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  • Question 1 - A 64-year old lady has been diagnosed with hypertension. Her GP explains how...

    Correct

    • A 64-year old lady has been diagnosed with hypertension. Her GP explains how this occurs, and that blood pressure is determined by multiple factors which include action by the heart, nervous system and the diameter of the blood vessels. This lady's cardiac output (CO) is 4L/min. Her exam today revealed a mean arterial pressure (MAP) of 140 mmHg. Using these values, her systemic vascular resistance (SVR) is which of these?

      Your Answer: 35mmHg‹…min‹…mL-1

      Explanation:

      Impaired ventricular relaxation reduces diastolic filling and therefore preload.

      Decreased blood volume decreases preload due to reduced venous return.

      Heart failure is characterized by reduced ejection fraction and therefore stroke volume.

      Cardiac output = stroke volume x heart rate

      Left ventricular ejection fraction = (stroke volume / end diastolic LV volume ) x 100%

      Stroke volume = end diastolic LV volume – end systolic LV volume

      Pulse pressure (is increased by stroke volume) = Systolic Pressure – Diastolic Pressure

      Systemic vascular resistance = mean arterial pressure / cardiac output
      Factors that increase pulse pressure include:
      -a less compliant aorta (this tends to occur with advancing age)
      -increased stroke volume
      Aortic stenosis would decrease stroke volume as end systolic volume would increase.
      This is because of an increase in afterload, an increase in resistance that the heart must pump against due to a hard stenotic valve.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      153.3
      Seconds
  • Question 2 - Gentamicin is a drug used for the treatment of bronchiectasis. Which of the...

    Correct

    • Gentamicin is a drug used for the treatment of bronchiectasis. Which of the following is true regarding the mechanism of action of gentamicin?

      Your Answer: Inhibit the 30S subunit of ribosomes

      Explanation:

      Gentamicin is a broad-spectrum antibiotic whose mechanism of action involves inhibition of protein synthesis by binding to 30s ribosomes. Its major adverse effect is nephrotoxicity and ototoxicity

      Aminoglycoside bind to 30s subunit of ribosome causing misreading of mRNA

      Tetracyclines inhibit protein synthesis through reversible binding to bacterial 30s ribosomal subunits, which prevent binding of new incoming amino acids (aminoacyl-tRNA) and thus interfere with peptide growth.

      Chloramphenicol binds to the 50s subunit and inhibits peptidyl transferase

      Clindamycin binds to the 50s ribosomal subunit of bacteria and disrupts protein synthesis by interfering with the transpeptidation reaction, which thereby inhibits early chain elongation.

    • This question is part of the following fields:

      • Pharmacology
      5.5
      Seconds
  • Question 3 - An 80-year old lady has a background history of a previous myocardial infarction...

    Correct

    • An 80-year old lady has a background history of a previous myocardial infarction which has left permanent damage to her heart's conduction system. The part of the conduction system with the highest velocities is damaged, and this has resulted in desynchronisation of the ventricles. The part of the heart that conducts the fastest is which of the following?

      Your Answer: Purkinje fibres

      Explanation:

      The electrical conduction system of the heart starts with the SA node which generates spontaneous action potentials.

      This is conducted across both atria by cell to cell conduction, and occurs at around 1 m/s. The only pathway for the action potential to enter the ventricles is through the AV node in a normal heart.
      At this site, conduction is very slow at 0.05ms, which allows for the atria to completely contract and fill the ventricles with blood before the ventricles depolarise and contract.

      The action potentials are conducted through the Bundle of His from the AV node which then splits into the left and right bundle branches. This conduction is very fast, (,2m/s), and brings the action potential to the Purkinje fibres.

      Purkinje fibres are specialised conducting cells which allow for a faster conduction speed of the action potential (,2-4m/s). This allows for a strong synchronized contraction from the ventricle and thus efficient generation of pressure in systole.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      42.8
      Seconds
  • Question 4 - A 74-year-old man presents to a hospital for manipulation of Colles fracture. The...

    Correct

    • A 74-year-old man presents to a hospital for manipulation of Colles fracture. The patient is 50 kg and the anaesthetic plan is to perform an intravenous regional (Bier's) block. Which of the following is the appropriate dose of local anaesthetic for the procedure?

      Your Answer: 0.5% prilocaine (40 ml)

      Explanation:

      Prilocaine is the drug of choice for intravenous regional anaesthesia. 0.5% prilocaine (40 ml) is indicated for this condition.
      Lidocaine is another alternative for this condition but volume and dose are likely to be inadequate for the procedure.

