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  • Question 1 - Following are some examples of induction agents. Which one has the longest elimination...

    Correct

    • Following are some examples of induction agents. Which one has the longest elimination half-life?

      Your Answer: Thiopental

      Explanation:

      Thiopental has the longest elimination half-life of 6-15 hours.

      Elimination half-life of other drugs are given as:
      – Propofol: 5-12 h
      – Methohexitone: 3-5 h
      – Ketamine: 2 h
      – Etomidate: 1-4 h

    • This question is part of the following fields:

      • Pharmacology
      6.7
      Seconds
  • Question 2 - A 76-year-old female, presents to her GP. She complains of fatigue and increased...

    Correct

    • A 76-year-old female, presents to her GP. She complains of fatigue and increased shortness of breath. On examination, she is noted to have pallor, an increased respiratory and heart rate. Her GP requests further diagnostic investigations, including a full blood count (FBC) which finds decreased MCV and MCHC. What is the most likely cause of her symptoms?

      Your Answer: Iron deficiency

      Explanation:

      The patient’s diagnosis is microcytic hypochromic anaemia which is often as a result of iron deficiency and thalassaemia.

      Macrocytic anaemia is often caused by folate and B12 deficiencies and alcohol abuse.

      Normocytic normochromic anaemia is often caused by acute blood loss, haemolytic anaemia, anaemia of chronic disease and leucoerythroblastic anaemias.

    • This question is part of the following fields:

      • Clinical Measurement
      42
      Seconds
  • Question 3 - When describing the surface anatomy of the sacrum, which of the following anatomical...

    Incorrect

    • When describing the surface anatomy of the sacrum, which of the following anatomical landmarks refers to the base of an equilateral triangle is formed by the sacral hiatus?

      Your Answer: A line connecting the greater trochanters

      Correct Answer: A line connecting the posterior superior iliac spines

      Explanation:

      The apex of an equilateral triangle completed by the posterior superior iliac spines is where the sacral hiatus or sacrococcygeal membrane can normally located. The failure of posterior fusion of the laminae of the fourth and fifth sacral vertebrae allows the sacral canal to be accessible via the membrane.

      In adults, the spine of L4 usually lies on a line drawn between the highest points of the iliac crests (Tuffier’s line). A line connecting each anterior iliac spine, approximates to the L3/4 interspace in the sitting position. Both of these options are incorrect.

      A line connecting the greater trochanters is also incorrect.

      A line connecting the posterior superior iliac spines is correct, but in adults the presence of a sacral fat pad can still make identification of this landmark less straightforward.

      The processes of S5 are remnants only and form the sacral cornua, which are also used to help identify the sacral hiatus.

    • This question is part of the following fields:

      • Anatomy
      34.9
      Seconds
  • Question 4 - What separates the tunica media from the tunica adventitia in a blood vessel?...

    Incorrect

    • What separates the tunica media from the tunica adventitia in a blood vessel?

      Your Answer: Internal elastic lamina

      Correct Answer: External elastic lamina

      Explanation:

      Blood vessels (except capillaries and venules) have three distinctive layers (innermost to outermost):
      1. Tunica intima
      2. Tunica media
      3. Tunica adventitia

      The tunica media contains smooth muscle cells and is separated from the intima layer by the internal elastic lamina and the adventitia by the external elastic lamina.

    • This question is part of the following fields:

      • Anatomy
      11.6
      Seconds
  • Question 5 - Which of the following, at a given PaO2, increases the oxygen content of...

    Correct

    • Which of the following, at a given PaO2, increases the oxygen content of arterial blood?

      Your Answer: A reduced erythrocyte 2,3-diphosphoglycerate level

      Explanation:

      The oxygen content of arterial blood can be calculated by the following equation:
      (10 x haemoglobin x SaO2 x 1.34) + (PaO2 x 0.0225).
      This is the sum of the oxygen bound to haemoglobin and the oxygen dissolved in the plasma.

      Oxygen content x cardiac output = The amount of oxygen delivered to the tissues in unit time which is known as the oxygen flux.

      Any factor that increases the metabolic demand will encourage oxygen offloading from the haemoglobin in the tissues and this causes the oxygen dissociation curve (ODC) to shift to the right. This subsequently reduced the oxygen content of arterial blood.

