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Question 1
Incorrect
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Which of the following is true regarding respiration?
Your Answer: Forced inspiration requires the use of rectus abdominis
Correct Answer: The diaphragm is responsible for abdominal breathing
Explanation:The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 2
Correct
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A newborn baby is born by vaginal delivery to a mother who has a Chlamydia infection and who is started on treatment after the delivery. The neonate subsequently develops an infection also.Which one of these is the most common neonatal manifestation of Chlamydia trachomatis infection?
Your Answer: Conjunctivitis
Explanation:Conjunctivitis is the most common neonatal manifestation of Chlamydia trachomatis infection. The second commonest neonatal manifestation is pneumoniaOphthalmia neonatorum refers to any conjunctivitis in the newborn period, irrespective of causative organism. Presently, chlamydia is the single most common cause, accounting for up to 40% of cases. Ophthalmia neonatorum caused by chlamydia typically presents 5 to 14 days after birth with unilateral or bilateral watery discharge that progressively becomes more copious and purulent. There is no associated risk of ulceration and perforation, and the eyes are less inflamed.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 3
Incorrect
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A patient in the Emergency Department had a diagnosis of diabetic ketoacidosis (DKA) and you commence an insulin infusion. Which of these statements concerning insulin is true?
Your Answer: Glucagon inhibits insulin release
Correct Answer: Insulin has a short half-life of around 5-10 minutes
Explanation:Insulin, a peptide hormone, is produced in the pancreas by the beta-cells of the islets of Langerhans.The beta-cells first synthesise an inactive precursor called preproinsulin which is converted to proinsulin by signal peptidases, which remove a signal peptide from the N-terminus. Proinsulin is converted to insulin by the removal of the C-peptide.Insulin has a short half-life in the circulation of about 5-10 minutes.Glucagon and parasympathetic stimulation stimulates insulin release.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 4
Correct
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A 19-year-old with a longstanding history of asthma presents to the ED with worsening symptoms of cough and wheeze and a peak expiratory flow rate (PEFR) measurement is taken.Which statement concerning PEFR is true?
Your Answer: PEFR is dependent upon the patient's height
Explanation:The maximum flow rate generated during a forceful exhalation, after maximal inspiration is the peak expiratory flow rate (PEFR).PEFR is dependent upon initial lung volume. It is, therefore, dependant on patient’s age, sex and height.PEFR is dependent on voluntary effort and muscular strength of the patient.PEFR is decreased with increasing airway resistance, e.g. in asthma, and it correlates well with the forced expiratory volume in one second (FEV1) value measured in spirometry. This correlation decreases in patients with asthma as airflow decreases.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 5
Correct
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A 6-year-old child presents with profuse watery diarrhoea and dehydration. Which of the following statements is considered correct regarding infective diarrhoea?
Your Answer: E.Coli can cause diarrhoea and renal failure
Explanation:E. coli may cause several different gastrointestinal syndromes. Based on virulence factors, clinical manifestation, epidemiology, and different O and H serotypes, there are five major categories of diarrheagenic E. coli, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroadherent, which includes diffusely adherent E. coli (DAEC) and enteroaggregative E. coli (EAEC). These five categories are sometimescollectively referred to as enterovirulent E. coli or diarrheagenic E. coli.Norwalk virus is part of the Caliciviridae family of viruses which are single-stranded RNA viruses and are the most common cause of infectious gastroenteritis in the US.Rotaviruses are the most common cause of viral gastroenteritisin infants and children. With the introduction in 2006 of a human-bovine rotavirus vaccine (RV5; RotaTeq, Merck), a delay in the onset of rotavirusseason was seen. RotaTeq is a series of three oral vaccines beginning at 6 to 12 weeks of age. A second vaccine, Rotarix (RV1; GlaxoSmithKline, Middlesex, England), was approved in June 2008.Cryptosporidium causes an illness characterized by abdominal cramping, watery diarrhoea, vomiting, fever, and anorexia. This organism is resistant to chlorine, so public swimming pools can be the source of an outbreak.G. lamblia has a worldwide distribution and has frequently been identified as the causative agent of outbreaks of gastroenteritis and traveller’s diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 6
Correct
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A 30-year-old male with a known allergy to natural latex rubber presents with an allergic reaction to a food he has just eaten. Which ONE of these foods is most likely to cause an associated hypersensitivity in him?
