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  • Question 1 - Which statement best describes the bispectral index (BIS)? ...

    Incorrect

    • Which statement best describes the bispectral index (BIS)?

      Your Answer: It predicts brain damage during cardiopulmonary bypass

      Correct Answer: It decreases during normal sleep

      Explanation:

      The bispectral index (BIS) is one of several systems used in anaesthesiology as of 2003 to measure the effects of specific anaesthetic drugs on the brain and to track changes in the patient’s level of sedation or hypnosis. It is a complex mathematical algorithm that allows a computer inside an anaesthesia monitor to analyse data from a patient’s electroencephalogram (EEG) during surgery. It is a dimensionless number (0-100) that is a summative measurement of time domain, frequency domain and high order spectral parameters derived from electroencephalogram (EEG) signals.

      Sleep and anaesthesia have similar behavioural characteristics but are physiologically different but BIS monitors can be used to measure sleep depth. With increasing sleep depth during slow-wave sleep, BIS levels decrease. This correlates with changes in regional cerebral blood flow when measured using positron emission tomography (PET).

      BIS shows a dose-response relationship with the intravenous and volatile anaesthetic agents. Opioids produce a clinical change in the depth of sedation or analgesia but fail to produce significant changes in the BIS. Ketamine increases CMRO2 and EEG activity.

      BIS is unable to predict movement in response to a surgical stimulus. Some of these are spinal reflexes and not perceived by the cerebral cortex.

      BIS is used during cardiopulmonary bypass to measure depth of anaesthesia and an index of cerebral perfusion. However, it cannot predict subtle or significant cerebral damage.

    • This question is part of the following fields:

      • Physiology
      24.3
      Seconds
  • Question 2 - Regarding the classification of breathing systems, which of the following is true? ...

    Incorrect

    • Regarding the classification of breathing systems, which of the following is true?

      Your Answer: The Bain is a coaxial version of the Magill

      Correct Answer: The Conway classification describes a functional classification based on whether a CO2 absorber is required

      Explanation:

      Breathing system is an assembly of components which connects patient’s airway to anaesthesia machine through which controlled composition of gas mixture is dispensed. It delivers gas to the patient, removes expired gas and controls the temperature and humidity of the inspired mixture. It allows spontaneous, controlled, or assisted respiration. It may also provide ports for gas sampling, airway pressure, flow and volume monitoring.

      Breathing systems have been classified by Conway and Mapleson.
      Conway suggested a functional classification:
      – Circuits requiring a CO2 absorber
      – Circuits not requiring a CO2 absorber

      William Mapleson designated varying arrangements of breathing system components (masks, breathing tubes, fresh gas flow inlets, adjustable pressure-limiting valves, and reservoir bags) as Mapleson A-E circuits.
      Mapleson A: Arranged as FGF inlet, reservoir bag, APL valve, mask.
      In this circuit, because the reservoir bag is between the FGF inlet valve and the APL valve, expired gas from the patient may re-enter the system and fill the reservoir bag during controlled ventilation. This is the most efficient system for spontaneous breathing as the FGF must only be equal to a patient’s minute ventilation to prevent rebreathing.

      Mapleson B: Arranged as reservoir bag, FGF inlet, APL valve, mask.
      In this circuit, the FGF inlet is closer to the APL valve, which helps prevent the rebreathing concern in the Mapleson A circuit as above during controlled ventilation.

      Mapleson C: Arranged as reservoir bag, FGF inlet, APL valve, mask.
      In this circuit, the arrangement is the same as the Mapleson B circuit. However, this circuit is shorter as it does not contain elongated corrugated tubing. This circuit also has the FGF inlet close to the APL valve to aid in preventing rebreathing.

      Mapleson D: Arranged as reservoir bag, APL valve, FGF inlet, and mask.
      In this circuit, the arrangement interchanges the FGF inlet and APL valve of the Mapleson A circuit. This system prevents rebreathing by directing FGF towards the APL valve rather than towards the patient during exhalation.

      Mapleson E: Arranged as corrugated tubing, FGF inlet, and mask.
      In this circuit, there is no reservoir bag and no APL valve. Given the inability to alter the pressure of the circuit, this is ideal for spontaneously ventilating neonates or paediatric patients where low-pressure ventilation is desired. The system prevents rebreathing, similar to the Mapleson D circuit.