      Conditions like fever, metabolic or respiratory acidosis lowers the oxygen content and shifts the ODC to the right.
      A low level of 2,3 diphosphoglycerate (2,3-DPG) is usually related to an increased oxygen content as there is less offloading, and so the ODC is shifted to the left.

      So for a given PaO2, a high blood oxygen content is related to any factors that can shift the ODC to the left and not to the right.

      A low haematocrit usually means that there is a decreased haemoglobin concentration, and therefore is associated with decreased oxygen binding to haemoglobin.

    • This question is part of the following fields:

      • Physiology
      29.4
      Seconds
  • Question 6 - Which of the following best describes why phenytoin's hepatic extraction ratio is low? ...

    Correct

    • Which of the following best describes why phenytoin's hepatic extraction ratio is low?

      Your Answer: It has a clearance that is insensitive to changes in liver blood flow

      Explanation:

      The following are the pharmacokinetic properties of drugs with a low hepatic extraction ratio:

      Changes in liver blood flow have no effect on drug clearance.
      When given orally, drug clearance is extremely sensitive to changes in protein binding, intrinsic metabolism, and excretion, and there is no first-pass metabolism.

      Warfarin and phenytoin are two drugs with low hepatic extraction ratios.

      The following are the pharmacokinetic properties of drugs with a high hepatic extraction ratio:

      When taken orally, undergo extensive first-pass metabolism; drug clearance is dependent on liver blood flow, and drug clearance is less sensitive to changes in protein binding and intrinsic metabolism.

      Morphine, lidocaine, propranolol, and etomidate are examples of drugs with high hepatic extraction ratios.

    • This question is part of the following fields:

      • Pharmacology
      10.5
      Seconds
  • Question 7 - Which nerve does NOT pass through the posterior triangle of the neck? ...

    Incorrect

    • Which nerve does NOT pass through the posterior triangle of the neck?

      Your Answer: Phrenic nerve

      Correct Answer: Ansa cervicalis

      Explanation:

      The sternocleidomastoid muscle divides the neck into anterior and posterior triangles on both sides of the neck.

      The posterior triangle has the following boundaries:
      anteriorly – sternocleidomastoid muscle
      posteriorly – trapezius
      roof – investing layer of deep cervical fascia
      floor – prevertebral fascia overlying splenius capitis, levator scapulae, and the scalene muscles

      The contents of the posterior triangle are:
      1. fat
      2. lymph nodes (level V)
      3. accessory nerve
      4. cutaneous branches of the cervical plexus – greater auricular nerve, transverse cervical nerve, lesser occipital nerve, supraclavicular nerve (A major branch of this plexus is the phrenic nerve, which arises from the anterior divisions of spinal nerves C3-C5)
      5. inferior belly of omohyoid
      6. branches of the thyrocervical trunk (transverse cervical and suprascapular arteries)
      7. third part of the subclavian artery
      8. external jugular vein.

    • This question is part of the following fields:

      • Anatomy
      21.3
      Seconds
  • Question 8 - A 54-year-old lady comes in for a right-sided elective bunionectomy with a realignment...

    Incorrect

    • A 54-year-old lady comes in for a right-sided elective bunionectomy with a realignment osteotomy under local anaesthetic on her first (large) toe. For the operation, which of the following nerve blocks will be most effective?

      Your Answer: Saphenous, posterior tibial and superficial peroneal nerves

      Correct Answer: Superficial peroneal, deep peroneal and posterior tibial nerves

      Explanation:

      An ankle block is commonly used for anaesthesia and postoperative analgesia when operating on bunions. It results in the selective block of the superficial peroneal, deep peroneal, and posterior tibial nerves.

      The deep peroneal nerve supplies sensory input to the web space between the first and second toes (L4-5).

      The L2-S1 nerve, often known as the superficial peroneal nerve, is a mixed motor and sensory neuron. It gives sensory supply to the anterolateral region of the leg, the anterior aspect of the 1st, 2nd, 3rd, and 4th toes, and innervates the peroneus longus and brevis muscles (with the exception of the web space between 1st and 2nd toes).

      The sensory area of the saphenous nerve (L3-4) in the foot stretches from the proximal portion of the midfoot on the medial side to the proximal part of the midfoot on the lateral side.

      The lateral side of the little (fifth) toe is innervated by the sural nerve’s sensory supply (S1-2). The heel, medial (medial plantar nerve), and lateral (lateral plantar nerve) soles of the foot are all served by the posterior tibial nerve.

