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  • Question 1 - A 19-year-old student that has presented with a headache and a petechial rash...

    Incorrect

    • A 19-year-old student that has presented with a headache and a petechial rash is diagnosed with meningitis caused by Neisseria meningitidis.Which SINGLE statement regarding Neisseria meningitidis is true?

      Your Answer: It is a Gram-negative rod

      Correct Answer: Lipo-oligosaccharide activates complement activation and cytokine release

      Explanation:

      Neisseria meningitidisis is a Gram-negative diplococcusc that can cause meningococcal meningitis.Carriage of Neisseria meningitidisis very common and it exists in the normal flora in the nasopharynx in 5 – 15% of adults. Actual disease only develops in a very small percentage of individuals. Infection is most common in the winter months and epidemics tend to occur about once every 10 years.Most invasive infections are caused by serotypes A, B or C. In the UK, most cases of meningococcal septicaemia are caused byNeisseria meningitidisgroup B. The vaccination programme forNeisseria meningitidisgroup C has made this type much less common. A vaccine for group B disease has now been initiated in children.The main determinant of the pathogenicity of Neisseria meningitidisis the antiphagocytic polysaccharide capsule. Meningococci cross mucosal epithelium by endocytosis and the capsule allows survival in the bloodstream. Lipo-oligosaccharide activates complement activation and cytokine release, resulting in shock and disseminated intravascular coagulation (DIC).Theclinical featuresof meningococcal meningitis include:Non-blanching rashNeck stiffnessHeadachePhotophobiaAltered mental state (drowsiness, confusion)Focal neurological deficitsSeizuresSeptic shockThe diagnosis is usually made clinically and confirmed by culture of blood, aspirate from the rash and CSF. Rapid antigen detection or nucleic acid amplification testing (NAAT) on blood and CSF are both sensitive and reliable.Due to the potentially life-threatening nature of the disease treatment should not wait for laboratory confirmation and antibiotics should be started immediately. In the hospital setting IV ceftriaxone (2 g adult; 80 mg/kg child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the preferred agents. IM benzylpenicillin can be given as an alternative in the pre-hospital setting and chloramphenicol is a suitable alternative if there is a history of anaphylaxis to cephalosporins. Treatment does not eradicate carriage and the patient should be given ‘prophylaxis’ following recovery.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      19.2
      Seconds
  • Question 2 - A 7-year-old boy is brought to the emergency room with complaints of a...

    Incorrect

    • A 7-year-old boy is brought to the emergency room with complaints of a red and painful left eye. Upon physical examination, it was noted that there is the presence of conjunctival erythema. A mucopurulent discharge and crusting of the lid was also evident. A diagnosis of bacterial conjunctivitis was made. According to the latest NICE guidelines, which of the following should NOT be a part of the management of this patient?

      Your Answer: Advise that no school exclusion is necessary

      Correct Answer: Topical antibiotics should be prescribed routinely

      Explanation:

      The following are the NICE guidelines on the management of bacterial conjunctivitis:- Infective conjunctivitis is a self-limiting illness that usually settles without treatment within 1-2 weeks. If symptoms persist for longer than two weeks they should return for review.- Seek medical attention urgently if marked eye pain or photophobia, loss of visual acuity, or marked redness of the eye develop.- Remove contact lenses, if worn, until all symptoms and signs of infection have completely resolved and any treatment has been completed for 24 hours.- Lubricant eye drops may reduce eye discomfort; these are available over the counter, as well as on prescription.- Clean away infected secretions from eyelids and lashes with cotton wool soaked in water.- Wash hands regularly, particularly after touching the eyes.- Avoid sharing pillows and towels.- It is not necessary to exclude a child from school or childcare if they have infective conjunctivitis, as mild infectious illnesses should not interrupt school attendance. An exception would be if there is an outbreak of infective conjunctivitis, when advice should be sought from the Health Protection Agency by the school. – Adults who work in close contact with others, or with vulnerable patients, should avoid such contact until the discharge has settled.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      50.5
      Seconds
  • Question 3 - Which of the following occurs at the transverse thoracic plane: ...

