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Question 1
Correct
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A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?
Your Answer: 500 micrograms of adrenaline intramuscularly
Explanation:Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils. If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution). In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh. Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 2
Incorrect
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Which of the following laboratory findings are suggestive of functional hyposplenism:
Your Answer: Rouleaux formation
Correct Answer: Howell-Jolly bodies
Explanation:Functional hyposplenism is characterised by the blood film findings of Howell-Jolly bodies or siderotic granules on iron staining. The most frequent cause is surgical removal of the spleen e.g. after traumatic rupture, but hyposplenism can also occur in sickle cell anaemia, gluten-induced enteropathy, amyloidosis and other conditions.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 3
Correct
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A 6-year-old girl is brought into the paediatric emergency room by her mother in a state of high-grade fever and extreme irritability. She is also reluctant to urinate as it is associated with lower abdominal pain and stinging. She has no history of any UTIs requiring antibiotics in the past 12 months. The urine sensitivity test report is still unavailable. A clean catch urine sample is taken for urine dipstick, which reveals the presence of blood, protein, leukocytes and nitrites. Fresh blood tests were sent, and her estimated GFR is calculated to be 40 ml/minute. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?
Your Answer: Trimethoprim
Explanation:The NICE guidelines for children and young people under 16 years lower UTIs are:1. Get a urine sample before antibiotics are taken, and do a dipstick test OR send for culture and susceptibility2. Assess and manage children under 5 with lower UTI with fever as recommended in the NICE guideline on fever in under 5s.3. Prescribe an immediate antibiotic prescription and take into account the previous urine culture and susceptibility results, previous antibiotic use, which may have led to resistant bacteria4. If urine culture and susceptibility report is sent- Review the choice of antibiotic when the results are available AND- change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possibleThe choice of antibiotics for non-pregnant young people under 16 years with lower UTI is summarised below:1. Children under 3 months:- Refer to paediatric specialist and treat with intravenous antibiotic in line with NICE guideline on fever in under 5s2. Children over 3 months: – First-choice Nitrofurantoin – if eGFR >45 ml/minuteTrimethoprim – (if low risk of resistance*)- Second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice not suitable)Nitrofurantoin – if eGFR >45 ml/minute and not used as first-choiceAmoxicillin (only if culture results available and susceptible)Cefalexin
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 4
Correct
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You are prescribing ipratropium bromide for a patient who has presented with an exacerbation of her COPD. What is the mechanism of action of ipratropium bromide:
Your Answer: Muscarinic antagonist
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 5
Correct
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ACE inhibitors are indicated for all of the following EXCEPT for:
Your Answer: Angina
Explanation:ACE inhibitors have many uses and are generally well tolerated. They are indicated for:Heart failureHypertensionDiabetic nephropathySecondary prevention of cardiovascular events
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 6
Correct
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A patient is diagnosed with a Klebsiella infection.Which SINGLE statement regarding Klebsiella infections is true?
Your Answer: Klebsiella spp are an important cause of ventilator-associated pneumonia
Explanation:Klebsiellais a genus of non-motile,Gram-negative, rod-shaped bacteriawith a prominent polysaccharide-based capsule. They are routinely found in the nose, mouth and gastrointestinal tract as normal flora, however, they can also behave as opportunistic pathogens.Infections with Klebsiella spp. areusually nosocomial. They are an important cause of ventilator-associated pneumonia (VAP), urinary tract infection, wound infection and bacteraemia. Outbreaks of infections with Klebsiellaspp. in high-dependency units have been described and are associated with septicaemia and high mortality rates. Length of hospital stay and performance of invasive procedures are risk factors forKlebsiellainfections.Primary pneumonia withKlebsiella pneumoniaeis a rare,severe, community-acquired infection associated with a poor outcome.Klebsiella rhinoscleromatis causes a progressive granulomatous infection of the nasal passages and surrounding mucous membranes. This infection is mainly seen in the tropics.Klebsiella ozanae is a recognised cause of chronic bronchiectasis.Klebsiella organisms are resistant to multiple antibiotics including penicillins. This is thought to be a plasmid-mediated property. Agents with high intrinsic activity againstKlebsiellapneumoniaeshould be selected for severely ill patients. Examples of such agents include third-generation cephalosporins (e.g cefotaxime), carbapenems (e.g. imipenem), aminoglycosides (e.g. gentamicin), and quinolones (e.g. ciprofloxacin). These agents may be used as monotherapy or combination therapy. Aztreonam may be used in patients who are allergic to beta-lactam antibiotics.Species with ESBLs (Extended spectrum beta-lactamase) are resistant to penicillins and also cephalosporins such as cefotaxime and ceftriaxone.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Correct
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A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.Which of these statements describes the mechanism of action of corticosteroids in asthma?
