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Question 1
Correct
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What is the most common application of Nitrates?
Your Answer: Angina
Explanation:In patients with exertional stable angina, nitrates improve exercise tolerance, time to onset of angina, and ST-segment depression during exercise testing. In combination with beta-blockers or calcium channel blockers, nitrates produce greater anti-anginal and anti-ischemic effects.While they act as vasodilators, coronary vasodilators, and modest arteriolar dilators, the primary anti ischemic effect of nitrates is to decrease myocardial oxygen demand by producing systemic vasodilation more than coronary vasodilation. This systemic vasodilation reduces left ventricular systolic wall stress.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 2
Incorrect
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Which of the following statements is correct regarding gentamicin?
Your Answer: Gentamicin is effective against haemolytic streptococci.
Correct Answer: Gentamicin is ineffective against anaerobic bacteria.
Explanation:Gentamicin is the aminoglycoside of choice in the UK and is a parenterally administered, broad spectrum antibiotic typically used for moderate to severe gram negative infections. However, it is inactive against anaerobes. There is poor activity against haemolytic streptococci and pneumococci. It is usually given in conjunction with a penicillin or metronidazole (or both) when used for the blind treatment of undiagnosed serious infections. Nephrotoxicity and ototoxicity are the main toxic effects due to damage to the vestibulocochlear nerve (CN VIII).It is contraindicated in myasthenia gravis and should be used with great care in renal disease as it may result in accumulation and a higher risk of toxic side effects.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 3
Correct
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The renal team is currently prescribing erythropoietin to a patient with chronic kidney disease.Which of the following statements about erythropoietin is correct?
Your Answer: It protects red blood cell progenitors from apoptosis
Explanation:Erythropoietin is a glycoprotein hormone that regulates the formation of red blood cells (red cell production). It is mostly produced by interstitial fibroblasts in the kidney, which are located near the PCT. It is also produced in the liver’s perisinusoidal cells, however this is more common during the foetal and perinatal periods.The kidneys produce and secrete erythropoietin in response to hypoxia. On red blood cells, erythropoietin has two main effects:- It encourages stem cells in the bone marrow to produce more red blood cells.- It protects red blood cell progenitors and precursors from apoptosis by targeting them in the bone marrow.As a result of the increased red cell mass, the oxygen-carrying capacity and oxygen delivery increase.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 4
Incorrect
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How does dipyridamole mediate its antiplatelet effect:
Your Answer: It is a GPIIb/IIIa inhibitor.
Correct Answer: It is a phosphodiesterase inhibitor.
Explanation:Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 5
Incorrect
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Which of the following statements concerning the facial nerve is INCORRECT?
Your Answer: The facial nerve exits the skull via the stylomastoid foramen.
Correct Answer: Forehead sparing in facial nerve palsy is indicative of a lower motor neuron lesion.
Explanation:In facial nerve palsy, LMN damage will involve the forehead and there will be an inability to close the eyes due to paralysis of the orbicularis oculi or raise the eyebrows due to paralysis of the occipitofrontalis muscle.UMN damage causes sparing of the forehead as the occipitofrontalis and orbicularis oculi muscles have bilateral cortical representation.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 6
Correct
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Which of the following is NOT a notifiable disease:
Your Answer: HIV
Explanation:HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.HIV is not a notifiable disease.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 7
Correct
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A 43 year old lady suffering with idiopathic thrombocytopenic purpura has a splenectomy. She is advised to get the Pneumococcal vaccine booster every 5 - 10 years as Streptococcus pneumoniae has which of the following properties that make her prone to infection to this organism?
