct
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Which of the following is NOT a typical feature of benzodiazepine toxicity:
Your Answer: Hyperventilation
Explanation:Features of benzodiazepine toxicity include: drowsiness, ataxia, dysarthria, nystagmus, occasionally respiratory depression and coma
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 22
Incorrect
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and superior oblique
Correct Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 23
Correct
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Gastric emptying is increased by all of the following EXCEPT for:
Your Answer: Secretin
Explanation:Gastric emptying is increased by:Distension of the pyloric antrumA fall in the pH of chyme in the stomachParasympathetic stimulation (via vagus)GastrinThe hormones secretin, cholecystokinin and gastric inhibitory polypeptide (GIP) inhibit gastric emptying.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 24
Incorrect
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A 40-year-old female presents to the orthopaedic clinic complaining of pain and limited range of motion in the right elbow for the past two days. On examination, the right elbow is extremely tender with erythema and warmth of the overlying skin due to acute inflammation. Which ONE of the following statements is true with regards to acute inflammation?
Your Answer: Neutrophils flow in the axial stream during margination
Correct Answer: Neutrophils are activated and adhere to the endothelium as a result of interaction with endothelial cell adhesion molecules
Explanation:Acute inflammation is defined as inflammation occurring within minutes to hours in response to an injury lasting for less than two weeks. Acute inflammation Rapid onset (minutes to hours)Quick resolution (usually days)Chronic inflammationMay last weeks, months, or yearsThere are five cardinal signs of inflammation:1) Pain2) Redness3) Warmth4) Oedema5) Loss of functionDuring acute inflammation, neutrophils are activated and attracted to the site of inflammation in response to various interleukins and cytokines. This process takes place via the following mechanism:1) MarginationNeutrophils flow nearer the vessel wall rather than in the axial stream, which is referred to as margination2) Rolling along the surface of vascular endothelium3) Adhesion to the endothelium by interaction with adhesion molecules (ICAMS and VCAMS)4) Diapedesis is the movement of neutrophils from the endothelial cells into the interstitial space by squeezing through the gaps between adjacent endothelial cellsBradykinin and histamine are both responsible for vasodilation which causes oedema and decreases intravascular osmotic pressure.Neutrophils dominate early (2 days)- Live longer- Replicate in tissues
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 25
Correct
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A patient who was put on low molecular weight heparin for suspected DVT and was scheduled for an ultrasound after the weekend, arrives at the emergency department with significant hematemesis. Which of the following medications can be used as a heparin reversal agent:
Your Answer: Protamine sulfate
Explanation:The management of bleeding in a patient receiving heparin depends upon the location and severity of bleeding, the underlying thromboembolic risk, and the current aPTT (for heparin) or anti-factor Xa activity (for LMW heparin). As an example, a patient with minor skin bleeding in the setting of a mechanical heart valve (high thromboembolic risk) and a therapeutic aPTT may continue heparin therapy, whereas a patient with major intracerebral bleeding in the setting of venous thromboembolism several months prior who is receiving heparin bridging perioperatively may require immediate heparin discontinuation and reversal with protamine sulphate. If haemorrhage occurs it is usually sufficient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulphate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Clinician judgment and early involvement of the appropriate consulting specialists is advised.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 26
Incorrect
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Which of the following statements is correct with regards to Horner's syndrome?
Your Answer: Ptosis occurs due to paralysis of the levator palpebrae superioris muscle.
Correct Answer: Miosis occurs due to paralysis of the dilator pupillae muscle.
Explanation:The characteristics of Horner’s syndrome are pupil constriction, partial ptosis and anhidrosis.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 27
Incorrect
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A 2-day-old male is referred to a tertiary care hospital by the community midwife after a home visit due to jaundice and dyspnoea. After history and examination, the relevant blood work is performed, and the baby is found to have conjugated hyperbilirubinemia. The paediatric team suspects a hepatic origin for jaundice based on the findings. Which one of the following aetiologies is the most likely cause of jaundice in this case?