    Incorrect

    • Which of the following occurs at the transverse thoracic plane:

      Your Answer: Level of the horizontal fissure

      Correct Answer: Bifurcation of the trachea

      Explanation:

      A way to help remember the structures transected by the transverse thoracic plane is CLAPTRAP:C: cardiac plexusL: ligamentum arteriosumA: aortic arch (inner concavity)P: pulmonary trunkT: tracheal bifurcation (carina)R: right-to-left movement of the thoracic duct (posterior to the oesophagus)A: azygos vein drains into superior vena cavaP: pre-vertebral fascia and pre-tracheal fascia end

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      15.9
      Seconds
  • Question 4 - Gallstones are commonly found lodged in which of the following parts of the...

    Incorrect

    • Gallstones are commonly found lodged in which of the following parts of the gallbladder?

      Your Answer: Fundus

      Correct Answer: Neck

      Explanation:

      There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      13.3
      Seconds
  • Question 5 - Compliance is greater in all but which one of the following: ...

    Incorrect

    • Compliance is greater in all but which one of the following:

      Your Answer: The lung volume at functional residual capacity

      Correct Answer: Pulmonary oedema

      Explanation:

      Compliance changes at different lung volumes. Initially at lower lung volumes the compliance of the lung is poor and greater pressure change is required to cause a change in volume. This occurs if the lungs become collapsed for a period of time. At functional residual capacity (FRC) compliance is optimal since the elastic recoil of the lung tending towards collapse is balanced by the tendency of the chest wall to spring outwards. At higher lung volumes the compliance of the lung again becomes less as the lung becomes stiffer. At all volumes, the base of the lung has a greater compliance than the apex. Patients with emphysema have increased compliance. Compliance is affected by a person’s age, sex and height.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      354.9
      Seconds
  • Question 6 - A 32-year-old asthmatic patient on theophylline as part of her asthma management presents...

    Incorrect

    • A 32-year-old asthmatic patient on theophylline as part of her asthma management presents to the Emergency Department with an unrelated medical condition.Which of these drugs should be avoided?

      Your Answer: Amitriptyline

      Correct Answer: Clarithromycin

      Explanation:

      Macrolide antibiotics (e.g. clarithromycin and erythromycin) are cytochrome P450 enzyme inhibitors. They increase blood levels of theophylline leading to hypokalaemia, and potentially increasing the risk of Torsades de pointes when they are prescribed together. Co-prescription with theophylline should be avoided.Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin. Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      18.8
      Seconds
  • Question 7 - Regarding the flexor digitorum profundus muscle, which of the following is true? ...

    Incorrect

    • Regarding the flexor digitorum profundus muscle, which of the following is true?

      Your Answer: The lateral aspect of the muscle is innervated by the radial nerve

      Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve

      Explanation:

      Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.Flexor digitorum profundus has a dual innervation:(1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);(2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      10.7
      Seconds
  • Question 8 - A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve...

    Correct

    • A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve injury. Which of the following will confirm the presence of an ulnar nerve injury?

      Your Answer: Claw hand appearance

      Explanation:

      An ulnar injury may result in abnormal sensations in the little finger and ring finger, usually on the palm side, weakness, and loss of coordination of the fingers. A claw like deformity of the hand and wrist is present. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve are also possible.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      8
      Seconds
  • Question 9 - A 33-year-old woman who is investigated for recurrent renal stones is discovered to...

    Correct

    • A 33-year-old woman who is investigated for recurrent renal stones is discovered to have a markedly elevated parathyroid hormone (PTH) level.Which of the following would stimulate PTH release under normal circumstances? Select ONE answer only.

