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  • Question 1 - Which of the following is NOT a pharmacological effect of beta-blockers: ...

    Correct

    • Which of the following is NOT a pharmacological effect of beta-blockers:

      Your Answer: Reduced AV conduction time

      Explanation:

      Effects of beta-blockers:Cardiovascular system: Reduce blood pressureReduce heart rate, contractility and cardiac outputIncrease AV conduction time, refractoriness and suppress automaticityEye:Reduce intraocular pressureRespiratory system:Cause bronchoconstriction

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      38.8
      Seconds
  • Question 2 - The syndrome of inappropriate antidiuresis due to excessive antidiuretic hormone (ADH) secretion is...

    Incorrect

    • The syndrome of inappropriate antidiuresis due to excessive antidiuretic hormone (ADH) secretion is diagnosed in a male patient with a history of recurrent hyponatraemia.Which of the following produces ADH?

      Your Answer: Posterior pituitary

      Correct Answer: Hypothalamus

      Explanation:

      Antidiuretic hormone (ADH), commonly known as vasopressin, is a peptide hormone that controls how much water the body retains.It is produced in the magnocellular and parvocellular neurosecretory cells of the paraventricular nucleus and supraoptic nucleus in the hypothalamus from a prohormone precursor. It is subsequently carried to the posterior pituitary via axons and stored in vesicles.The secretion of ADH from the posterior pituitary is regulated by numerous mechanisms:Increased plasma osmolality: Osmoreceptors in the hypothalamus detect an increase in osmolality and trigger ADH release.Stretch receptors in the atrial walls and big veins detect a decrease in atrial pressure as a result of this (cardiopulmonary baroreceptors). ADH release is generally inhibited by atrial receptor firing, but when the atrial receptors are stretched, the firing reduces and ADH release is promoted.Hypotension causes baroreceptor firing to diminish, resulting in increased sympathetic activity and ADH release.An increase in angiotensin II stimulates angiotensin II receptors in the hypothalamus, causing ADH production to increase.The main sites of action for ADH are:The kidney is made up of two parts. ADH’s main job is to keep the extracellular fluid volume under control. It increases permeability to water by acting on the renal collecting ducts via V2 Receptors (via a camp-dependent mechanism). This leads to a decrease in urine production, an increase in blood volume, and an increase in arterial pressure as a result.Vascular system: Vasoconstriction is a secondary function of ADH. ADH causes vasoconstriction via binding to V1 Receptors on vascular smooth muscle (via the IP3 signal transduction pathway). An increase in arterial pressure occurs as a result of this.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      18.7
      Seconds
  • Question 3 - Normal human immunoglobulin is mostly used to protect against which of the following...

    Incorrect

    • Normal human immunoglobulin is mostly used to protect against which of the following infectious diseases?

      Your Answer: Measles and varicella

      Correct Answer: Measles and hepatitis A

      Explanation:

      Immune globulin IM is indicated for prophylaxis following exposureto hepatitis A, to prevent or modify measles (rubeola) in a susceptible person exposed fewer than 6 days previously,for susceptible household contacts of measles patients,particularly contacts <1 year and pregnant women without evidence of immunity, and to modify rubella in exposed pregnant women who will not consider a therapeutic abortion.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      168.8
      Seconds
  • Question 4 - What is the main mechanism of action of dopamine as an inotropic sympathomimetic: ...

    Correct

    • What is the main mechanism of action of dopamine as an inotropic sympathomimetic:

      Your Answer: Beta1-receptor agonist

      Explanation:

      Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      65
      Seconds
  • Question 5 - Regarding the UK routine childhood immunisation schedule which of the following vaccines is...

    Incorrect

    • Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 2 months:

      Your Answer: Hepatitis B

      Correct Answer: Meningococcal group C

      Explanation:

      At 2 months the following vaccines are given: Diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (Hib) and hepatitis BRotavirus gastroenteritisMeningococcal group B

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      9.9
      Seconds
  • Question 6 - A 65-year-old man presents with a red, hot, swollen great toe. A diagnosis...

    Correct

    • A 65-year-old man presents with a red, hot, swollen great toe. A diagnosis of acute gout is made. His past medical history includes heart failure and type 2 diabetes mellitus.Which of the following is the most appropriate medication to use in the treatment of his gout? Select ONE answer only.

      Your Answer: Colchicine

      Explanation:

      In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
      58.7
      Seconds
  • Question 7 - A patient presents with a gastrointestinal infection. Which of the following microbes attaches...

    Correct

    • A patient presents with a gastrointestinal infection. Which of the following microbes attaches to gut mucosa via a specialised sucking disc:

      Your Answer: Giardia lamblia

      Explanation:

      Giardia lambliainfection occurs through the ingestion of dormant microbial cysts in contaminated water, food or via faceo-oral transmission via poor hygiene.Following ingestion of the cysts, the trophozoite emerges to an active state of feeding and motility. After the feeding stage they undergo asexual replication through longitudinal binary fission.They attach to the intestinal wall via a specialised sucking disc. The mechanism for diarrhoea in giardiasis remains unknown but could possibly be due to direct cytotoxicity.Giardial trophozoites and cysts pass through the digestive system in the faeces and are excreted. While the trophozoites may be found in the faeces, only the cysts are adapted for long-term survival outside the host.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      10.5
      Seconds
  • Question 8 - Which of these increases osteoclast activity? ...

