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Question 1
Correct
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You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble breathing after eating peanuts. Which of the following diagnostic tests will confirm this?
Your Answer: Mast cell tryptase
Explanation:The concentration of serum tryptase rises in anaphylaxis and anaphylactoid responses. Because tryptase is a significant component of mast cell granules, mast cell degranulation causes elevated tryptase levels in the blood. Although tryptase levels are not always high during anaphylaxis, it is considered a particular marker.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 2
Correct
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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: 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 3
Incorrect
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A 35-year-old man presents with haemoptysis, night sweats, and weight loss. Further examinations were done and a diagnosis of tuberculosis is suspected. Which of the following statements is considered correct regarding Mycobacterium tuberculosis?
Your Answer: Scrofula refers to extrapulmonary tuberculosis that affects the spine
Correct Answer: It is impervious to decolourisation with acid
Explanation:Mycobacterium tuberculosis are part of the Mycobacteriaceae family. They are described to have the characteristics of a Gram-positive cell wall but they are not easily stained with Gram stain. This is because their cell wall contains a high lipid content, and this lipid allows the Mycobacteria to bind to alkaline stains with the application and help of heat. Once stained, they are able to resist decolorization even with the use of acid alcohol as the decolourizer, making them very difficult to decolorize, that is why they are known to be acid-fast.The Ghon complex is a non-pathognomonic radiographic finding on a chest x-ray that is significant for pulmonary infection of tuberculosis. The location of the Ghon’s focus is usually subpleural and predominantly in the upper part of the lower lobe and lower part of the middle or upper lobe. Skeletal tuberculosis of the spine is referred to as Pott disease.The risk of reactivation TB is about 3.3% during the first year after a positive PPD skin test and a total of 5% to 15% thereafter in the person’s lifetime. Progression from infection to active disease varies with age and the intensity and duration of exposure. Reactivation TB occurs when there is an alteration or suppression of the cellular immune system in the infected host that favoursreplication of the bacilli and progression to disease.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 4
Incorrect
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An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:No. of post-menopausal women who took Calcium: 500No. of post-menopausal women who took Calcium and suffered a hip fracture: 10No. of post-menopausal women who took placebo: 500No. of post-menopausal women who took placebo and suffered a hip fracture: 25Compute for the absolute risk reduction of a hip fracture.
Your Answer: None of the other options
Correct Answer: 0.03
Explanation:Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).ARR = ARC-ARTARR = (25/500) – (10/500)ARR = 0.03
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This question is part of the following fields:
- Evidence Based Medicine
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Question 5
Incorrect
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Regarding likelihood ratios, which of the following statements is INCORRECT:
Your Answer: The positive likelihood ratio can be used to calculate the post-test odds of a disease.
Correct Answer: Likelihood ratios, like predictive values, are affected by the prevalence of the disease in the population.
Explanation:A likelihood ratio is a measure of the diagnostic value of a test. Likelihood ratios show how many times more likely patients with a disease are to have a particular test result than patients without the disease. Likelihood ratios are more useful than predictive values because they are calculated from sensitivity and specificity and therefore remain constant even when the prevalence of the disorder changes.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 6
Incorrect
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CSF is reabsorbed from subarachnoid space via which of the following structures:
Your Answer: Cerebral aqueduct
Correct Answer: Arachnoid granulations
Explanation:From the subarachnoid cisterns in the subarachnoid space, CSF is reabsorbed via arachnoid granulations which protrude into the dura mater, into the dural venous sinuses and from here back into the circulation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 7
Correct
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In adults, there are normally how many teeth:
Your Answer: 32
Explanation:In adults, there are 32 teeth, 16 in the upper jaw and 16 in the lower jaw. On each side in both upper and lower arches, there are two incisors, one canine, two premolars and three molar teeth.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 8
Correct
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Which of these is an example of ordinal data?