    • This question is part of the following fields:

      • Pathophysiology
      42.5
      Seconds
  • Question 9 - A new proton pump inhibitor (PPI) is being evaluated in elderly patients who...

    Correct

    • A new proton pump inhibitor (PPI) is being evaluated in elderly patients who are taking aspiring. Study designed has 120 patients receiving the PPI, while a control group of 240 individuals is given the standard PPI. Over a span of 6 years, 24 of the group receiving the new PPI had an upper GI bleed compared to 60 individuals who received the standard PPI. How would you calculate the absolute risk reduction?

      Your Answer: 5%

      Explanation:

      Absolute risk reduction = (Control event rate) – (Experimental event rate)

      Experimental event rate = 24 / 120 = 0.2

      Control event rate = 60 / 240 = 0.25

      Absolute risk reduction = 0.25 – 0.2 = 0.05 = 5% reduction

    • This question is part of the following fields:

      • Statistical Methods
      77.9
      Seconds
  • Question 10 - The statement that best describes temperature management is: ...

    Correct

    • The statement that best describes temperature management is:

      Your Answer: Gauge thermometers use coils of different metals with different co-efficients of expansion which either tighten or relax with changes in temperature

      Explanation:

      There are different types of temperature measurement. These include:

      Thermistor – this is a type of semiconductor, meaning they have greater resistance than conducting materials, but lower resistance than insulating materials. There are small beads of semiconductor material (e.g. metal oxide) which are incorporated into a Wheatstone bridge circuit. As the temperature increases, the resistance of the bead decreases exponentially

      Thermocouple – Two different metals make up a thermocouple. Generally, in the form of two wires twisted, welded, or crimped together. Temperature is sensed by measuring the voltage. A potential difference is created that is proportional to the temperature at the junction (Seebeck effect)

      Platinum resistance thermometers (PTR) – uses platinum for determining the temperature. The principle used is that the resistance of platinum changes with the change of temperature. The thermometer measures the temperature over the range of 200°C to1200°C. Resistance in metals show a linear increase with temperature

      Tympanic thermometers – uses infrared radiation which is emitted by all living beings. It analyses the intensity and wavelength and then transduces the heat energy into a measurable electrical output

      Gauge/dial thermometers – Uses coils of different metals with different co-efficient of expansion. These either tighten or relax with changes in temperature, moving a lever on a calibrated dial.

    • This question is part of the following fields:

      • Clinical Measurement
      22.3
      Seconds
  • Question 11 - A transport ventilator is powered by an air/oxygen mix using a full oxygen...

    Correct

    • A transport ventilator is powered by an air/oxygen mix using a full oxygen cylinder (class CD) with an internal capacity of 2 litres, and pressure of 23,000 kPa, with a gas flow of 4 litres/minute. The ventilator also has a control resulting in an additional gas consumption of 1 litre/minute. How long will it take for the cylinder to empty?

      Your Answer: 92 minutes

      Explanation:

      The Drager Oxylog® 1000 is a pneumatically powered, time-dependent, volume-titrated emergency ventilator with a pressure limit. It is compatible with CD cylinder oxygen. The CD cylinder is a strong and lightweight cylinder usually composed of aluminium or Kevlar. The internal cylinder volume is 2 litres, and the pressure of a full cylinder is 230 bar. The volume of the full cylinder is determined by applying Boyle’s law: P1 × V1 = P2 × V2

      Where:
      P1= pressure of a full cylinder (230 bar)
      V1= volume of oxygen at that pressure (2 litres)
      P2= final pressure (1 bar), and
      V2= volume of oxygen in the full cylinder.

      Substituting values into the equation:

      230 × 2 = 1 x V2
      V2 = 460 litres. The flow of fresh gas is 4 litres/minute + 1 litre/minute required by the control, making a total of 5 litres/minute. The amount of time it takes for the cylinder to empty would be the total volume of oxygen in the full cylinder divided by the amount of oxygen expelled per minute: 460/5 = 92, meaning it would take 92 minutes for the cylinder to empty.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      87.5
      Seconds
  • Question 12 - A 45-year-old woman complains of pain in her upper abdomen to her physician....