      Jackson Rees later modified the Mapleson E by adding an open ended bag, which has since become known as the Mapleson F.
      Mapleson F: Arranged as APL valve directly connected to reservoir bag, corrugated tubing, FGF inlet, and mask.
      The system prevents rebreathing similarly to Mapleson D by directing FGF towards the APL valve.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      11.9
      Seconds
  • Question 3 - After establishing a cardiopulmonary bypass, the right atrium is opened to repair the...

    Incorrect

    • After establishing a cardiopulmonary bypass, the right atrium is opened to repair the tricuspid valve. Out of the following, which is NOT a part of the right atrium?

      Your Answer:

      Correct Answer: Trabeculae carnae

      Explanation:

      The right atrium receives blood supply from the SVC, IVC, and coronary sinus. It forms the right border of the heart.

      The interior of the right atrium has 5 distinct features:
      1. Sinus venarum – smooth, thin-walled posterior part of the right atrium where the SVC, IVC, and coronary sinus open
      2. Musculi pectinati – an anterior rough, wall of pectinate muscles
      3. Tricuspid valve orifice – the opening through which the right atrium empties blood into the right ventricle
      4. Crista terminalis – separates the rough (musculi pectinati) from the smooth (sinus venarum) internally
      5. Fossa ovalis – a thumbprint size depression in the interatrial septum which is a remnant of the oval foramen and its valve in the foetus

      The trabeculae carneae are irregular muscular elevations that form the interior of the right ventricle.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 4 - Regarding bilirubin, which one of the following statement is true? ...

    Incorrect

    • Regarding bilirubin, which one of the following statement is true?

      Your Answer:

      Correct Answer: Conjugated bilirubin is stored in the gall bladder

      Explanation:

      Bilirubin is the tetrapyrrole and a catabolic product of heme. 70-90% of bilirubin is end product of haemoglobin degradation in the liver.

      Bilirubin circulates in the blood in 2 forms; unconjugated and conjugated bilirubin.

      Unconjugated bilirubin is insoluble in water. It travels through the bloodstream to the liver, where it changes from insoluble into a soluble form (i.e.; unconjugated into conjugated form).

      This conjugated bilirubin travels from the liver into the small intestine and the gut bacteria convert bilirubin into urobilinogen and then into urobilin (not urobilin to urobilinogen). A very small amount passes into the kidneys and is excreted in urine.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 5 - Which of the following is true regarding the mechanism of action of daptomycin?...

    Incorrect

    • Which of the following is true regarding the mechanism of action of daptomycin?

      Your Answer:

      Correct Answer: Interferes with the outer membrane of gram positive bacteria resulting in cell death

      Explanation:

      Daptomycin alters the curvature of the membrane, which creates holes that leak ions. This causes rapid depolarization, resulting in loss of membrane potential. Thus it interferes with the outer membrane of gram-positive bacteria resulting in cell death.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 6 - Blood pressure monitoring is a requirement for in-patient care. Different factors can result...

    Incorrect

    • Blood pressure monitoring is a requirement for in-patient care. Different factors can result in an inaccurate blood pressure reading, including the damping of an arterial waveform. How does a damped arterial waveform affect blood pressure measurements?

      Your Answer:

      Correct Answer: The systolic pressure is lower and the diastolic pressure higher with the same mean

      Explanation:

      Damping is the reduction of energy in a system achieved by reducing the amplitude of oscillations. It is necessary to some degree to prevent wave overshoots.

      Critical damping usually causes the system to be slow, so optimal damping is normally applied to provide a balance between speed and distortion.

      Damping can cause errors if excessive (overdamping) or inadequate (Underdamping). The amount of damping in a system can be determined using the damping coefficient (D), where:

      Undamped: 0
      Critically damped: 1
      Optimally damped: 0.64

      An overdamped system will cause an artificial decrease in the systolic blood pressure, and an artificial increase in the diastolic blood pressure.

      An underdamped system will cause an artificial increase in systolic blood pressure and an artificial decrease in diastolic blood pressure.