Your Answer: Biliary atresia
Correct Answer: Alpha 1-antitrypsin deficiency
Explanation:The presence of dyspnoea makes alpha-1 antitrypsin deficiency the more likely diagnosis as biliary atresia does not cause respiratory symptoms. Deficiency of the enzyme alpha-1 antitrypsin causes uninhibited elastase activity and a decrease in elastic tissue. This causes liver cirrhosis leading to an elevation of conjugated bilirubin and emphysema in the lungs.Rhesus disease, hereditary spherocytosis and breast milk jaundice cause an elevation of unconjugated bilirubin thus ruling it out in this case. Breast milk jaundice occurs due to an inability of the newborn to metabolize the proteins in breast milk. Rhesus disease occurs when an Rh negative mother gives birth to an Rh positive baby. The jaundice would have been accompanied by anaemia and oedema. Hereditary spherocytosis occurs due to extravascular haemolysis as defective RBCs are removed by the spleen. The patient would present with jaundice, splenomegaly and possibly an aplastic crisis (if Parvovirus B19 infection).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 28
Correct
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Ipratropium bromide should be used with caution in patients with which of the following conditions:
Your Answer: Prostatic hyperplasia
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma)
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 29
Correct
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A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.Which statement about ipratropium bromide is true?
Your Answer: It can trigger acute closed-angle glaucoma
Explanation:Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD. It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists. It can trigger acute closed-angle glaucoma in patients that are susceptible. First-line treatment for moderate asthma attacks is short-acting β2agonists.The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 30
Correct
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Which of the following ions is more abundant in extracellular fluid than in intracellular fluid:
Your Answer: Cl -
Explanation:Protein and phosphate are the primary intracellular anions, while chloride (Cl-) and bicarbonate are the predominant extracellular anions (HCO3-).
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 31
Incorrect
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Which of the following nerves supplies innervation to the extensor hallucis longus?
Your Answer: Tibial nerve
Correct Answer: Deep peroneal nerve
Explanation:Extensor hallucis longus is innervated by the deep fibular nerve (root value L5 and S1).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 32
Incorrect
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A 42-year-old woman with a history of hyposplenism arrives at the Emergency Department sick and feverish. A complete set of bloods, including a peripheral blood film, is organised.On a hyposplenic blood film, which of the following features is LEAST likely to be seen?
Your Answer: Howell-Jolly bodies
Correct Answer: Teardrop cells
Explanation:The collection of abnormalities found in these patients is referred to as a hyposplenic film.The following features can be seen on hyposplenic blood films:Howell-Jolly bodiesHeinz’s bodiesTarget cellsRBCs with nuclei on occasionLymphocytosisMacrocytosisAcanthocytesTeardrop cells, also known as dacrocytes, are named for their teardrop-shaped shape. Dacrocytosis is a condition in which a large number of these cells are present. Myelofibrosis and beta thalassemia major both have dacrocytes, but hyposplenism does not.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 33
Correct
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An 82-year-old woman was brought in an ambulance to the Emergency Department with a 1-hour history of left-sided weakness and dysphasia. A CT scan is performed, and primary intracerebral haemorrhage is excluded as a possible cause. She is prepared for thrombolysis when her blood pressure is recorded at 200/115 mmHg.Out of the following, which step would be the most appropriate as the next step in her management?
Your Answer: Labetalol 10 mg IV
Explanation:A patient suffering from acute ischemic stroke can commonly present with hypertensive emergencies. Thrombolytic therapy is contraindicated in a patient with:1. Systolic blood pressure greater than 185 mmHg2. Diastolic blood pressure greater than 110 mmHgBut delaying thrombolytic therapy is associated with increased morbidity in patients with acute ischemic stroke. Managing high blood pressure in acute ischemic stroke requires a slower and more controlled reduction in BP. In the presence of an ischaemic stroke, rapid reduction of MAP can compromise blood flow, causing further ischemia and worsening of the neurological deficit.Intravenous labetalol is the agent of choice. The dose is 10 mg IV over 1-2 minutes. This dose can be repeated, or an infusion can be set up that runs at 2-8 mg/minute. Thrombolysis can be performed once the blood pressure is brought down to less than 180/105 mmHg.A nitrate infusion (for example, Isoket) can be used as an alternative in patients with contraindications to the use of beta-blockers (e.g., asthma, heart block, cardiac failure).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 34
Incorrect
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A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration is 1246 pg/mL.Glucagon INHIBITS which of the following processes? Select ONE answer only.
Your Answer: The hydrolysis of triglycerides
Correct Answer: Glycolysis
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:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis 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.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 35
Correct
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A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.Which of the following statements is TRUE regarding naloxone?
Your Answer: It can be given by a continuous infusion if repeated doses are required
Explanation:Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity. It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg. If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 36
Correct
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A 45-year-old obese patient goes to the emergency department with a fever and significant right upper quadrant pain. The pain radiates to her right shoulder tip. Murphy's sign is positive and acute cholecystitis is diagnosed. The pain referred to the shoulder tip is caused by one of the following nerves:
Your Answer: Phrenic nerve
Explanation:Gallbladder inflammation can cause pain in the right upper quadrant and right shoulder, which is caused by irritation of the diaphragmatic peritoneum. Pain from areas supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3-C5.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 37
Incorrect
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Which of the following statements about sickle cell disease is TRUE:
Your Answer: Adults with sickle cell anaemia usually have massive splenomegaly.