    Correct

    • A 45-year-old woman complains of pain in her upper abdomen to her physician. The pain comes intermittently in waves and gets worse after eating food. There are no associated complaints of fever or bowel problems. The pain intensity is 6/10, and paracetamol relieves it a little. There is suspicion that part of the biliary tree is blocked. Which area of the duodenum does this blocked tube open into?

      Your Answer: 2nd part of the duodenum

      Explanation:

      The patient is likely suffering from biliary colic since her pain is intermittent and comes and goes in waves. Biliary colic pain gets worse after eating, especially fatty food as bile helps digest fats. Gallstones are the most common cause of biliary colic and are usually located in the cystic duct or common bile duct. But since this patient has no signs of jaundice or steatorrhea, the duct most likely blocked is the cystic duct.

      The cystic duct drains the gallbladder and combines with the common hepatic duct to form the common bile duct. The common bile duct then merges with the pancreatic duct and opens into the second part of the duodenum (major duodenal papilla).

      The duodenojejunal flexure is attached to the diaphragm by the ligament of Treitz and is not associated with any common pathology.
      The fourth part of the duodenum passes very close to the abdominal aorta and can be compressed by an abdominal aortic aneurysm.
      The third part of the duodenum can be affected by superior mesenteric artery syndrome, where the duodenum is compressed between the SMA and the aorta, often in cases of reduced body fat.
      The first part of the duodenum is the most common location for peptic ulcers affecting this organ.

    • This question is part of the following fields:

      • Anatomy
      18.5
      Seconds
  • Question 13 - Radical prostatectomy is being performed on a 60-year-old man for carcinoma of the...

    Incorrect

    • Radical prostatectomy is being performed on a 60-year-old man for carcinoma of the prostate gland. What is the direct blood supply of the prostate?

      Your Answer: Internal iliac artery

      Correct Answer: Inferior vesical artery

      Explanation:

      The prostate gland is primarily supplied by the inferior vesical artery, which branches off from the anterior division of the internal iliac artery. The inferior vesical artery supplies the base of the bladder, the distal ureters, and the prostate. The branches to the prostate communicate with the corresponding vessels of the opposite side.

      The inferior vesical artery branches into two main arteries:
      1. Urethral artery – supplies the transition zone and is the main arterial supply for the adenomas in BPH
      2. Capsular artery – supplies the glandular tissue

      The venous drainage of the prostate is from the prostatic venous plexus, which drains into the paravertebral veins.

    • This question is part of the following fields:

      • Anatomy
      14.9
      Seconds
  • Question 14 - Which nerve is responsible for the direct innervation of the sinoatrial node? ...

    Incorrect

    • Which nerve is responsible for the direct innervation of the sinoatrial node?

      Your Answer: Right vagus nerve

      Correct Answer: None of the above

      Explanation:

      The sinoatrial node receives innervation from multiple nerves arising from the complex cardiac plexus.

      The cardiac plexus sends tiny branches into cardiac vessels, alongside the right and left coronary arteries.

      The vagal efferent fibres originate from the vagal and accessory nerves in the brainstem, and then travel to the cardiac plexus within the heart. The resulting vagal discharge controls heart rate.

      No singular nerve directly innervates the sinoatrial node.

    • This question is part of the following fields:

      • Anatomy
      66.7
      Seconds
  • Question 15 - A patient admitted to the hospital is on oxygen via a venturi mask....

    Correct

    • A patient admitted to the hospital is on oxygen via a venturi mask. The air entrainment ratio is 1:9 i.e. 1 litre of 100% oxygen from the source entrains 9 litres of air from the atmosphere). The flow rate of 100% oxygen is 6L/minute. Based on the given data which of the following value approximates the oxygen concentration delivered to the patient?

      Your Answer: 28%

      Explanation:

      The formula for calculating air: oxygen entrainment ratio is given as :
      100% ˆ’ FiO2 = air/oxygen entrainment ratio
      Since FiO2 ˆ’ 21% and the entrainment ratio is already known. Substituting the values in the equation: x = FiO2.

      100 ˆ’ x = 9
      x ˆ’ 21
      100 ˆ’ x = 9(x ˆ’ 21)
      100 ˆ’ x = 9x ˆ’ 189
      10x = 289
      x = 289/10
      x = 28.9%.

    • This question is part of the following fields:

      • Basic Physics
      743.5
      Seconds
  • Question 16 - Following a near drowning accident, a 5-year-old child is admitted to the emergency...