      Damping can be caused by a number of factors affecting different parts of the system, including:

      The tubing/cannula: The presence of air bubbles, increased blood viscosity or formation of blood clots.
      The diaphragm/tubing: Increased malleability/compliance
      The tubing: Presence of kinks, narrowing or too many ports of injection.

      The answer here is a damped system will have a low systolic pressure, a high diastolic pressure with a normal mean pressure.

    • This question is part of the following fields:

      • Clinical Measurement
      0
      Seconds
  • Question 7 - Which drug, if given to a pregnant woman, can lead to deleterious fetal...

    Incorrect

    • Which drug, if given to a pregnant woman, can lead to deleterious fetal effects due to its ability to cross the placenta?

      Your Answer:

      Correct Answer: Atropine

      Explanation:

      It is well known that atropine will cross the placenta and that maternal administration results in an increase in fetal heart rate.

      Atropine is highly selective for muscarinic receptors. Its potency at nicotinic receptors is much lower, and actions at non-muscarinic receptors are generally undetectable clinically. Atropine does not distinguish among the M1, M2, and M3 subgroups of muscarinic receptors. In contrast, other antimuscarinic drugs are moderately selective for one or another of these subgroups. Most synthetic antimuscarinic drugs are considerably less selective than atropine in interactions with nonmuscarinic receptors.

      A study on glycopyrrolate, a quaternary ammonium salt, was found to have a fetal: maternal serum concentration ratio of 0.4 indicating partial transfer.

      Heparin, suxamethonium, and vecuronium do not cross the placenta.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 8 - Which of the following statements is correct about a characteristic that is normally...

    Incorrect

    • Which of the following statements is correct about a characteristic that is normally distributed in a population?

      Your Answer:

      Correct Answer: There will be approximately equal numbers who have more or less of the characteristic than the mean

      Explanation:

      68% of the population will be found in one standard deviation (SD) above plus one SD below the mean. Two SDs above plus two SDs below the mean will include 95% of the population.

      The median can be greater or less than the mean as it is simply the mid point of the data after the data is arranged. Half the data are above and half below the median .

      The mode is a true score, unlike the mean or the median. It is the most common score or the score obtained from the largest number of subjects in any given data.

    • This question is part of the following fields:

      • Statistical Methods
      0
      Seconds
  • Question 9 - Gag reflex was assessed as a part of brain stem death in a...

    Incorrect

    • Gag reflex was assessed as a part of brain stem death in a 22-year-old man with severe traumatic brain injury. Which of the following nerves forms the afferent limb of this reflex?

      Your Answer:

      Correct Answer: Glossopharyngeal nerve

      Explanation:

      The gag reflex is a protective mechanism that prevents any foreign material to enter the aerodigestive tract.

      This reflex has afferent (sensory) and effect (motor) components.
      – Glossopharyngeal nerve form the afferent limb
      – Vagus nerve form the efferent limb.

    • This question is part of the following fields:

      • Pathophysiology
      0
      Seconds
  • Question 10 - The muscle that lies behind the first part of the axillary nerve is?...

    Incorrect

    • The muscle that lies behind the first part of the axillary nerve is?

      Your Answer:

      Correct Answer: Subscapularis

      Explanation:

      The axillary nerve lies behind the axillary artery initially, and in front of the subscapularis. It passes downward to the lower border of the subscapularis muscle.

      In company with the posterior humeral circumflex artery and vein, it winds backward through a quadrilateral space bounded above by the subscapularis (anterior) and teres minor (posterior), below by the teres major, medially by the long head of the triceps brachii, and laterally by the humerus (surgical neck).

      It then divides into an anterior and a posterior part. The anterior division supplies the deltoid (anterior and middle heads) while the posterior division supplies the teres minor and posterior part of deltoid
      The posterior division terminates as the superior lateral cutaneous nerve of the arm.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 11 - Which of these anaesthetics has the best chance of preventing HPV (hypoxic pulmonary...

    Incorrect

    • Which of these anaesthetics has the best chance of preventing HPV (hypoxic pulmonary vasoconstriction)?

      Your Answer:

      Correct Answer: Desflurane 2 MAC

      Explanation:

      Resistance pulmonary arteries constrict in response to alveolar and airway hypoxia, diverting blood to better-oxygenated alveoli.