Your Answer: Banana
Explanation:About one third of patients with allergy to natural latex rubber (NRL) have an associated allergy to some plant-derived foods. It is known as the latex-fruit syndrome and occurs commonly with consumption of fresh fruits. Banana and avocado are the most implicated fruits but it can also be seen with tomato, kiwi and chestnut.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 7
Incorrect
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Which of the following best describes the popliteal artery's course?
Your Answer: Terminates as the posterior tibial and the fibular artery
Correct Answer: After exiting the popliteal fossa terminates at the lower border of the popliteus muscle
Explanation:The popliteal artery divides into the anterior and posterior tibial arteries at the lower border of the popliteus after exiting the popliteal fossa between the gastrocnemius and popliteus muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Incorrect
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What is the primary mode of action of Enoxaparin?
Your Answer: Directly inhibits thrombin
Correct Answer: Inhibits factor Xa
Explanation:Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.
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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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Which type of collagen is initially laid down in early wound healing:
Your Answer: IV
Correct Answer: III
Explanation:Fibroblasts migrate to the wound (about 2 – 5 days after wounding), proliferate and secrete extracellular matrix comprising mainly collagen (type III) and fibronectin to plug the gap.
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This question is part of the following fields:
- Pathology
- Wound Healing
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Question 10
Incorrect
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Which of the following clinical features is most suggestive of a lesion of the temporal lobe:
Your Answer: Expressive dysphasia
Correct 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 11
Incorrect
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The following statements are not true of the extensor carpi radialis brevis muscle, except?
Your Answer: It lies in the anterior compartment of the forearm
Correct Answer: It receives its blood supply from the radial artery
Explanation:Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Incorrect
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A 36-year-old man presented to the emergency room with a two-week history of shortness of breath, fevers, and malaise. A chest X-ray was ordered and the results confirmed the diagnosis of a right middle lobe pneumonia. Which of the following structures of the heart lies closest to the consolidation?
Your Answer: Left ventricle
Correct Answer: Right atrium
Explanation:In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:Anterior (or sternocostal) – Right ventriclePosterior (or base) – Left atriumInferior (or diaphragmatic) – Left and right ventriclesRight pulmonary – Right atriumLeft pulmonary – Left ventricleThe silhouette sign of Felson is with respect to the right middle lobe. The right heart border should have a distinct appearance due to the right atrium abutting aerated right middle lobe. The consolidation in the right middle lobe has resulted in loss of this silhouette.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 13
Incorrect
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An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:No. of post-menopausal women who took Calcium: 500No. of post-menopausal women who took Calcium and suffered a hip fracture: 10No. of post-menopausal women who took placebo: 500No. of post-menopausal women who took placebo and suffered a hip fracture: 25Compute for the absolute risk reduction of a hip fracture.
Your Answer: 0.3
Correct Answer: 0.03
Explanation:Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).ARR = ARC-ARTARR = (25/500) – (10/500)ARR = 0.03
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This question is part of the following fields:
- Evidence Based Medicine
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Question 14
Incorrect
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Which of the following nerves provides cutaneous innervation to the posterior surface of the scrotum?
