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Question 1
Incorrect
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You intend to suture a hand wound with plain 1 percent lidocaine.In 1 mL of plain 1 percent lidocaine solution, how much lidocaine hydrochloride is there?
Your Answer: 1 mg lidocaine hydrochloride
Correct Answer: 10 mg lidocaine hydrochloride
Explanation:10 mg of lidocaine hydrochloride is contained in each 1 mL of plain 1 percent lidocaine solution.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 2
Incorrect
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In the Paediatric Emergency Department, you saw a 6-year-old girl with severe bilateral conjunctivitis. You give her mother some general eye hygiene advice and prescribe chloramphenicol eye drops.What is the chloramphenicol's mechanism of action?
Your Answer: Anti-metabolic activity
Correct Answer: Inhibition of protein synthesis
Explanation:Chloramphenicol is a broad-spectrum antibiotic that inhibits bacterial protein synthesis by blocking the 50S subunit of the bacterial ribosome’s peptidyl transferase activity. When administered systemically, it has limited usage due to the potential of significant side effects such as aplastic anaemia, peripheral neuropathy, and optic neuritis. It’s only used to treat typhoid fever and Haemophilus influenzae meningitis, but it’s usually better to use a broad-spectrum cephalosporin.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 3
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A 71-year-old woman is treated with co-amoxiclav for a chest infection but she returns 1 week later. Her chest infection has resolved but she developed a profuse, offensive smelling diarrhoea and abdominal cramps. You suspect Clostridium difficile associated diarrhoea (CDAD).ONE of these statements is true concerning this diagnosis.
Your Answer: The gold standard for the diagnosis of Clostridium difficile colitis is cytotoxin assay
Explanation:Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.Alcohol hand gel is not effective against Clostridium Difficile spores. Hand washing with soap and water is very essential for healthcare workers who come in contact with it.Currently, the gold standard for the diagnosis of Clostridium difficile colitis is cytotoxin assay. Stool culture to detect Clostridium difficile is not specific for pathogenic strains, is expensive and therefore not specific for a diagnosis of CDAD
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 4
Incorrect
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A 35-year-old man is feeling unwell following his return from a business trip. He is diagnosed with a vector transmitted disease.Which of these organisms is commonly spread by vector-borne transmission?
Your Answer: Vibrio cholerae
Correct Answer: Borrelia burgdorferi
Explanation:Borrelia burgdorferiis, primarily spread by ticks and lice, is a zoonotic, vector-borne organism that causes Lyme disease.Neisseria meningitidis and Bordetella pertussis are droplet borne infections (airborne particle > 5 µm)Vibrio cholerae and Ascaris lumbricoides are spread by the faeco-oral route
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 5
Correct
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Question 6
Correct
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Compression of this nerve can cause weakness in the left leg while walking and thigh adduction weakness at the hip joint.
Your Answer: Obturator nerve
Explanation:The obturator nerve is a sensory and motor nerve that emerges from the lumbar plexus and innervates the thigh. This nerve supplies motor innervation to the medial compartment of the thigh, making it necessary for thigh adduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 7
Incorrect
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What is the partial pressure of oxygen if it makes up 20.9 percent of the ambient air composition and the atmospheric pressure of ambient air is 760 mmHg?
Your Answer: 597 mmHg
Correct Answer: 159 mmHg
Explanation:Ambient air is atmospheric air in its natural state. Ambient air is typically 78.6% nitrogen and 20.9% oxygen. The extra 1% is made up of carbon, helium, methane, argon and hydrogen. The partial pressure of any gas can be calculated using this formula: P = atmospheric pressure (760 mmHg) x percent content in the mixture. Atmospheric pressure is the sum of all of the partial pressures of the atmospheric gases added together: The formula for atmospheric pressure is: Patm = PN2 + PO2 + PH2O + PCO2. The atmospheric pressure is known to be 760 mmHg. The partial pressures of the various gases can be estimated to have partial pressures of approximately 597.4 mmHg for nitrogen, 158.8 mm Hg for oxygen, and 7.6 mmHg for argon.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 8
Incorrect
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A 27-year-old female is brought to the Emergency Department by ambulance with extensive bleeding from her upper arm following a fall from a bicycle onto a fence. On inspection her biceps brachii muscle has been lacerated.How will the muscle heal from this injury? Select ONE answer only.