Correct Answer: Hand-foot syndrome is frequently a first presentation of the disease.
Explanation:Hand-foot syndrome in children is typically the first symptom of the disease, produced by infarction of the metaphysis of small bones. The disease is inherited as an autosomal recessive trait. By adulthood, the spleen has usually infarcted. Infection with the B19 parvovirus is usually followed by an aplastic crisis. Thrombocytopenia is caused by splenic sequestration.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 38
Incorrect
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Which of the following has the most potent glucocorticoid effect:
Your Answer: Fludrocortisone
Correct Answer: Dexamethasone
Explanation:Dexamethasone and betamethasone have the most potent glucocorticoid (anti-inflammatory) effect.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 39
Correct
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After reviewing a child with respiratory distress who presented to the clinic, you make a diagnosis of bronchiolitis.What is the most common causative organism?
Your Answer: Respiratory syncitial virus
Explanation:Bronchiolitis is a common respiratory infection that occurs in infancy between the ages of 3-6 months and in the winter months. It is most commonly caused by the respiratory syncytial virus (70% of cases)Although it can also be caused by parainfluenza virus, adenovirus, coronavirus, rhinovirus, and influenza virus, these are not the most common causes
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 40
Correct
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A 19-year-old with a longstanding history of asthma presents to the ED with worsening symptoms of cough and wheeze and a peak expiratory flow rate (PEFR) measurement is taken.Which statement concerning PEFR is true?
Your Answer: PEFR is dependent upon the patient's height
Explanation:The maximum flow rate generated during a forceful exhalation, after maximal inspiration is the peak expiratory flow rate (PEFR).PEFR is dependent upon initial lung volume. It is, therefore, dependant on patient’s age, sex and height.PEFR is dependent on voluntary effort and muscular strength of the patient.PEFR is decreased with increasing airway resistance, e.g. in asthma, and it correlates well with the forced expiratory volume in one second (FEV1) value measured in spirometry. This correlation decreases in patients with asthma as airflow decreases.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 41
Incorrect
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Which of the following comprises a negative feedback mechanism?
Your Answer: Detectors, amplifiers, comparators, a fixed set point and effectors
Correct Answer: Detectors, comparators, a variable set point and effectors
Explanation:Negative feedback loops, also known as inhibitory loops, play a crucial role in controlling human health. It is a self-regulating mechanism of some sort. A negative feedback system is made up of three main components: a detector (often neural receptor cells) that measures the variable in question and provides input to the comparator; a comparator (usually a neural assembly in the central nervous system) that receives input from the detector, compares the variable to the variable set point, and determines whether or not a response is required. The comparator activates an effector (typically muscular or glandular tissue) to conduct the appropriate reaction to return the variable to its set point.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 42
Correct
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You are reviewing a patient complaining of loss of vision. Previous images shows a lesion at the optic chiasm. What type of visual field defect are you most likely to see in a lesion at the optic chiasm:
Your Answer: Bitemporal hemianopia
Explanation:A lesion at the optic chiasm will result in a bitemporal hemianopia.A lesion of the optic nerve will result in ipsilateral monocular visual loss.A lesion of the optic tract will result in a contralateral homonymous hemianopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 43
Correct
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Typically, granulomatous inflammation is associated with one of the following infections:
Your Answer: Tuberculosis
Explanation:Granulomatous inflammation is typically seen when an infective agent with a digestion-resistance capsule (e.g. Mycobacterium tuberculosis) or a piece of inert foreign material (such as suture or glass) is introduced into the tissue. A transient acute inflammatory response occurs and when this is ineffective in eradicating the stimulus, chronic inflammation occurs.Tuberculosis is the prototype of the granulomatous diseases, but sarcoidosis, cat-scratch disease, lymphogranuloma inguinale, leprosy, brucellosis, syphilis, some mycotic infections, berylliosis, reactions of irritant lipids, and some autoimmune diseases are also included
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 44
Incorrect
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Regarding Escherichia coli, which of the following statements is INCORRECT:
Your Answer: It is a common cause of neonatal meningitis.
Correct Answer: It is a predominant member of the normal flora of the skin.
