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  • Question 1 - All of the following are responses to massive haemorrhage except which of the...

    Incorrect

    • All of the following are responses to massive haemorrhage except which of the following?

      Your Answer: Fluid moves into the intravascular space due to decreased capillary hydrostatic pressure

      Correct Answer: Decreased cardiac output by increased direct parasympathetic stimulation

      Explanation:

      With regards to compensatory response to blood loss, the following sequence of events take place:

      1. Decrease in venous return, right atrial pressure and cardiac output
      2. Baroreceptor reflexes (carotid sinus and aortic arch) are immediately activated
      3. There is decreased afferent input to the cardiovascular centre in medulla. This inhibits parasympathetic reflexes and increases sympathetic response
      4. This results in an increased cardiac output and increased SVR by direct sympathetic stimulation. There is increased circulating catecholamines and local tissue mediators (adenosine, potassium, NO2)
      5. Fluid moves into the intravascular space as a result of decreased capillary hydrostatic pressure absorbing interstitial fluid.

      A slower response is mounted by the hypothalamus-pituitary-adrenal axis.
      6. Reduced renal blood flow is sensed by the intra renal baroreceptors and this stimulates release of renin by the juxta-glomerular apparatus.
      7. There is cleavage of circulating Angiotensinogen to Angiotensin I, which is converted to Angiotensin II in the lungs (by Angiotensin Converting Enzyme ACE)

      Angiotensin II is a powerful vasoconstrictor that sets off other endocrine pathways.
      8. The adrenal cortex releases Aldosterone
      9. There is antidiuretic hormone release from posterior pituitary (also in response to hypovolaemia being sensed by atrial stretch receptors)
      10. This leads to sodium and water retention in the distal convoluted renal tubule to conserve fluid
      Fluid conservation is also aided by an increased amount of cortisol which is secreted in response to the increase in circulating catecholamines and sympathetic stimulation.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      38.8
      Seconds
  • Question 2 - Regarding gas laws, which one best explains the ability of a Bourdon gauge...

    Incorrect

    • Regarding gas laws, which one best explains the ability of a Bourdon gauge to measure temperature?

      Your Answer: Gay-Lussac's law

      Correct Answer: Charles's law

      Explanation:

      Charles’ Law states that there is a direct correlation between temperature and volume, where pressure and amount gas are constant. As temperature increases, volume also increases.

      Boyle’s Law states that Pressure is inversely proportional to volume, assuming that temperature and amount of gas are constant. As volume increases, pressure decreases. In Dalton’s law of partial pressure, the total pressure exerted by a mixture of gases is equal to the sum of the partial pressure of the gases in mixture.

      According to Henry’s Law for concentration of dissolved gases, at a constant temperature, the amount of a given gas that dissolves in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid. An equivalent way of stating the law is that the solubility of a gas in a liquid is directly proportional to the partial pressure of the gas above the liquid.

      Gay-Lussac’s Law states that the pressure of a given mass of gas varies directly with the absolute temperature of the gas, when the volume is kept constant. This law is very similar to Charles’ Law, with the only difference being the type of container. Whereas the container in a Charles’ Law experiment is flexible, it is rigid in a Gay-Lussac’s Law experiment.

    • This question is part of the following fields:

      • Basic Physics
      14.9
      Seconds
  • Question 3 - Diagnosis of the neuroleptic malignant syndrome is best supported by which of the...

    Correct

    • Diagnosis of the neuroleptic malignant syndrome is best supported by which of the following statement?

      Your Answer: Increased Creatine Kinase

      Explanation:

      The neuroleptic malignant syndrome is a rare complication in response to neuroleptic or antipsychotic medication.

      The main features are:
      – Elevated creatinine kinase
      – Hyperthermia and tachycardia
      – Altered mental state
      – Increased white cell count
      – Insidious onset over 1-3 days
      – Extrapyramidal dysfunction (muscle rigidity, tremor, dystonia)
      – Autonomic dysfunction (Labile blood pressure, sweating, salivation, urinary incontinence)

      Management is supportive ICU care, anticholinergic drugs, increasing dopaminergic activity with Amantadine, L-dopa, and dantrolene, and non- depolarising neuromuscular blockade drugs

    • This question is part of the following fields:

      • Pharmacology
      11.2
      Seconds
  • Question 4 - A 27-year-old woman is admitted to the emergency room with an ectopic pregnancy...

    Incorrect

    • A 27-year-old woman is admitted to the emergency room with an ectopic pregnancy that has ruptured. The following is a description of the clinical examination: Anxious, Capillary refill time of 3 seconds, Cool peripheries, Pulse 120 beats per minute, Blood pressure 120/95 mmHg, Respiratory rate 22 breaths per minute. Which of the following is the most likely explanation for these clinical findings?

