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  • Question 1 - A participant of a metabolism study is to be fed only granulated sugar...

    Correct

    • A participant of a metabolism study is to be fed only granulated sugar and water for 48 hours. What would be his expected respiratory quotient at the end of the study?

      Your Answer: 1

      Explanation:

      The respiratory quotient is the ratio of CO2 produced to O2 consumed while food is being metabolized:

      RQ = CO2 eliminated/O2 consumed

      Most energy sources are food containing carbon, hydrogen and oxygen. Examples include fat, carbohydrates, protein, and ethanol. The normal range of respiratory coefficients for organisms in metabolic balance usually ranges from 1.0-0.7.

      Granulated sugar is a refined carbohydrate with no significant fat, protein or ethanol content.

      The RQ for carbohydrates is = 1.0

      The RQ for the rest of the compounds are:

      Fats RQ = 0.7
      The chemical composition of fats differs from that of carbohydrates in that fats contain considerably fewer oxygen atoms in proportion to atoms of carbon and hydrogen.

      Protein RQ = 0.8
      Due to the complexity of various ways in which different amino acids can be metabolized, no single RQ can be assigned to the oxidation of protein in the diet; however, 0.8 is a frequently utilized estimate.

    • This question is part of the following fields:

      • Physiology
      25.1
      Seconds
  • Question 2 - Of the stated laws, which is correct? ...

    Correct

    • Of the stated laws, which is correct?

      Your Answer: Boyle's law states that at constant temperature the volume of a given mass of gas varies inversely with absolute pressure.

      Explanation:

      Boyle’s law is correctly stated as it states that the volume of a gas of known mass is inversely proportional with absolute pressure, at a constant temperature.

      Beer’s law states that radiation absorption by a solution of known thickness and concentration is identical to that of a solution of double thickness and half concentration.

      Bougner’s (or Lambert’s) law states that every layer with the same thickness will absorb the same amount of radiation as it passes through.

      Graham’s law states that the diffusion rate of a gas is inversely related to the square root of its molecular weight.

      Raoult’s law states that the reduction of a solvent’s vapour pressure is directly proportional to the solute’s molar concentration.

    • This question is part of the following fields:

      • Statistical Methods
      16.9
      Seconds
  • Question 3 - Noradrenaline is used as an infusion to increase blood pressure in a 43-year-old...

    Correct

    • Noradrenaline is used as an infusion to increase blood pressure in a 43-year-old woman with pneumonia admitted to ICU. Which of the following statements is true regarding Noradrenaline?

      Your Answer: Has a short half life about 2 minutes

      Explanation:

      Noradrenaline has a short half-life of about 2 minutes. It is rapidly cleared from plasma by a combination of cellular reuptake and metabolism.

      It acts as sympathomimetics by acting on α1 receptors and also on β receptors.

      It decreases renal and hepatic blood flow.

      Norepinephrine is metabolized by the enzymes monoamine oxidase and catechol-O-methyltransferase to 3-methoxy-4-hydroxymandelic acid and 3-methoxy-4-hydroxyphenylglycol (MHPG).

      Natural catecholamines are Adrenaline, Noradrenaline, and Dopamine

    • This question is part of the following fields:

      • Pharmacology
      14.3
      Seconds
  • Question 4 - The following is true about the extracellular fluid (ECF) in a normal adult...

    Correct

    • The following is true about the extracellular fluid (ECF) in a normal adult woman weighing 60 kg.

      Your Answer: Has a total volume of about 12 litres

      Explanation:

      Total body water (TBW) is about 50% to 70% in adults depending on how much fat is present. ECF is relatively contracted in an obese person.

      The simple rule is 60-40-20. (60% of weight = total body water, 40% of body weight is ICF and 20% is ECF)

      For this woman, the total body water is 36 litres (0.6 × 60). ECF is 12 litres (1/3 of TBW) and 24 litres (2/3 of TBW) is intracellular fluid .

      Sodium concentration is approximately 135-145 mmol/L in the ECF.

      The ECF is made up of both intravascular and extravascular fluid and plasma proteins is found in both.

    • This question is part of the following fields:

      • Physiology
      23.7
      Seconds
  • Question 5 - Where should you insert a needle to obtain a femoral artery sample to...

    Incorrect

    • Where should you insert a needle to obtain a femoral artery sample to be used for an arterial blood gas?

      Your Answer: Mid point of the inguinal ligament

      Correct Answer: Mid inguinal point

      Explanation:

      The needle should be inserted just below the skin at the mid inguinal point which is the surface indicator for the femoral artery.