      In atelectasis, pneumonia, asthma, and adult respiratory distress syndrome, hypoxic pulmonary vasoconstriction optimises O2 uptake. Hypoxic pulmonary vasoconstriction helps maintain systemic oxygenation during single-lung anaesthesia.

      A redox-based O2 sensor within pulmonary artery smooth muscle cells is involved in hypoxic pulmonary vasoconstriction. The production of reactive oxygen species by smooth muscle cells in the pulmonary artery varies in proportion to PaO2. Hypoxic removal of these redox second messengers inhibits voltage-gated potassium channels, depolarizing smooth muscle cells in the pulmonary artery.

      L-type calcium channels are activated by depolarization, which raises cytosolic calcium and causes hypoxic pulmonary vasoconstriction. Some anaesthetics suppress this response, increasing the risk of further deterioration in ventilation perfusion mismatch.

      Agents that inhibit HPV are ether, halothane, and desflurane (>1.6 MAC).
      Agents with no effect on HPV include thiopentone, fentanyl, desflurane (1MAC), isoflurane (<1.5MAC), sevoflurane(1MAC), and propofol.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 12 - A 33-year old man was referred to you because of difficulty moving his...

    Incorrect

    • A 33-year old man was referred to you because of difficulty moving his limbs. History revealed that he was placed under anaesthesia for a major surgery 12 hours prior to the referral. Other symptoms were noted such as anxiousness, agitation, and fever of 38°C. Upon physical examination, he was tachycardic at 119 beats per minute. Moreover, his medical history showed that he was on Fluoxetine for clinical depression. The nurses reported that, because of his frequent complaints of axillary pain, he was given tramadol with paracetamol. Which of the following is responsible for his clinical features?

      Your Answer:

      Correct Answer: Tramadol

      Explanation:

      Tramadol is weak agonist at the mu receptor. It inhibits the neuronal reuptake of serotonin and norepinephrine, and inhibits pain neurotransmission. It is given for moderate pain, chronic pain syndromes, and neuropathic pain.

      Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It inhibits the neuronal reuptake of serotonin by inhibiting the serotonin transporter (SERT). It is the drug of choice for major depressive disorder, and is given for other psychiatric disorders such as anxiety, obsessive-compulsive, post-traumatic stress, and phobias.

      When tramadol is given with SSRIs, serotonin syndrome may occur. Serotonin syndrome is characterized by fever, agitation, tremors, clonus, hyperreflexia and diaphoresis. The onset of symptoms may occur within a few hours, and the first-line treatment is sedation, paralysis, intubation and ventilation.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 13 - Which of the following statements is false when considering the electrical safety of...

    Incorrect

    • Which of the following statements is false when considering the electrical safety of equipment?

      Your Answer:

      Correct Answer: The low leakage currents limit is 0.01mA for Class I CF

      Explanation:

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Clinical Measurement
      0
      Seconds
  • Question 14 - A survey aimed at finding out mean glucose level in individuals that took...

    Incorrect

    • A survey aimed at finding out mean glucose level in individuals that took antipsychotics medicines was conducted. The results were as follows: Mean Value: 7mmol/L, Standard Deviation: 6mmol/L, Sample Size: 9, Standard Error: 2mmol/L. For a confidence interval of 95%, which of the option presents the correct range up to the nearest value?

      Your Answer:

      Correct Answer: 3-11 mmol/L

      Explanation:

      Key Point: While finding out confidence intervals, standard errors are used. Standard error and Standard deviation are two distinct entities and should not be confused.

      For 99.7% confidence interval, you can find the range as follows:

      Multiply the standard error by 3.

      Subtract the answer from mean value to get the lower limit.

      Add the answer obtained in step 1 from the mean value to get the upper limit.

      The range turns out to be 1-13 mmol/L.

      For a confidence interval of 68%, multiply the standard error with 1 and repeat the process. The range found for this interval is 3-11 mmol/L.

      For a 95% confidence interval. Standard Error is multiplied by 1.96 which gives us the limit ranging from 3.08 to 10.92 mmol/L which could be approximated to 3-11 mmol/L.