      Your Answer: Reduction in blood volume of 30-40%

      Correct Answer: Reduction in blood volume of 15-30%

      Explanation:

      The following is the Advanced Trauma Life Support (ATLS) classification of haemorrhagic shock:

      Class I haemorrhage:
      It has blood loss up to 15%. There is very less tachycardia, and no changes in blood pressure, RR or pulse pressure. Usually, fluid replacement is not required.

      Class II haemorrhage:
      It has 15-30% blood loss, equivalent to 750 – 1500 ml. There is tachycardia, tachypnoea and a decrease in pulse pressure. Patient may be frightened, hostile and anxious. It can be stabilised by crystalloid and blood transfusion.

      Class III haemorrhage:
      There is 30-40% blood loss. It portrays inadequate perfusion, marked tachycardia, tachypnoea, altered mental state and fall in systolic pressure. It requires blood transfusion.

      Class IV haemorrhage:
      There is > 40% blood volume loss. It is a preterminal event, and the patient will die in minutes. It portrays tachycardia, significant depression in systolic pressure and pulse pressure, altered mental state, and cold clammy skin. There is need for rapid transfusion and surgical intervention.

    • This question is part of the following fields:

      • Physiology
      18.2
      Seconds
  • Question 5 - Which compound is secreted only from the adrenal medulla? ...

    Incorrect

    • Which compound is secreted only from the adrenal medulla?

      Your Answer: Cortisol

      Correct Answer: Adrenaline

      Explanation:

      The adrenal medulla comprises chromaffin cells (pheochromocytes), which are functionally equivalent to postganglionic sympathetic neurons. They synthesize, store and release the catecholamines noradrenaline (norepinephrine) and adrenaline (epinephrine) into the venous sinusoids.
      The majority of the chromaffin cells synthesize adrenaline.

    • This question is part of the following fields:

      • Anatomy
      6.9
      Seconds
  • Question 6 - An aged patient that has been suffering from diabetes criticised the health minister...

    Incorrect

    • An aged patient that has been suffering from diabetes criticised the health minister for his comments on incidence and prevalence. The minister had said that they both are two separate entities. It can be therefore inferred that the patient thinks that prevalence and incidence are the same thing. Is he right?

      Your Answer:

      Correct Answer: No. In chronic disease prevalence is greater than incidence.

      Explanation:

      Only on rare occasions has it been found that the prevalence and incidence were same. Incidence can be greater than prevalence in acute cases only. In case of chronic diseases prevalence is far greater than incidence. One needs to have a deeper understanding of both the concepts to understand the health literature.

    • This question is part of the following fields:

      • Statistical Methods
      0
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  • Question 7 - A caudal epidural block is planned for a 6-year-old child scheduled for an...

    Incorrect

    • A caudal epidural block is planned for a 6-year-old child scheduled for an inguinoscrotal hernia repair under general anaesthesia. The weight of the child is 20kg. The most important safety aspect the anaesthetist must keep in mind while performing the block is?

      Your Answer:

      Correct Answer: Limiting the bupivacaine dose to no more than 40 mg

      Explanation:

      Choosing an appropriate dose of local anaesthetic to reduce the chance of toxicity is the most important safety aspect in performing a caudal block.

      The caudal will have to be inserted following induction of anaesthesia as performing it in an awake child is not a viable option.

      The patient is placed in the lateral position and the sacral hiatus is identified. Under strict asepsis, a needle ( usually a 21-23FG needle) is advanced at an angle of approximately 55-65° to the coronal plane at the apex of the sacrococcygeal membrane. When there is loss of resistance, thats the endpoint. The needle must first be aspirated before anaesthetic agent is injected because there is a risk (1 in 2000) of perforating the dura or vascular puncture.

      Alternatively, a 22-gauge plastic cannula can be used. Following perforation of the sacrococcygeal membrane, the stilette is removed and only the blunter plastic cannula is advanced. This reduces the risk of intravascular perforation.

      Eliciting an appropriate end motor response at an appropriate current strength when the caudal and epidural spaces are stimulated helps in improving the efficacy and safety of neural blockade. A 22G insulated needle is advanced in the caudal canal until a pop is felt. If the needle is placed correctly, an anal sphincter contractions (S2 to S4) is seen when an electrical stimulation of 1-10 mA is applied.

      The application of ultrasound guidance in identification of the caudal epidural space has been shown to prevent inadvertent dural puncture and to increase the safety and efficacy of the block in children.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 8 - Which of the following statement is false regarding dopamine? ...

    Incorrect

    • Which of the following statement is false regarding dopamine?

      Your Answer:

      Correct Answer: Urine output decreases due to inhibition of proximal tubule Na+ reabsorption

      Explanation:

      Dopamine (DA) is a dopaminergic (D1 and D2) as well as adrenergic α and β1 (but not β2 ) agonist.