    Correct

    • Which of these increases osteoclast activity?

      Your Answer: Parathyroid hormone

      Explanation:

      Osteoclasts are bone cell that break down bone tissue. Parathyroid hormone increases osteoclastic activity.1,25-dihydroxycholecalciferol increases osteoclastic activityCalcitonin inhibits osteoclastic activityBisphosphonates are osteoclast inhibitors.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      36.2
      Seconds
  • Question 9 - C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:...

    Correct

    • C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:

      Your Answer: IL-6

      Explanation:

      Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      7.2
      Seconds
  • Question 10 - Which of the following lifestyle changes is not likely to improve symptoms of...

    Correct

    • Which of the following lifestyle changes is not likely to improve symptoms of gastro-oesophageal reflux disease (GORD):

      Your Answer: Lowering the head of the bed

      Explanation:

      The following approaches have some benefit in adult patients with reflux:Weight loss or weight management for individuals who are overweightHead of bed elevation is important for individuals with nocturnal or laryngeal symptoms, but its value for other situations is unclear.The following lifestyle approaches also are used frequently. There is some evidence that these lifestyle changes improve laboratory measures of reflux (such as lower oesophageal sphincter pressure).Dietary modification – A practical approach is to avoid a core group of reflux-inducing foods, including chocolate, peppermint, and alcohol, which may reduce lower oesophageal sphincter pressure. Acidic beverages, including colas with caffeine and orange juice also may exacerbate symptoms. Avoiding the supine position soon after eating.Promotion of salivation by either chewing gum or using oral lozenges. Salivation neutralizes refluxed acid, thereby increasing the rate of oesophageal acid clearance.Avoidance of tobacco (including passive exposure to tobacco smoke) and alcohol. Nicotine and alcohol reduce lower oesophageal sphincter pressure, and smoking also diminishes salivation.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      14.1
      Seconds
  • Question 11 - A 60-year-old patient with a history of hypertension and chronic kidney disease (CKD) walks...

    Correct

    • A 60-year-old patient with a history of hypertension and chronic kidney disease (CKD) walks into the clinic to discuss her most recent blood results indicating an accelerated progression of CKD.Which of the following is the correct definition for accelerated progression of CKD?

      Your Answer: A sustained decrease in GFR of 15 ml/minute/1.73 m 2 per year

      Explanation:

      Chronic kidney disease (CKD) is a disorder in which kidney function gradually deteriorates over time. It’s fairly prevalent, and it typically remains unnoticed for years, with only advanced stages of the disease being recognized. There is evidence that medication can slow or stop the progression of CKD, as well as lessen or prevent consequences and the risk of cardiovascular disease (CVD).CKD is defined as kidney damage (albuminuria) and/or impaired renal function (GFR 60 ml/minute per 1.73 m2) for three months or longer, regardless of clinical diagnosis.A prolonged decline in GFR of 25% or more with a change in GFR category within 12 months, or a sustained drop in GFR of 15 ml/minute/1.73 m² per year, is considered accelerated CKD progression.End-stage renal disease (ESRD) is defined as severe irreversible kidney impairment with a GFR of less than 15 ml/minute per 1.73 m² and a GFR of less than 15 ml/minute per 1.73 m².

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      41
      Seconds
  • Question 12 - Glucagon is contraindicated in which of the following: ...

    Incorrect

    • Glucagon is contraindicated in which of the following:

      Your Answer: Severe hypertension

      Correct Answer: Pheochromocytoma

      Explanation:

      Glucagon is contraindicated in pheochromocytoma.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      48.2
      Seconds
  • Question 13 - All these structures make up the portal triad EXCEPT? ...

    Incorrect

    • All these structures make up the portal triad EXCEPT?

      Your Answer: Vagal parasympathetic nerve fibres

      Correct Answer: Branches of the hepatic vein

      Explanation:

      The portal triad, is made up of a portal arteriole (a branch of the hepatic artery), a portal venule (a branch of the hepatic portal vein) and a bile duct. Also contained within the portal triad are lymphatic vessels and vagal parasympathetic nerve fibres.Branches of the hepatic vein is not part of the portal triad

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      34.7
      Seconds
  • Question 14 - 1-alpha-hydroxylase is a cytochrome p450 enzyme that is involved in the production of...

    Correct

    • 1-alpha-hydroxylase is a cytochrome p450 enzyme that is involved in the production of vitamin D's hormonally active metabolite.Which of the following promotes the activity of 1-alpha-hydroxylase?

      Your Answer: Parathyroid hormone

      Explanation:

      1-alpha-hydroxylase converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol in the kidney.The key regulatory point in the formation of 1,25-dihydroxycholecalciferol is 1-alpha-hydroxylase, which is promoted by parathyroid hormone or hypophosphatemia.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      56
      Seconds
  • Question 15 - A 34-year-old man arrives at the department befuddled. He has a history of...

    Incorrect

    • A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.Which of the following statements about antipsychotic drug side effects is correct?

