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  • Question 1 - Regarding anti diuretic hormone (ADH), one of the following statements is correct: ...

    Correct

    • Regarding anti diuretic hormone (ADH), one of the following statements is correct:

      Your Answer: Increases the total amount of electrolyte free water in the body

      Explanation:

      The major action of ADH is to increase reabsorption of osmotically unencumbered water from the glomerular filtrate and decreases the volume of urine passed. The osmolarity of urine is increased to a maximum of four times that of plasma (approx. 1200 mOsm/kg) by Increasing water reabsorption.

      Chronic water loading, Lithium, potassium deficiency, cortisol and calcium excess, all blunt the action of ADH. This leads to nephrogenic diabetes insipidus.

      ADH’s primary site of action is the distal tubule and collecting duct.

    • This question is part of the following fields:

      • Physiology
      38.7
      Seconds
  • Question 2 - All of the following statements are false regarding insulin except: ...

    Incorrect

    • All of the following statements are false regarding insulin except:

      Your Answer: Causes an increased glucose-protein transport on the endoplasmic reticulum

      Correct Answer: Can be detected in the lymph

      Explanation:

      Insulin is secreted from the β cells of the pancreas. It consists of 51 amino acids arranged in two chains. It interacts with cell surface receptors (not the nuclear receptors and thus mechanism of action is not similar to steroids).
      Since insulin can pass from plasma to interstitium and lymphatics, it can be measured in lymph but the concentrations here can be up to 30% less than that of plasma.

      It decreases blood glucose by stimulating the entry of glucose in muscle and fat (by increasing the synthesis of Glucose transporters)

    • This question is part of the following fields:

      • Pharmacology
      28.3
      Seconds
  • Question 3 - A new clinical trial evaluates the effect of a new drug Z on...

    Correct

    • A new clinical trial evaluates the effect of a new drug Z on all-cause mortality. The rate of death in the group receiving this drug is 8%, compared with 16% in the control group. What is the number needed to treat with drug Z to prevent death?

      Your Answer: 13

      Explanation:

      Number needed to treat is a measure of the impact of a treatment or intervention that is often used to communicate results to patients, clinicians, the public and policymakers. It states how many patients need to be treated for one additional patient to experience an adverse outcome (e.g. a death).

      It is calculated as the inverse of the absolute risk reduction and is rounded to the next highest whole number.

      The absolute risk reduction is 8% (16% – 8%). 100/8 = 12.5, so rounding up the next integer this gives at NNT of 13. i.e. you would need to give the new drug to 13 people to ensure that you prevented one death.

    • This question is part of the following fields:

      • Statistical Methods
      37.3
      Seconds
  • Question 4 - A morbidly obese (BMI=48) patient has the following co-morbidities: type II diabetes mellitus...

    Correct

    • A morbidly obese (BMI=48) patient has the following co-morbidities: type II diabetes mellitus and hypertension. It is recommended for the patient to undergo bariatric surgery. If the patient is laid flat for induction of anaesthesia, what physiologic changes of the respiratory system is the most important to consider?

      Your Answer: Functional residual capacity will decrease

      Explanation:

      A decrease in the functional residual capacity (FRC) is the most important physiologic change to consider for such patients.

      FRC is the sum of the expiratory reserve volume and the residual volume. It is the resting volume of the lung, and is an important marker for lung function. During this time, the alveolar pressure is equal to the atmospheric pressure. When morbidly obese individuals lie supine, the FRC decreases by as much as 40% because the abdominal contents push the diaphragm into the thoracic cavity.

      Chest wall compliance is expected to reduce because of fat deposition surrounding adjacent structures.

      Inspiratory reserve volume (IRV) is expected to increase, and peak expiratory flow is expected to decrease, however the decrease in FRC is more important to consider because of the risk of hypoxia secondary to premature airway closure and ventilation-perfusion mismatch.

    • This question is part of the following fields:

      • Physiology
      20.8
      Seconds
  • Question 5 - A new intravenous neuromuscular blocking agent has been developed. It has a hepatic...

    Correct

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

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

      Explanation:

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

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

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

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

      Therefore:

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

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

    • This question is part of the following fields:

      • Pharmacology
      83.2
      Seconds
  • Question 6 - A 26-year-old doctor has recently been diagnosed with lung cancer. He would like...