      Your Answer: Decreased plasma calcium concentration

      Explanation:

      Parathyroid hormone (PTH) is a polypeptide containing 84 amino acids. It is the principal controller of free calcium in the body.PTH is synthesised by and released from the chief cells of the four parathyroid glands that are located immediately behind the thyroid gland.PTH is released in response to the following stimuli:Decreased plasma calcium concentrationIncreased plasma phosphate concentration (indirectly by binding to plasma calcium and reducing the calcium concentration)PTH release is inhibited by the following factors:Normal/increased plasma calcium concentrationHypomagnesaemiaThe main actions of PTH are:Increases plasma calcium concentrationDecreases plasma phosphate concentrationIncreases osteoclastic activity (increasing calcium and phosphate resorption from bone)Increases renal tubular reabsorption of calciumDecreases renal phosphate reabsorptionIncreases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      215.3
      Seconds
  • Question 10 - A patient presents with nausea, anorexia, jaundice and right upper quadrant pain. A...

    Incorrect

    • A patient presents with nausea, anorexia, jaundice and right upper quadrant pain. A diagnosis of acute hepatitis B is suspected.Which of the following blood results is most suggestive of an acute hepatitis B infection? Select ONE answer only.

      Your Answer: HBsAg positive, Anti-HBc negative

      Correct Answer: HBsAg positive, IgM anti-HBc positive

      Explanation:

      Hepatitis B surface antigen (HBsAg) is a protein on the surface of the hepatitis B virus, that is the first serologic marker to appear in a new acute infection.It can be detected as early as 1 week and as late as 9 weeks. It can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine.Hepatitis B surface antibody (anti-HBs) indicates recovery and immunity from the hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame. It is not present following hepatitis B vaccination.IgM antibody to hepatitis B core antigen (IgM anti-HBc) indicates recent infection with hepatitis B virus (<6 months). Its presence indicates acute infection.The following table summarises the presence of hepatitis B markers according to each situation:Susceptible to infection:HBsAg = NegativeAnti-HBc = NegativeAnti-HBs = NegativeImmune due to natural infection:HBsAg = NegativeAnti-HBc = PositiveAnti-HBs = PositiveImmune due to vaccination:HBsAg = NegativeAnti-HBc = NegativeAnti-HBs = PositiveAcute infection:HBsAg = PositiveAnti-HBc = PositiveAnti-HBs = NegativeIgM anti-HBc = PositiveChronic infection:HBsAg = PositiveAnti-HBc = PositiveAnti-HBs = NegativeIgM anti-HBc = Negative

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      23.1
      Seconds
  • Question 11 - Which among the following antibacterial regimens is considered the most appropriate to prescribe...

    Correct

    • Which among the following antibacterial regimens is considered the most appropriate to prescribe in a patient presenting with clinical signs and symptoms consistent with a diagnosis of pelvic inflammatory disease?

      Your Answer: Ceftriaxone plus doxycycline plus metronidazole

      Explanation:

      The endocervix is the most common site of Neisseria gonorrhoeae infection in women. Symptoms of infection, when present, include dysuria, cervical discharge, and lower abdominal pain. However, 50% of cases in women may be asymptomatic leading to complications such as pelvic inflammatory disease (PID), which may cause sterility, ectopic pregnancy, or perihepatitis.PID is also known as Fitz-Hugh-Curtis syndrome is defined as an inflammation of the upper genital tract due to an infection in women. The disease affects the uterus, fallopian tubes, and ovaries. It is typically an ascending infection, spreading from the lower genital tract. The recommended intramuscular or oral regimens for PID are as follows:Ceftriaxone at 500 mg IM in a single dose (for persons weighing ≥150 kg, administer 1 g of ceftriaxone); plus doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      20.5
      Seconds
  • Question 12 - Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department...

    Incorrect

    • Due to severe palpitations, a 28-year-old woman is transported to the Emergency Department by ambulance. Her heart rate is 180 beats per minute, and the rhythm strip shows supraventricular tachycardia. You intend to give adenosine.Which of the following is NOT a contraindication for adenosine use?