    Correct

    • Following a near drowning accident, a 5-year-old child is admitted to the emergency department and advanced paediatric life support is started. What is the child's approximate weight, according to the preferred formulae of the Resuscitation Council (UK), the European Resuscitation Council, and the Royal College of Anaesthetists?

      Your Answer: 20-25kg

      Explanation:

      For estimating a child’s weight, the Resuscitation Council (UK) and European Resuscitation Council teach the following formula:

      Weight = (age + 4) × 2

      The weight of the child will be around 20 kg.

      This formula is used in the Primary FRCA exam by the Royal College of Anaesthetists.

      In ‘developed’ countries, the traditional ‘APLS formula’ for estimating weight in children based on age (wt in kg = [age+4] x 2) is acknowledged as underestimating weight by 33.4 percent on average, with the degree of underestimation increasing with increasing age.

      However, more recently, the APLS formula ‘Weight=3(age)+7’ has been found to provide a mean underestimate of only 6.9%. This formula is applicable to children aged 1 to 13 years.

      The estimated weight based on age using this formula is 25 kg.

    • This question is part of the following fields:

      • Physiology
      37.9
      Seconds
  • Question 17 - A 32-year-old male is admitted to the critical care unit. He has suffered...

    Incorrect

    • A 32-year-old male is admitted to the critical care unit. He has suffered a heroin overdose and requires intubation and ventilatory support. What would be his predicted total static compliance (lung and chest wall) measurements.

      Your Answer: 20 ml/cmH2O

      Correct Answer: 100 ml/cmH2O

      Explanation:

      Static lung compliance refers to the change in volume within the lung per given change in unit pressure. It is usually measured when air flow is absent, such as during pauses in inhalation and exhalation.

      It is a combination of:

      Chest wall compliance: normal value is 200 mL/cmH2O
      Lung tissue compliance: normal value is 200 mL/ cmH2O

      It is represented mathematically as:

      1/Crs = 1/Cl + 1/Ccw

      Where,

      Crs = total compliance of the respiratory system
      Cl = compliance of the lung
      Ccw = compliance of the chest wall

      Therefore in this case:

      1/Crs = 1/200 + 1/200

      1/Crs = 0.005 + 0.005 = 0.01

      1/Ct = 0.01

      Rearranging equation gives:

      Ct = 1/0.01 = 100 mL/cmH2O.

    • This question is part of the following fields:

      • Clinical Measurement
      63.2
      Seconds
  • Question 18 - The following statements concern the sensory innervation of the nasal passage: ...

    Incorrect

    • The following statements concern the sensory innervation of the nasal passage:

      Your Answer: posteriorly the floor of the nose is supplied by the superior dental nerves

      Correct Answer: the infraorbital branch of the maxillary nerve supplies the vestibule

      Explanation:

      The walls of the anterior nasal passage are supplied by the anterior ethmoidal branch of the nasociliary nerve, and the floor is innervated by the superior dental nerve (not the sphenopalatine nerves).

      The walls and floor of the posterior nasal passage are innervated by the long and short sphenopalatine nerves and the great palatine nerve (not the superior dental nerves and the nasociliary nerve).

      The vestibule is innervated by small branches of the infraorbital branch of the maxillary nerve.

      The nasopharynx is innervated by the sensory branches of the trigeminal nerve (not the great palatine nerve).

    • This question is part of the following fields:

      • Anatomy
      22.4
      Seconds
  • Question 19 - Regarding the information about kidney, which of the following is true? ...

    Incorrect

    • Regarding the information about kidney, which of the following is true?

      Your Answer: Renal plasma flow is 1200 ml/minute

      Correct Answer: Each kidney contains approximately 1.2 million nephrons

      Explanation:

      Each kidney is composed of about 1.2 million uriniferous tubules. Each tubule consists of two parts that are embryologically distinct from each other. They are as follows:
      a) Excretory part, called the nephron, which elaborates urine
      b) Collecting part which begins as a junctional tubule from the distal convoluted tubule.

      There are two types of nephrons in the kidney:
      The cortical nephron comprises 80% of the total nephron and its major function is the excretion of waste products in urine whereas the juxtamedullary nephron comprises 20% of the total nephron and its major function is the concentration of urine by counter current mechanism.
      In the superficial (cortical) nephrons, peritubular capillaries branch off the efferent arterioles and deliver nutrients to epithelial cells as well as serve as a blood supply for reabsorption and secretion. In juxtamedullary nephrons, the peritubular capillaries have a specialization called the vasa recta, which are long, hairpin-shaped blood vessels that follow the same course as a loop of Henle. The vasa recta serve as osmotic exchangers for the production of concentrated urine.