Your Answer: It is encapsulated
Explanation:There is a lifelong susceptibility to increased risk of infection from a variety of organisms in patients with hyposplenism, especially in children under 5 years and those with sickle cell anaemia. Patients are most susceptible is to the encapsulated bacteria Streptococcus pneumoniae, Haemophilus influenzae type B and Neisseria meningitidis. Streptococcus pneumoniae is particular concerning as it can cause rapid and fulminant disease, which can be fatal. Malaria and animal bites that become infected also tend to be more severe.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 8
Correct
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Which of the following describes the pulse pressure:
Your Answer: Systolic - diastolic pressure
Explanation:During systole, the pressure in the left ventricle increases and blood is ejected into the aorta. The rise in pressure stretches the elastic walls of the aorta and large arteries and drives blood flow. Systolic pressure is the maximum arterial pressure during systole. During diastole, arterial blood flow is partly maintained by elastic recoil of the walls of large arteries. The minimum pressure reached before the next systole is the diastolic pressure. The difference between the systolic and diastolic pressure is the pulse pressure.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 9
Incorrect
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The cutaneous circulation is responsible for the skin's blood supply. Because the skin is not a highly metabolically active tissue with low energy requirements, its blood supply differs from that of other tissues. Instead of capillaries, some of the circulating blood volume in the skin passes through arteriovenous anastomoses (AVAs).Which of the following statements regarding arteriovenous anastomoses is correct?
Your Answer: AVAs are short vessels with little to no smooth muscle in their walls
Correct Answer: AVAs are innervated by sympathetic fibres originating from the hypothalamus
Explanation:Short vessels called arteriovenous anastomoses (AVAs) link tiny arteries and veins. They have a large lumen diameter. The strong and muscular walls allow AVAs to completely clog the vascular lumen, preventing blood flow from artery to vein (acting like a sphincter). When the AVAs open, they create a low-resistance connection between arteries and veins, allowing blood to flow into the limbs’ superficial venous plexuses. There is no diffusion of solutes or fluid into the interstitium due to their strong muscle walls.AVAs are densely innervated by adrenergic fibres from the hypothalamic temperature-regulation centre. High sympathetic output occurs at normal core temperatures, inducing vasoconstriction of the AVAs and blood flow through the capillary networks and deep plexuses. When the temperature rises, sympathetic output decreases, producing AVA vasodilation and blood shunting from the artery to the superficial venous plexus. Heat is lost to the environment as hot blood rushes near to the skin’s surface.AVAs are a specialized anatomical adaptation that can only be found in large quantities in the fingers, palms, soles, lips, and pinna of the ear.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 10
Correct
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A 67-year-old woman complains of general malaise, nausea, and vomiting. She is perplexed and declares that everything 'looks yellow.' Her potassium level is 6.8 mmol/l, according to a blood test.Which of the drugs listed below is most likely to be the cause of her symptoms?
Your Answer: Digoxin
Explanation:Because digoxin has a narrow therapeutic index, it can cause toxicity both during long-term therapy and after an overdose. Even when the serum digoxin concentration is within the therapeutic range, it can happen.Acute digoxin toxicity usually manifests itself within 2-4 hours of an overdose, with serum levels peaking around 6 hours after ingestion and life-threatening cardiovascular complications following 8-12 hours.Chronic digoxin toxicity is most common in the elderly or those with impaired renal function, and it is often caused by a coexisting illness. The clinical signs and symptoms usually appear gradually over days to weeks.The following are characteristics of digoxin toxicity:Nausea and vomitingDiarrhoeaAbdominal painConfusionTachyarrhythmias or bradyarrhythmiasXanthopsia (yellow-green vision)Hyperkalaemia (early sign of significant toxicity)Some precipitating factors are as follows:Elderly patientsRenal failureMyocardial ischaemiaHypokalaemiaHypomagnesaemiaHypercalcaemiaHypernatraemiaAcidosisHypothyroidismSpironolactoneAmiodaroneQuinidineVerapamilDiltiazem
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 11
Incorrect
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A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.Which of the following statements regarding the opponens pollicis muscle is considered correct?