Your Answer: Reduction of bronchial inflammation
Explanation:Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 8
Correct
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Adenosine has a half-life of approximately:
Your Answer: 8 - 10 seconds
Explanation:Adenosine stimulates A1-adenosine receptors and opens acetylcholine sensitive K+ channels, increasing K+ efflux. This hyperpolarises the cell membrane in the atrioventricular node and, by inhibiting the calcium channels, slows conduction in the AVN. As it has a very short duration of action (half-life only about 8 – 10 seconds), most side effects are short lived.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 9
Incorrect
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A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.Which drug is NOT likely to cause cholestatic jaundice out of the following?
Your Answer: Ramipril
Correct Answer: Isoniazid
Explanation:Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.The drugs that cause cholestatic jaundice are the following:1. Nitrofurantoin2. Erythromycin3. Cephalosporins4. Verapamil5. NSAIDs6. ACE inhibitors7. Tricyclic antidepressants8. Phenytoin9. Azathioprine10. Carbamazepine11. Oral contraceptive pills12. Diazepam13. Ketoconazole14. Tamoxifen
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 10
Correct
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You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available.In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines?
Your Answer: Lidocaine
Explanation:If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 11
Correct
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Question 12
Correct
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Bordetella pertussis causes which of the following infectious diseases:
Your Answer: Whooping cough
Explanation:Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 13
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 14
Correct
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A six-year-old boy presents with coryzal symptoms that have persisted for more than two weeks. He was born and raised in the Middle East. His mother claims he has been tired and has complained of various 'aches and pains.' On examination, you find splenomegaly and enlarged cervical lymph nodes. His legs and arms are covered in petechiae.In this case, what is the most likely diagnosis?
Your Answer: Acute lymphoblastic leukaemia (ALL)
Explanation:ALL is the most common leukaemia in children, with a peak incidence between the ages of 2 and 5.ALL has a wide range of clinical symptoms, but many children present with an acute illness that resembles coryza or a viral infection. ALL also has the following features:Weakness and sluggishness all overMuscle, joint, and bone pain that isn’t specificAnaemiaPetechiae and unexplained bruisingOedemaLymphadenopathyHepatosplenomegalyThe following are typical features of a full blood count in patients with ALL:Anaemia (normocytic or macrocytic)Leukopenia affects about half of the patients (WCC 4 x 109/l).Around 25% of patients have leucocytosis (WCC > 10 x 109/l).Around 25% of patients have hyperleukocytosis (WCC > 50 x 109/l).Thrombocytopaenia
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Correct
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Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.
Explanation:A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 16
Incorrect
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Compliance is decreased by all but which one of the following:
Your Answer: Hyperinflated lungs
Correct Answer: Aging
Explanation:Factors increasing compliance:Old ageEmphysemaFactors decreasing compliance:Pulmonary fibrosisPulmonary oedemaAtelectasisExtremes of lung volumes (at higher lung volumes the compliance of the lung becomes less as the lung becomes stiffer)
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 17
Incorrect
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A 26-year-old woman is currently 9 weeks pregnant. Upon interview and history taking, she mentioned that she visited a friend whose child had just been diagnosed with slapped cheek disease.If the mother contracts an illness during pregnancy, which among the following is not known to cause fetal abnormalities?