Explanation:Escherichia coli is a Gram-negative bacilli that is an important member of the intestinal flora. It is the most common cause of UTI in adults (about 70 – 95% of cases), followed by Staphylococcus saprophyticus (about 5 – 10% of cases), and an important cause of neonatal meningitis. E. coli O157 strain is implicated in the development of dysentery associated with haemolytic uraemic syndrome characterised by haemolytic anaemia, thrombocytopenia and acute renal failure.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 45
Correct
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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 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 46
Correct
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A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part in a powerlifting competition, he felt a painful snap at the front of his shoulder and chest. There is also the presence of bruising and swelling over the left side of his chest. A ruptured pectoralis major muscle was suspected upon examining the injured area. Which of the following statements regarding the surface markings of the pectoralis major muscle is considered correct?
Your Answer: It inserts into the lateral lip of the bicipital groove of the humerus
Explanation:The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.Its origin lies anterior surface of the medial half of the clavicle, the anterior surface of the sternum, the first 7 costal cartilages, the sternal end of the sixth rib, and the aponeurosis of the external oblique of the anterior abdominal wall.The insertion of the pectoralis major is at the lateral lip of the intertubercular sulcus of the humerus. There are 2 heads of the pectoralis major, the clavicular and the sternocostal, which reference their area of origin. The function of the pectoralis major is 3-fold and dependent on which heads of muscles are involved:- Flexion, adduction and medial rotation of the arm at the glenohumeral joint- Clavicular head causes flexion of the extended arm- Sternoclavicular head causes extension of the flexed armArterial supply of the pectoralis major, the pectoral artery, arises from the second branch of the axillary artery, the thoracoacromial trunk.The 2 heads of the pectoralis major have different nervous supplies. The clavicular head derives its nerve supply from the lateral pectoral nerve. The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the medial pectoral nerve arises from the medial cord.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 47
Correct
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Mast cells play a significant part in which of the following?
Your Answer: Allergic disease
Explanation:Mast cells play a central role in the response to allergen challenges. The activation of mast cells results in both an early and a delayed phase of inflammation. Mast cells have been implicated in both physiologic and pathogenic processes. Mast cells are important in defence against some bacteria and viruses and contribute to defence against parasites. They are key effector cells in both innate and acquired immunity and are capable of inducing and amplifying both types of responses. Specifically, mast cells are capable of detecting microbial products through surface pattern recognition receptors, and they are involved in the recruitment of other leukocytes, containment of bacterial infections, and tissue repair.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 48
Correct
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Question 49
Correct
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A 20-year-old male receives a small cut over his hand while climbing a fence causing it to bleed. Upon applying pressure for a few minutes, the bleeding stops. Which one of the following physiological components of the blood is responsible for the primary haemostasis reaction, such as in this case?
Your Answer: Platelet plug formation
Explanation:Haemostasis is your body’s defence against an injury that causes bleeding. It stops bleeding in three main steps: 1) Primary haemostasis – formation of a weak platelet plug- The primary reaction of the body is to cause local vasoconstriction at the site of injury and decrease blood flow to the affected area- the release of cytokines and inflammatory markers lead to adhesion of platelets and aggregation at the site of injury forming a platelet plug- the injured vessel wall has exposed subendothelial collagen that releases von Willebrand factor Any damage to the vessel wall causes the release of the Von Willebrand factor, which is necessary for platelet adhesion. Tissue Thromboplastin is also released, which activates the coagulation pathway, a component of secondary haemostasis. The coagulation cascade ultimately results in the conversion of fibrinogen to fibrin.2) Secondary haemostasis 3) Fibrinolysis
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 50
Correct
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You've been summoned to your Emergency Department resuscitation area to see a patient. You consider giving him an atropine shot because he is severely bradycardic.Which of the following statements about the use of atropine is correct?
Your Answer: It blocks the effects of the vagus nerve on both the SA and AV nodes
Explanation:At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.The most common cause of asystole during cardiac arrest is primary myocardial pathology, not excessive vagal tone, and there is no evidence that atropine is helpful in the treatment of asystole or PEA. As a result, it is no longer included in the ALS algorithm’s non-shockable section. Atropine is most commonly used in the peri-arrest period. It is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of 500 mcg IV:ShockSyncopeMyocardial ischaemiaHeart failureAtropine is also used for the following purposes:Topically as a cycloplegic and mydriatic to the eyesTo cut down on secretions (e.g. in anaesthesia)Organophosphate poisoning is treated withAtropine’s side effects are dose-dependent and include:Mouth is parchedVomiting and nauseaVision is hazyRetention of urineTachyarrhythmiasIt can also cause severe confusion and hallucinations in patients, especially the elderly.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