Your Answer: Branches of the anterior femoral cutaneous nerve
Correct Answer: Branch of the perineal nerve
Explanation:The following nerves provide cutaneous innervation to the scrotum, and other anatomic structures:The perineal nerve supplies the muscles in the urogenital triangle, and the skin on the posterior surface of the scrotum (or labia majora).The genital branch of the genitofemoral nerve supplies the cremaster muscle, the skin over the anterior surface of the thigh, and the anterolateral surface of the scrotum.The ilioinguinal nerve supplies the external oblique, internal oblique, transversus abdominis, skin of the upper medial aspect of thigh, the root of the penis and the anterior surface of the scrotum in the male, and the mons pubis and labia majora in the female.The posterior cutaneous nerve of the thigh, or posterior femoral cutaneous nerve, supplies the skin over the lower medial quadrant of the buttock, the inferior skin of the scrotum or labium majus, and the back of the thigh and the upper part of the leg.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 15
Correct
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A 40-year-old man with episodes of blood in urine and flank pain that are recurrent presents for management. He has a history of hypertension that is difficult to control and recurrent urinary tract infections. Other findings are: bilateral masses in his flanks and haematuria (3+ on dipstick).What is the most likely diagnosis?
Your Answer: Polycystic kidney disease
Explanation:Autosomal dominant polycystic kidney disease (ADPKD) presents with abdominal or loin discomfort due to the increasing size of the kidneys, acute loin pain with or without haematuria, hypertension, and male infertility. It is the most common cause of serious renal disease and the most common inherited cause of renal failure in adults. Alport syndrome has hearing loss and eye abnormalities in addition to symptoms of kidney disease.Renal cell carcinoma presents with additional features of unexplained weight loss, loss of appetite, fever of unknown origin and anaemia.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 16
Incorrect
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The functional residual capacity (FRC) will be increased in which of the following:
Your Answer: Pregnancy
Correct Answer: Emphysema
Explanation:Factors increasing FRC:EmphysemaAir trapping in asthmaAgeing (due to loss of elastic properties)Increasing height of patient
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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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In the treatment of bradyarrhythmias with adverse characteristics or risk of asystole, what is the initial suggested dose of atropine?
Your Answer: 6 mg
Correct Answer: 500 micrograms
Explanation:Atropine 500 mcg IV bolus should be administered if there are any adverse features or risk of asystole. If the reaction is not adequate, repeat the steps every 3 to 5 minutes up to a maximum dose of 3 mg. In the case of acute myocardial ischemia or myocardial infarction, atropine should be taken with caution since the increased heart rate may aggravate the ischemia or increase the size of the infarct.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 18
Incorrect
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Gastrin release from antral G-cells is inhibited by all but which one of the following:
Your Answer: Low gastric pH
Correct Answer: Vagal stimulation
Explanation:Gastrin secretion is inhibited by:Low gastric pH (negative feedback mechanism)SomatostatinSecretinGastric inhibitory polypeptide (GIP)Cholecystokinin
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 19
Correct
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A 53 year old women presents to the emergency room with a chronic cough. The pulmonary receptors likely to be involved in causing her cough are:
Your Answer: Irritant receptors
Explanation:Throughout the airways, there are irritant receptors which are located between epithelial cells which are made of rapidly adapting afferent myelinated fibres in the vagus nerve. A cough is as a result of receptor stimulation located in the trachea, hyperpnoea is as a result of receptor stimulation in the lower airway. Stimulation may also result in reflex bronchial and laryngeal constriction. Many factors can stimulate irritant receptors. These include irritant gases, smoke and dust, airway deformation, pulmonary congestion, rapid inflation/deflation and inflammation. Deep augmented breaths or sighs seen every 5 – 20 minutes at rest are due to stimulation of these irritant receptors. This reverses the slow lung collapse that occurs in quiet breathing.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 20
Correct
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Which of the following statements is correct regarding homeostasis?
Your Answer: In negative feedback mechanisms, effectors always act to move the variable in the opposite direction to the change that was originally detected.