Your Answer: Rubella
Correct Answer: Hepatitis A
Explanation:Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)toxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 18
Incorrect
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A 14-year-old female is brought to the Emergency Room by her mother after a fall from a tree in which she injured her elbow. An elbow fracture is suspected based on the examination findings, and she is given Entonox for analgesia as her elbow is set in a cast. Which one of the following statements regarding this drug is true?
Your Answer: It is a 75/25 mix of oxygen and nitrous oxide
Correct Answer: It can cause inhibition of vitamin B12 synthesis
Explanation:Entonox is a mixture of 50% Oxygen and 50% nitrous oxide and is given in an inhaled form as a quick form of analgesia. Entonox causes non-competitive inhibition of NMDA (N-methyl-D-aspartate) receptors, which are a subtype of the glutamate receptor. It is stored in blue and white cylinders and administered via a pressure regulator and demand valve. The administration of this medicine reduces pain and anxiety in paediatric and dental procedures ands during labour. Effects are apparent after 20 seconds, and peak action occurs after 3 to 5 minutes as it is a drug with a rapid onset and the patient will also recover rapidly from its effects. Entonox is widely used as it does not accumulate in the body and does not cause many side effects. However, a notable side effect is the inhibition of Vitamin B12 synthesis.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 19
Incorrect
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Damage to this nerve affects the flexor digitorum longus.
Your Answer: Superficial peroneal nerve
Correct Answer: Tibial nerve
Explanation:Like all muscles in the deep posterior compartment of the leg, flexor digitorum longus muscle is innervated by branches of the tibial nerve (root value L5, S1 and S2) which is a branch of sciatic nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 20
Correct
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Question 21
Incorrect
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Which of the following statements is correct with regards to Hodgkin's lymphoma?
Your Answer: The presence of paraprotein in serum is integral to diagnosis.
Correct Answer: Most patients present with painless asymmetrical lymphadenopathy, with cervical nodes involved most commonly.
Explanation:Lymphoma is a cancer of the lymphatic system, which is part of the body’s germ-fighting network. They are a group of diseases that are caused by malignant lymphocytes. These malignant cells accumulate in lymph nodes and other lymphoid tissue, giving rise to the characteristic clinical feature of lymphadenopathy. They can be subdivided into Hodgkin lymphoma (HL) which are characterised by the presence of Reed-Sternberg cells, and non-Hodgkin lymphoma (NHL). Characteristics of HL include:1. can present at any age but is rare in children and has a peak incidence in young adults, 2. almost 2:1 male predominance. 3. presents with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. 4. cervical node involvement in 60-70% of cases, 5. axillary node involvement in 10-15% 6. inguinal node involvement in 6-12%. 7. modest splenomegaly during the course of the disease in 50% of patients8. may occasionally have liver enlargement9. bone marrow failure involvement is unusual in early disease. Approximately 85% of patients are cured, but the prognosis depends on age, stage and histology. Two well‐known but rare symptoms in HL are alcohol‐induced pain and pruritus.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 22
Correct
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Which of the following bacteria is a rod-shaped, oxidase-positive, opportunistic gram-negative bacteria that can cause a catheter-related urinary tract infection (UTI)?
Your Answer: Pseudomonas aeruginosa
Explanation:Listeria monocytogenes is a gram-positive bacteria that does not produce spores. Staphylococcus aureus is a gram-positive bacteria, while Candida albicans is a gram-positive yeast with a single bud. Among the choices, gram-negative bacteria include only Klebsiella pneumoniae and Pseudomonas aeruginosa. Pseudomonas aeruginosa is an oxidase-positive bacterium, while Klebsiella pneumoniae is an oxidase-negative bacterium. P. aeruginosa can cause urinary tract infections (UTIs) and is spread through poor hygiene or contaminated medical equipment or devices, such as catheters that haven’t been fully sterilized.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 23
Incorrect
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A patient presents with a cough, productive of green sputum and fever. He was commenced on antibiotics 4 days earlier, but his condition has worsened. There is a documented history of penicillin allergy, and the GP prescribed erythromycin.Erythromycin exert its pharmacological effect by binding to?