      Your Answer: Haloperidol is the safest antipsychotic drug to use in elderly patients with dementia-related psychosis

      Correct Answer: Haloperidol is the most common causative antipsychotic drug

      Explanation:

      Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.Renal impairment causes increased cerebral sensitivity, so lower doses should be used.In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.The following are some of the antipsychotic drugs’ contraindications:Reduced level of consciousness/comaDepression of the central nervous systemPhaeochromocytoma

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      43
      Seconds
  • Question 16 - Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:

      Your Answer: Ca 2+ influx accounts for about 70% of the rise in intracellular [Ca 2+ ].

      Correct Answer: The Treppe effect refers to an increase in contractility secondary to an increase in heart rate.

      Explanation:

      Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane. When more action potentials occur per unit time, more Ca2+enters the cell during the AP plateau, more Ca2+is stored in the SR, more Ca2+is released from the SR and thus more Ca2+is left inside the cell and greater tension is produced during contraction. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Cardiac glycosides such as digoxin have a positive inotropic effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      61.1
      Seconds
  • Question 17 - One of your patients is in resuscitation and is suffering from kidney failure....

    Incorrect

    • One of your patients is in resuscitation and is suffering from kidney failure. The intensive care outreach team arrives to assess them and determines that a dopamine infusion is necessary.Dopamine primarily acts on which of the following receptors at low doses?

      Your Answer: Beta-1 receptors

      Correct Answer: Dopamine receptors

      Explanation:

      Dopamine is a catecholamine that occurs naturally and is used to treat low cardiac output, septic shock, and renal failure. It is both adrenaline and noradrenaline’s immediate precursor.Dopamine acts on D1 and D2 dopamine receptors in the renal, mesenteric, and coronary beds at low doses (1-5 g/kg/min). Dopamine causes a significant decrease in renal vascular resistance and an increase in renal blood flow at these doses. Within this dose range, it is also involved in central modulation of behaviour and movement.Dopamine stimulates beta- and alpha-adrenergic receptors directly and indirectly at higher doses. Beta-stimulation predominates at a rate of 5-10 g/kg/min, resulting in a positive inotropic effect that increases cardiac output and coronary blood flow. Alpha-stimulation predominates at infusion rates greater than 15 g/kg/min, resulting in peripheral vasoconstriction and an increase in venous return and systolic blood pressure.Below is a summary of the mechanisms and effects of various inotropic agents:InotropeMechanismEffectsAdrenaline (epinephrine)Beta-1 and -2 agonist at increasing doses;Alpha-agonist at high dosesIncreased cardiac output;Vasoconstriction at higher dosesNoradrenaline (norepinephrine)Mainly alpha-agonist;Beta-1 and -2 agonist at increasing dosesVasoconstriction;Some increased cardiac outputDopamineDopamine agonist at low doses;Beta-1 and -2 agonist at increasing doses;Alpha-agonist at high dosesIncreased cardiac output;Vasoconstriction at higher dosesDobutamineMainly beta-1 agonistIncreased cardiac output

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      24.6
      Seconds
  • Question 18 - A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular...

    Correct

    • A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular medication.What is the dosage per inhalation of a standard metered dose salbutamol inhaler?

      Your Answer: 100 micrograms

      Explanation:

      The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      18.8
      Seconds
  • Question 19 - A patient complains of stomach ache. You see a midline scar in the...

    Incorrect

    • A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The gastric ECL cells secrete which of the following substances?

      Your Answer: Mucous

      Correct Answer: Histamine

      Explanation:

      Enterochromaffin-like cells (ECL cells) are a type of neuroendocrine cell located beneath the epithelium in the stomach glands. They’re most typically located near the parietal cells of the stomach. The ECL cells’ primary role is to produce histamine, which stimulates the formation of stomach acid by the parietal cells.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      37.2
      Seconds
  • Question 20 - Regarding relationships between two variables, what does a negative correlation coefficient indicate: ...

    Correct

    • Regarding relationships between two variables, what does a negative correlation coefficient indicate:

      Your Answer: The two variables are inversely related

      Explanation:

      A negative correlation coefficient means that the two variables are inversely related e.g. socio-economic class and mortality.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      16
      Seconds
  • Question 21 - Regarding fat digestion, which of the following statements is CORRECT: ...

    Correct

    • Regarding fat digestion, which of the following statements is CORRECT:

      Your Answer: Chylomicrons are exocytosed from enterocytes to enter lacteals and thus the lymphatic system.

      Explanation:

      Dietary fat is chiefly composed of triglycerides (esters of free fatty acids and glycerol which may be saturated or unsaturated). The essential fatty acids are linoleic acid and alpha-linoleic acid, which cannot be manufactured in the body. Dietary fat provides 37 kJ (9 kcal) of energy per gram. Fats are digested almost entirely in the small intestine and are only released from the stomach into the duodenum at the rate at which they can be digested.Pancreatic lipase is the most significant enzyme for fat digestion. In the duodenum fat is emulsified by bile acids, a process where larger lipid droplets are broken down into much smaller droplets providing a greater surface area for enzymatic digestion. Micelles are arranged so that hydrophobic lipid molecules lie in the centre, surrounded by bile acids arranged such the outer region is hydrophilic. Dietary and synthesised lipids are incorporated into chylomicrons in the Golgi body, which are exocytosed from the basolateral membrane to enter lacteals and thus the lymphatic system.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      29.3
      Seconds
  • Question 22 - The most common complication of paracetamol overdose is: ...