    • This question is part of the following fields:

      • Statistical Methods
      0
      Seconds
  • Question 15 - Which is the most appropriate statement describing the function of flowmeters? ...

    Incorrect

    • Which is the most appropriate statement describing the function of flowmeters?

      Your Answer:

      Correct Answer: Constant pressure, variable orifice - Heidbrink flowmeters

      Explanation:

      There are different models of flowmeters determined by the applied pressure and its orifice. For instance, the watersight flowmeter functions through applying variable pressure, and it has a variable orifice. In contrast, the bubble flowmeter is operated using a constant pressure and orifice. Flowmeters such as rotameters, Heidbrink and Peak have a constant pressure but variable orifice. On the other hand, flowmeters including a simple pressure gauge, water depression, and pneumotachograph have a constant orifice but variable pressure.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      0
      Seconds
  • Question 16 - A study was concerned with finding out the normal reference range of IgE...

    Incorrect

    • A study was concerned with finding out the normal reference range of IgE levels in adults was conducted. Presuming that the curve follows a normal distribution, what is the percentage of individuals having IgE levels greater than 2 standard deviations from mean?

      Your Answer:

      Correct Answer: 2.30%

      Explanation:

      Since the data is normally distributed, 95.4% of the values lie with in 2 standard deviations from mean. The rest of the 4.6% are distributed symmetrically outside of that range which means 2.3% of the values lie above 2 standard deviations of the mean.

    • This question is part of the following fields:

      • Statistical Methods
      0
      Seconds
  • Question 17 - A 50-year-old woman is brought into the emergency department in an ambulance. She...

    Incorrect

    • A 50-year-old woman is brought into the emergency department in an ambulance. She was found collapsed on the street. She has visual and oculomotor deficits on examination, but her motor function is intact. A digital subtraction angiography is performed that shows occlusion of the basilar artery at the site where the vertebral arteries fuse to form the basilar artery. Which anatomical landmark corresponds to this site of occlusion?

      Your Answer:

      Correct Answer: The base of the pons

      Explanation:

      The basilar artery is a large vessel that is formed by the union of the vertebral arteries at the junction of the medulla and pons. It lies in the pontine cistern and follows a shallow groove on the ventral pontine surface, extending to the upper border of the pons.

      The basilar artery then bifurcates into the two posterior cerebral arteries that form part of the Circle of Willis.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 18 - Which of the following statements about closing capacity is true? ...

    Incorrect

    • Which of the following statements about closing capacity is true?

      Your Answer:

      Correct Answer: It is less than the functional residual capacity in a 30-year-old

      Explanation:

      Closing capacity refers to volume of gas within the lungs at which the conducting small airways begin to close, that is, the point during expiration when small airways close.

      It is calculated mathematically as:

      Closing capacity = Closing volume (CV) + Residual volume (RV)

      Functional residual capacity (FRC) is the volume of gas still present within the lungs post expiration.

      Closing capacity is lower than the functional residual capacity in younger adults, but begins to rise to eventually equal, and then exceed it with increasing age (at about middle age), increasing intrabdominal pressure, decreasing blood flow in the pulmonary system and parenchymal disease within the pulmonary system.

    • This question is part of the following fields:

      • Clinical Measurement
      0
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  • Question 19 - Which of the following is true about the pulse oximeter? ...

    Incorrect

    • Which of the following is true about the pulse oximeter?

      Your Answer:

      Correct Answer: Is accurate to within +/- 2% in the range of 70% to 100% saturation

      Explanation:

      The pulse oximeter provides a continuous non-invasive measurement of the arterial oxygen saturation. The light emitting diodes (LEDs) produce beams of red and infrared light at 660 nm and 940 nm respectively (not 640 and 960 nm), which travel through a finger (toe, ear lobe or nose) and are then detected by a sensitive photodetector.

      The light absorbed by non-pulsatile tissues is constant (DC), and the non-constant absorption (AC) is the result of arterial blood pulsation. The DC and AC components at 660 and 940 nm are then analysed by the microprocessor and the result is related to the arterial saturation.

      An isosbestic point is a point at which two substances absorb a wavelength of light to the same degree. In pulse oximetry the different absorption profiles of oxyhaemoglobin and deoxyhaemoglobin are used to quantify the haemoglobin saturation (in %). Isosbestic points occur at 590 and 805 nm (not 490 and 805 nm), where the light absorbed is independent of the degree of saturation, and are used as reference points.