      Your Answer: 2 nd -degree heart block

      Correct Answer: History of heart transplant

      Explanation:

      The purine nucleoside adenosine is used to diagnose and treat paroxysmal supraventricular tachycardia. Adenosine works by stimulating A1-adenosine receptors and opening potassium channels that are sensitive to acetylcholine. This causes the atrioventricular (AV) node’s cell membrane to become hyperpolarized, slowing conduction by inhibiting calcium channels.Patients who have had a heart transplant are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg. Dipyridamole potentiates the effects of adenosine, so it should be used with caution in patients who are taking it.The use of adenosine is contraindicated in the following situations:AsthmaCOPD (chronic obstructive pulmonary disease)Decompensated heart failure Long QT syndromeAV block in the second or third degreeSinusitis is a condition in which the sinuses become (unless pacemaker fitted)Hypotension that is severeIt has a half-life of less than 10 seconds and acts quickly within that time frame. The actions last between 10 and 20 seconds. Because of the short half-life of the drug, any side effects are usually only temporary. These are some of them:a feeling of impending doomFlushing of the faceDyspnoeaUncomfortable chestTastes metallic

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      13.5
      Seconds
  • Question 13 - Regarding anaemia, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: Initial clinical features in acute haemorrhage are a result of reduction in blood volume rather than that of anaemia.

      Correct Answer: Anaemia is usually associated with a decrease in red cell 2,3 - DPG.

      Explanation:

      Anaemia is defined as a reduction in haemoglobin concentration below the normal range for the age and sex of the individual. Children tend to have lower haemoglobin than adults, and women tend to have lower haemoglobin than men. Anaemia may occur from an actual reduction in total circulating haemoglobin mass, or with an increase in plasma volume e.g. in pregnancy, causing a dilutional anaemia. After acute major blood loss, anaemia is not immediately apparent because total blood volume is reduced and it takes up to a day for plasma volume to be replaced and hence the degree of anaemia to become apparent. The initial clinical features in acute haemorrhage are therefore a result of reduction in blood volume rather than that of anaemia. When anaemia develops slowly, the associated symptoms are often very mild as the body has time to adapt to the fall in haemoglobin. This involves mechanisms such as an increase in red cell 2,3 -diphosphoglycerate (2,3 – DPG), which shifts the oxygen dissociation curve to the right, allowing enhanced delivery of O2 to the tissues, and an increase in stroke volume and heart rate.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      12.5
      Seconds
  • Question 14 - A 26 year old male presents to emergency room with a 2 day...

    Incorrect

    • A 26 year old male presents to emergency room with a 2 day history of burning pain when passing urine, accompanied by a green urethral discharge. Gonorrhoea is suspected. The first line antibiotic for this condition is which of the following?

      Your Answer: Doxycycline

      Correct Answer: Ceftriaxone

      Explanation:

      When there is a high suspicion of gonorrhoea from clinical features, empiric treatment should be commenced whilst waiting for laboratory confirmation. The first line treatment for uncomplicated anogenital and pharyngeal disease includes ceftriaxone 500 mg IM (single dose) + azithromycin 1 g orally as a single dose. This covers concomitant chlamydia infection. For all people who have been treated for gonorrhoea, a test of cure is recommended

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      85.6
      Seconds
  • Question 15 - A 40-year-old man with episodes of blood in urine and flank pain that...

    Correct

    • 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.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      18.5
      Seconds
  • Question 16 - Regarding defaecation, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding defaecation, which of the following statements is CORRECT:

      Your Answer: Distension of the rectum causes stimulation of afferent sympathetic fibres.

      Correct Answer: Colonic mass movement occurs shortly after a meal due to distension of the stomach and duodenum.

      Explanation:

      Colonic mass movement describes the intense contraction that begins halfway along the transverse colon and pushes the intestinal contents in the proximal colon towards the rectum. It occurs shortly after a meal due to distension of the stomach and duodenum as part of the gastrocolic reflex and if faeces is present in the rectum, stimulates the urge to defecate. Distention of the rectum causes firing of afferent cholinergic parasympathetic fibres. The internal sphincter is made up of circular smooth muscle innervated by the autonomic fibres, and the more distal external sphincter is composed of striated muscle innervated by motor fibres from the pudendal nerve. During defaecation, relaxation of pelvic muscles straightens the rectum.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      10.2
      Seconds
  • Question 17 - A 61-year-old woman returns to get the results of recent blood tests she...