    • This question is part of the following fields:

      • Anatomy
      38.3
      Seconds
  • Question 6 - All of the following are true when describing the autonomic nervous system except:...

    Incorrect

    • All of the following are true when describing the autonomic nervous system except:

      Your Answer: The parasympathetic post ganglionic synapses use Acetylcholine as the neurotransmitter but have Muscarinic receptors

      Correct Answer: Juxta glomerular apparatus, piloerector muscles and adipose tissue are all organs under sole parasympathetic control

      Explanation:

      With regards to the autonomic nervous system (ANS)

      1. It is not under voluntary control
      2. It uses reflex pathways and different to the somatic nervous system.
      3. The hypothalamus is the central point of integration of the ANS. However, the gut can coordinate some secretions and information from the baroreceptors which are processed in the medulla.

      With regards to the central nervous system (CNS)
      1. There are myelinated preganglionic fibres which lead to the
      ganglion where the nerve cell bodies of the non-myelinated post ganglionic nerves are organised.
      2. From the ganglion, the post ganglionic nerves then lead on to the innervated organ.

      Most organs are under control of both systems although one system normally predominates.

      The nerves of the sympathetic nervous system (SNS) originate from the lateral horns of the spinal cord, pass into the anterior primary rami and then pass via the white rami communicates into the ganglia from T1-L2.

      There are short pre-ganglionic and long post ganglionic fibres.
      Pre-ganglionic synapses use acetylcholine (ACh) as a neurotransmitter on nicotinic receptors.
      Post ganglionic synapses uses adrenoceptors with norepinephrine / epinephrine as the neurotransmitter.
      However, in sweat glands, piloerector muscles and few blood vessels, ACh is still used as a neurotransmitter with nicotinic receptors.

      The ganglia form the sympathetic trunk – this is a collection of nerves that begin at the base of the skull and travel 2-3 cm lateral to the vertebrae, extending to the coccyx.

      There are cervical, thoracic, lumbar and sacral ganglia and visceral sympathetic innervation is by cardiac, coeliac and hypogastric plexi.

      Juxta glomerular apparatus, piloerector muscles and adipose tissue are all organs under sole sympathetic control.

      The PNS has a craniosacral outflow. It causes reduced arousal and cardiovascular stimulation and increases visceral activity.

      The cranial outflow consists of
      1. The oculomotor nerve (CN III) to the eye via the ciliary ganglion,
      2. Facial nerve (CN VII) to the submandibular, sublingual and lacrimal glands via the pterygopalatine and submandibular ganglions
      3. Glossopharyngeal (CN IX) to lungs, larynx and tracheobronchial tree via otic ganglion
      4. The vagus nerve (CN X), the largest contributor and carries ¾ of fibres covering innervation of the heart, lungs, larynx, tracheobronchial tree parotid gland and proximal gut to the splenic flexure, liver and pancreas

      The sacral outflow (S2 to S4) innervates the bladder, distal gut and genitalia.

      The PNS has long preganglionic and short post ganglionic fibres.
      Preganglionic synapses, like in the SNS, use ACh as the neuro transmitter with nicotinic receptors.
      Post ganglionic synapses also use ACh as the neurotransmitter but have muscarinic receptors.

      Different types of these muscarinic receptors are present in different organs:
      There are:
      M1 = pupillary constriction, gastric acid secretion stimulation
      M2 = inhibition of cardiac stimulation
      M3 = visceral vasodilation, coronary artery constriction, increased secretions in salivary, lacrimal glands and pancreas
      M4 = brain and adrenal medulla
      M5 = brain

      The lacrimal glands are solely under parasympathetic control.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      46
      Seconds
  • Question 7 - Which of the following vertebral levels is the site where the oesophagus passes...

    Correct

    • Which of the following vertebral levels is the site where the oesophagus passes through the diaphragm to enter the abdominal cavity?

      Your Answer: T10

      Explanation:

      The diaphragm divides the thoracic cavity from the abdominal cavity. Structures penetrate the diaphragm at different vertebral levels through openings in the diaphragm to communicate between the two cavities. The diaphragm has openings at three vertebral levels:

      T8: vena cava, terminal branches of the right phrenic nerve
      T10: oesophagus, vagal trunks, left anterior phrenic vessels, oesophageal branches of the left gastric vessels
      T12: descending aorta, thoracic duct, azygous and hemi-azygous vein.

    • This question is part of the following fields:

      • Anatomy
      4
      Seconds
  • Question 8 - Prior to rapid sequence induction of anaesthesia, a man with a BMI of...