Your Answer: Disease staging system
Explanation:Categorical data or data that is ordered is Ordinal data e.g. disease staging system, pain scoring system.Disease staging system is the correct answer
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 9
Incorrect
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An arterial blood gas test is performed to a 25-year-old students who presents with confusion, headache, nausea and malaise. The results show that carbon monoxide levels are significantly high. Which of the following carbon monoxide poisoning assertions is true?
Your Answer: It causes the oxygen dissociation curve to shift to the right
Correct Answer: The PO 2 of the blood in CO poisoning can be normal
Explanation:By combining with haemoglobin to form carboxyhaemoglobin, carbon monoxide (CO) disrupts the blood’s oxygen transport function. CO binds to haemoglobin with a 240-fold higher affinity than oxygen. As a result, even small amounts of CO can bind a large portion of the blood’s haemoglobin, making it unavailable for oxygen transport. During a suspected carbon monoxide poisoning, the blood PO2 and haemoglobin concentrations will be normal, but the oxygen concentration will be drastically reduced. The oxygen dissociation curve will also shift to the left in the presence of Carboxyhaemoglobin ( haemoglobin and carbon monoxide combination), interfering with oxygen unloading.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 10
Correct
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Which of the following describes the site of a Meckel's diverticulum:
Your Answer: Ileum
Explanation:Meckel’s lies on the antimesenteric surface of the middle-to-distal ileum, approximately 2 feet proximal to the ileocaecal junction. It appears as a blind-ended tubular outpouching of bowel, about 2 inches long, occurring in about 2% of the population, and may contain two types of ectopic tissue (gastric and pancreatic). The rich blood supply to the diverticulum is provided by the superior mesenteric artery.Proximal to the major duodenal papilla the duodenum is supplied by the gastroduodenal artery (branch of the coeliac trunk) and distal to the major duodenal papilla it is supplied by the inferior pancreaticoduodenal artery (branch of superior mesenteric artery). The arterial supply to the jejunoileum is from the superior mesenteric artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 11
Correct
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Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT:
Your Answer: There is a much greater predilection to disseminate to extranodal sites than in Hodgkin lymphoma.
Explanation:Non-Hodgkin’s lymphoma (NHL) refers to a group of lymphoproliferative malignancies (about 85% of B-cell and 15% of T or NK (natural killer) cell origin) with different behavioural patterns and treatment responses. This group of malignancies encompasses all types of lymphoma without Reed-Sternberg cells being present. The Reed-Sternberg cell is classically seen in Hodgkin’s lymphoma.NHL is five times as common as Hodgkin’s lymphoma. The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.The following are recognised risk factors for NHL:Chromosomal translocations and molecular rearrangementsEpstein-Barr virus infectionHuman T-cell leukaemia virus type-1 (HTLV-1)Hepatitis CCongenital and acquired immunodeficiency statesAutoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditisThe most common clinical features at presentation are:Lymphadenopathy (typically asymmetrical and painless)Weight lossFatigueNight sweatsHepatosplenomegalyFor clinical purposes, NHL is divided into three groups: indolent, high-grade, and lymphoblastic.Indolent (low-grade) NHL:The cells are relatively matureDisease follows an indolent course without treatmentOften acceptable to follow a ‘watch and wait’ strategyLocal radiotherapy often effectiveRelatively good prognosis with median survival of 10 yearsHigh-grade NHL:Cells are immatureDisease progresses rapidly without treatmentSignificant number of patients can be cured with intensive combination chemotherapy regimensApproximately 40% cure rateLymphoblastic NHL:Cells are very immature and have a propensity to involve the CNSTreatment and progression are similar to that of acute lymphoblastic leukaemia (ALL)
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This question is part of the following fields:
- Haematology
- Pathology
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Question 12
Correct
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Which anatomical structure is divided following an emergency department anterolateral thoracotomy?