      The D1 receptors in renal and mesenteric blood vessels are the most sensitive: i.v. infusion of a low dose of Dopamine dilates these vessels (by raising intracellular cAMP). This increases g.f.r. In addition, DA exerts a natriuretic effect by D1 receptors on proximal tubular cells.

      Moderately high doses produce a positive inotropic (direct β1 and D1 action + that due to NA release), but the little chronotropic effect on the heart.

      Vasoconstriction (α1 action) occurs only when large doses are infused.

      At doses normally employed, it raises cardiac output and systolic BP with little effect on diastolic BP. It has practically no effect on nonvascular α and β receptors; does not penetrate the blood-brain barrier€”no CNS effects.

      Dopamine is less arrhythmogenic than adrenaline

      Regarding dopamine part of the dose is converted to Noradrenaline in sympathetic nerve terminals.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 9 - All of the following statements about that parasympathetic nervous system (PNS) are true...

    Incorrect

    • All of the following statements about that parasympathetic nervous system (PNS) are true except:

      Your Answer:

      Correct Answer: The PNS has nicotinic receptors throughout the system

      Explanation:

      With regards to the autonomic nervous system (ANS)

      1. It is not under voluntary control
      2. It uses reflex pathways and different to the somatic nervous system.
      3. The hypothalamus is the central point of integration of the ANS. However, the gut can coordinate some secretions and information from the baroreceptors which are processed in the medulla.

      With regards to the central nervous system (CNS)
      1. There are myelinated preganglionic fibres which lead to the
      ganglion where the nerve cell bodies of the non-myelinated post ganglionic nerves are organised.
      2. From the ganglion, the post ganglionic nerves then lead on to the innervated organ.

      Most organs are under control of both systems although one system normally predominates.

      The nerves of the sympathetic nervous system (SNS) originate from the lateral horns of the spinal cord, pass into the anterior primary rami and then pass via the white rami communicates into the ganglia from T1-L2.

      There are short pre-ganglionic and long post ganglionic fibres.
      Pre-ganglionic synapses use acetylcholine (ACh) as a neurotransmitter on nicotinic receptors.
      Post ganglionic synapses uses adrenoceptors with norepinephrine / epinephrine as the neurotransmitter.
      However, in sweat glands, piloerector muscles and few blood vessels, ACh is still used as a neurotransmitter with nicotinic receptors.

      The ganglia form the sympathetic trunk – this is a collection of nerves that begin at the base of the skull and travel 2-3 cm lateral to the vertebrae, extending to the coccyx.

      There are cervical, thoracic, lumbar and sacral ganglia and visceral sympathetic innervation is by cardiac, coeliac and hypogastric plexi.

      Juxta glomerular apparatus, piloerector muscles and adipose tissue are all organs under sole sympathetic control.

      The PNS has a craniosacral outflow. It causes reduced arousal and cardiovascular stimulation and increases visceral activity.

      The cranial outflow consists of
      1. The oculomotor nerve (CN III) to the eye via the ciliary ganglion,
      2. Facial nerve (CN VII) to the submandibular, sublingual and lacrimal glands via the pterygopalatine and submandibular ganglions
      3. Glossopharyngeal (CN IX) to lungs, larynx and tracheobronchial tree via otic ganglion
      4. The vagus nerve (CN X), the largest contributor and carries ¾ of fibres covering innervation of the heart, lungs, larynx, tracheobronchial tree parotid gland and proximal gut to the splenic flexure, liver and pancreas

      The sacral outflow (S2 to S4) innervates the bladder, distal gut and genitalia.

      The PNS has long preganglionic and short post ganglionic fibres.
      Preganglionic synapses, like in the SNS, use ACh as the neuro transmitter with nicotinic receptors.
      Post ganglionic synapses also use ACh as the neurotransmitter but have muscarinic receptors.

      Different types of these muscarinic receptors are present in different organs:
      There are:
      M1 = pupillary constriction, gastric acid secretion stimulation
      M2 = inhibition of cardiac stimulation
      M3 = visceral vasodilation, coronary artery constriction, increased secretions in salivary, lacrimal glands and pancreas
      M4 = brain and adrenal medulla
      M5 = brain

      The lacrimal glands are solely under parasympathetic control.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      0
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  • Question 10 - Anaesthetic gas concentrations can be measured using a refractometer. The main principal which...

    Incorrect

    • Anaesthetic gas concentrations can be measured using a refractometer. The main principal which allows it to be used for this purpose is which of the following?

      Your Answer:

      Correct Answer: Refraction

      Explanation:

      Refractometers measure the degree to which the light changes direction, called the angle of refraction. A refractometer takes the refraction angles and correlates them to refractive index (nD) values that have been established. Using these values, you can determine the concentrations of solutions.

    • This question is part of the following fields:

      • Basic Physics
      0
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  • Question 11 - With regards to arterial oxygen content, which of the following contributes most from...