    Correct

    • The most common complication of paracetamol overdose is:

      Your Answer: Hepatic failure

      Explanation:

      The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      5.6
      Seconds
  • Question 23 - The renal corpuscle, consisting of the Bowman's capsule and the glomerulus is found...

    Incorrect

    • The renal corpuscle, consisting of the Bowman's capsule and the glomerulus is found where in the kidney:

      Your Answer: The medulla

      Correct Answer: The cortex

      Explanation:

      All nephrons have their renal corpuscles in the renal cortex. Cortical nephrons have their renal corpuscles in the outer part of the cortex and relatively short loops of Henle. Juxtamedullary nephrons have their corpuscles in the inner third of the cortex, close to the corticomedullary junction, with long loops of Henle extending into the renal medulla.

    • This question is part of the following fields:

      • Physiology
      • Renal
      17.5
      Seconds
  • Question 24 - For an action potential to occur, which of the following must be true:...

    Correct

    • For an action potential to occur, which of the following must be true:

      Your Answer: Depolarisation of the membrane must reach threshold potential

      Explanation:

      For an action potential to occur, the membrane must become more permeable to Na+and the Na+influx must be greater than the K+efflux. An action potential occurs when depolarisation of the membrane reaches threshold potential. The membrane must be out of the absolute refractory period, however an action potential can still occur in a relative refractory period but only in response to a larger than normal stimulus.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      32.5
      Seconds
  • Question 25 - A patient presents to ED with heartburn for which they already take regular...

    Correct

    • A patient presents to ED with heartburn for which they already take regular antacids. Which of the following drugs can be affected if taken with antacids:

      Your Answer: Digoxin

      Explanation:

      Antacids should preferably not be taken at the same time as other drugs since they may affect absorption. When antacids are taken with acidic drugs (e.g. digoxin, phenytoin, chlorpromazine, isoniazid) they cause the absorption of the acidic drugs to be decreased, which causes low blood concentrations of the drugs, which ultimately results in reduced effects of the drugs. Antacids taken with drugs such as pseudoephedrine and levodopa increase absorption of the drugs and can cause toxicity/adverse events due to increased blood levels of the drugs. Antacids that contain magnesium trisilicate and magnesium hydroxide when taken with some other medications (such as tetracycline) will bind to the drugs, and reduce their absorption and effects.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      8.9
      Seconds
  • Question 26 - A 54-year-old man with a long history of poorly controlled hypertension complains of...

    Correct

    • A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.Which of the following is the patient's preferred drug treatment?

      Your Answer: 25% of the mean arterial pressure over the first hour

      Explanation:

      End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      119.5
      Seconds
  • Question 27 - The qSOFA score is a bedside prompt designed to identify patients with suspected...

    Correct

    • The qSOFA score is a bedside prompt designed to identify patients with suspected infection who are at greater risk for a poor outcome outside of the intensive care unit.Which of the following is one of the criteria used in the qSOFA score? Select ONE answer only.

      Your Answer: Respiratory rate >22

      Explanation:

      In February 2016 the Society of Critical Care Medicine published a JAMA article reformatting the definitions of sepsis in an attempt to overcome the shortcomings of the old definitions.The main changes are a new definition of sepsis, the replacement of the SIRS criteria with the quick Sepsis-related Organ Failure Assessment (qSOFA), and the complete removal of “severe sepsis” as an entity.The new definition of sepsis is that it is “life-threatening organ dysfunction caused by a dysregulated host response to infection.”Septic shock is “a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to increase mortality.”In essence this means that septic shock is sepsis plus the following, despite adequate fluid resuscitation:Vasopressors required to maintain a MAP > 65 mmHgSerum lactate > 2 mmol/lThe qSOFA score is a bedside prompt designed to identify patients with suspected infection who are at greater risk for a poor outcome outside of the intensive care unit. It uses the following three criteria:Hypotension (SBP < 100 mmHg)Tachypnoea (RR > 22)Altered mental status (GCS < 15)The presence of 2 or more of the qSOFA criteria near the onset of infection is associated with greater risk of death or a prolonged intensive care unit stay.

    • This question is part of the following fields:

      • Pathology
      • Pathology Of Infections
      12.3
      Seconds
  • Question 28 - An analytical study is conducted to compare the risk of stroke between Ticagrelor...

    Correct

    • An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:No. of patients who took Ticagrelor: 300No. of patients who took Ticagrelor and suffered a stroke: 30No. of patients who took Warfarin: 500No. of patients who took Warfarin and suffered a stroke: 20Compute for the risk ratio of a stroke.

      Your Answer: 2.5

      Explanation:

      Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).RR = ART/ARCRR = (30/300) / (20/500)RR = 2.5Recall that:If RR < 1, then the intervention reduces the risk of the outcome.If RR = 1, then the treatment has no effect on the outcome.If RR > 1, then the intervention increases the risk of the outcome.

    • This question is part of the following fields:

      • Evidence Based Medicine
      59.9
      Seconds
  • Question 29 - A 28-year-old female arrives after taking an unknown chemical in excess. She is tired...

    Correct

    • A 28-year-old female arrives after taking an unknown chemical in excess. She is tired and her speech is slurred. The following are her observations and results: HR 118, BP 92/58, SaO2 96%HR 118,  11/15  The following are the results  of his arterial blood gas (ABG):pH: 7.24 pO 2 : 9.4 kPa PCO2 : 3.3 kPa HCO 3 -: 22 mmol/l Na + : 143 mmol/l Cl – : 99 mmol/l Lactate: 5 IU/lWhich of the following statements about this patient is TRUE?