Your Answer: Latissimus dorsi
Explanation:Thoracotomy describes an incision made in the chest wall to access the contents of the thoracic cavity. Thoracotomies typically can be divided into two categories; anterolateral thoracotomies and posterolateral thoracotomies. These can be further subdivided into supra-mammary and infra-mammary and, of course, further divided into the right or left chest. Each type of incision has its utility given certain circumstances.A scalpel is used to sharply divide the skin along the inframammary crease overlying the fifth rib. Electrocautery is then used to divide the pectoralis major muscle and serratus anterior muscle. Visualization of the proper operative field can be achieved with the division and retraction of the latissimus dorsi. Either the fourth or fifth intercostal space is then entered after the division of intercostal muscles above the rib to ensure the preservation of the neurovascular bundle. Once the patient is properly secured to the operating table, the ipsilateral arm is raised and positioned anteriorly and cephalad to rest above the head. The incision is started along the inframammary crease and extended posterolaterally below the tip of the scapula. It is then extended superiorly between the spine and the edge of the scapula, a short distance. The trapezius muscle and the subcutaneous tissues are divided with electrocautery. The serratus anterior and latissimus dorsi muscles are identified and can be retracted. The intercostal muscles are then divided along the superior border of the ribs, and the thoracic cavity is accessed.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 13
Incorrect
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A 29-year-old woman with anaphylactic reaction to peanuts, had to use her EpiPen on the way to hospital. What percentage of patients with anaphylactic reaction suffer a biphasic response?.
Your Answer: 30%
Correct Answer: 20%
Explanation:About 20% of patients that suffer an anaphylactic reaction suffer a biphasic response 4-6 hours after the initial response (sometimes up to 72 hours after).
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 14
Correct
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A patient with a diagnosis of HIV presents with a fever, sore throat, and general malaise and you are concerned the patient may have an AIDS defining illness.Which one of these, according to the CDC definition, would mean a patient infected with HIV has AIDS?
Your Answer: CD4 T-cell percentage of total lymphocytes of less than 15%
Explanation:According to the CDC definition, a patient co-infected with HIV can be diagnosed with AIDS if he or she has:A CD4 T-cell count of less than 200 cells/mm3 or;A CD4 T-cell percentage of total lymphocytes of less than 15% or;An AIDS defining infectionA Streptococcal throat infection is not an AIDS defining infection.A normal CD4 count ranges from 500-1000 cells/mm3. A CD4 (not CD8) count of less than 200 cells/mm3 is AIDS defining.The CD4 count can vary from day to day and depending upon the time that the blood test is taken. It can also be affected by the presence of other infections or illnesses. Treatment with anti-retroviral therapy should be considered at CD4 count of less than 350 cells/mm3.Serum concentrations of the p24 antigen (the viral protein that makes up most of the core of the HIV) are usually high in the first few weeks after human immunodeficiency virus (HIV) infection and testing for p24 antigen is therefore a useful way of diagnosing very early infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 15
Incorrect
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A 59-year-old otherwise well woman presents with a history of polydipsia and polyuria. There is a past history of kidney stones, and blood tests done reveal the following: Na: 147 mmol/L (135-147 mmol/L) K: 4.0 mmol/L (3.5-5.5 mmol/L) Urea: 7.3 mmol/L (2.0-6.6 mmol/L) Creatinine: 126 mmol/L (75-125 mmol/L) Fasting blood glucose: 5.0 mmol/L (3.4-5.5 mmol/L) Corrected calcium: 3.21 mmol/L (2.05-2.60 mmol/L) Phosphate: 0.70 mmol/L (0.8-1.4 mmol/L) Parathyroid hormone: 189 ng/L (10-60 ng/L)The most likely diagnosis is?