    Correct

    • Prior to rapid sequence induction of anaesthesia, a man with a BMI of 35 is pre-oxygenated. Which method of pre-oxygenation with a tight-fitting face mask is the most effective?

      Your Answer: Oxygen 6 litres per minute via a Mapleson A breathing system, with patient sitting up at 30 degrees breathing four vital capacity breaths

      Explanation:

      This patient is morbidly obese and has a high risk of developing hypoxia. This will be exacerbated by the patient’s supine position, as a result of:

      Functional residual capacity has been reduced (FRC)
      Increased closing capacity (CC)
      Reduced tidal volume due to increased airway resistance, decreased thoracic cage compliance, and decreased respiratory muscle strength and endurance
      Following induction of general anaesthesia, there is a tendency for atelectasis and increased O2 consumption due to the increased workload of respiratory muscles and the overall increase in metabolism.

      Pre-oxygenation with 100 percent oxygen via a tight-fitting mask can be done using either tidal volume breaths for three to five minutes or four vital capacity breaths in normal circumstances. In the head-up position, this patient is much more likely to be adequately pre-oxygenated, maximising the FRC and minimising the CC. In spontaneously breathing patients, the Mapleson A and circle systems are both effective, but the Mapleson D requires 160-200 ml/kg/minute to prevent rebreathing.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      41.2
      Seconds
  • Question 9 - The external urethral sphincter arises from which nerve root? ...

    Correct

    • The external urethral sphincter arises from which nerve root?

      Your Answer: S2, S3, S4

      Explanation:

      The external urethral sphincter functions to provide voluntary control of urine flow from the bladder to the urethra.

      It receives its innervation from the branches of the pudendal nerve which originate from S2, S3 and S4.

    • This question is part of the following fields:

      • Anatomy
      6.9
      Seconds
  • Question 10 - Regarding bilirubin, which one of the following statement is true? ...

    Incorrect

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

      Your Answer: Gut bacteria convert urobilin to urobilinogen

      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
      23.8
      Seconds
  • Question 11 - Rocuronium is substituted for succinylcholine during induction of anaesthesia for a caesarean section...

    Incorrect

    • Rocuronium is substituted for succinylcholine during induction of anaesthesia for a caesarean section delivery. Which of the following feature of rocuronium ensures the neonate shows no clinical signs of muscle relaxation?

      Your Answer:

      Correct Answer: Highly ionised

      Explanation:

      Drugs cross the placenta by Simple, Ion channel and Facilitated diffusion; Exocytosis and Endocytosis, Osmosis, and Active transport (primary and secondary)

      The following factors influence rate of diffusion across the placenta:

      Protein binding
      Degree of ionisation
      Placental blood flow
      Maternal and foetal blood pH
      Materno-foetal concentration gradient.
      Thickness of placental membrane
      Molecular weight of drug <600 Daltons cross by diffusion
      Lipid solubility (lipid soluble molecules readily diffuse across the placenta)

      Rocuronium has a F/M ratios of 0.16, a 30% plasma protein binding, low lipid solubility, a low volume of distribution (0.25L/kg), and a high molecular weight (530Da).

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 12 - The following haemodynamic data is available from a patient with pulmonary artery catheter...

    Incorrect

    • The following haemodynamic data is available from a patient with pulmonary artery catheter inserted: Pulse rate - 100 beats per minute, Blood pressure - 120/70mmHg, Mean central venous pressure (MCVP) - 10mmHg, Right ventricular pressure (RVP) - 30/4 mmHg, Mean pulmonary artery wedge pressure (MPAWP) - 12mmHg. Which value best approximates the patient's coronary perfusion pressure?

      Your Answer:

      Correct Answer: 58mmHg

      Explanation:

      Coronary perfusion pressure(CPP), the difference between aortic diastolic pressure (Pdiastolic) and the left ventricular end-diastolic pressure (LVEDP), is mainly determined by the formula:

      CPP = Pdiastolic -LVEDP
      where
      Pdiastolic is the lowest pressure in the aorta before left ventricular ejection and
      LVEDP is measured directly during a cardiac catheterisation or indirectly using a pulmonary artery catheter. The pulmonary artery occlusion or wedge pressure approximates best with LVEDP.

      Using this patient’s haemodynamic data:

      CPP = Pdiastolic – MPAWP
      COO = 70 – 12 = 58mmHg.

    • This question is part of the following fields:

      • Clinical Measurement
      0
      Seconds
  • Question 13 - With regards to this state of matter which has a volume but no...