      The kidney receives about 25% of cardiac output and about 20% of this is filtered at the glomeruli of the kidney. Thus, renal blood flow is 1200 ml/minute and renal plasma flow is 650 ml/minute.

    • This question is part of the following fields:

      • Anatomy
      27.4
      Seconds
  • Question 20 - Which is correct about normal distribution? ...

    Incorrect

    • Which is correct about normal distribution?

      Your Answer: Standard deviation = mean / square root (variance)

      Correct Answer: Mean = mode = median

      Explanation:

      The normal distribution is a symmetrical, bell-shaped distribution in which the mean, median and mode are all equal.

    • This question is part of the following fields:

      • Statistical Methods
      31.9
      Seconds
  • Question 21 - A 60-year-old man had previously been diagnosed with Type 2 diabetes. He had...

    Correct

    • A 60-year-old man had previously been diagnosed with Type 2 diabetes. He had recently started gliclazide, a sulphonyl urea, as his diabetes was not controlled by metformin alone. Now, he presents to his physician with complaints of anxiety, sweating, and palpitations since the morning. On physical examination, he is pale and clammy and has mydriasis and increased bowel sounds. Which biological site primarily synthesizes the hormone responsible for this patient's condition?

      Your Answer: Chromaffin cells of the adrenal medulla

      Explanation:

      This patient has been shifted to a sulfonylurea drug whose most common side effect is hypoglycaemia. Similar symptoms can arise in a patient on insulin too. The signs and symptoms are consistent with a hypoglycaemic attack and include tachycardia, altered consciousness, and behaviour. This needs to be treated as an emergency with rapid correction of the blood glucose level using glucose or IV 20% dextrose.

      In a hypoglycaemic attack, the body undergoes stress and releases hormones to increase blood glucose levels. These include:
      Glucagon
      Cortisol
      Adrenaline

      Adrenaline or epinephrine is the hormone responsible for this patient’s condition and is primarily produced in the medulla of the adrenal gland. It functions primarily to raise cardiac output and raise blood glucose levels in the blood.

      Alpha-cells of the islets of Langerhans produce the hormone glucagon, which has opposing effects to insulin.

      Follicular cells of the thyroid gland produce and secrete thyroid hormones. Thyroid hormones can cause similar symptoms, but it is unlikely with the patient’s medical history.

      Post-ganglionic neurons of the sympathetic nervous system use norepinephrine as a neurotransmitter. Adrenaline can be made in these cells, but it is not their primary production site.

      Zona fasciculata of the adrenal cortex is the main site for the production of cortisol.

    • This question is part of the following fields:

      • Anatomy
      75.1
      Seconds
  • Question 22 - Which of the following drug is enzyme inducer? ...

    Incorrect

    • Which of the following drug is enzyme inducer?

      Your Answer: Rifampicin

      Correct Answer: Erythromycin

      Explanation:

      Rifampicin is a potent inducer of liver cytochrome enzymes. Other enzyme inducers are:
      Carbamazepine
      Sodium valproate
      Phenytoin
      Phenobarbitone

    • This question is part of the following fields:

      • Pharmacology
      6.9
      Seconds
  • Question 23 - The clavipectoral fascia is penetrated by the cephalic vein to terminate in which...

    Correct

    • The clavipectoral fascia is penetrated by the cephalic vein to terminate in which of the listed veins?

      Your Answer: Axillary

      Explanation:

      The cephalic vein is a superficial vein that runs through the forearm and the arm, before draining into the axillary vein where it terminates.

    • This question is part of the following fields:

      • Anatomy
      6.6
      Seconds
  • Question 24 - A 25-year-old soldier is shot in the abdomen. He has multiple injuries, including...

    Correct

    • A 25-year-old soldier is shot in the abdomen. He has multiple injuries, including a major disruption to the abdominal aorta. The bleeding is torrential and needs to be controlled by placing a vascular clamp immediately inferior to the diaphragm. During this manoeuvre, which vessel may be injured?