      Your Answer: Her anion gap is elevated

      Explanation:

      The interpretation of arterial blood gas (ABG) aids in the measurement of a patient’s pulmonary gas exchange and acid-base balance. The normal values on an ABG vary a little depending on the analyser, but they are roughly as follows:Variable RangepH 7.35 – 7.45PaO2 10 – 14 kPaPaCO2 4.5 – 6 kPaHCO3- 22 – 26 mmol/lBase excess -2 – 2 mmol/lThe patient’s history indicates that she has taken an overdose in this case. Because her GCS is 11/15 and she can communicate with slurred speech, she is clearly managing her own airway, there is no current justification for intubation.The following are the relevant ABG findings:Hypoxia (mild)pH has been lowered (acidaemia)PCO2 levels are low.bicarbonate in its natural stateLactate levels have increasedThe anion gap represents the concentration of all the unmeasured anions in the plasma. It is the difference between the primary measured cations and the primary measured anions in the serum. It can be calculated using the following formula:Anion gap = [Na+] – [Cl-] – [HCO3-]The reference range varies depending on the technique of measurement, but it is usually between 8 and 16 mmol/L.The following formula can be used to compute her anion gap:Anion gap = [143] – [99] – [22]Anion gap = 22As a result, it is clear that she has a metabolic acidosis with an increased anion gap.The following are some of the causes of type A and type B lactic acidosis:Type A lactic acidosisType B lactic acidosisShock (including septic shock)Left ventricular failureSevere anaemiaAsphyxiaCardiac arrestCO poisoningRespiratory failureSevere asthma and COPDRegional hypoperfusionRenal failureLiver failureSepsis (non-hypoxic sepsis)Thiamine deficiencyAlcoholic ketoacidosisDiabetic ketoacidosisCyanide poisoningMethanol poisoningBiguanide poisoning

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      106.5
      Seconds
  • Question 30 - You investigated a patient with a chest infection and want to start antibiotics right...

    Incorrect

    • You investigated a patient with a chest infection and want to start antibiotics right away. The patient says they she can't take cephalosporins when you ask about allergies.Choose the 'second-generation' cephalosporin from the following choices? 

      Your Answer: Ceftriaxone

      Correct Answer: Cefuroxime

      Explanation:

      Cephalosporins of the first generation  include cephalexin, cefradine, and cefadroxil. Urinary tract infections, respiratory tract infections, otitis media, and skin and soft-tissue infections are all treated with them.Second-generation cephalosporins include cefuroxime, cefaclor, and cefoxitin. These cephalosporins are less vulnerable to beta-lactamase inactivation than the ‘first-generation’ cephalosporins. As a result, they’re effective against germs that are resistant to other antibiotics, and they’re especially effective against Haemophilus influenzae.Cephalosporins of the third generation include cefotaxime, ceftazidime, and ceftriaxone. They are more effective against Gram-negative bacteria than second generation’ cephalosporins. They are, however, less effective against Gram-positive bacteria such Staphylococcus aureus than second-generation cephalosporins.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      20.9
      Seconds
  • Question 31 - You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy...

    Incorrect

    • You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her with Cushing's syndrome.When would her random cortisol level likely be abnormal? 

      Your Answer: 0900 hrs

      Correct Answer: 2400 hrs

      Explanation:

      Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep.The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      21.8
      Seconds
  • Question 32 - The parasympathetic supply to the rectum is from which of the following: ...

    Incorrect

    • The parasympathetic supply to the rectum is from which of the following:

      Your Answer: Sacral splanchnic nerves

      Correct Answer: Pelvic splanchnic nerves

      Explanation:

      Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      16.1
      Seconds
  • Question 33 - On review of a patient's serum and urine osmolality test result, you note...

    Incorrect

    • On review of a patient's serum and urine osmolality test result, you note that both osmolarities are decreased. There urine osmolality does not increase with fluid ingestion.What is the most likely cause?

      Your Answer: Syndrome of inappropriate antidiuresis

      Correct Answer: Hyponatraemia

      Explanation:

      As part of the investigation of hyponatraemia, serum osmolality is commonly requested in combination with urine osmolality to aid diagnosis.When: Serum osmolality is decreased and urine osmolality is decreased with no intake of fluid, the causes areHyponatraemiaOverhydrationAdrenocortical insufficiencySodium loss (diuretic or a low-salt diet)Serum osmolality is normal or increased and urine osmolality is increased the causes include:DehydrationHyperkalaemiaHyperglycaemiaHyponatremiaMannitol therapyDiabetes mellitusAlcohol ingestionCongestive heart failureRenal disease and uraemiaSerum osmolality is normal or increased and urine osmolality is decreased the usual cause is diabetes insipidusSerum osmolality is decreased and urine osmolality is increased the usual cause is syndrome of inappropriate antidiuresis (SIAD)

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      113.7
      Seconds
  • Question 34 - A 30-year-old rugby player suffers from an anterior cruciate ligament tear while pivoting...

    Correct

    • A 30-year-old rugby player suffers from an anterior cruciate ligament tear while pivoting to attempt to run around another player. An MRI was performed and showed that his injury caused two other structures in the knee joint to be injured. Which of the following structures is most likely also injured?