Your Answer: It receives its blood supply from the deep palmar arch
Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint
Explanation:Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
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 13
Correct
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Which of the following is NOT a typical feature of lithium toxicity:
Your Answer: Miosis
Explanation:Features of toxicity include:Increasing gastrointestinal disturbances (vomiting, diarrhoea, anorexia)Visual disturbancesPolyuria and incontinenceMuscle weakness and tremorTinnitusCNS disturbances (dizziness, confusion and drowsiness increasing to lack of coordination, restlessness, stupor)Abnormal reflexes and myoclonusHypernatraemiaWith severe overdosage (serum-lithium concentration > 2 mmol/L) seizures, cardiac arrhythmias (including sinoatrial block, bradycardia and first-degree heart block), blood pressure changes, electrolyte imbalance, circulatory failure, renal failure, coma and sudden death may occur.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 14
Incorrect
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The correct statement about the glomerular filtration barrier is which of the following?
Your Answer: The glomerular capillaries are continuous, with cells connected by tight junctions.
Correct Answer: The basement membrane is negatively charged, restricting filtration of negatively charged molecules.
Explanation:The main factor in determining whether a substance is filtered or not is molecular weight. Molecules < 7 kDa in molecular weight e.g. glucose, amino acids, urea, ions are filtered freely, but larger molecules are increasingly restricted up to 70 kDa, and there is very little filtration for anything above this. There is further restriction of negatively charged molecules because they are repelled by negative charges, particularly in the basement membrane. Albumin, which has a molecular weight of 69 kDa and is negatively charged, is filtered but only in very small amounts. All of the filtered albumin is reabsorbed in the proximal tubule. Small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. Other than the ultrafiltrate being essentially protein free, it has an otherwise identical composition of plasma. Bowman's capsule consists of:- an epithelial lining which consists of a single layer of cells called podocytes- endothelium which is perforated by pores or fenestrations – this allows plasma components with a molecular weight of < 70 kDa to pass freely.
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This question is part of the following fields:
- Physiology
- Renal
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Question 15
Incorrect
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You examine a 48-year-old woman's blood results and notice that her glucose level is elevated. When you tell her about it, she tells you that her doctor recently ran some tests and discovered that she has impaired glucose tolerance.Which of the following medications has not been linked to a reduction in glucose tolerance?
Your Answer: Olanzapine
Correct Answer: Amlodipine
Explanation:The following drugs have been linked to impaired glucose tolerance:Thiazide diuretics, e.g. BendroflumethiazideLoop diuretics, e.g. furosemideSteroids, e.g. prednisoloneBeta-blockers, e.g. atenolol
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Incorrect
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The last two segments of the nephrons are the distal convoluted tubule (DCT) and collecting duct (CD).Which cell reabsorbs sodium more in the late DCT and CD?
Your Answer: Subsidiary cells
Correct Answer: Principal cells
Explanation:The main Na+ reabsorbing cells in the late distal convoluted tubule and collecting duct are the principal cells. These make up the majority of the tubular cells. The exchange is driven by the Na.K.ATPase pumps on the basolateral membrane.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 17
Incorrect
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Which of the following is true regarding respiration?
Your Answer: The ‘bucket handle’ action of the ribs is their downward and lateral movement
Correct Answer: The diaphragm is responsible for abdominal breathing
Explanation:The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 18
Correct
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The flow of ions across a cell membrane causes electrical activity in biological tissues. Excitable tissues are specialized tissues that may generate a significant electrical signal called an action potential, which is followed by a refractory period.Which set of ion channels is responsible for the refractory period?Â
Your Answer: Sodium channels
Explanation:A refractory period follows each action potential. The absolute refractory time and the relative refractory period are two divisions of refractory periods. Because the sodium channels seal after an AP, they enter an inactive state during which they cannot be reopened regardless of membrane potential, this time occurs.The sodium channels slowly come out of inactivation during the relative refractory period that follows. During this time, a stronger stimulus than that required to initiate an action potential can excite the cell. The strength of the stimulus required early in the relative refractory period is relatively high, and it steadily decreases as more sodium channels recover from the inactivation of the refractory period.Nodes of Ranvier are periodic holes in a myelinate axon when there is no myelin and the axonal membrane is exposed. There are no gated ion channels in the portion of the axon covered by the myelin sheath, but there is a high density of ion channels in the Nodes of Ranvier. Action potentials can only occur at the nodes as a result of this.