Your Answer: Primary hypoparathyroidism
Correct Answer: Primary hyperparathyroidism
Explanation:​Primary hyperparathyroidism the commonest cause of hypercalcaemia. It is commonest in women aged 50 to 60.The commonest cause of primary hyperparathyroidism is a solitary adenoma of the parathyroid gland (approximately 85% of cases). Primary hyperparathyroidism may present with features of hypercalcaemia such as polyuria, polydipsia, renal stones, bone and joint pain, constipation, and psychiatric disorders.In primary Hyperparathyroidism:PTH is elevatedCalcium is elevatedPhosphate is loweredIn secondary Hyperparathyroidism:PTH is elevatedCalcium is low or low-normalPhosphate is raised in CRFIn tertiary Hyperparathyroidism:PTH is elevatedCalcium is elevatedPhosphate is lowered in CRF
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 16
Correct
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A 57-year-old woman receives vitamin B12 injections following a gastrectomy.Which of the following cell types, if absent, is responsible for her vitamin B12 deficiency?
Your Answer: Parietal cells
Explanation:Intrinsic factor, produced by the parietal cells of the stomach, is essential for the absorption of vitamin B12 from the terminal ileum. After a gastrectomy, the absorption of vitamin B12 is markedly reduced, and a deficiency will occur.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 17
Incorrect
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Depolarisation of a neuron begins with which of the following:
Your Answer: Closing of ligand-gated Na + channels
Correct Answer: Opening of ligand-gated Na + channels
Explanation:Action potentials are initiated in nerves by activation of ligand-gated Na+channels by neurotransmitters. Opening of these Na+channels results in a small influx of sodium and depolarisation of the negative resting membrane potential (-70 mV). If the stimulus is sufficiently strong, the resting membrane depolarises enough to reach threshold potential (generally around -55 mV), at which point an action potential can occur. Voltage-gated Na+channels open, causing further depolarisation and activating more voltage-gated Na+channels and there is a sudden and massive sodium influx, driving the cell membrane potential to about +40 mV.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 18
Correct
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A 6-year-old girl is brought to the nephrology clinic by her mother due to facial oedema. Her lab workup shows proteinuria of 7 g/24 hours and serum albumin levels of 15 g/L. A diagnosis of Nephrotic Syndrome is made, and corticosteroid therapy is initiated. Which one of the following is the most likely cause of nephrotic syndrome in this patient?
Your Answer: Minimal change disease
Explanation:Minimal Change Disease is the most common cause of Nephrotic Syndrome in the paediatric population. It may be caused by NSAID use. Electron microscopy shows the fusion of foot processes while light microscopy will appear normal.Focal segmental glomerulosclerosis causes Nephrotic Syndrome in adults. It is associated with Heroin use and HIV infection. There is a limited response to steroids, and the disease progresses to end-stage renal failure in 5-10 years.Diabetic nephropathy occurs after a long period of diabetes due to the deposition of amyloid protein leading to a decrease in glomerular filtration. There is no history of Hepatitis B in this patient and no symptoms of liver disease such as jaundice. Membranous glomerulonephritis would present with features of Nephritic Syndrome. These would be oedema, haematuria; red blood cell casts in the urine and hypertension.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 19
Correct
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A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs. Which one is a nucleic acid synthesis inhibitor?
Your Answer: Ciprofloxacin
Explanation:Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.The following is a summary of the many modes of action of various types of antimicrobial agents:Action Mechanisms-Â Examples:Cell wall production is inhibitedVancomycinVancomycinCephalosporinsThe function of the cell membrane is disrupted NystatinPolymyxinsAmphotericin BÂ Inhibition of protein synthesisChloramphenicolMacrolidesAminoglycosidesTetracyclinesNucleic acid synthesis inhibitionQuinolonesTrimethoprimRifampicin5-nitroimidazolesSulphonamidesAnti-metabolic activityIsoniazid
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 20
Incorrect
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The percentage of patients with hepatitis B that develop chronic infection is about:
Your Answer: 30%
Correct Answer: 10%
Explanation:With hepatitis B, about 90% of people will develop lifelong immunity after clearing the infection. Chronic hepatitis develops in about 10% of patients and this may be complicated by cirrhosis or hepatocellular carcinoma. There is a very high risk of chronic infection and hepatocellular carcinoma when there is congenital infection. The risk of this in healthy adults is only about 5%.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Incorrect
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A 7-year-old girl is admitted to the hospital with a persistently high temperature. To help her reduce her fever, you decide to give her paracetamol and ibuprofen.What are the effects of paracetamol and ibuprofen on fever?