      The pulse oximeter is accurate to within +/- 2% in the range of 70% to 100% saturation, and below 70% the readings are extrapolated. Pulse oximeters average their readings every 10 to 20 seconds and thus they cannot detect acute desaturation events. Consequently, they are often referred to as ‘lag’ monitors, due to the time delay in identifying the desaturation episode.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
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  • Question 20 - A new intravenous neuromuscular blocking agent has been developed. It has a hepatic...

    Incorrect

    • A new intravenous neuromuscular blocking agent has been developed. It has a hepatic extraction ratio of 0.25 and three quaternary nitrogen atoms in its structure. It has been discovered that it has a half-life of fifteen minutes in healthy volunteers. Which of the following elimination mechanisms is the most likely to explain this pharmacological behaviour?

      Your Answer:

      Correct Answer: It is filtered and not reabsorbed by the renal tubules

      Explanation:

      The neuromuscular blocking agent is likely to be filtered and not reabsorbed by the renal tubules due to an exclusion process.

      Neuromuscular blocking agents that contain one or more quaternary nitrogen atoms are polar and ionised. As a result, the molecules have low lipid solubility, low membrane diffusion capacity, and low distribution volume.

      It’s unlikely that a compound with three quaternary nitrogen atoms is an ester. Its high polarity would prevent molecules from moving quickly into tissues.

      When drugs have a low hepatic extraction ratio (0.3), the venous and arterial drug concentrations are nearly identical. The liver is not the primary site of drug metabolism.

      Therefore:

      Changes in liver blood flow have no effect on clearance.
      Protein binding, intrinsic metabolism, and excretion are all very sensitive to changes in clearance.
      When taken orally, there is no first-pass metabolism.

      There is no reason for the lungs to eliminate any neuromuscular blocking agent.

    • This question is part of the following fields:

      • Pharmacology
      0
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  • Question 21 - Which of the following is incorrect with regards to atrial natriuretic peptide? ...

    Incorrect

    • Which of the following is incorrect with regards to atrial natriuretic peptide?

      Your Answer:

      Correct Answer: Secreted mainly by the left atrium

      Explanation:

      Atrial natriuretic peptide (ANP) is secreted mainly from myocytes of right atrium and ventricle in response to increased blood volume.
      It is secreted by both the right and left atria (right >> left).

      It is a 28 amino acid peptide hormone, which acts via cGMP
      degraded by endopeptidases.

      It serves to promote the excretion of sodium, lowers blood pressure, and antagonise the actions of angiotensin II and aldosterone.

    • This question is part of the following fields:

      • Physiology And Biochemistry
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  • Question 22 - In endurance athletes, which of the following physiological adaptations to exercise is the...

    Incorrect

    • In endurance athletes, which of the following physiological adaptations to exercise is the best predictor of performance?

      Your Answer:

      Correct Answer: Velocity of blood lactate accumulation

      Explanation:

      Multiple regression analysis revealed that velocity of lactate accumulation (VOBLA) accounted for 92 percent of the variation in marathon running velocity (VM), and VOBLA plus training volume prior to the marathon accounted for 96 percent of the variation. Percent ST muscle fibre distribution (r = 0.55-0.69) and capillary density (r = 052-0.63) were found to be positively correlated with all performance variables. As a result, marathon running performance was linked to VOBLA and the ability to run at a pace close to it during the race. The percent ST, capillary density, and training volume were all related to these properties.

      Another metabolic adaptation compared to normal people is the early selection of fat for oxidation by muscle, especially when glucose availability is limited during high-intensity exercise. This helps to delay the onset of muscle fatigue, but it does not prevent VOBLA.

      For a given level of exercise, training can also result in cardiovascular adaptation, such as increased heart size, increased contractility, and a slower heart rate. All of these factors contribute to an increase in maximal oxygen consumption (VO2 max), but genetic factors, despite intensive training, play a large role in an athlete’s performance.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 23 - Regarding the treatment of bladder cancer, a study concerned with the usage of...