    Incorrect

    • With regards to arterial oxygen content, which of the following contributes most from a quantitative perspective?

      Your Answer:

      Correct Answer: Haemoglobin concentration

      Explanation:

      The amount of oxygen carried by 100 ml of blood is called the arterial oxygen content (CaO2)and is normally 17-24 ml/dL and can be determined by this equation:

      CaO2 = oxygen bound to haemoglobin + oxygen dissolved in plasma

      CaO2 = (1.34 × Hgb × SaO2 × 0.01) + (0.003 × PaO2)

      where:

      1.34 = Huffner’s constant (D) – Huffner’s constant does not change and its magnitude relatively small.
      Hgb is the haemoglobin level in g/dL and SaO2 is the percent oxyhaemoglobin saturation of arterial blood
      PaO2 is (0.0225 = ml of O2 dissolved per 100 ml plasma per kPa, or 0.003 ml per mmHg).

      Quantitatively, the amount of oxygen dissolved in plasma is 0.3 mL/dL.

      Henry’s law states that at constant temperature, the amount of gas dissolved at equilibrium in a given quantity of a liquid is proportional to the pressure of the gas in contact with the liquid.

      Given a haemoglobin concentration of 15 g/dL and a SaO2 of 100% and a PaO2 of 13.3 kPa, the amount of oxygen bound to haemoglobin is 20.4 mL/100mL.

      Cardiac output is an important determinant of oxygen delivery but does not influence the oxygen content of blood.

    • This question is part of the following fields:

      • Basic Physics
      0
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  • Question 12 - Which oral hypoglycaemic agent has no effect on insulin sensitivity or secretion? ...

    Incorrect

    • Which oral hypoglycaemic agent has no effect on insulin sensitivity or secretion?

      Your Answer:

      Correct Answer: Alpha glucosidase inhibitors

      Explanation:

      Because alpha glucosidase inhibitors slow starch digestion in the small intestine, glucose from a meal enters the bloodstream more slowly and can be matched more effectively by an impaired insulin response or sensitivity, glucose from a meal enters the bloodstream more slowly and can be matched more effectively by an impaired insulin response or sensitivity.

      Biguanides decrease hepatic glucose output while increasing glucose uptake in peripheral cells.

      The meglitinides are secretagogues that act on a different site of the KATP receptors.

      Insulin secretion is stimulated by sulphonylureas, which stimulate insulin secretion from pancreatic beta cells. The KATP channels are inhibited by these substances.

      Insulin-sensitive genes are influenced by thiazolidinediones, which increase the production of mRNAs for insulin-dependent enzymes. As a result, the cells make better use of glucose.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 13 - Which of the following statements is true regarding oxygen? ...

    Incorrect

    • Which of the following statements is true regarding oxygen?

      Your Answer:

      Correct Answer: Forms molecules containing either two or three atoms

      Explanation:

      Oxygen is formed by a molecule of oxygen and two molecules of hydrogen with a molecular formula of H2O

      The critical temperature is defined as a temperature above which the substance cannot be liquefied, no matter how much pressure is applied.
      Water has a critical temperature of -118.6oC. So, it cannot be liquified at room temperature.

      Medical oxygen cylinder is stored in a cylinder with a white shoulder and black body. Meanwhile, medial air is stored in cylinders with a white and black shoulder and a French grey body.

      The partial pressure of air at a high altitude is less but the relative concentration remains constant.

    • This question is part of the following fields:

      • Basic Physics
      0
      Seconds
  • Question 14 - The action potential in a muscle fibre is initiated by which of these...

    Incorrect

    • The action potential in a muscle fibre is initiated by which of these ions?

      Your Answer:

      Correct Answer: Sodium ions

      Explanation:

      The cardiac action potential has several phases which have different mechanisms of action as seen below:
      Phase 0: Rapid depolarisation – caused by a rapid sodium influx.
      These channels automatically deactivate after a few ms

      Phase 1: caused by early repolarisation and an efflux of potassium.

      Phase 2: Plateau – caused by a slow influx of calcium.

      Phase 3 – Final repolarisation – caused by an efflux of potassium.

      Phase 4 – Restoration of ionic concentrations – The resting potential is restored by Na+/K+ATPase.
      There is slow entry of Na+into the cell which decreases the potential difference until the threshold potential is reached. This then triggers a new action potential

      Of note, cardiac muscle remains contracted 10-15 times longer than skeletal muscle.

      Different sites have different conduction velocities:
      1. Atrial conduction – Spreads along ordinary atrial myocardial fibres at 1 m/sec

      2. AV node conduction – 0.05 m/sec

      3. Ventricular conduction – Purkinje fibres are of large diameter and achieve velocities of 2-4 m/sec, the fastest conduction in the heart. This allows a rapid and coordinated contraction of the ventricles

    • This question is part of the following fields:

      • Physiology
      0
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  • Question 15 - Which of the following nerves is responsible for carrying taste sensation from the...