    • This question is part of the following fields:

      • Pharmacology
      11.6
      Seconds
  • Question 5 - Following an acute appendicectomy, a 6-year-old child is admitted to the recovery unit....

    Correct

    • 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: 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
      74.7
      Seconds
  • Question 6 - Which of the following statements is true regarding the Wrights Respirometer? ...

    Incorrect

    • Which of the following statements is true regarding the Wrights Respirometer?

      Your Answer: May over-read at low flows

      Correct Answer: Measures the minute volume to within an accuracy of +/- 10%

      Explanation:

      A Wrights Respirometer measures the volume of air exhaled over the course of one minute of normal breathing

      It is unidirectional and measures tidal volume and minute volume of gas flow in one direction. It is placed at the expiratory side (lower pressure than inspiratory side therefore lower chances of gas leaks)

      Slits are arranged such that incoming gas will rotate the vane at a rate of 150 revolutions per litre of flowing gas

      The Wright respirometer tends to over-read at high flow rates and under-read at low flows because of mechanical causes like friction and inertia and the accumulation of water vapour

      The ideal flow for accurate readings is 2 L/min for the respirometer. The respirometer reads the tidal volume and minute volume with a ±5€“10% accuracy within the range of 4€“24 L/min.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      45.1
      Seconds
  • Question 7 - A double blind placebo control clinical trial is done. Which of these is...

    Correct

    • A double blind placebo control clinical trial is done. Which of these is correct about it?

      Your Answer: The clinician assessing the effects of the treatment does not know which treatment the patient has been given

      Explanation:

      A ‘double blind crossover study’ happens when every patient receive both treatments.

      It is incorrect to say that only half of the patients do not know which treatment they receive because in a double blind placebo control clinical trial ALL of the patients are blind to their treatment choice .

      If some of the patients are not treated, they would be aware that they were not being treated and it could not be considered a blind trial.

      In a double blind placebo control clinical trial both the clinician and the patient are blind to the treatment choice. The clinician assessing the effects of the treatment, therefore, does not know which treatment the patient has been given.

    • This question is part of the following fields:

      • Statistical Methods
      15.8
      Seconds
  • Question 8 - A 78-year-old man with a previous history of ischaemic heart disease is admitted...

    Correct

    • A 78-year-old man with a previous history of ischaemic heart disease is admitted to hospital. He is scheduled for a cardiopulmonary exercise test (CPX) before he undergoes an elective abdominal aneurysm repair. What measurement obtained during a CPX test alone provides the best indication for postoperative mortality?

      Your Answer: Anaerobic threshold

      Explanation:

      Cardiopulmonary exercise testing (CPX, CPEX, CPET) is a non-invasive testing method used to determine the performance of the heart, lungs and skeletal muscle. It measures the exercise tolerance of the patient.

      The parameters measured include:

      ECG and ST-segment analysis and blood pressure
      Oxygen consumption (VO2)
      Carbon dioxide production (VCO2)
      Gas flows and volumes
      Respiratory exchange ratio (RER)
      Respiratory rate
      Anaerobic threshold (AT)

      The anaerobic threshold (AT) is an estimate of exercise ability. Any measurement below 11 ml/kg/min is usually related with an increase in mortality, especially when there is a background of myocardial ischaemia occurring during the test.

      Peak VO2 <20 mL/kg with a low AT have a correlation with postoperative complications and a 30 day mortality. The CPX test is used for risk-testing patients prior to surgery to determine the appropriate postoperative care facilities.

      The V slope measured in CPX testing represents VO2 versus VCO2 relationship.

      During AT, the ramp of V slope increases, but does not provide a picture of postoperative mortality.

    • This question is part of the following fields:

      • Clinical Measurement
      8.8
      Seconds
  • Question 9 - A patient on admission is given an infusion of 1000 mL of 10%...

    Correct

    • A patient on admission is given an infusion of 1000 mL of 10% glucose and 500 mL of 20% lipid over a 24 hour period. Which of these best approximates to the energy input over this time period?

      Your Answer: 1300 kcal

      Explanation:

      1% solution contains 1 g of substance per 100 mL.

      A solution of 10% glucose is 10 g/100mL. Therefore 1000 mL of this glucose solution will contain 100 g.

      1 g of glucose yields about 4 kcal of energy. One litre of 10% glucose will therefore release approximately 4x100g = 400 kcal of energy.

      A solution of 20% fat is 20 g/100mL. Therefore 1000 mL of this fat solution will have 200 g and 500 mL will contain 100 g.

      1 g of fat yields approximately 9 kcal. 500 mL of 20% fat therefore has the potential to yield 900 kcal of energy.

      The total energy input over this 24 hour period is approximately 400kcal + 900kcal = 1300 kcal.