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This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 19
Incorrect
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A 66-year-old female presents to the Emergency Department with a nose bleed. She says that she has been having frequent episodes of nose bleeds over the past four months, along with increasing fatigue and some weight loss. On examination, she has a diffuse petechial rash and hypertrophy of the gingiva. Which one of the following conditions is this patient most likely to have?
Your Answer: Chronic myeloid leukaemia (CML)
Correct Answer: Acute myeloid leukaemia (AML)
Explanation:The history of nosebleeds and fatigue, and gingival hyperplasia presents a typical picture of acute myeloid leukaemia. Leukemic infiltrates within the gingiva cause hypertrophy and distinguish this condition from other types of leukaemia. The fatigue is secondary to anaemia, while the nosebleeds are caused by thrombocytopenia secondary to leukemic infiltration of bone marrow. Patients may also report frequent infections secondary to neutropenia and hepatosplenomegaly.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 20
Correct
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Which of the following is NOT a typical electrolyte disturbance caused by furosemide:
Your Answer: Hypercalcaemia
Explanation:Adverse effects of loop diuretics include:Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathyHyperglycaemiaAcute urinary retentionWater and electrolyte imbalanceHyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolismMetabolic alkalosisHyperuricaemiaBlood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)Visual disturbance, tinnitus and deafnessHypersensitivity reactions
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 21
Incorrect
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A 53-year-old man arrives at the emergency department complaining of visual impairment in his right eye. On examination, you notice that neither his right nor left pupil constricts when you shine a light in his right eye. When you flash a light in his left eye, the pupils of both his left and right eyes constrict. Which of the following nerves is the most likely to be affected:
Your Answer: Trochlear nerve
Correct Answer: Optic nerve
Explanation:In full optic nerve palsy, the afferent pupillary light reflex is lost. Because the afferent optic nerve does not sense light flashed in the afflicted eye, the ipsilateral direct and contralateral consensual reflexes are gone. However, the contralateral direct and ipsilateral consensual reflexes are intact because the efferent oculomotor nerve is normal.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 22
Correct
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Regarding saliva, which of the following statements is CORRECT:
Your Answer: Saliva production is decreased by inhibition of the parasympathetic nervous system.
Explanation:At rest, saliva is predominantly produced by the submandibular gland (65%) but when stimulated, the parotid glands produce a higher proportion of the total saliva production (50%) than at rest. Saliva is alkaline and hypotonic to plasma. The predominant digestive enzymes in saliva are alpha-amylase and lingual lipase; lingual lipase is not functionally very important, but alpha-amylase is important for the initiation of starch digestion. Saliva production is decreased by inhibition of the parasympathetic nervous system e.g. by sleep, dehydration, anticholinergic drugs and fear.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 23
Incorrect
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Regarding iron deficiency anaemia, which of the following statements is INCORRECT:
Your Answer: Iron deficiency is associated with koilonychia and atrophic glossitis.
Correct Answer: Dietary insufficiency is the most common cause of iron deficiency anaemia in adult men in the UK.
Explanation:Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia in adult men and postmenopausal women.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 24
Correct
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Regarding benzylpenicillin, which of the following statements is CORRECT:
Your Answer: If meningococcal disease is suspected, benzylpenicillin should be given before transfer to hospital.
Explanation:Benzylpenicillin (although inactivated by bacterial beta-lactamases) is effective for many streptococcal (including pneumococcal), gonococcal, and meningococcal infections and also for anthrax, diphtheria, gas gangrene, leptospirosis, and treatment of Lyme disease. If meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) is suspected, benzylpenicillin should be given before transfer to hospital, so long as this does not delay the transfer; benzylpenicillin is no longer the drug of first choice for pneumococcal meningitis. Although benzylpenicillin is effective in the treatment of tetanus, metronidazole is preferred. Benzylpenicillin is inactivated by gastric acid and absorption from the gastrointestinal tract is poor and therefore it must be given by injection.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 25
Correct
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A patient who is a known case of rheumatoid arthritis presents to the clinic as his grandson was recently diagnosed with chickenpox. His grandson spent the weekend with her, and he was in close contact with him. He takes 50 mg of prednisolone once daily and has been for the past six months. There is no history of chickenpox.Out of the following, which is TRUE regarding the next plan of action for her care?