    Incorrect

    • With regards to this state of matter which has a volume but no definite shape, particles are not tightly packed together. These are incompressible although there is free movement within the volume. This statement best describes which one of the following states of matter?

      Your Answer:

      Correct Answer: Liquid

      Explanation:

      The solid state of matter has a definite volume and shape and particles are packed closely together and are incompressible. Within this tight lattice, there is enough thermal energy to produce vibration of particles.

      Liquids however have a volume but no definite shape. These particles are less tightly packed together. Although there is free movement within the volume, they are incompressible.

      Gases, however, have no finite shape or volume and particles are free to move rapidly in a state of random motion. They are compressible and are completely shaped by the space in which they are held. Vapours exist as a gas phase in equilibrium with identical liquid or solid matter below its boiling point.

      The most prevalent state of matter in the universe is plasma which is formed by heating atoms to very high temperatures to form ions.

    • This question is part of the following fields:

      • Basic Physics
      0
      Seconds
  • Question 14 - A 50-year-old female is having her central venous pressure (CVP) measured. A long...

    Incorrect

    • A 50-year-old female is having her central venous pressure (CVP) measured. A long femoral line was inserted that passes from the common iliac vein into the inferior vena cava. At which level of vertebra does this occur?

      Your Answer:

      Correct Answer: L5

      Explanation:

      The inferior vena cava is formed by the union of the right and left common iliac veins. This occurs at the L5 vertebral level. The IVC courses along the right anterolateral side of the vertebral column and ascends through the central tendon of the diaphragm at the T8 vertebral level.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 15 - Systemic vascular resistance (multiplied by 80) to produce the units of dynes.s.cm-5 is...

    Incorrect

    • Systemic vascular resistance (multiplied by 80) to produce the units of dynes.s.cm-5 is represented by?

      Your Answer:

      Correct Answer: Mean arterial pressure (MAP) - central venous pressure (CVP)/cardiac output (CO)

      Explanation:

      Systemic vascular resistance (SVR) is a derived value based on:

      SVR = (MAP-CVP)/CO x 80

      = (60 -10)/5 x 80 = 800 dynes.s.cm-5

      A correction factor of 80 is needed in converting mmHg to dynes.s.cm-5
      Normal values is between 700 -1600 dynes.s.cm-5

      Pulmonary resistance (PVR) = (MPAP-PCWP)/CO x 80

      = (10 – 5)/5 x 80 = 80 dynes.s.cm-5

      To account for body size, cardiac index (CI) can be used instead of CO. CI = CO/body surface area (m2) or mL/minute/m2.
      N/B: either MAP and CVP, or MPAP and PCWP are used in calculation to get dynes.s.cm-5.

    • This question is part of the following fields:

      • Clinical Measurement
      0
      Seconds
  • Question 16 - When there is a relation between two variables due to the existence of...

    Incorrect

    • When there is a relation between two variables due to the existence of a confounding factor, this association is termed as:

      Your Answer:

      Correct Answer: Indirect

      Explanation:

      When the association among any two classes of object is defined by the presence of a third entity it is termed as indirect association. For an instance, the age of the employee may affect the rate of pay, which would have implications on job satisfaction. So, in this example, an indirect relationship between age and job satisfaction exists due to a third party i.e. rate of pay.

    • This question is part of the following fields:

      • Statistical Methods
      0
      Seconds
  • Question 17 - In the adrenal gland: ...

    Incorrect

    • In the adrenal gland:

      Your Answer:

      Correct Answer: Catecholamine release is mediated by cholinergic nicotinic transmission

      Explanation:

      The adrenal (suprarenal) gland is composed of two main parts: the adrenal cortex, which is the largest and outer part of the gland, and the adrenal medulla. The adrenal cortex consists of three zones: 1. Zona glomerulosa (outermost layer) is responsible for the production of mineralocorticoids, mainly aldosterone, which regulates blood pressure and electrolyte balance. 2. Zona fasciculata (middle layer) is responsible for the production of glucocorticoids, predominantly cortisol, which increases blood sugar levels via gluconeogenesis, suppresses the immune system, and aids in metabolism. It also produces 11-deoxycorticosterone and corticosterone in addition to cortisol. 3. Zona reticularis (innermost layer) is responsible for the production of gonadocorticoids, mainly dehydroepiandrosterone (DHEA), which serves as the starting material for many other important hormones produced by the adrenal gland, such as oestrogen, progesterone, testosterone, and cortisol. It is also responsible for administering these hormones to the reproductive regions of the body.