    • This question is part of the following fields:

      • Physiology
      33.6
      Seconds
  • Question 10 - Which compound is secreted only from the adrenal medulla? ...

    Correct

    • Which compound is secreted only from the adrenal medulla?

      Your Answer: Adrenaline

      Explanation:

      The adrenal medulla comprises chromaffin cells (pheochromocytes), which are functionally equivalent to postganglionic sympathetic neurons. They synthesize, store and release the catecholamines noradrenaline (norepinephrine) and adrenaline (epinephrine) into the venous sinusoids.
      The majority of the chromaffin cells synthesize adrenaline.

    • This question is part of the following fields:

      • Anatomy
      12.7
      Seconds
  • Question 11 - An aged patient that has been suffering from diabetes criticised the health minister...

    Correct

    • An aged patient that has been suffering from diabetes criticised the health minister for his comments on incidence and prevalence. The minister had said that they both are two separate entities. It can be therefore inferred that the patient thinks that prevalence and incidence are the same thing. Is he right?

      Your Answer: No. In chronic disease prevalence is greater than incidence.

      Explanation:

      Only on rare occasions has it been found that the prevalence and incidence were same. Incidence can be greater than prevalence in acute cases only. In case of chronic diseases prevalence is far greater than incidence. One needs to have a deeper understanding of both the concepts to understand the health literature.

    • This question is part of the following fields:

      • Statistical Methods
      34.9
      Seconds
  • Question 12 - The plateau phase of the myocardial action potential is as a result of:...

    Correct

    • The plateau phase of the myocardial action potential is as a result of:

      Your Answer: Slow influx of calcium

      Explanation:

      Cardiac conduction

      Phase 0 – Rapid depolarization. Opening of fast sodium channels with large influx of sodium

      Phase 1 – Rapid partial depolarization. Opening of potassium channels and efflux of potassium ions. Sodium channels close and influx of sodium ions stop

      Phase 2 – Plateau phase with large influx of calcium ions. Offsets action of potassium channels. The absolute refractory period

      Phase 3 – Repolarization due to potassium efflux after calcium channels close. Relative refractory period

      Phase 4 – Repolarization continues as sodium/potassium pump restores the ionic gradient by pumping out 3 sodium ions in exchange for 2 potassium ions coming into the cell. Relative refractory period

    • This question is part of the following fields:

      • Physiology And Biochemistry
      20
      Seconds
  • Question 13 - A 72-year-old woman with a medical history of ischaemic heart disease, hypertension, and...

    Correct

    • A 72-year-old woman with a medical history of ischaemic heart disease, hypertension, and hypothyroidism was brought to ER with a change in her mental state over the past few hours. Medications used by her were hydrochlorothiazide, aspirin, ramipril, and levothyroxine. On physical examination, decreased skin turgor, orthostatic hypotension, and disorientation of time and place were found. There were no significant neurological signs. Initial biochemical tests are as follows: Na: 111 mmol/L (135-145), K: 4.1 mmol/L (3.5-5.1), Cl: 105 mmol/L (99-101), Bic: 29 mmol/L (22-29), Urea: 16.4 mmol/L (1.7-8.3), Creatinine: 320µmol/L (44-80), Glucose: 13.5mmol/L (3.5-5.5), Plasma osmolality: 278mOsm/kg, Urinary osmolality: 450mOsm/kg, TSH: 6.2 miu/L (0.1-6.0), Free T4: 10.1 pmol/L (10-25), Free T3: 1.4nm/L (1.0-2.5), Which of the following is most likely cause for this condition of the patient?

      Your Answer: Drug idiosyncrasy

      Explanation:

      Based on the laboratory reports, the patient is suffering from significant hyponatremia. The symptoms of hyponatremia are mainly neurological and depend on the severity and rapidity of onset of hyponatremia.

      Patient symptom according to the hyponatremia level is correlated below:

      125 – 130mmol/L – Nausea and malaise
      115 – 125mmol/L – Headache, lethargy, seizures, and coma
      <120mmol/L – Up to 11% present with coma.

    • This question is part of the following fields:

      • Pathophysiology
      73.7
      Seconds
  • Question 14 - An 85-year old female is being investigated and treated for pancytopenia of unknown...

    Correct

    • An 85-year old female is being investigated and treated for pancytopenia of unknown origin. Her most recent blood test is shown below which shows that he has a low platelet count. Hb-102 g/l, WBC - 2.9* 109/l, Platelets - 7 * 109/l. Which of the following normally stimulates platelet production?

      Your Answer: Thrombopoietin

      Explanation:

      Interleukin-4 is a cytokine which acts to regulate the responses of B and T cells.