Your Answer: Scar formation with no myocyte regeneration
Correct Answer: Satellite cells will produce a small number of regenerated myocytes
Explanation:Muscle heals with fibrous tissue to form a scar. Once cut, it will never regain its previous bulk or power. Within the scar a small number of myocytes (muscle cells) may be seen, which are formed from satellite cells but they contribute little to the function of the muscle overall.In more widespread ischaemic injury, such as critical ischaemic limb due to arterial compromise, or in compartment syndrome, damaged myocytes are replaced diffusely with fibrous tissue. This fibrous tissue contracts and reduces movement, and in extreme cases can pull the limb into abnormal positions such as in Volkmann’s ischaemic contracture of the forearm.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 9
Correct
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A 45-year-old businessman returns from a trip to West Africa with headaches and intermittent fevers. Thick and thin films are sent to the lab and a diagnosis is made of malaria. The patient is started on treatment but his condition deteriorates and he develops jaundice, renal failure and haemoglobinuria.Which of the following is the MOST likely causative organism? Select ONE answer only.
Your Answer: Plasmodium falciparum
Explanation:Malaria is an infectious disease transmitted by female of theAnophelesgenus of mosquito. It is a parasitic infection caused by the genusPlasmodium. Five species are recognized as causing disease in humans;Plasmodium falciparum,Plasmodium ovale,Plasmodium vivax,Plasmodium malariaeandPlasmodium knowlesi.The classic symptom of malaria is the malarial paroxysm, a cyclical occurrence of a cold phase, where the patient experiences intense chills, a hot stage, where the patient feels extremely hot and finally a sweating stage, where the fever declines and the patient sweats profusely. On examination the patient may show signs of anaemia, jaundice and have hepatosplenomegaly without evidence of lymphadenopathy.Plasmodium falciparum is the most serious form and is responsible for most deaths. Severe or complicated malaria is suggested by the presence of impaired consciousness, seizures, hypoglycaemia, anaemia, renal impairment, respiratory distress and spontaneous bleeding.Plasmodium falciparum is the most likely type in this case in view of the presentation.Haemoglobinuria and renal failure following treatment is suggestive of blackwater fever, which is caused byPlasmodium falciparum. An autoimmune reaction between the parasite and quinine causes haemolysis, haemoglobinuria, jaundice and renal failure. This can be fatal.The benign malarias: P.vivax, P. malariae and P.ovale are usually treated with chloroquine. A course of primaquine is also required in P.vivax and P.ovale infection. Artesunate is the drug treatment of choice for Plasmodium falciparum malaria. Quinine can still be used where artesunate is not available. Often combination therapy with drugs such as doxycycline or fansidar is also required.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 10
Correct
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A 45-year-old obese patient goes to the emergency department with a fever and significant right upper quadrant pain. The pain radiates to her right shoulder tip. Murphy's sign is positive and acute cholecystitis is diagnosed. The pain referred to the shoulder tip is caused by one of the following nerves:
Your Answer: Phrenic nerve
Explanation:Gallbladder inflammation can cause pain in the right upper quadrant and right shoulder, which is caused by irritation of the diaphragmatic peritoneum. Pain from areas supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3-C5.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 11
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Which of the following clinical features is most suggestive of a lesion of the temporal lobe:
Your Answer: Receptive dysphasia
Explanation:Damage to the Wernicke’s speech area in the temporal lobe can result in a receptive dysphasia. Hemispatial neglect is most likely to occur in a lesion of the parietal lobe. Homonymous hemianopia is most likely to occur in a lesion of the occipital lobe. Expressive dysphasia is most likely to occur in a lesion of the Broca speech area in the frontal lobe. Conjugate eye deviation towards the side of the lesion is most likely to occur in a lesion of the frontal lobe.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 12
Correct
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Regarding bile acids, which of the following statements is INCORRECT:
Your Answer: The main primary bile acids are deoxycholic acid and lithocholic acid.
Explanation:Bile acids have a hydrophobic and a hydrophilic end and in aqueous solution, bile salts orient themselves around droplets of lipid forming micelles to keep the lipid droplets dispersed. The principal primary bile acids are cholic acid and chenodeoxycholic acid. They are made more soluble by conjugation with taurine or glycine in the liver. Of the bile acids excreted into the intestine, about 95% are reabsorbed into the portal circulation by active transport mechanisms in the distal ileum and recycled by the liver.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 13
Incorrect
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A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is diagnosed with hyperaldosteronism.Which of these is the commonest cause of hyperaldosteronism?