      Your Answer: Medial meniscus

      Explanation:

      The O’Donoghue unhappy triad or terrible triad often occurs in contact and non-contact sports, such as basketball, football, or rugby, when there is a lateral force applied to the knee while the foot is fixated on the ground. This produces an abduction-external rotation mechanism of injury.The O’Donoghue unhappy triad comprises three types of soft tissue injury that frequently tend to occur simultaneously in knee injuries. O’Donoghue described the injuries as: anterior cruciate ligament tear, medial collateral ligament injury, and medial meniscal tear (lateral compartment bone bruise).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      5.4
      Seconds
  • Question 35 - You're called to a cardiac arrest in your Emergency Department resuscitation area. The...

    Correct

    • You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available.In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines?

      Your Answer: Lidocaine

      Explanation:

      If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      26.1
      Seconds
  • Question 36 - Regarding the routine childhood immunisation schedule, which of the following vaccines is given...

    Correct

    • Regarding the routine childhood immunisation schedule, which of the following vaccines is given to preschool children (aged 3 years and 4 months):

      Your Answer: Measles, mumps and rubella (MMR)

      Explanation:

      The current UK childhood immunisation schedule is as follows:8 weeks:DTaP/IPV(polio)/Hib/Hep B (diptheria, tetanus, pertussis, polio,Haemophilus influenzatype b and hepatitis B) – 6-in-one injection (Infranix hexa);plus:Rotavirus gastroenteritis (Rotarix) – oral route (drops)Meningitis B (Bexsero)12 weeks:DTaP/IPV(polio)/Hib/Hep B – 2nddose: 6-in-one injection, 2nddose (Infranix hexa);plus:PCV (pneumococcal conjugate vaccine) – in a separate injection (Prevenar 13)Rotavirus gastroenteritis 2nddose (Rotarix) – oral route (drops)16 weeks:DTaP/IPV(polio)/Hib/Hep B – 3rddose: 6-in-one injection, 3rddose (Infranix hexa);plus:Meningitis B 2nddose (Bexsero)Between 12 and 13 months:Hib/Men C (combined as one injection) – 4th dose of Hib and 1stdose of Meningitis C (Menitorix);plus:MMR (measles, mumps and rubella) – combined as one injection (Priorix or M-M-RVAXPRO);plus:PCV (pneumococcal conjugate vaccine) – 2nddose in a separate injection (Prevenar 13);plus:Meningitis B 3rddose (Bexsero)From 2 to end of primary school:Nasal flu spray (Fluenz Tetra). For children aged 2,3 and 4, this is usually given in the GP surgery. Children in school years 1,2 and 3 may have this at school.3 years and 4 months:Pre-school booster of DTaP/IPV (polio) – 4-in-one injection (Repevax or Infanrix-IPV);plus:MMR – 2nd dose (Priorix or M-M-RVAXPRO) – in a separate injectionBetween 12 and 13 years:HPV (human papilloma virus types 6,11, 16 and 18) –twoinjections of Gardasil given. The second injection is given 6-24 months after the first one.14 years:Td/IPV (polio) booster – 3-in-one injection (Revaxis)Men ACWY: combined protection against meningitis A, C, W and Y (Nimenrix or Menveo)The BCG vaccination against tuberculosis is only offered to neonates in high-risk areas or with high-risk backgrounds. When required it is usually given before leaving the hospital soon after birth.

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      47.6
      Seconds
  • Question 37 - Which extraocular muscle is entrapped in a patient with a blowout fracture? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      38.8
      Seconds
  • Question 38 - After collapsing in his nursing home, a 70-year-old man is brought into the...

    Correct

    • After collapsing in his nursing home, a 70-year-old man is brought into the ER. He has diabetes mellitus and is on medication for it. An RBS of 2.0 mmol/L (3.9-5.5 mmol/L) is recorded in the ER. Out of the following, which medication for diabetes mellitus is LEAST likely responsible for his hypoglycaemic episode?

      Your Answer: Metformin

      Explanation:

      Metformin is a biguanide used as the first-line to treat type 2 diabetes mellitus. It has a good reputation as it has an extremely low risk of causing hypoglycaemia compared to the other agents for diabetes. It does not affect the insulin secreted by the pancreas or increase insulin levels. Toxicity with metformin can, however, cause lactic acidosis with associated hypoglycaemia.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      15.1
      Seconds
  • Question 39 - Regarding co-amoxiclav, which of the following statements is INCORRECT: ...

    Correct

    • Regarding co-amoxiclav, which of the following statements is INCORRECT:

      Your Answer: Clavulanic acid acts to inhibit cross-linking of bacterial peptidoglycan polymers.

      Explanation:

      Co-amoxiclav consists of amoxicillin with the beta-lactamase inhibitor clavulanic acid. Clavulanic acid itself has no significant antibacterial activity but, by inactivating beta-lactamases, it makes the combination active against beta-lactamase-producing bacteria that are resistant to amoxicillin.The most common adverse effects of co-amoxiclav include nausea, vomiting, skin rash and diarrhoea. Pseudomembranous colitis should be considered if a person develops severe diarrhoea during or after treatment with co-amoxiclav. Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav. An epidemiological study has shown that the risk of acute liver toxicity was about 6 times greater with co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 years and in men; these reactions have only rarely been reported in children. Jaundice is usually self-limiting and very rarely fatal.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      48.2
      Seconds
  • Question 40 - A 66-year-old female with a history of stroke one year ago presents to...