      Erythropoietin is responsible for the signal that initiated red blood cell production.

      Granulocyte-colony stimulating factor stimulates the bone marrow to produce granulocytes.

      Interleukin-5 is a cytokine that stimulates the proliferation and activation of eosinophils.

      Thrombopoietin is the primary signal responsible for megakaryocyte and thus platelet production.
      Platelets are also called thrombocytes. They, like red blood cells, are also derived from myeloid stem cells. The process involves a megakaryocyte developing from a common myeloid progenitor cell. A megakaryocyte is a large cell with a multilobulated nucleus, this grows to become massive where it will then break up to form platelets.

      Immune cells are generated from haematopoietic stem cells in bone marrow. They generate two main types of progenitors, myeloid and lymphoid progenitor cells, from which all immune cells are derived.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      34.2
      Seconds
  • Question 15 - A common renal adverse effect of non-steroidal anti-inflammatory drugs is? ...

    Incorrect

    • A common renal adverse effect of non-steroidal anti-inflammatory drugs is?

      Your Answer: Renal papillary necrosis

      Correct Answer: Haemodynamic renal insufficiency

      Explanation:

      Prostaglandins do not play a major role in regulating RBF in healthy resting individuals. However, during pathophysiological conditions such as haemorrhage and reduced extracellular fluid volume (ECVF), prostaglandins (PGI2, PGE1, and PGE2) are produced locally within the kidneys and serve to increase RBF without changing GFR. Prostaglandins increase RBF by dampening the vasoconstrictor effects of both sympathetic activation and angiotensin II. These effects are important because they prevent severe and potentially harmful vasoconstriction and renal ischemia. Synthesis of prostaglandins is stimulated by ECVF depletion and stress (e.g. surgery, anaesthesia), angiotensin II, and sympathetic nerves.

      Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, potently inhibit prostaglandin synthesis. Thus administration of these drugs during renal ischemia and hemorrhagic shock is contraindicated because, by blocking the production of prostaglandins, they decrease RBF and increase renal ischemia. Prostaglandins also play an increasingly important role in maintaining RBF and GFR as individuals age. Accordingly, NSAIDs can significantly reduce RBF and GFR in the elderly.

    • This question is part of the following fields:

      • Physiology
      20.5
      Seconds
  • Question 16 - Which of the following is an expected change in pulmonary function seen during...

    Correct

    • Which of the following is an expected change in pulmonary function seen during a moderate asthma attack?

      Your Answer: Decreased forced expiratory volume in 1 sec (FEV1)

      Explanation:

      Asthma is a lung condition that causes reversible narrowing and swelling of airway passages. It is classified by the frequency and severity of symptoms.

      The following are symptoms of moderate asthma:

      Symptoms include cough, wheezing, chest tightness, or difficulty breathing which occurs daily
      Decreased activity levels due to flare-ups
      Night-time symptoms 5 or more times a month
      Lung function test FEV1 is 60-80% of predicted normal values
      Peak flow has more than 30% variability

      With moderate asthma attacks, the arterial pCO2 levels may decrease, but as severity increases, so does the pCO2, reaching normal levels, and then exceeding them in severe asthma attacks.

      Airway obstruction increases the functional residual capacity.

      Concentration of serum bicarbonate would not increase in moderate asthma, but it could possibly increase in life-threatening asthma via the same mechanism as what increases arterial PCO2.

      FEV1 is a good measure of airway obstruction. and is reduced in acute asthma attacks.

      In the case of a pneumothorax, a decrease in arterial PO2 is higher.

    • This question is part of the following fields:

      • Pathophysiology
      14.2
      Seconds
  • Question 17 - Which among the following is summed up by F statistic? ...

    Incorrect

    • Which among the following is summed up by F statistic?

      Your Answer: Chi squared test

      Correct Answer: ANOVA

      Explanation:

      ANOVA is based upon within group variance (i.e. the variance of the mean of a sample) and between group variance (i.e. the variance between means of different samples). The test works by finding out the ratio of the two variances mentioned above. (Commonly known as F statistic).

    • This question is part of the following fields:

      • Statistical Methods
      8.4
      Seconds
  • Question 18 - A pre-operative evaluation for a trans-sphenoidal pituitary adenectomy is being performed on a...

    Correct

    • A pre-operative evaluation for a trans-sphenoidal pituitary adenectomy is being performed on a 57-year-old woman. Her vision is causing her problems. A macroadenoma compressing the optic chiasm is visible on MRI. What is the most likely visual field defect to be discovered during an examination?