Your Answer: She should receive prophylactic varicella-zoster Immunoglobulin (VZIG)
Explanation:Varicella-zoster immunoglobulin (VZIG) is indicated for post exposure prevention and treatment of varicella. It is recommended as prophylaxis for high-risk patients with no known immunity (i.e. no known previous chickenpox) who have had a significant exposure to varicella-zoster (considered >4 hours close contact).The high-risk groups are:1. Neonates2. Pregnant women3. The immunocompromised (e.g. cancer, immunosuppressive therapies)4. Those on high dose steroids (children on more than 2 mg/kg/day for more than 14 days, or adults on 40 mg/day for more than a week)This patient is at high risk of developing adrenal insufficiency and may need a temporary increase in her steroid dose during infection or stress. It would be inappropriate to stop or wean down her dose of prednisolone and can cause side effects.Since he is on steroids without immunity for chickenpox, he is at risk of developing severe varicella infection, with possible complications including pneumonia, hepatitis and DIC. If he develops a varicella infection, he will need to be admitted and require a specialist review and intravenous Acyclovir.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 26
Incorrect
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Regarding fat digestion, which of the following statements is CORRECT:
Your Answer: Fatty acids and monoglycerides in the duodenum stimulate gastric emptying.
Correct Answer: Lipids are reesterified in the smooth endoplasmic reticulum of the enterocyte.
Explanation:Fats are digested almost entirely in the small intestine and are only released from the stomach into the duodenum at the rate at which they can be digested (the presence of fatty acids and monoglycerides in the duodenum inhibits gastric emptying). In the duodenum fat is emulsified by bile acids, a process where larger lipid droplets are broken down into much smaller droplets providing a greater surface area for enzymatic digestion. Pancreatic lipase digests triglyceride into monoglycerides and free fatty acids. The products of fat digestion (fatty acids and monoglycerides), cholesterol and fat-soluble vitamins diffuse passively into the enterocytes. Once inside the epithelial cell, lipid is taken into the smooth endoplasmic reticulum where much of it is re esterified. Dietary and synthesised lipids are then incorporated into chylomicrons in the Golgi body, which are exocytosed from the basolateral membrane to enter lacteals.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 27
Incorrect
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A 24-year-old female visits her family physician to complain of painless lumps in her neck. Her physician notes several enlarged, rubbery, non-tender cervical lymph nodes on examination. He immediately refers the patient for a lymph node biopsy, the results of which show the presence of Reed-Sternberg cells. What is the diagnosis in this case based on the above scenario?