    Incorrect

    • Regarding the treatment of bladder cancer, a study concerned with the usage of a combined or monotherapy was conducted. A forest plot was used for the visual representation of the data. Which of the following is true regarding forest plots?

      Your Answer:

      Correct Answer: Forest plots can present data from multiple studies

      Explanation:

      Being the part of a meta analysis, forest plots are more valued as evidence then randomised control trials.

      The notion that forest plots can only be used if the results are substantial is not true. They are good indicators of the significance of the data. If the diamond intersects the central line, the data is rendered significant. It also aggregates means and confidence intervals from studies conducted in the past which makes the study much more reliable as errors associated with individual studies tend to have less of an impact in this way.

      The suggestion that forest plots are primarily used for qualitative data is factually incorrect. Forest plots require numerical values to function.

      All in all, forest plots help us in determining whether or not there is a significant trend in that particular field of study.

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 24 - Following an acute appendicectomy, a 6-year-old child is admitted to the recovery unit....

    Incorrect

    • Following an acute appendicectomy, a 6-year-old child is admitted to the recovery unit. Your consultant has requested that you prescribe maintenance fluids for the next 12 hours. The child is 21 kg in weight. What is the most suitable fluid volume to be prescribed?

      Your Answer:

      Correct Answer: 732 ml

      Explanation:

      After a paediatric case, you’ll frequently have to calculate and prescribe maintenance fluids. The ‘4-2-1 rule’ should be used as a guideline:

      1st 10 kg – 4 ml/kg/hr
      2nd 10 kg – 2 ml/kg/hr
      Subsequent kg – 1 ml/kg/hr

      Hence

      1st 10 kg = 4 × 10 = 40 ml
      2nd 10 kg = 2 × 10 = 20 ml
      Subsequent kg = 1 × 1 = 1 ml
      Total = 61 ml/hr

      61 × 12 = 732 ml over 12 hrs.

    • This question is part of the following fields:

      • Physiology
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  • Question 25 - In the United Kingdom, a new breast cancer screening test is being conducted...

    Incorrect

    • In the United Kingdom, a new breast cancer screening test is being conducted compared to the conventional use of mammography. This test predicts that if the breast cancer is diagnosed at an earlier stage, it could improve the survival rate but the overall results remains constant. This is an example of what kind of bias?

      Your Answer:

      Correct Answer: Lead time bias

      Explanation:

      Recall bias introduced when participants in a study are systematically more or less likely to recall and relate information on exposure depending on their outcome status.

      In procedure bias, the researcher decides assignment of a treatment versus control and assigns particular patients to one group or the other non-randomly. This is unlikely to have occurred in this case, although it is not mentioned specifically.

      Self Selection or volunteer bias occur when those subjects are selected to participate in the study who are not the representative of the entire target population. those subjects may be from high socio-economic status and practice those activities or lifestyle that improves their health.

      Lead-time bias occurs when a disease is detected by a screening test at an earlier time point rather than it would have been diagnosed by its clinical appearance. In this bias, earlier detection improves the survival time in the intervention group.

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 26 - During 2015 it was reported in the New England Journal of Medicine that...

    Incorrect

    • During 2015 it was reported in the New England Journal of Medicine that the usage of empagliflozin(a sodium-glucose-co-transporter 2 inhibitor) caused a decrease in the cardiovascular deaths, non fatal heart attacks and strokes in patients suffering from type 2 diabetes. The results were published per 1000 patient years. With the above mentioned drug, the event rate turned out to be 37.3/1000 patient years whereas the placebo had an event rate of 43.9/1000 patient years. How many further patients need to be treated with empagliflozin to avoid any further incidence of cardiovascular death or non fatal myocardial infraction and non fatal stroke?

      Your Answer:

      Correct Answer: 150

      Explanation:

      Number needed to treat can be defined as the number of patients who need to be treated to prevent one additional bad outcome.

      It can be found as:

      NNT=1/Absolute Risk Reduction (rounded to the next integer since number of patients can be integer only).

      where ARR= (Risk factor associated with the new drug group) — (Risk factor associated with the currently available drug)

      So,

      ARR= (43.9-37.3)

      ARR= 6.6

      NNT= 1000/6.6

      NNT=151.5

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 27 - A 23-year-old man who is currently on fluoxetine for depression was anaesthetized two...