    Incorrect

    • Which of the following nerves is responsible for carrying taste sensation from the given part of the tongue?

      Your Answer:

      Correct Answer: Anterior two thirds of tongue - facial nerve

      Explanation:

      Taste sensation from the anterior two-thirds of the tongue is carried by chorda tympani, a branch of the facial nerve.

      The general somatic sensation of the anterior two-third of the tongue is supplied by the lingual nerve, a branch of the mandibular nerve.

      Both general somatic sensation and taste from the posterior third of the tongue are carried by the glossopharyngeal nerve.

      All the muscles of the tongue except palatoglossus are supplied by the hypoglossal nerve whereas palatoglossus is supplied by the vagus nerve. (This is because palatoglossus is the only tongue muscle derived from the fourth branchial arch)

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 16 - A 68-year-old woman is a known case of acute myeloid leukaemia and was...

    Incorrect

    • A 68-year-old woman is a known case of acute myeloid leukaemia and was treated with chemotherapy as a child. She now presents in rhesus, and you are called in to attend this patient as it is getting difficult to gain vascular access in her arms. The medical registrar asks you to site a cannula during the arrest call as intraosseous access is delayed. The ITU SHO wants to assist you in performing a venous cutdown of one of the veins in her ankle that passes anterior to the medial malleolus. Which vessel is this?

      Your Answer:

      Correct Answer: Long saphenous vein

      Explanation:

      Venous cutdown is a surgical procedure when venous access is difficult, and other procedures like the Seldinger technique, ultrasound-guided venous access, and intraosseous vascular access have failed.

      The vein of choice for venous cutdown is the long/great saphenous vein. It is part of the superficial venous collecting system of the lower extremity. It is the preferred vein as the long saphenous vein has anatomic consistency and is superficially located at the ankle anterior to the medial malleolus. It is also the most commonly used conduit for cardiovascular bypass operations.

      Origin- in the foot at the confluence of the dorsal vein of the first digit and the dorsal venous arch of the foot
      Route- runs ANTERIOR to the medial malleolus and travels up in the medial leg and upper thigh.
      Termination: in the femoral vein within the femoral triangle

      Regarding the other options:
      The short saphenous vein passes posterior to the lateral malleolus.
      The dorsalis pedis vein accompanies the dorsalis pedis artery on the anterior foot.
      The posterior tibial vein is part of the deep venous system accompanying the posterior tibial artery. There is no significant sural vein (there is a sural nerve), but the sural veins accompany the sural arteries and drain to the popliteal vein.

    • This question is part of the following fields:

      • Anatomy
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  • Question 17 - Which of the following statements is true regarding drug dose and response? ...

    Incorrect

    • Which of the following statements is true regarding drug dose and response?

      Your Answer:

      Correct Answer: Intrinsic activity determines maximal response

      Explanation:

      There are two types of drug dose-response relationships, namely, the graded dose-response and the quantal dose-response relationships.

      Drug response curves are plotted as percentage response again LOG drug concentration. This graph is sigmoid in shape.

      Agonists are drugs with high affinity and high intrinsic activity. Meanwhile, the antagonist is a drug with high affinity but no intrinsic activity. Intrinsic activity determines the maximal response. The maximal response can be achieved even by activation of a small proportion of receptor sites.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 18 - An 80-year-old female suffered a TIA 2 weeks ago. She has been admitted...

    Incorrect

    • An 80-year-old female suffered a TIA 2 weeks ago. She has been admitted to the vascular ward as she will be undergoing carotid endarterectomy tomorrow morning. To explain the procedure and its complications, the surgeon gives her information about the procedure, telling her the artery will be tied during the operation. She inquires about the areas supplied by the different arteries. You explain that the internal carotid artery supplies the brain while the external carotid artery ascends the neck and bifurcates into two arteries. One of these arteries is the superficial temporal artery. Which of the following is the second branch?

      Your Answer:

      Correct Answer: Maxillary artery

      Explanation:

      Carotid endarterectomy is the procedure to relieve an obstruction in the carotid artery by opening the artery at its origin and stripping off the atherosclerotic plaque with the intima. This procedure is performed to prevent further episodes, especially in patients who have suffered ischemic strokes or transient ischemic attacks.

      The external carotid artery terminates by dividing into the superficial temporal and maxillary branches. The maxillary artery is the larger of the two terminal branches and arises posterior to the neck of the mandible.

      The other arteries mentioned in the answer options branch off from the following:
      Temporal arteries from the maxillary artery
      Middle meningeal artery from the maxillary artery
      Lingual artery from the anterior aspect of the external carotid artery
      Facial artery from the anterior aspect of the external carotid artery.

    • This question is part of the following fields:

      • Anatomy
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  • Question 19 - Out of the following, which is NOT a part of the contents of...