Your Answer: Chronic lymphocytic leukaemia
Correct Answer: Hodgkin’s lymphoma
Explanation:The presence of Reed-Sternberg cells is pathognomonic for Hodgkin’s Lymphoma, which is a disease-causing neoplastic transformation of lymphocytes. There is a bimodal age distribution with peaks in the 20s and 60s. Patients typically present with enlarged, rubbery, non-tender lymph nodes. Symptoms such as fever, night sweats and weight loss may be present. Pain after alcohol consumption is a pathognomonic sign of Hodgkin’s lymphoma, it is, however, not a ‘B’ symptom. It is rare though, only occurring in 2-3% of patients with Hodgkin’s lymphoma.The Ann Arbour clinical staging is as follows:Stage I: one involved lymph node groupStage II two involved lymph node groups on one side of the diaphragmStage III: lymph node groups involved on both sides of the diaphragmStage IV: Involvement of extra-nodal tissues, such as the liver or bone marrowDiagnosis is made by lymph node biopsy, which should be taken from a sufficiently large specimen or excisional biopsy, as opposed to a fine needle biopsy. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs. In non-Hodgkin’s lymphoma, Reed-Sternberg cells are not present. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 28
Incorrect
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Which of the following is NOT a typical effect of cortisol:
Your Answer: Increased gluconeogenesis
Correct Answer: Decreased protein catabolism
Explanation:Cortisol is a steroid hormone produced in the zona fasciculata of the adrenal cortex. It is released in response to stress and low blood glucose concentrations.Cortisol acts to: raise plasma glucose by stimulating glycolysis and gluconeogenesis in the liver and inhibiting peripheral glucose uptake into storage tissues, increase protein breakdown in skeletal muscle, skin and bone to release amino acids, increase lipolysis from adipose tissues to release fatty acidsand at higher levels and mimic the actions of aldosterone on the kidney to retain Na+ and water and lose K+ ionssuppress the action of immune cells
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 29
Incorrect
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A 56-year-old female presents at the hospital with a diabetic foot ulcer that has become infected. She has a longstanding history of type 2 diabetes mellitus and diabetic polyneuropathy. She has trouble controlling her blood sugar levels, and recently, she was converted to a new insulin regimen that includes intermediate-acting insulin.Out of the following, which one is the intermediate-acting insulin?
Your Answer: Insulin glulisine
Correct Answer: Isophane insulin
Explanation:Insulin is used mainly in type 1 diabetes, where the pancreas makes no insulin and can sometimes be prescribed in type 1 diabetes. There are different types of insulin categorized by their onset of action:1. Intermediate-acting insulins (isophane insulin NPH): – intermediate duration of action, designed to mimic the effect of endogenous basal insulin- starts their action in 1 to 4 hours- peaks in 4 to 8 hours – dosing is usually twice a day and helps maintain blood sugar throughout the day- Isophane insulin is a suspension of insulin with protamine2. Short-acting insulins (regular insulin)- starts the action in 30 to 40 minutes- peaks in 90 to 120 minutes- duration of action is 6 to 8 hours- taken before meals, and food is necessary within 30 minutes after its administration to avoid hypoglycaemia3. Long-acting insulins (glargine, detemir, degludec)- start action in 1 to 2 hours- plateau effect over 12 to 24 hours- Dosing is usually during the night-time after meals. Their long duration of action helps in reducing the frequency of dosing throughout the day. 4. Rapid-acting insulins (lispro, aspart, glulisine) – start their action in 5 to 15 minutes- peak in 30 minutes- The duration of action is 3 to 5 hours- generally used before meals and always used along with short-acting or long-acting insulins to control sugar levels throughout the day.
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This question is part of the following fields:
- Endocrine Pharmacology
- Pharmacology
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Question 30
Incorrect
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Regarding anaemia, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Anaemia is usually associated with a decrease in red cell 2,3 - DPG.
Explanation:Anaemia is defined as a reduction in haemoglobin concentration below the normal range for the age and sex of the individual. Children tend to have lower haemoglobin than adults, and women tend to have lower haemoglobin than men. Anaemia may occur from an actual reduction in total circulating haemoglobin mass, or with an increase in plasma volume e.g. in pregnancy, causing a dilutional anaemia. After acute major blood loss, anaemia is not immediately apparent because total blood volume is reduced and it takes up to a day for plasma volume to be replaced and hence the degree of anaemia to become apparent. The initial clinical features in acute haemorrhage are therefore a result of reduction in blood volume rather than that of anaemia. When anaemia develops slowly, the associated symptoms are often very mild as the body has time to adapt to the fall in haemoglobin. This involves mechanisms such as an increase in red cell 2,3 -diphosphoglycerate (2,3 – DPG), which shifts the oxygen dissociation curve to the right, allowing enhanced delivery of O2 to the tissues, and an increase in stroke volume and heart rate.
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This question is part of the following fields:
- Haematology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