Explanation:The vast majority of systems within the body work by negative feedback mechanisms. This negative feedback refers to the way that effectors act to move the variable in the opposite direction to the change that was originally detected. Because there is an inherent time delay between detecting a change in a variable and effecting a response, the negative feedback mechanisms cause oscillations in the variable they control. There is a narrow range of values within which a normal physiological function occurs and this is called the ‘set point’. The release of oxytocin in childbirth is an example of positive feedback.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 21
Correct
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Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:
Your Answer: Calcium gluconate
Explanation:Calcium gluconate is given to antagonise cardiac cell membrane excitability to reduce the risk of arrhythmias. It has no effect on serum potassium levels unlike the alternative drugs listed above.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 22
Correct
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Which of the following does NOT affect the rate of flow of a liquid through a tube:
Your Answer: Surface tension
Explanation:Flow through a tube is dependent upon:The pressure difference across the ends of the tube (P1– P2)The resistance to flow provided by the tube (R)This is Darcy’s law, which is analogous to Ohm’s law in electronics:Flow = (P1– P2) / RResistance in the tube is defined by Poiseuille’s law, which is determined by the diameter of the tube and the viscosity of the fluid. Poiseuille’s law is as follows:Resistance = (8VL) / (πR4)Where:V = The viscosity of the fluidL = The length of the tubeR = The radius of the tubeTherefore, in simple terms, resistance is directly proportional to the viscosity of the fluid and the length of the tube and inversely proportional to the radius of the tube. Of these three factors, the most important quantitatively and physiologically is vessel radius.It can be seen that small changes in the radius can have a dramatic effect on the flow of the fluid. For example, the constriction of an artery by 20% will decrease the flow by approximately 60%.Another important and frequently quoted example of this inverse relationship is that of the radius of an intravenous cannula. Doubling the diameter of a cannula increases the flow rate by 16-fold (r4). This is the reason the diameter of an intravenous cannula in resuscitation scenarios is so important.*Please note that knowledge of the detail of Poiseuille’s law is not a requirement of the RCEM Basic Sciences Curriculum.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 23
Correct
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A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy vaginal bleeding. She complains of feeling hot and cold during transfusion of the second unit and her temperature is 38.5ºC. Prior to the transfusion, her temperature was 37ºC. She has no other symptoms.Which of these transfusions reactions most likely occurred?
Your Answer: Febrile transfusion reaction
Explanation:Febrile transfusion reactions presents with an unexpected temperature rise (≥ 38ºC or ≥ 1ºC above baseline, if baseline ≥ 37ºC) during or shortly after transfusion. It is usually an isolated finding and the fever is accompanied by chills and malaise occasionally.Allergic reaction is commonly caused by foreign plasma proteins but may be due to anti-IgA. Allergic type reactions usually present with urticaria, pruritus, hives. Associations include laryngeal oedema or bronchospasm.Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.Transfusion-related lung injury (TRALI) is a form of acute respiratory distress caused by the donor plasma containing antibodies against the patient’s leukocytes. It is defined as hypoxia and bilateral pulmonary oedema that occurs within 6 hours of a transfusion in the absence of other causes of acute lung injury. Clinical features include Breathlessness, cough, frothy sputum, hypertension or hypotension, hypoxia and fever. Chest X-ray shows multiple perihilar nodules with infiltration of the lower lung fields.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 24
Incorrect
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When the pulmonary artery is completely blocked, what is the ventilation over perfusion ratio for the area that it supplies?
Your Answer: 1
Correct Answer: Infinity
Explanation:The ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching ventilation and perfusion. A pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. When a large pulmonary embolus completed blocked a pulmonary artery the alveoli were ventilated but not perfused at all, then the V/Q ratio would be infinity.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 25
Correct
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Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed with psittacosis based on his symptoms and history of being a pigeon enthusiast. Which of the following is the causative bacteria of psittacosis?
Your Answer: Chlamydia psittaci
Explanation:Chlamydia psittaci is a microorganism that is commonly found in birds. These bacteria can infect people and cause psittacosis. Psittacosis is an infectious disease that may cause high fever and pneumonia associated with headaches, altered mental state, and hepatosplenomegaly.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 26
Correct
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A 43 year old lady who has a previous medical history of hyperthyroidism presents to the emergency room with sweating, palpitations and agitation. On examination, she is tachycardic, hypertensive and hyperpyrexic. She recently had a stomach bug and has not been able to take her medication regularly. The best medication to immediately treat her symptoms is which of the following?