      The adrenal medulla majorly secretes epinephrine (adrenaline), and norepinephrine in small quantity. Both hormones have similar functions and initiate the flight or fight response.

      Catecholamine is mediated by cholinergic nicotinic transmission through changes in sympathetic nervous system (T5 – T11), being increased during stress and hypoglycaemia.

      Blood supply to the adrenal gland is by these three arteries: superior suprarenal arteries, middle suprarenal artery and inferior suprarenal artery. Venous drainage is via the suprarenal vein to the left renal vein or directly to the inferior vena cava on the right side. There is no portal (venous) system between cortex and medulla.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 18 - A 26-year-old doctor has recently been diagnosed with lung cancer. He would like...

    Incorrect

    • A 26-year-old doctor has recently been diagnosed with lung cancer. He would like to find out his survival time for the condition. Which statistical method is used to predict survival rate?

      Your Answer:

      Correct Answer: Kaplan-Meier estimator

      Explanation:

      The Weibull distribution are used to describe various types of observed failures of the components. it is used in reliability and survival analysis.

      Regression Analysis is used to measure the relationship between among two or more variable. It determines the effect of independent variables on the dependent variables.

      Student t-test is one of the most commonly used method to test the hypothesis. It determines the significant difference between the means of two different groups.

      A time series is a collection of observations of well-defined data obtained at regular interval of time.

      Kaplan-Meier estimator is used to estimate the survival function from lifetime data. It can be derived from maximum likelihood estimation of hazard function. It is most likely used to measure the fraction of patient’s life for a certain amount of time after treatment.

    • This question is part of the following fields:

      • Statistical Methods
      0
      Seconds
  • Question 19 - A 64-year-old man is admitted to the critical care unit. He has a...

    Incorrect

    • A 64-year-old man is admitted to the critical care unit. He has a recent medical history of faecal peritonitis for which a laparotomy was performed. His vitals have been monitored using an invasive pulmonary artery flotation catheter. His vital readings are: Temperature: 38.1°C. Blood pressure: 79/51 mmHg (mean 58 mmHg), Pulmonary artery pressure: 19/6 mmHg (mean 10 mmHg). Pulmonary capillary occlusion pressure: 5 mmHg, Central venous pressure: 12 mmHg, Cardiac output: 5 L/min, Mixed venous oxygen saturation: 82%. Calculate his approximate pulmonary vascular resistance. Note: A correction factor of 80 is require to convert mmHg to dynes·s·cm-5

      Your Answer:

      Correct Answer: 80 dynes·s·cm-5

      Explanation:

      Pulmonary vascular resistance (PVR) refers to the resistance to blood flow to the left atrium from the pulmonary artery.
      It is derived mathematically by:

      PVR = MPAP – PCWP
      CO
      where,
      MPAP: Mean pulmonary artery pressure
      PCWP: Pulmonary capillary occlusion pressure
      CO: Cardiac output

      For this patient:
      PVR = 10 – 5 = 1mmHg
      5

      Remember, multiply by correction factor 80 to change units:

      PVR = 1mmHg x 80 = 80 dynes·s·cm-5

      Normal values range between 20-130 dynes·s·cm-5.

    • This question is part of the following fields:

      • Clinical Measurement
      0
      Seconds
  • Question 20 - Patient's having disease (Test Positive: 60, Test Negative:40). Patient's not having the disease...

    Incorrect

    • Patient's having disease (Test Positive: 60, Test Negative:40). Patient's not having the disease (Test Positive:20, Test Negative: 80). This is a result of a new tumour marker blood test, that was performed on 200 women for breast cancer screening. The director of the screening programme asks you to evaluate the observations and inform them the specificity of this new test. Which one of the following figure you will relay to the programme director?

      Your Answer:

      Correct Answer: 80%

      Explanation:

      The positive predictive value is the ratio of patients truly diagnosed as positive to all those who had positive test results. In this case, this is 60/(60+20)=75%.

      The negative predictive value is the ratio of patients truly diagnosed as negative to all those who had negative test results. In this case, this is 80/(80+40)=67%.

      The sensitivity is the ratio of patients with the disease who test positive i.e. true positive patients to the total number of people with the disease. In this case, this is 60/(60+40)=60%.

      The specificity is the ratio of people who don’t have the disease who test negative i.e. true negatives to the total number of people without the disease. In this case, this is 80/(20+80)=80%.

      70% is not the result of any screening measurements

    • This question is part of the following fields:

      • Statistical Methods
      0
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SESSION STATS - PERFORMANCE PER SPECIALTY

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