    Incorrect

    • A 61-year-old woman returns to get the results of recent blood tests she had done for non-specific malaise, lethargy, and weight loss. The only abnormality discovered during the blood tests was a 580 x 10 9 /l increase in platelets. Her platelets were also elevated on a blood test taken 6 months earlier, according to her previous results. You're aware of the recent emergence of elevated platelet levels as a cancer risk marker and decide to look into it.Which of the following cancers is most likely to cause isolated thrombocytosis?

      Your Answer: Multiple myeloma

      Correct Answer: Colorectal cancer

      Explanation:

      Raised platelet levels have emerged as a cancer risk marker, according to a large population-based study published in 2017(link is external). According to the study, 12 percent of men and 6% of women with thrombocytosis were diagnosed with cancer within a year. These figures increased to 18% in men and 10% in women if a second platelet count was taken within 6 months of the first and showed an increased or stable elevated platelet count.The researchers discovered that thrombocytosis linked to cancer is most common in colorectal and lung cancers, and it is linked to a worse prognosis. Furthermore, one-third of the cancer patients in the study had no other symptoms that would have prompted an immediate cancer referral.The exact mechanism by which these cancers cause thrombocytosis is unknown, but one theory proposes the existence of pathogenic feedback loops between malignant cells and platelets, with a reciprocal interaction between tumour growth and metastasis, as well as thrombocytosis and platelet activation. Another hypothesis is that thrombocytosis occurs independently of cancer but aids in its spread and progression.The findings show that routinely testing for thrombocytosis could cut the time it takes to diagnose colorectal and lung cancer by at least two months. In the UK, this could result in around 5500 earlier cancer diagnoses per year.Because the positive predictive value of thrombocytosis in middle age for cancer (10%) is higher than the positive predictive value for a woman in her 50s presenting with a new breast lump (8.5%), this is clearly an important research paper that should be used to adjust future clinical practise. The current NICE guidelines predate these new research findings, so we’ll have to wait and see how they affect cancer referral guidelines in the UK.Because there are so many possible cancers associated with thrombocytosis, the treating clinician should take a thorough history and perform a thorough clinical examination if a patient is diagnosed with it. Further investigation and the most appropriate referral route should be aided by this information.It’s worth noting that the patients in the study had their blood tests done for a medical reason rather than as a random screening test.If there are no other symptoms to guide investigation and referral (one-third of the patients in the study had no other symptoms), keep in mind that the two most common cancers encountered were colorectal and lung cancer, so a chest X-ray and a faecal immunochemical test (FIT) for faecal blood may be reasonable initial investigations.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      40
      Seconds
  • Question 18 - Which family of receptors does the glucagon receptor belong? ...

    Correct

    • Which family of receptors does the glucagon receptor belong?

      Your Answer: G-protein coupled receptors

      Explanation:

      Glucagon binds to class B G-protein coupled receptors and activates adenylate cyclase, increasing cAMP intracellularly. This activates protein kinase A. Protein kinase A phosphorylates and activates important enzymes in target cells.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      5.1
      Seconds
  • Question 19 - Renal potassium excretion is promoted by all but which one of the following:...

    Correct

    • Renal potassium excretion is promoted by all but which one of the following:

      Your Answer: Increased intracellular magnesium

      Explanation:

      Aldosterone: A rise in [K+] in the extracellular fluid of the adrenal cortex directly stimulates aldosterone release. Aldosterone promotes the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane, and also stimulates apical sodium and potassium channel activity, overall acting to increase sodium reabsorption and potassium secretion.pH changes: Potassium secretion is reduced in acute acidosis and increased in acute alkalosis. A higher pH increases the apical K+channel activity and the basolateral Na+/K+ATPase activity – both changes that promote K+secretion.Flow rates: Increased flow rates in the collecting duct reduce K+concentration in the lumen and therefore enhance K+secretion. Increased flow also activates BK potassium channels, and ENaC channels which promote potassium secretion and sodium reabsorption respectively.Sodium delivery: Decreased Na+delivery to the collecting ducts results in less Na+reabsorption and hence a reduced gradient for K+secretion.Magnesium: Intracellular magnesium can bind and block K+channels inhibiting K+secretion into the tubules. Therefore magnesium deficiency reduces this inhibitory effect and so allows more potassium to be secreted into tubules and can cause hypokalaemia.