Your Answer: EF-G-GDP
Correct Answer: The 50S subunit of the bacterial ribosome
Explanation:Macrolides are bacteriostatic antibiotics. They act by binding to the 50S subunit of the bacterial ribosome and inhibit translocation, therefore, inhibiting protein synthesis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 24
Correct
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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: 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 25
Incorrect
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In the Kaplan-Meier plot, which of the following labels should be applied to the X-axis?
Your Answer: Number of study participants
Correct Answer: Time in years
Explanation:Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death, is called as survival time and the analysis of group data as survival analysis. The graph plotted between estimated survival probabilities/estimated survival percentages (on Y axis) and time past after entry into the study (on X axis) consists of horizontal and vertical lines.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 26
Incorrect
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A patient presents to ED complaining of a purulent discharge, urethral discomfort and dysuria. You suspect gonorrhoea. Which of the following cell components produced by Neisseria gonorrhoeae is responsible for attachment to host cells:
Your Answer: Outer membrane porin protein
Correct Answer: Pili
Explanation:Infection of the genital mucosa by Neisseria gonorrhoeae involves attachment to and invasion of epithelial cells. Initial adherence of gonococci to columnar epithelial cells is mediated by type IV pili assembled from pilin subunit PilE proteins and pilus tip-associated PilC proteins, it then invades the epithelial layer, triggering a local acute inflammatory response.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 27
Correct
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Regarding the human cell, which of the following cell organelles is responsible for the production of ATP:
Your Answer: Mitochondria
Explanation:Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 28
Correct
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A 61-year-old man complains of crushing chest pain that radiates to his left arm and jaw. An ECG is taken, and the lateral leads show extensive ST depression. His blood pressure is currently 190/123 mmHg, and as part of his treatment, you intend to begin drug therapy to lower it.Which of the following is the INITIAL drug treatment for this patient's BP reduction?
Your Answer: Glyceryl trinitrate
Explanation:End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.In the presence of cardiac ischaemia, hypertensive emergencies require immediate treatment to prevent myocardial infarction. Similarly, if myonecrosis occurs in the presence of an existing infarction, prompt treatment is required to prevent further myonecrosis. When thrombolysis is used as the primary reperfusion therapy for acute myocardial infarction, blood pressure control is especially important.An intravenous nitrate is the drug of choice in this situation (e.g. GTN). These have a dual purpose in that they can help patients with ischaemic chest pain manage their symptoms. Because lowering blood pressure with nitrates isn’t always enough to achieve optimal results, intravenous beta-blockers are frequently used as a supplement. For this, intravenous atenolol and metoprolol are commonly used.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 29
Correct
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Which of the following statements is true about percutaneous needle aspiration?
Your Answer: The needle should be inserted just above the upper border of the chosen rib
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 30
Incorrect
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Which of the following decreases activation of vitamin D:
Your Answer: Hypophosphataemia
Correct Answer: Chronic renal failure
Explanation:Calcium deficiency (low Ca2+ diet or hypocalcemia) activates 1-alpha-hydroxylase in the cells of the renal proximal tubule which catalyses the conversion of vitamin D to its active form, 1,25-dihydroxycholecalciferol. Increased parathyroid hormone (PTH) and hypophosphatemia also stimulate the enzyme. Chronic renal failure is associated with a constellation of bone diseases, including osteomalacia caused by failure of the diseased renal tissue to produce the active form of vitamin D.
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This question is part of the following fields:
- Endocrine
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