    Incorrect

    • Out of the following, which is NOT a part of the contents of the porta hepatis?

      Your Answer:

      Correct Answer: Cystic duct

      Explanation:

      The porta hepatis is a fissure in the inferior surface of the liver. All the neurovascular structures that enter and leave the porta hepatis are:
      1. hepatic portal vein
      2. hepatic artery
      3. hepatic ducts
      4. hepatic nerve plexus (It contains the sympathetic branch to the liver and gallbladder and the parasympathetic, hepatic branch of the vagus nerve.)

      These structures supply and drain the liver. Only the hepatic vein is not part of the porta hepatis.
      The porta hepatis is also surrounded by lymph nodes, that may enlarge to produce obstructive jaundice.
      These structures divide immediately after or within the porta hepatis to supply the functional left and right lobes of the liver.

      The cystic duct lies outside the porta hepatis and is an important landmark in laparoscopic cholecystectomy.

    • This question is part of the following fields:

      • Anatomy
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  • Question 20 - Which of the following statements is not true regarding Adrenaline? ...

    Incorrect

    • Which of the following statements is not true regarding Adrenaline?

      Your Answer:

      Correct Answer: Exerts its effect by decreasing intracellular calcium

      Explanation:

      Noradrenaline also called norepinephrine belongs to the catecholamine family that functions in the brain and body as both a hormone and neurotransmitter.

      They have sympathomimetic effects acting via adrenoceptors (α1, α2, β1, β2, β3) or dopamine receptors (D1, D2).

      May cause reflex bradycardia, reduce cardiac output and increase myocardial oxygen consumption

    • This question is part of the following fields:

      • Pharmacology
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  • Question 21 - A common renal adverse effect of non-steroidal anti-inflammatory drugs is? ...

    Incorrect

    • A common renal adverse effect of non-steroidal anti-inflammatory drugs is?

      Your Answer:

      Correct Answer: Haemodynamic renal insufficiency

      Explanation:

      Prostaglandins do not play a major role in regulating RBF in healthy resting individuals. However, during pathophysiological conditions such as haemorrhage and reduced extracellular fluid volume (ECVF), prostaglandins (PGI2, PGE1, and PGE2) are produced locally within the kidneys and serve to increase RBF without changing GFR. Prostaglandins increase RBF by dampening the vasoconstrictor effects of both sympathetic activation and angiotensin II. These effects are important because they prevent severe and potentially harmful vasoconstriction and renal ischemia. Synthesis of prostaglandins is stimulated by ECVF depletion and stress (e.g. surgery, anaesthesia), angiotensin II, and sympathetic nerves.

      Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, potently inhibit prostaglandin synthesis. Thus administration of these drugs during renal ischemia and hemorrhagic shock is contraindicated because, by blocking the production of prostaglandins, they decrease RBF and increase renal ischemia. Prostaglandins also play an increasingly important role in maintaining RBF and GFR as individuals age. Accordingly, NSAIDs can significantly reduce RBF and GFR in the elderly.

    • This question is part of the following fields:

      • Physiology
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  • Question 22 - Which statement is the most accurate when describing electrical equipment and shock? ...

    Incorrect

    • Which statement is the most accurate when describing electrical equipment and shock?

      Your Answer:

      Correct Answer: Type CF is considered to safe for direct connection with the heart

      Explanation:

      There are different classes of electrical equipment that can be classified in the table below:

      Class 1 – provides basic protection only. It must be connected to earth and insulated from the mains supply

      Class II – provides double insulation for all equipment. It does not require an earth.

      Class III – uses safety extra low voltage (SELV) which does not exceed 24 V AC. There is no risk of gross electrocution but risk of microshock exists.

      Type B – All of above with low leakage currents (0.5mA for Class IB, 0.1 mA for Class IIB)

      Type BF – Same as with other equipment but has ‘floating circuit’ which means that the equipment applied to patient is isolated from all its other parts.

      Type CF – Class I or II equipment with ‘floating circuits’ that is considered to be safe for direct connection with the heart. There are extremely low leakage currents (0.05mA for Class I CF and 0.01mA for Class II CF).

    • This question is part of the following fields:

      • Clinical Measurement
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  • Question 23 - A caudal anaesthetic block is planned for a 3-year-old girl presenting for inguinal...

    Incorrect

    • A caudal anaesthetic block is planned for a 3-year-old girl presenting for inguinal hernia repair. Choose the best answer that explains why the caudal epidural space is accessed via the sacral hiatus.

      Your Answer:

      Correct Answer: The failure of fusion of the laminae of S4 and S5 provides a suitable point of entry

      Explanation:

      The sacral hiatus is shaped by incomplete midline fusion of the posterior elements of the distal portion of S4 and S5. This inverted U shaped space is covered by the posterior aspect of the sacrococcygeal membrane and is an important landmark in caudal anaesthetic block. Distal most portion of the dural sac and the sacral hiatus usually terminate between levels S1 and S3. The dural sac ends at the level of S2 in adults and S3 in children.