    Correct

    • A 66-year-old female with a history of stroke one year ago presents to the Family Medicine clinic complaining of fatigue, weight loss, and tongue discolouration. On examination, she seems malnourished, her tongue is beefy red, and an ataxic gait pattern is noticed. Which ONE of the following conditions does this patient most likely have?

      Your Answer: Vitamin B12 deficiency

      Explanation:

      A history of stroke and poor nutritional status points towards a nutritional deficiency as the most likely cause of her symptoms. The examination would differentiate between Vitamin B12 and Folic acid deficiency as in the former. The patient has a beefy red tongue and symptoms indicating peripheral nervous system involvement or subacute combined spinal cord degeneration. The patient may also have a lemon-yellow skin colour, loss of proprioception and vibratory sense and oral ulceration. Investigations in B12 deficiency can reveal the following:1. Macrocytic anaemia2. Neutropoenia3. Thrombocytopaenia4. Blood film: anisocytosis, poikilocytosis5. Low serum B126. Raised serum bilirubin (haemolysis)7. Intrinsic factor antibodies8. Positive Schilling test

    • This question is part of the following fields:

      • Haematology
      • Pathology
      62.6
      Seconds
  • Question 41 - Regarding fibrinolytics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding fibrinolytics, which of the following statements is INCORRECT:

      Your Answer: Tenecteplase has a longer half-life than alteplase allowing for bolus administration.

      Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.

      Explanation:

      Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      60.3
      Seconds
  • Question 42 - Which of the following is the most common cause of hyperthyroidism: ...

    Correct

    • Which of the following is the most common cause of hyperthyroidism:

      Your Answer: Graves disease

      Explanation:

      Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disease in which autoantibodies against TSH receptors are produced. These antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Therefore, the signs and symptoms of Graves disease are the same as those of hyperthyroidism, reflecting the actions of increased circulating levels of thyroid hormones: increased heat production, weight loss, increased 02 consumption and cardiac output and exophthalmos (bulging eyes, not drooping eyelids). TSH levels will be decreased (not increased) as a result of the negative feedback effect of increased T3 levels on the anterior pituitary.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      15.1
      Seconds
  • Question 43 - Which anatomical structure is divided following an emergency department anterolateral thoracotomy? ...

    Correct

    • Which anatomical structure is divided following an emergency department anterolateral thoracotomy?

      Your Answer: Latissimus dorsi

      Explanation:

      Thoracotomy describes an incision made in the chest wall to access the contents of the thoracic cavity. Thoracotomies typically can be divided into two categories; anterolateral thoracotomies and posterolateral thoracotomies. These can be further subdivided into supra-mammary and infra-mammary and, of course, further divided into the right or left chest. Each type of incision has its utility given certain circumstances.A scalpel is used to sharply divide the skin along the inframammary crease overlying the fifth rib. Electrocautery is then used to divide the pectoralis major muscle and serratus anterior muscle. Visualization of the proper operative field can be achieved with the division and retraction of the latissimus dorsi. Either the fourth or fifth intercostal space is then entered after the division of intercostal muscles above the rib to ensure the preservation of the neurovascular bundle. Once the patient is properly secured to the operating table, the ipsilateral arm is raised and positioned anteriorly and cephalad to rest above the head. The incision is started along the inframammary crease and extended posterolaterally below the tip of the scapula. It is then extended superiorly between the spine and the edge of the scapula, a short distance. The trapezius muscle and the subcutaneous tissues are divided with electrocautery. The serratus anterior and latissimus dorsi muscles are identified and can be retracted. The intercostal muscles are then divided along the superior border of the ribs, and the thoracic cavity is accessed.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      19.4
      Seconds
  • Question 44 - Which of the following is NOT a typical effect caused by adrenaline: ...

    Correct

    • Which of the following is NOT a typical effect caused by adrenaline:

      Your Answer: Bronchoconstriction

      Explanation:

      Actions of adrenaline:Cardiovascular system- Increased rate and force of cardiac contraction- Vasoconstriction of vessels in skin, mucous membranes and splanchnic bed- Vasodilation of skeletal muscle vessels- Increased cardiac output and blood pressureRespiratory system- Bronchodilation- Increased ventilation rateGastrointestinal system- Smooth muscle relaxation- Contraction of sphincters- Metabolism- Decreased insulin release- Increased glucagon release- Increased thermogenesis- Increased glycolysis- Increased lipolysisEye- Pupillary dilation

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      27.6
      Seconds
  • Question 45 - A 29-year-old man is diagnosed with a severe case of asthma.In the treatment...

    Correct

    • A 29-year-old man is diagnosed with a severe case of asthma.In the treatment of acute asthma in adults, which of the following is NOT recommended? 