Your Answer: Resetting of the central thermostatic control
Correct Answer: Reduction in prostaglandin synthesis
Explanation:Interleukin-1, which is released by leukocytes and acts on the thermoregulatory centre of the hypothalamus, causes fever. Because prostaglandins mediate this process, antipyretics such as NSAIDs, paracetamol, and aspirin reduce prostaglandin levels by inhibiting cyclooxygenase enzymes. Malignant disease secretes interleukins, which cause the B-symptoms seen in lymphoma, for example. Bacterial toxins can also cause interleukins to be produced.Pyrexia of unknown origin (PUO) is defined as a fever of greater than 38.3 degrees Celsius that lasts for more than 2-3 weeks with no clear diagnosis despite extensive investigation.Investigation necessitates a thorough understanding of the conditions that can cause febrile illness, which may be missed during an initial investigation, as well as a thorough history, examination, and investigation centred on that list.Pyrexia of unknown origin has a wide differential diagnosis, which includes:InfectionBacterialPyogenic abscessTuberculosisInfective endocarditisBrucellosisLyme diseaseViralHIV Epstein Barr VirusCytomegalovirusParasiteToxoplasmosisMalignancy LeukaemiaLymphomaRenal cell carcinomaHepatocellular carcinomaVasculitides Still’s diseaseGranulomatosis with polyangiitis (formerly Wegener’s)Systemic lupus erythematosusGiant cell arteritisRheumatoid arthritisPolymyalgia rheumaticaMiscellaneous Drug induced fevers Familial Mediterranean feverThyrotoxicosisInflammatory bowel diseaseSarcoidosisFactitious fever Exaggerated normal circadian fluctuationThe patient might need to be admitted to the hospital for observation and further investigation. Because infection is still a possibility, blood cultures should be repeated on a regular basis, and inflammatory markers should be closely monitored. CT, PET, and MRI imaging have largely replaced diagnostic laparotomy as a diagnostic tool.
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This question is part of the following fields:
- Pathology
- Pathology Of Infections
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Question 22
Correct
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Regarding folate requirements, which of the following statements is CORRECT:
Your Answer: Dietary folate is found particularly in leafy green vegetables and liver.
Explanation:Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 23
Correct
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Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 24
Incorrect
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An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:No. of patients who took Ticagrelor: 300No. of patients who took Ticagrelor and suffered a stroke: 30No. of patients who took Warfarin: 500No. of patients who took Warfarin and suffered a stroke: 20Compute for the absolute risk reduction of a stroke, with Warfarin as the standard of treatment.
Your Answer: -0.04
Correct Answer: -0.06
Explanation:Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).Since Warfarin is the standard of treatment, Warfarin is considered as the control group.ARR = ARC-ARTARR = (20/500) – (30/300)ARR = -0.06This means that there is increased risk of stroke in the treatment group, which is the Ticagrelor group.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 25
Correct
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Which of the following is NOT a common side effect of diazepam:
Your Answer: Bradycardia
Explanation:Adverse effects include:Drowsiness and lightheadednessConfusion and ataxia (especially in the elderly), amnesia, muscle weaknessHeadache, vertigo, tremor, dysarthria, hypotension, decreased libido, erectile dysfunction, gynaecomastia, urinary retentionParadoxical effects such as talkativeness, excitement, irritability, aggression, anti-social behaviour, and suicidal ideationWithdrawal symptoms, for example anxiety, depression, anorexia, impaired concentration, insomnia, abdominal cramps, palpitations, tremor, tinnitus and perceptual disturbancesTolerance and dependence (people who use benzodiazepines longer term can develop tolerance and eventual dependence)
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 26
Incorrect
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In the emergency department, a 50-year-old female appears with a lack of sensation over the front two-thirds of her tongue. Taste and salivation are both present. The patient might have damage which of her nerves?