      An equilateral triangle is formed between the apex of the sacral hiatus and the posterior superior iliac spines. This triangle is used to determine the location of the sacral hiatus during caudal anaesthetic block.

    • This question is part of the following fields:

      • Anatomy
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  • Question 24 - An study on post-operative nausea and vomiting (PONV) among paediatric patients who underwent...

    Incorrect

    • An study on post-operative nausea and vomiting (PONV) among paediatric patients who underwent tonsillectomy showed a decrease in incidence from 10% to 5% following a new management protocol. Which of the following best estimates the numbers needed to treat (NNT) for one additional patient to benefit from the new management of PONV?

      Your Answer:

      Correct Answer: 20

      Explanation:

      The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome. For example, if a drug has an NNT of 5, it means you have to treat 5 people with the drug to prevent one additional bad outcome.

      To calculate the NNT, you need to know the Absolute Risk Reduction (ARR); the NNT is the inverse of the ARR:

      NNT = 1/ARR

      Where ARR = CER (Control Event Rate) €“ EER (Experimental Event Rate).

      NNTs are always rounded up to the nearest whole number.

      In this case, the NNT can be computed as follows:

      ARR = 10% – 5% = 0.05

      NNT = 1/0.05 = 20

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 25 - Which of the following is true regarding the dose of propofol? ...

    Incorrect

    • Which of the following is true regarding the dose of propofol?

      Your Answer:

      Correct Answer: 1-2mg/kg

      Explanation:

      Propofol is a short-acting medication used for starting and maintenance of general anaesthesia, sedation for mechanically ventilated adults, and procedural sedation.
      The dose of propofol is 1-2 mg/kg.

      Dose of some other important drugs are listed below:
      Thiopental dose: 3-7 mg/kg
      Ketamine dose: 1-2 mg/kg
      Etomidate dose: 0.3 mg/kg
      Methohexitone dose: 1.0-1.5 mg/kg

    • This question is part of the following fields:

      • Pharmacology
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  • Question 26 - A 30-year old female athlete was brought to the Emergency Room for complaints...

    Incorrect

    • A 30-year old female athlete was brought to the Emergency Room for complaints of light-headedness and nausea. Clinical chemistry studies were done and the results were the following: Na: 144 mmol/L (Reference: 137-144 mmol/L), K: 6 mmol/L (Reference: 3.5-4.9 mmol/L), Cl: 115 mmol/L (Reference: 95-107 mmol/L), HCO3: 24 mmol/L (Reference: 20-28 mmol/L), BUN: 9.5 mmol/L (Reference: 2.5-7.5 mmol/L), Crea: 301 µmol/l (Reference: 60 - 110 µmol/L), Glucose: 3.5 mmol/L (Reference: 3.0-6.0 mmol/L). Taking into consideration the values above, in which of the following ranges will his osmolarity fall into?

      Your Answer:

      Correct Answer: 300-313

      Explanation:

      Osmolarity refers to the osmotic pressure generated by the dissolved solute molecules in 1 L of solvent. Measurements of osmolarity are temperature dependent because the volume of the solvent varies with temperature. The higher the osmolarity of a solution, the more it attracts water from an opposite compartment.

      Osmolarity can be computed using the following formulas:

      Osmolarity = Concentration x number of dissociable particles; OR
      Plasma osmolarity (Posm) = 2([Na+]) + (glucose in mmol/L) + (BUN in mmol/L)

      Posm = 2 (144) + 3.5 + 9.5 = 301 mOsm/L

      Suppose there is electrical neutrality, the formula will double the cation activity to account for the anions.

      Plasma osmolarity (Posm) = 2([Na+] + [K+]) + (glucose in mmol/L) + (BUN in mmol/L)

      Posm = 2 (144 + 6) + 3.5 + 9.5 = 313 mOsm/L

    • This question is part of the following fields:

      • Physiology
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  • Question 27 - The statement that best describes the classification of theatre equipment in terms of...

    Incorrect

    • The statement that best describes the classification of theatre equipment in terms of electrical safety is:

      Your Answer:

      Correct Answer: A floating circuit is equipment applied to patient that is isolated from all its other parts

      Explanation:

      There are different classes of electrical equipment that can be classified in the table below:

      Class 1 – provides basic protection only. It must be connected to earth and insulated from the mains supply

      Class II – provides double insulation for all equipment. It does not require an earth.

      Class III – uses safety extra low voltage (SELV) which does not exceed 24 V AC. There is no risk of gross electrocution but risk of microshock exists.