      Your Answer: Inferior phrenic arteries

      Explanation:

      The inferior phrenic nerves are at the highest risk of damage as they are the first branches of the abdominal aorta. The potential space at the level of the diaphragmatic hiatus is a potentially useful site for aortic occlusion. However, leaving the clamp applied for more than 10 -15 minutes usually leads to poor outcomes.

      The superior phrenic artery branches from the thoracic aorta.

      The abdominal aorta begins at the level of the body of T12 near the midline, as a continuation of the thoracic aorta. It descends and bifurcates at the level of L4 into the common iliac arteries.

      The branches of the abdominal aorta (with their vertebra level) are:
      1. Inferior phrenic arteries: T12 (upper border)
      2. Coeliac artery: T12
      3. Superior mesenteric artery: L1
      4. Middle suprarenal arteries: L1
      5. Renal arteries: Between L1 and L2
      6. Gonadal arteries: L2 (in males, it is the testicular artery, and in females, the ovarian artery)
      7. Inferior mesenteric artery: L3
      8. Median sacral artery: L4
      9. Lumbar arteries: Between L1 and L4.

    • This question is part of the following fields:

      • Anatomy
      89.4
      Seconds
  • Question 25 - A breakthrough lipid-lowering therapy for stroke had a number needed to treat (NNT)...

    Correct

    • A breakthrough lipid-lowering therapy for stroke had a number needed to treat (NNT) of 20 for the prevention of the primary end-point. These results can be best described as:

      Your Answer: For 1000 patients treated with active therapy, there would be 50 fewer strokes

      Explanation:

      Number needed to treat (NNT) is a time specific epidemiological measure that indicates how many patients would be require for an intervention to prevent one additional bad outcome. A perfect NNT would be 1, where everyone improves with treatment, thus the higher the NNT, the less effective the treatment.

      Thus if you treat 1000 patients then you will expect to have 50 fewer strokes.

    • This question is part of the following fields:

      • Statistical Methods
      52.5
      Seconds
  • Question 26 - The rapid depolarisation phase of the myocardial action potential is caused by: ...

    Correct

    • The rapid depolarisation phase of the myocardial action potential is caused by:

      Your Answer: Rapid sodium influx

      Explanation:

      The cardiac action potential has several phases which have different mechanisms of action as seen below:
      Phase 0: Rapid depolarisation – caused by a rapid sodium influx.
      These channels automatically deactivate after a few ms

      Phase 1: caused by early repolarisation and an efflux of potassium.

      Phase 2: Plateau – caused by a slow influx of calcium.

      Phase 3 – Final repolarisation – caused by an efflux of potassium.

      Phase 4 – Restoration of ionic concentrations – The resting potential is restored by Na+/K+ATPase.
      There is slow entry of Na+into the cell which decreases the potential difference until the threshold potential is reached. This then triggers a new action potential

      Of note, cardiac muscle remains contracted 10-15 times longer than skeletal muscle.

      Different sites have different conduction velocities:
      1. Atrial conduction – Spreads along ordinary atrial myocardial fibres at 1 m/sec

      2. AV node conduction – 0.05 m/sec

      3. Ventricular conduction – Purkinje fibres are of large diameter and achieve velocities of 2-4 m/sec, the fastest conduction in the heart. This allows a rapid and coordinated contraction of the ventricles

    • This question is part of the following fields:

      • Physiology And Biochemistry
      8.5
      Seconds
  • Question 27 - A radical neck dissection is being performed. The ENT surgeon wishes to expose...

    Incorrect

    • A radical neck dissection is being performed. The ENT surgeon wishes to expose the external carotid artery fully. He inserts a self-retaining retractor close to the origin of the external carotid artery. What structure lies posterolaterally to the external carotid at this point?

      Your Answer: None of the above

      Correct Answer: Internal carotid artery

      Explanation:

      External carotid artery originates at the upper border of the thyroid cartilage. It ascends and lies anterior to the internal carotid arteries and posterior to the posterior belly of the digastric muscle and stylohyoid muscle.

      The external carotid artery has eight important branches:
      Anterior surface:
      1. Superior thyroid artery (first branch)
      2. Lingual artery
      3. Facial artery
      Medial branch
      4. Ascending pharyngeal artery
      Posterior branches
      5. Occipital artery
      6. Posterior auricular artery
      Terminal branches
      7. Maxillary artery
      8. Superficial temporal artery.