Your Answer: Chorda tympani nerve
Correct Answer: Lingual nerve
Explanation:The lingual nerve, a branch of the mandibular nerve, transmits sensation to the anterior two-thirds of the tongue. The chorda tympani, a branch of the facial nerve, transmits taste to the front two-thirds of the tongue as well as secretomotor innervation to the submandibular and sublingual glands. As a result, any damage to the lingual nerve can cause changes in salivary secretion on the affected side, as well as a loss of taste in the anterior two-thirds of the tongue and temporary or permanent sensory changes in the anterior two-thirds of the tongue and the floor of the mouth.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 27
Correct
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You are about to perform an emergency pericardiocentesis on a 26-year-old male who was involved in a car accident and is suspected of having cardiac tamponade due to signs of hypotension, muffled heart sounds, and distended neck veins. Where should you insert the needle to relieve tamponade?
Your Answer: Inferior and to the left of the xiphochondral junction
Explanation:Pericardiocentesis is a procedure that removes excess fluid from the pericardium. As a result, it’s used in cases of cardiac tamponade, which occurs when there’s too much fluid in the space around the heart. During the procedure, a needle and a small catheter are inserted 1 to 2 cm inferior and to the left of the xiphochondral junction into the pericardial cavity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 28
Incorrect
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A 26-year-old male presents to your clinic with the complaint of recurrent fevers over the past three months. On documentation of the fever, it is noted that the fever increases and decreases in a cyclical pattern over a 1-2 week period. After the appropriate investigations, a diagnosis of Pel-Ebstein fever is made. Which ONE of the following conditions is most likely to cause this patient's fever?
Your Answer: Glandular fever
Correct Answer: Hodgkin lymphoma
Explanation:The release of cytokines from Reed-Sternberg cells can cause fever in patients with Hodgkin lymphoma, which increases and decreases in a cyclical pattern of 1 to 2 weeks. This is called Pel-Ebstein or Ebstein-Cardarelli fever, specifically seen in Hodgkin lymphoma. The fever is always high grade and can reach 40 degrees or higher.Cyclical fever in other conditions is common but is not termed as Pel-Ebstein fever. This term is reserved only with Hodgkin lymphoma.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 29
Correct
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A 25-year-old female arrives at the emergency room with a severe case of asthma. When she doesn't seem to be improving after initial treatment, you decide to start an aminophylline infusion.From the options below, which is Aminophylline's main mechanism of action?Â
Your Answer: Phosphodiesterase inhibition
Explanation:Theophylline and Ethylenediamine are combined in a 2:1 ratio to form Aminophylline. Its solubility is improved by the addition of Ethylenediamine. It has a lower potency and a shorter duration of action than Theophylline.It is used to treat the following conditions: Heart failureIt is used to treat the following conditions: COPDBradycardiasAminophylline has the following properties:Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.It has slight positive inotropic and chronotropic effects, increasing cardiac output and decreasing systemic vascular resistance, lowering arterial blood pressure. It has been used historically in the treatment of refractory heart failure and is indicated by the current ALS guidelines as a substitute treatment for bradycardia. The daily oral dose for adults is 900 mg, divided into 2-3 doses. For severe asthma or COPD, a loading dosage of 5 mg/kg over 10-20 minutes is given, followed by a continuous infusion of 0.5 mg/kg/hour. The therapeutic range is small (10-20 microgram/ml), hence assessments of aminophylline plasma concentrations are useful during long-term treatment.
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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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Discontinuous capillaries are typically found where in the body:
Your 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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