Your Answer: Propranolol
Explanation:There is a high suspicion of a thyroid crisis in this patient and emergent treatment should be initiated even before the results of TFT’s have returned. Antiadrenergic drugs like IV propranolol should be administered immediately to minimise sympathomimetic symptoms. Antithyroid medications like propylthiouracil or carbimazole should be administered to block further synthesis of thyroid hormones. After thionamide therapy has been started to prevent stimulation of new hormone synthesis, there should then be delayed administration of oral iodine solution. Hydrocortisone administration is also recommended as it treats possible relative adrenal insufficiency while also decreases peripheral conversion of T4 to T3.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 27
Incorrect
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Which extraocular muscle is entrapped in a patient with a blowout fracture?
Your Answer: Inferior oblique
Correct Answer: Inferior rectus
Explanation:A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. The common mechanisms are falls, high-velocity ball-related sports, traffic accidents, and interpersonal violence.The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bones. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles.The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. Finally, the orbital injury can lead to retinal oedema, hyphema, and significant loss of vision.While some cases may be managed with conservative care, others may require some type of surgical intervention.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 28
Correct
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You review a 50-year-old man that is requesting the seasonal influenza vaccination.Which of the following single clinical risk groups is NOT eligible to receive the seasonal influenza vaccination? Select ONE answer only.
Your Answer: Patients over the age of 50
Explanation:Patients with hypertension are only eligible for the seasonal influenza vaccination if they have co-existent cardiac complications.The UK national policy is that the seasonal influenza vaccine should be offered to the following groups:All those aged 65 years and olderChildren aged 2 to 15 yearsResidents of nursing and residential homes for the elderly (and other long-stay facilities)Carers of persons whose welfare may be at risk if the carer falls illAll those aged 6 months or older in a clinical risk groupThe following table outlines the clinical risk groups that are considered eligible for the vaccine:CategoryExamples of eligible groupsRespiratory diseaseCOPDInterstitial lung diseaseCystic fibrosisAsthma (requiring oral or inhaled steroids)Heart diseaseCongenital heart diseaseChronic heart failureCoronary heart disease (requiring medication and/or follow-up)Hypertension with cardiac complicationsKidney diseaseChronic kidney diseaseNephrotic syndromeRenal transplant patientsLiver diseaseLiver cirrhosisChronic hepatitisBiliary atresiaNeurological diseaseCerebrovascular accidentTransient ischaemic attackEndocrine diseaseType 1 and 2 diabetesImmunosuppressionPatients undergoing chemotherapyPatients taking immunosuppressive drug therapy (including systemic steroids)Asplenia or splenic dysfunctionHIV infectionPregnancyAll pregnant women
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 29
Correct
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A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.Which drug is least likely to have caused his hypokalaemia?
Your Answer: Spironolactone
Explanation:Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 30
Incorrect
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You evaluate a 80-year-old man who has a history of persistent heart failure and discover that he has generalised oedema.Which of the following claims regarding capillary hydrostatic pressure (P c) is false?
Your Answer: P c is the most variable of the four Starling factors affecting filtration at capillary beds
Correct Answer: P c increases along the length of the capillary, from arteriole to venule
Explanation:The capillary hydrostatic pressure (Pc) is normally between 15 and 30 millimetres of mercury. Pc Decreases along the capillary’s length, mirroring the arteriolar and venule pressures proximally and distally.Pc is determined by the ratio of arteriolar resistance (RA) to venular resistance (RV).When the RA/RV ratio is high, the pressure drop across the capillary is modest, and Pcis is close to venule pressure.When the ratio of RA/RV is low, the pressure drop across the capillary is considerable, and Pcis is close to arteriolar pressure.Pcis closer to the venule pressure and thus more responsive to changes in venous pressure than arteriolar pressure when RA/RV is high.Pcis the major force behind fluid pushing out of the capillary bed and into the interstitium.It is also the most variable of the forces affecting fluid transport at the capillary, partly because sympathetic-mediated arteriolar vasoconstriction varies.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