    • This question is part of the following fields:

      • Physiology
      • Renal
      15.1
      Seconds
  • Question 20 - You suspected typhoid disease in a patient who had recently returned from South...

    Incorrect

    • You suspected typhoid disease in a patient who had recently returned from South America and presented to the emergency department with fever, constipation, and a rose spot rash. Which of the following antibiotics will be administered to this patient?

      Your Answer: Vancomycin

      Correct Answer: Cefotaxime

      Explanation:

      Typhoid fever, often known as enteric fever, is a potentially fatal multi-systemic sickness caused predominantly by Salmonella enterica serotype typhi and, to a lesser extent, paratyphi A, B, and C. Cefotaxime is the first-line treatment for typhoid fever (or ceftriaxone). In cases of mild or moderate sickness caused by multiresistant pathogens, azithromycin is an option. If the bacterium is sensitive, ciprofloxacin is an option.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      48.6
      Seconds
  • Question 21 - Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the...

    Incorrect

    • Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the other hand, calcium-induced calcium release (CICR) is a mechanism that is unique to Cardiac myocytes. The influx of calcium ions (Ca 2+) into the cell causes a 'calcium spark,' which causes more ions to be released into the cytoplasm.In CICR, which membrane protein in the sarcoplasmic reticulum is involved? 

      Your Answer: Ligand-gated calcium channel

      Correct Answer: Ryanodine receptor

      Explanation:

      Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.The release of Ca2+ from the sarcoplasmic reticulum is required for calcium-induced calcium release (CICR). This is mostly accomplished by ryanodine receptors (RyR) on the sarcoplasmic reticulum membrane; Ca2+ binds to RyR, causing additional Ca2+ to be released.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      1078.8
      Seconds
  • Question 22 - 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
      16.9
      Seconds
  • Question 23 - All of the following statements regarding Helicobacter pylori is considered true, except: ...

    Incorrect

    • All of the following statements regarding Helicobacter pylori is considered true, except:

      Your Answer: It is a Gram-negative bacterium

      Correct Answer: Serum antibody levels should be used to check for successful eradication

      Explanation:

      Helicobacter pylori is a curved, non-spore forming, Gram-negative bacteria that is primarily linked to gastric infections. Once acquired, it colonizes the stomach for a long time and can cause a low-grade inflammatory process, producing a chronic superficial gastritis.H. pylori can be recovered from gastric biopsy materials. Samples must be transported quickly to the laboratory.Helicobacter infections usually are identified by nonculture methods. H. pylori can be presumptively identified in a gastric biopsy specimen by testing for the presence of a rapid urease reaction.Serologic testing is an important screening method for the diagnosis of H. pylori infection. It can also be diagnosed by faecal antigen detection, microscopic examination of stained gastric tissue, and DNA amplification tests.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      18.4
      Seconds
  • Question 24 - Which of the following diseases is caused by a build-up of lymphoblasts in...

    Correct

    • Which of the following diseases is caused by a build-up of lymphoblasts in the bone marrow?

      Your Answer: Acute lymphoblastic leukaemia

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is a clonal (malignant) bone marrow disorder in which early lymphoid precursors multiply and replace the marrow’s normal hematopoietic cells. ALL is most common between the ages of 3 and 7, with 75 percent of cases occurring before the age of 6.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      9.1
      Seconds
  • Question 25 - Regarding the extensor carpi ulnaris muscle, which of the following statements is true?...

    Incorrect

    • Regarding the extensor carpi ulnaris muscle, which of the following statements is true?

      Your Answer: It arises from the medial epicondyle of the elbow

      Correct Answer: It receives its blood supply from the ulnar artery

      Explanation:

      Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      13.3
      Seconds
  • Question 26 - A lesion to which part of the optic radiation will result in contralateral...