      Type B – All of above with low leakage currents (0.5mA for Class IB, 0.1 mA for Class IIB)

      Type BF – Same as with other equipment but has ‘floating circuit’ which means that the equipment applied to patient is isolated from all its other parts.

      Type CF – Class I or II equipment with ‘floating circuits’ that is considered to be safe for direct connection with the heart. There are extremely low leakage currents (0.05mA for Class I CF and 0.01mA for Class II CF).

    • This question is part of the following fields:

      • Clinical Measurement
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  • Question 28 - A pharmaceutical company has developed a new drug considered a breakthrough in treating...

    Incorrect

    • A pharmaceutical company has developed a new drug considered a breakthrough in treating ovarian cancer. The efficacy of this drug can be assessed by which phase of a clinical trial?

      Your Answer:

      Correct Answer: Phase IIb

      Explanation:

      Phase IIa studies are usually pilot studies designed to demonstrate clinical efficacy or biological activity (‘proof of concept’ studies) whereas phase IIb studies determine the optimal dose at which the drug shows biological activity with minimal side-effects (€˜definite dose-finding’ studies).

      Phase III and Phase IV studies are performed on larger set of participants (usually hundreds to thousands) when safety and efficacy have been established.

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 29 - Which of the following statements is true about oxygen face masks? ...

    Incorrect

    • Which of the following statements is true about oxygen face masks?

      Your Answer:

      Correct Answer: The oxygen concentration delivered by high air flow oxygen enrichment devices is not dependent on the respiratory pattern of the patient

      Explanation:

      The normal peak inspiratory flow in healthy individuals is 20-30 L/min during each normal tidal ventilation. This is expected to increase with greater respiratory rate and deeper inspiration.

      Face masks are used to facilitate the delivery of oxygen from a breathing system to a patient. Face masks can be divided into two types: fixed performance or variable performance devices.

      In fixed performance devices (also known as high air flow oxygen enrichment or HAFOE), fixed inspired oxygen concentration is delivered to the patent, independent and greater than that of the patient’s peak inspiratory flow rate (PIFR). No random entrainment is expected to occur at the time of PIFR, hence, the oxygen concentration in HAFOE devices is not dependent on the patient’s respiratory pattern.

      Moreover, in HAFOE masks, the concentration of oxygen at a given oxygen flow rate is determined by the size of the constriction; a device with a greater entrainment aperture delivers a lower oxygen concentration. Therefore, a 40% Venturi device will have lesser entrainment aperture when compared to a 31% Venturi. Venturi masks allow relatively fixed concentrations of supplemental oxygen to be inspired e.g. 24%, 28%, 31%, 35%, 40% and 60% oxygen. These are colour coded and marked with the recommended oxygen flow rate.

      Variable performance devices deliver variable inspired oxygen concentration to the patient, and is dependent on the PIFR. The PIFR can often exceed the flow rate at which oxygen or an oxygen/air mixture is supplied by the device, depending on a patient’s inspiratory effort. In addition, these masks allow expired air to be released through the holes in the sides of the mask. Thus, with increased respiratory rate, rebreathing of alveolar gas from inside the mask may occur.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
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  • Question 30 - The whole water content of the body is calculated by multiplying body mass...

    Incorrect

    • The whole water content of the body is calculated by multiplying body mass with 0.6. This water is diffused into distinct compartments. Which fluid compartment can be measured indirectly?

      Your Answer:

      Correct Answer: Intracellular volume

      Explanation:

      The total body water content of a 70kg man is (70 × 0.6) = 42 litres. For a woman, the calculation is (70 × 0.55) = 38.5 litres.

      For a man, it is subdivided into:

      Extracellular fluid (ECF) = 14L (1/3)
      Intracellular fluid (ICF) = 28L (2/3).

      The ECF volume is further divided into:

      Interstitial fluid = 10.5 litres
      Plasma = 3 litres
      Transcellular fluid (CSF/synovial fluid) = 0.5 litres.

      Directly measured fluid compartments:

      Heavy water (deuterium) can be used to measure total body water content, which is freely distributed.
      Albumin labelled with a radioactive isotope or using a dye called Evans blue can be used to measure Plasma volume . They do not diffuse into red blood cells.
      Radiolabelled (Cr-51) red blood cells can be used to measure total erythrocyte volume.
      Inulin as the tracer can be used to measure ECF volume as it circulate freely in the interstitial and plasma volumes.

      Indirectly measured fluid compartments:

      Total blood volume can be calculated with the level of haematocrit and the volume of total circulating red blood cells.
      ICF volume can be calculated by subtracting ECF volume from total blood volume.

    • This question is part of the following fields:

      • Basic Physics
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SESSION STATS - PERFORMANCE PER SPECIALTY

Physiology And Biochemistry (0/1) 0%
Basic Physics (0/1) 0%
Pharmacology (1/1) 100%
Physiology (0/1) 0%
Anatomy (0/1) 0%
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