Your Answer: Adrenal hyperplasia
Correct Answer: Adrenal adenoma
Explanation:When there are excessive circulating levels of aldosterone, hyperaldosteronism occurs. There are two main types of hyperaldosteronism:Primary hyperaldosteronism (,95% of cases)Secondary hyperaldosteronism (,5% of cases)Primary causes of hyperaldosteronism include:Adrenal adenoma (Conn’s syndrome) Adrenal hyperplasiaAdrenal cancerFamilial aldosteronismSecondary causes of hyperaldosteronism include:DrugsObstructive renal artery disease Renal vasoconstrictionOedematous disorders syndrome Adrenal adenoma is the commonest cause of hyperaldosteronism (seen in ,80% of all cases).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 14
Correct
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Gastrin primarily acts to perform which of the following functions:
Your Answer: Stimulate gastric acid secretion
Explanation:Gastrin primarily acts to stimulate acid secretion from parietal cells (both directly and indirectly by stimulating release of histamine from ECL cells).
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 15
Correct
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What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 16
Incorrect
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The Meissner’s plexus acts as the main control for gastrointestinal secretion and local blood flow within the gut.The Meissner’s plexus lies in which layer of the gut wall?
Your Answer: Muscular layer
Correct Answer: Submucosa
Explanation:The Meissner’s plexus (submucosal plexus), an enteric nervous plexus, acts as the main control for gastrointestinal secretion and local blood flow within the gut.It is located in the submucosal layer on the inner surface of the muscularis externa.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 17
Correct
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Regarding defaecation, which of the following statements is CORRECT:
Your Answer: Colonic mass movement occurs shortly after a meal due to distension of the stomach and duodenum.
Explanation:Colonic mass movement describes the intense contraction that begins halfway along the transverse colon and pushes the intestinal contents in the proximal colon towards the rectum. It occurs shortly after a meal due to distension of the stomach and duodenum as part of the gastrocolic reflex and if faeces is present in the rectum, stimulates the urge to defecate. Distention of the rectum causes firing of afferent cholinergic parasympathetic fibres. The internal sphincter is made up of circular smooth muscle innervated by the autonomic fibres, and the more distal external sphincter is composed of striated muscle innervated by motor fibres from the pudendal nerve. During defaecation, relaxation of pelvic muscles straightens the rectum.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 18
Correct
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In the extrinsic pathway of the coagulation cascade, the tenase complex is:
Your Answer: Factor VIIa-tissue factor complex
Explanation:The extrinsic pathway for initiating the formation of prothrombin activator begins with a traumatized vascular wall or traumatized extravascular tissues that come in contact with the blood. Exposed and activated by vascular injury, with plasma factor VII. The extrinsic tenase complex, factor VIIa-tissue factor complex, activates factor X to factor Xa.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 19
Correct
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A 6 year old boy is brought into the ED by his mom with a rash that is associated with Koplik's spots and a diagnosis of measles is made. What advice should be given about returning to school?
Your Answer: 4 days from the onset of the rash
Explanation:Prevention of spread of measles is extremely important and infected patients should be isolated. The infectious stage is from 3 days before the rash emerges and patients are advised to stay away from school/nursery/work for 4 days from onset of the rash.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 20
Incorrect
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Which of the following statements accurately describes the number needed to harm?
Your Answer: A low NNH indicates a safe treatment option
Correct Answer: The NNH is the number of patients that need to be treated for one to experience the side effect
Explanation:Number needed to harm (NNH) corresponds to the number of individuals that must be treated, so that one of them presents an adverse reaction accountable to the treatment.Hence, a NNH of 100 means that 100 individuals need to be treated in order to produce an adverse effect of the treatment in one individual.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 21
Correct
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Which of the following best describes the correct administration of adrenaline for a shockable rhythm in adult advanced life support?
Your Answer: Give 1 mg of adrenaline after the third shock and every 3 - 5 minutes thereafter
Explanation:The correct administration of IV adrenaline 1 mg (10 mL of 1:10,000 solution) is that it should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 22
Correct
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Following a decrease in extracellular volume, which of the following is a reaction to enhanced sympathetic innervation of the kidney:
Your Answer: Release of renin
Explanation:The RAS pathway begins with renin cleaving its substrate, angiotensinogen (AGT), to produce the inactive peptide, angiotensin I, which is then converted to angiotensin II by endothelial angiotensin-converting enzyme (ACE). ACE activation of angiotensin II occurs most extensively in the lung. Angiotensin II mediates vasoconstriction as well as aldosterone release from the adrenal gland, resulting in sodium retention and increased blood pressure.
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This question is part of the following fields:
- Physiology
- Renal
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Question 23
Correct
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Which of the following muscles inserts into the patella?