      Your Answer: Bitemporal hemianopia

      Explanation:

      The pituitary gland plays a crucial role in the neuro-endocrine axis. It is located at the base of the skull in the sella turcica of the sphenoid bone. It is connected superiorly to the hypothalamus, third ventricle, and visual pathways, and laterally to the cavernous sinuses, internal carotid arteries, and cranial nerves III, IV, V, and VI.

      Pituitary tumours make up about 10-15% of all intracranial tumours. The majority of adenomas are benign. Over-secretion of pituitary hormones (most commonly prolactin, growth hormone, or ACTH), under-secretion of hormones, or localised or generalised pressure effects can all cause symptoms.

      Compression of the optic chiasm can result in visual field defects, the most common of which is bitemporal hemianopia. This is caused by compression of the nasal retinal fibres, which carry visual impulses from temporal vision across the optic chiasm to the contralateral sides before continuing to the optic tracts.

      The interruption of the visual pathways distal to the optic chiasm causes a homonymous visual field defect. The loss of the right or left halves of each eye’s visual field is referred to as homonymous hemianopia. It’s usually caused by a middle or posterior cerebral artery territory stroke that affects the occipital lobe’s optic radiation or visual cortex.

      Binasal hemianopia is a condition in which vision is lost in the inner half of both eyes (nasal or medial). It’s caused by compression of the temporal visual pathways, which don’t cross at the optic chiasm and instead continue to the ipsilateral optic tracts. Binasal hemianopia is a rare complication caused by the internal carotid artery impinging on the temporal (lateral) visual fibres.

      A monocular visual loss (that is, loss of vision in only one eye) can be caused by a variety of factors, but if caused by nerve damage, the damage would be proximal to the optic chiasm on the ipsilateral side.

      A central scotoma is another name for central visual field loss. Every normal mammalian eye has a scotoma, also known as a blind spot, in its field of vision. The optic disc is a region of the retina that lacks photoreceptor cells and is where the retinal ganglion cell axons that make up the optic nerve exit the retina. When both eyes are open, visual signals that are absent in one eye’s blind spot are provided for the other eye by the opposite visual cortex, even if the other eye is closed.

      Scotomata can be caused by a variety of factors, including demyelinating disease such as multiple sclerosis, damage to nerve fibre layer in the retina, methyl alcohol, ethambutol, quinine, nutritional deficiencies, and vascular blockages either in the retina or in the optic nerve.

      Bilateral scotoma can occur when a pituitary tumour compresses the optic chiasm, causing a bitemporal paracentral scotoma, which then spreads out to the periphery, causing bitemporal hemianopsia. A central scotoma in a pregnant woman could be a sign of severe pre-eclampsia.

    • This question is part of the following fields:

      • Pathophysiology
      15
      Seconds
  • Question 19 - A 25 year-old female came to the out-patient department with complaints of vaginal...

    Incorrect

    • A 25 year-old female came to the out-patient department with complaints of vaginal discharge with a distinct fishy odour. She was later diagnosed with bacterial vaginosis and was prescribed to take metronidazole. The mechanism of action of metronidazole is?

      Your Answer: Interferes with bacterial cell wall synthesis

      Correct Answer: Interferes with bacterial DNA synthesis

      Explanation:

      Metronidazole is a nitroimidazole antiprotozoal drug that is selectively absorbed by anaerobic bacteria and sensitive protozoa. Once taken up be anaerobes, it is nonenzymatically reduced by reacting with reduced ferredoxin. This reduction results in products that accumulate in and are toxic to anaerobic cells. The metabolites of metronidazole are taken up into bacterial DNA, forming unstable molecules. This action occurs only when metronidazole is partially reduced, and, because this reduction usually happens only in anaerobic cells, it has relatively little effect on human cells or aerobic bacteria.

    • This question is part of the following fields:

      • Pharmacology
      17.5
      Seconds
  • Question 20 - During the design phase of a study, which among the given is aimed...

    Incorrect

    • During the design phase of a study, which among the given is aimed at addressing confounding factors?

      Your Answer: Funnel plots

      Correct Answer: Randomisation

      Explanation:

      Randomisation allows for performance of experimental trials in a random order. Using this method gives us control over the confounding variables that are not supposed to be held constant.

      For an instance, by employing randomisation we get to control biological differences among individual human beings during experimental trials.

    • This question is part of the following fields:

      • Statistical Methods
      22.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Physiology And Biochemistry (4/4) 100%
Pharmacology (2/3) 67%
Physiology (2/3) 67%
Anaesthesia Related Apparatus (0/1) 0%
Statistical Methods (2/4) 50%
Clinical Measurement (1/1) 100%
Anatomy (1/1) 100%
Pathophysiology (3/3) 100%
Passmed