    Incorrect

    • A lesion to which part of the optic radiation will result in contralateral homonymous inferior quadrantanopia?

      Your Answer: Left parietal lobe

      Correct Answer: Right parietal lobe

      Explanation:

      A visual loss in the lower left quadrant in both visual fields is an indication of an inferior homonymous. This is due to a lesion of the superior fibres of the optic radiation in the parietal lobe on the contralateral side of the visual pathway.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      30.7
      Seconds
  • Question 27 - You come across a 60-year-old woman with a history of chronic pancreatitis. Today...

    Incorrect

    • You come across a 60-year-old woman with a history of chronic pancreatitis. Today she is complaining of epigastric pain. She has blood tests done especially to review her cholecystokinin levels.Which of the following is a cholecystokinin (CCK) releasing site? 

      Your Answer: D-cells in the pancreas

      Correct Answer: I-cells in the upper small intestine

      Explanation:

      The I-cells in the duodenum generate and release cholecystokinin (CCK), a peptide hormone. It has a crucial role in the digestion process as a hormonal regulator.CCK cells are concentrated in the proximal small intestine, and when food is consumed, the hormone is produced into the bloodstream. The presence of partly digested lipids and proteins in the duodenum is one of the most powerful stimulus for CCK synthesis.CCK’s key physiological effects include:Encourages the pancreas to release digesting enzymes into the small intestine.Stimulates gallbladder contraction and sphincter of Oddi relaxation, resulting in bile delivery into the duodenum.Gastric emptying is inhibited, and gastric acid output is reduced.Satiety induction is a process that involves inducing a feeling of fullness.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      85.8
      Seconds
  • Question 28 - Which of the following vitamins is not paired correctly with its deficiency syndrome:...

    Incorrect

    • Which of the following vitamins is not paired correctly with its deficiency syndrome:

      Your Answer:

      Correct Answer: Vitamin B12 - Wernicke-Korsakoff syndrome

      Explanation:

      Clinical Effects of vitamin deficiency include:Vitamin C – ScurvyThiamine (Vitamin B1) – Beriberi/Wernicke-Korsakoff syndromeVitamin B12 – Megaloblastic anaemia/Subacute combined degeneration of spinal cordFolate – Megaloblastic anaemiaVitamin D – Osteomalacia/RicketsVitamin K – Defective clottingVitamin A – Blindness

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      0
      Seconds
  • Question 29 - Which of the following best describes pathogenicity: ...

    Incorrect

    • Which of the following best describes pathogenicity:

      Your Answer:

      Correct Answer: The ability to cause disease

      Explanation:

      Pathogenicity is the ability to cause disease.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      0
      Seconds
  • Question 30 - A mother has serious concerns about vaccinating her child. She has read about...

    Incorrect

    • A mother has serious concerns about vaccinating her child. She has read about many contraindications and risks in the papers and would like to discuss them with you.One of these is a valid contraindication to vaccination.

      Your Answer:

      Correct Answer: None of the other options

      Explanation:

      The options listed in this question are not true contraindications to vaccination. Therefore, the correct answer is ‘none of the other options’.The contraindications to vaccination are:Confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.A confirmed anaphylactic reaction to another component in the vaccine.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Microbiology (1/7) 14%
Specific Pathogen Groups (1/5) 20%
Anatomy (1/6) 17%
Thorax (0/1) 0%
Abdomen And Pelvis (0/1) 0%
Physiology (3/7) 43%
Respiratory (0/1) 0%
Pharmacology (1/3) 33%
Respiratory Pharmacology (0/1) 0%
Upper Limb (1/3) 33%
Endocrine Physiology (2/2) 100%
Cardiovascular Pharmacology (0/1) 0%
Haematology (1/3) 33%
Pathology (2/4) 50%
Pathogens (0/2) 0%
General Pathology (1/1) 100%
Gastrointestinal (0/1) 0%
Renal (1/1) 100%
Basic Cellular Physiology (0/1) 0%
Endocrine Pharmacology (1/1) 100%
Central Nervous System (0/1) 0%
Gastrointestinal Physiology (0/1) 0%
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