    • This question is part of the following fields:

      • Anatomy
      44.9
      Seconds
  • Question 28 - The thebesian veins contribute to the venous drainage of the heart. Into which...

    Correct

    • The thebesian veins contribute to the venous drainage of the heart. Into which of the following structures do they primarily drain?

      Your Answer: Atrium

      Explanation:

      The heart has two venous drainage systems:
      1. Greater venous system – it parallels the coronary arterial circulation and provides 70% venous drainage to the heart
      2. Lesser venous system – includes the thebasian veins and provides up to 30% of the venous drainage to the heart

      Thebasian veins (also called venae cordis minimae) are the smallest coronary veins and run in the myocardial layer of the heart. They serve to drain the myocardium and are present in all four heart chambers. They are more abundant on the right side of the heart and, more specifically, are most abundant in the right atrium. Thebesian veins drain the subendocardial myocardium either directly, via connecting intramural arteries and veins, or indirectly, via subendocardial sinusoidal spaces.

    • This question is part of the following fields:

      • Anatomy
      10.6
      Seconds
  • Question 29 - Which of the following is true regarding the dose of propofol? ...

    Correct

    • Which of the following is true regarding the dose of propofol?

      Your Answer: 1-2mg/kg

      Explanation:

      Propofol is a short-acting medication used for starting and maintenance of general anaesthesia, sedation for mechanically ventilated adults, and procedural sedation.
      The dose of propofol is 1-2 mg/kg.

      Dose of some other important drugs are listed below:
      Thiopental dose: 3-7 mg/kg
      Ketamine dose: 1-2 mg/kg
      Etomidate dose: 0.3 mg/kg
      Methohexitone dose: 1.0-1.5 mg/kg

    • This question is part of the following fields:

      • Pharmacology
      6.5
      Seconds
  • Question 30 - A 26-year old male patient was admitted to the surgery department for appendectomy....

    Correct

    • A 26-year old male patient was admitted to the surgery department for appendectomy. Medical history revealed that he has major depressive disorder and was on Phenelzine. Aside from abdominal pain, initial assessment was unremarkable. However, thirty minutes after, the patient was referred to you for generalized seizures. He was given an analgesic and it was noted that, during the first 15 minutes of administration, he became anxious, with profuse sweating, which later developed into seizures. Upon physical examination, he was febrile at 38.3°C. Which of the following statements is the best explanation for the patient's symptoms?

      Your Answer: Drug interaction with pethidine

      Explanation:

      The clinical picture best describes a probable drug interaction with pethidine.

      Phenelzine, a monoamine oxidase (MAO) inhibitor, when given with pethidine, an opioid analgesic, may lead to episodes of hypertension, rigidity, excitation, hyperpyrexia, seizures, coma and death. Studies have shown that pethidine reacts more significantly with MAO inhibitors than morphine.

      When pethidine is metabolised to normeperidine, it acts as a serotonin reuptake inhibitor and cause an increase in serotonin levels in the brain. MAO inhibitors can also lead to elevated levels of serotonin because of its mechanism of action by inhibiting the enzyme monoamine oxidase that degrades serotonin.

      The excess serotonin levels may lead to serotonin syndrome, of which some of the common precipitating drugs are selective serotonin reuptake inhibitors, MAO inhibitors, tricyclic antidepressants, meperidine, and St. John’s Wort. Onset of symptoms is within hours, which includes fever, agitation, tremor, clonus, hyperreflexia and diaphoresis.

      Drug interaction between phenelzine and paracetamol do not commonly precipitate serotonin syndrome.

      Neuroleptic malignant syndrome is due to dopamine antagonism, precipitated commonly by antipsychotics. Its onset of symptoms occur in 1 to 3 days, and is characterized by fever, encephalopathy, unstable vitals signs, elevated CPK, and rigidity.

      Altered mental status is the most common manifestation of sepsis-associated encephalopathy. Patient also exhibit confusional states and inappropriate behaviour. In some cases, this may lead to coma and death.

    • This question is part of the following fields:

      • Pharmacology
      40.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Pharmacology (4/5) 80%
Clinical Measurement (2/3) 67%
Anatomy (5/13) 38%
Physiology (2/2) 100%
Pathophysiology (0/1) 0%
Statistical Methods (2/3) 67%
Anaesthesia Related Apparatus (1/1) 100%
Basic Physics (1/1) 100%
Physiology And Biochemistry (1/1) 100%
Passmed