      Your Answer: Nebulised magnesium

      Explanation:

      There is no evidence to support the use of nebulized magnesium sulphate in the treatment of adults at this time.In adults with acute asthma, the following medication dosages are recommended:By using an oxygen-driven nebuliser, you can get 5 milligrams of salbutamol.500 mcg ipratropium bromide in an oxygen-driven nebuliserOral prednisolone 40-50 mg100 mg hydrocortisone intravenous1.2-2 g magnesium sulphate IV over 20 minutesWhen inhaled treatment is ineffective, intravenous salbutamol (250 mcg IV slowly) may be explored (e.g. a patient receiving bag-mask ventilation).Following senior counsel, current ALS recommendations propose that IV aminophylline be explored in severe or life-threatening asthma. If utilized, a loading dose of 5 mg/kg should be administered over 20 minutes, then a 500-700 mcg/kg/hour infusion should be given. To avoid toxicity, serum theophylline levels should be kept below 20 mcg/ml.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      12.3
      Seconds
  • Question 46 - Which of the following statements is correct regarding the partial pressure of oxygen...

    Incorrect

    • Which of the following statements is correct regarding the partial pressure of oxygen during respiration?

      Your Answer: Exhaled PO 2 < Alveolar PO 2 < Inhaled PO 2

      Correct Answer: Exhaled PO 2 > Alveolar PO 2

      Explanation:

      Because of humidification, inspired PO2 in the airways is less than inhaled PO2. Because of gas exchange, alveolar PO2 is less than inhaled or inspired PO2.Because of mixing with anatomical dead space (air that has not taken part in gas exchange, exhaled PO2 is greater than alveolar O2, and therefore that has relatively higher PO2 on the way out, but is less than inhaled or inspired PO2.Typical values for a resting young healthy male (in kPa) are shown below:-Inhaled air: PO221.2, PCO20.0-Inspired air in airways (after humidification): PO219.9, PCO20.0-Alveolar air (after equilibrium with pulmonary capillaries): PO213.3, PCO25.3-Exhaled air (after mixing with anatomical dead space air): PO215.5, PCO24.3

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      52
      Seconds
  • Question 47 - A 62 year old man has sustained a penetrating injury to the submandibular...

    Correct

    • A 62 year old man has sustained a penetrating injury to the submandibular triangle. On examination, his tongue is weak and when protruded deviates to the left. Which of the following nerves has most likely been injured:

      Your Answer: Left hypoglossal nerve

      Explanation:

      Damage to the hypoglossal nerve results in weakness of the tongue, with deviation of the tongue towards the weak side on protrusion.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      31.4
      Seconds
  • Question 48 - After collapsing in his nursing home, a 70-year-old man is brought into the...

    Correct

    • After collapsing in his nursing home, a 70-year-old man is brought into the ER. He is a known case of diabetes mellitus and is on medication for it. An RBS of 2.5 mmol/L (3.9-5.5 mmol/L) is recorded in the ER. Out of the following, which medication for diabetes mellitus is MOST likely responsible for his hypoglycaemic episode?

      Your Answer: Pioglitazone

      Explanation:

      Pioglitazone is used to treat type 2 diabetes mellitus. It selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-γ) and to a lesser extent PPAR-α. Of the medications mentioned in this question, only pioglitazone is a recognized cause of hypoglycaemia.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      15.6
      Seconds
  • Question 49 - All of the following statements are correct with regards to protection of the...

    Correct

    • All of the following statements are correct with regards to protection of the gastric mucosa except which of the following?

      Your Answer: NSAIDs directly stimulate increased parietal cell acid production.

      Explanation:

      Prostaglandin production, which usually inhibits acid secretion and increases mucus and bicarbonate secretion, is inhibited by NSAIDs.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      58.4
      Seconds
  • Question 50 - You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble...

    Correct

    • You suspect an anaphylactic reaction in a patient who is hypotensive, with trouble breathing after eating peanuts. Which of the following diagnostic tests will confirm this?

      Your Answer: Mast cell tryptase

      Explanation:

      The concentration of serum tryptase rises in anaphylaxis and anaphylactoid responses. Because tryptase is a significant component of mast cell granules, mast cell degranulation causes elevated tryptase levels in the blood. Although tryptase levels are not always high during anaphylaxis, it is considered a particular marker.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      40.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (2/4) 50%
Pharmacology (15/22) 68%
Physiology (9/16) 56%
Renal Physiology (2/3) 67%
Immunoglobulins And Vaccines (1/3) 33%
Musculoskeletal Pharmacology (1/1) 100%
Microbiology (1/1) 100%
Principles (1/1) 100%
Endocrine Physiology (2/3) 67%
Inflammatory Responses (1/1) 100%
Pathology (3/3) 100%
Gastrointestinal (4/4) 100%
Endocrine (2/3) 67%
Abdomen (0/2) 0%
Anatomy (3/6) 50%
CNS Pharmacology (0/1) 0%
Cardiovascular Pharmacology (2/3) 67%
Respiratory Pharmacology (2/2) 100%
Gastrointestinal Physiology (0/1) 0%
Evidence Based Medicine (2/2) 100%
Statistics (1/1) 100%
Central Nervous System (1/1) 100%
Renal (0/1) 0%
Basic Cellular (1/1) 100%
Pathology Of Infections (1/1) 100%
Infections (1/2) 50%
Basic Cellular Physiology (0/1) 0%
Lower Limb (1/1) 100%
Head And Neck (0/1) 0%
Endocrine Pharmacology (2/2) 100%
Haematology (1/1) 100%
Thorax (1/1) 100%
Respiratory (1/2) 50%
Cranial Nerve Lesions (1/1) 100%
Passmed