Your Answer: The quadriceps femoris complex
Explanation:The quadriceps femoris muscle translates to “four-headed muscle” from Latin. It bears this name because it consists of four individual muscles; rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. Out of all four muscles, only the rectus femoris crosses both the hip and knee joints. The others cross only the knee joint. These muscles differ in their origin, but share a common quadriceps femoris tendon which inserts into the patella. The function of the quadriceps femoris muscle is to extend the leg at the knee joint and to flex the thigh at the hip joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 24
Correct
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The following are all important buffers of H+EXCEPT for:
Your Answer: Calcium
Explanation:Buffers are weak acids or bases that can donate or accept H+ions respectively and therefore resist changes in pH. Buffering does not alter the body’s overall H+load, ultimately the body must get rid of H+by renal excretion if the buffering capacity of the body is not to be exceeded and a dangerous pH reached. Bicarbonate and carbonic acid (formed by the combination of CO2 with water, potentiated by carbonic anhydrase) are the most important buffer pair in the body, although haemoglobin provides about 20% of buffering in the blood, and phosphate and proteins provide intracellular buffering. Buffers in urine, largely phosphate, allow the excretion of large quantities of H+.
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This question is part of the following fields:
- Physiology
- Renal
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Question 25
Incorrect
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Regarding carbon dioxide transport in the blood, which of the following statements is CORRECT:
Your Answer: Carbon dioxide is formed from the dissociation of bicarbonate ions.
Correct Answer: Deoxygenated haemoglobin acts as a buffer for H+ ions.
Explanation:CO2generated in the tissues and water combine to form carbonic acid which readily dissociates to form HCO3-and H+. The first part of this reaction is very slow in plasma, but is accelerated dramatically by the enzyme carbonic anhydrase present in red blood cells. Bicarbonate is therefore formed preferentially in red cells, from which it freely diffuses down its concentration gradient into plasma where it is transported to the lungs. The red cell membrane is impermeable to H+ions which remain in the cell. To maintain electroneutrality, Cl-ions diffuse into the cell to replace HCO3-, an effect known as the chloride shift. Deoxygenated haemoglobin acts as a buffer for H+, allowing the reaction to continue.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 26
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 27
Correct
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Regarding antihistamines, which of the following statements is CORRECT:
Your Answer: Elderly patients and children are more susceptible to side effects.
Explanation:Elderly patients and children are more susceptible to side effects. Antihistamines are competitive inhibitors at the H1-receptor. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent. Antihistamines are used as a second line adjunct to adrenaline in anaphylaxis.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 28
Correct
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A 36-year-old man who works in a farm presents with a deep laceration over the palm of his hand. A median nerve block was performed at his wrist to facilitate wound exploration and closure.Which of the following statements regarding median nerve blocks at the wrist is considered correct?
Your Answer: The needle should be inserted approximately 2.5 cm proximal to flexor retinaculum
Explanation:A median nerve block is a simple, safe, and effective method of obtaining anaesthesia to the palmar aspect of the thumb, index finger, middle finger, radial portion of the palm and ring finger. The median nerve lies deep to the flexor retinaculum and about one centimetre under the skin of the volar wrist.The palmaris longus tendon lies superficial to the retinaculum and is absent in up to 20% of patients.The median nerve is located slightly lateral (radial) to the palmaris longus tendon and medial (ulnar) to the flexor carpi radialis tendon.The procedure is as follows:- Check sensation and motor function of the median nerve. Wear gloves and use appropriate barrier precautions.- Locate the flexor carpi radialis and palmaris longus tendons, which become prominent when the patient flexes the wrist against resistance. The palmaris longus tendon is usually the more prominent of the two tendons.- Needle-entry site: The needle will be inserted adjacent to the radial (lateral) border of the palmaris longus tendon just proximal to the proximal wrist crease. If the palmaris longus tendon is absent, the needle-entry site is about 1 cm ulnar to the flexor carpi radialis tendon.- Cleanse the site with antiseptic solution. Place a skin wheal of anaesthetic, if one is being used, at the needle-entry site.- Insert the needle perpendicularly through the skin and advance it slowly until a slight pop is felt as the needle penetrates the flexor retinaculum. When paraesthesia in the distribution of the median nerve confirms proper needle placement, withdraw the needle 1 to 2 mm.- Aspirate to exclude intravascular placement and then slowly (i.e., over 30 to 60 seconds) inject about 3 mL of anaesthetic. If the patient does not feel paraesthesia, redirect the needle in an ulnar direction, under the palmaris longus tendon. If paraesthesia is still not felt, slowly inject 3 to 5 mL of anaesthetic in the proximity of the nerve 1 cm deep to the tendon.- Allow about 5 to 10 minutes for the anaesthetic to take effect.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 29
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 30
Correct
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Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 4 months:
Your Answer: Rotavirus
Explanation:At 4 months the following vaccines are given:Diphtheria, tetanus, pertussis, polio, Hib and hepatitis B (3rd dose)Meningococcal group B (2nd dose)
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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