    Incorrect

    • A 23-year-old man who is currently on fluoxetine for depression was anaesthetized two hours ago for knee arthroscopy. He seems agitated, confused, with a heart rate of 120 beats per minute, a temperature of 38.2oC, and developed difficulty moving his limbs. He is on paracetamol and tramadol for analgesia. Which of the following is the most likely cause for his condition?

      Your Answer:

      Correct Answer: Tramadol

      Explanation:

      Agitation or restlessness, Rapid heart rate, high Blood Pressure, loss of muscle coordination, or twitching muscles is common symptoms of Serotonin Syndrome.

      Tramadol should not be given to patients taking selective serotonin receptor inhibitor (SSRI) therapy because of the risk of serotonin syndrome

      Tramadol is a centrally acting analgesic that is an atypical opioid that relieves pain by opioids as well as additional mechanisms. Its affinity for µ opioid receptor is low, while that for κ and δ is very low. Unlike other opioids, it inhibits the reuptake of Noradrenaline (NA) and 5- Hydroxytryptamine (5-HT), increases 5-HT release, and thus activates monoaminergic spinal inhibition of pain.

      Its analgesic action is only partially reversed by the opioid antagonist naloxone.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 28 - You are asked about the relative risk associated with a drug. You happened...

    Incorrect

    • You are asked about the relative risk associated with a drug. You happened to have read a report in which the same drug was compared with a placebo and your initial thoughts after reading the study were that the drug will have significant side effects. What do you expect the value of relative risk to be?

      Your Answer:

      Correct Answer: Greater than 1

      Explanation:

      Risk ratio (relative risk) compares the probability of an event in an exposed (experimental) group to that of an event in the unexposed (control) group.

      A relative risk of 1 suggests that there is no discernible difference in the outcome whether or not it has been exposed.

      A relative risk of less than 1 indicates that probability of occurrence of an event is less if there is exposure.

      A relative risk of greater than 1 highlights that an event is most likely to occur if it was provided exposure. Since you believe that exposure (the new drug) would have side effects, the value should be greater than 1.

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 29 - The most sensitive indicator of mild obstructive airway disease is? ...

    Incorrect

    • The most sensitive indicator of mild obstructive airway disease is?

      Your Answer:

      Correct Answer: Forced expiratory flow (FEF25-75%)

      Explanation:

      The volume expired in the first second of maximal expiration after a maximal inspiration is known as forced expiratory volume in one second (FEV1), and it indicates how quickly full lungs can be emptied. It is the most commonly measured parameter for bronchoconstriction assessment.

      The maximum volume of air exhaled after a maximal inspiration is known as the ‘slow’ vital capacity (VC). VC is normally equal to FVC after a forced vital capacity (FVC) or slow vital capacity (VC) manoeuvre, unless there is an airflow obstruction, in which case VC is usually higher than FVC.

      The FEV1/FVC (Tiffeneau index) is a clinically useful index of airflow restriction that can be used to distinguish between restrictive and obstructive respiratory disorders.

      The average expired flow over the middle half (25-75 percent) of the FVC manoeuvre is the forced expiratory volume (FEF25-75). The airflow from the resistance bronchioles corresponds to this. It’s a more sensitive indicator of mild small airway narrowing than FEV1, but it’s difficult to tell if the VC (or FVC) is decreasing or increasing.

      The maximum expiratory flow rate achieved is called the peak expiratory flow (PEF), which is usually 8-14 L/second.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 30 - Which of the following is included in monosynaptic reflexes? ...

    Incorrect

    • Which of the following is included in monosynaptic reflexes?

      Your Answer:

      Correct Answer: The patellar or knee jerk reflex.

      Explanation:

      Monosynaptic reflexes is a type of reflex arc providing direct communication between motor and sensory innervation in a muscle. It occurs very quickly as it arises and ends in the same muscle. Examples include: biceps reflex, brachioradialis reflex, extensor digitorum reflex, triceps reflex, Achilles reflex and patellar reflex.

      Polysynaptic reflexes facilitates contraction and inhibition in muscle by providing communication between multiple muscles.

    • This question is part of the following fields:

      • Pathophysiology
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