    Correct

    • 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: 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
      8.9
      Seconds
  • Question 7 - The phenomenon that the patients behaved in a different manner when they know...

    Correct

    • The phenomenon that the patients behaved in a different manner when they know that they are being observed is termed as?

      Your Answer: Hawthorne effect

      Explanation:

      Hawthorne effect explains the change in any behavioural aspect owing to the awareness that the person is being observed.
      Simpson’s Paradox explains the association developed when the data from several groups is combined to form a single larger group.

      The remaining terms are made up.

    • This question is part of the following fields:

      • Statistical Methods
      15
      Seconds
  • Question 8 - Which of the following statements is true regarding enantiomers? ...

    Incorrect

    • Which of the following statements is true regarding enantiomers?

      Your Answer: Sevoflurane is a chiral compound

      Correct Answer: Desflurane is a chiral compound

      Explanation:

      A compound that contains an asymmetric centre (chiral atom or chiral centre) and thus can occur in two non-superimposable mirror-image forms (enantiomers) are called chiral compounds.

      Desflurane, Halothane, and isoflurane are chiral compounds but Sevoflurane is not a chiral compound.

    • This question is part of the following fields:

      • Pharmacology
      17.4
      Seconds
  • Question 9 - A laser is a device that stimulates atoms or molecules to emit light...

    Correct

    • A laser is a device that stimulates atoms or molecules to emit light at particular wavelengths and amplifies that light, typically producing a very narrow beam of radiation. This can be of visible, infrared, or ultraviolet wavelengths. They have been widely utilized in theatre environment. Which of the following safety measures is most likely to reduce chances of eye injury to the theatre personnel?

      Your Answer: Wearing laser protective goggles

      Explanation:

      Eye damage is the most common potential hazard associated with laser energy. Everyone in the laser treatment room has the risk of eye exposure when working with a Class 3b or Class 4 healthcare laser system, and damage to various structures in the eye depending on wavelength of the laser if they are unprotected.

      Red and near-infrared light (400-1400 nm) has very high penetration power. The light causes painless burns on the retina after it is absorbed by melanin in the pigment epithelium just behind the photoreceptors.

      Infrared radiation (IR), or infrared light (>1060 nm), is a type of radiant energy that’s invisible to human eyes and hence won’t elicit the protective blink.

      Ultraviolet light (<400 nm) is also a form of electromagnetic radiation which is can penetrate the cornea and be absorbed by the iris or the pupil and cause burn injuries or cataract occur due to irreversible photochemical retinal damage.

      Safety eyewear is the best method of providing eye protection and are designed to absorb light specific to the laser being used. Laser protective eyewear (LPE) includes glasses or goggles of proper optical density (OD). The lenses should not be glass or plastic. The LPE should withstand direct and diffuse scattered laser beams.

      The laser protection supervisor (LPS) or LSO is an individual who is responsible for any clinical area in which lasers are used. They are expected to have a certain level of equipment and determine what control measures are appropriate, for each individual system, but their presence does not guarantee the chances of having an eye injury.

      Class 1 lasers are generally safe under every conceivable condition and is not likely to cause any eye damage. Class 3b or Class 4 medical laser systems are utilized in healthcare which have their own safety precautions.

      Polarized spectacles can make your eyes more comfortable by eliminated glare, however, they will not be able to offer any protection against wavelengths at which laser act.
      Using short bursts to reduce energy is also not correct as it would still be harmful to eye.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      26.5
      Seconds
  • Question 10 - Under general anaesthesia, a 48-year-old patient is scheduled for some dental extractions. He...

    Correct

    • Under general anaesthesia, a 48-year-old patient is scheduled for some dental extractions. He tells you that he has a heart murmur and that he has always received antibiotic prophylaxis at the dentist. There are no allergies that he is aware of. Which antibiotic prophylaxis strategy is most appropriate for this patient?

      Your Answer: Prophylactic antibiotics are unnecessary for this patient

      Explanation:

      The National Institute for Health and Care Excellence (NICE) has published guidelines on infective endocarditis prophylaxis (IE). The goal was to create clear guidelines for antibiotic prophylaxis in patients undergoing dental procedures as well as certain non-dental interventional procedures. A number of studies have found an inconsistent link between recent interventional procedures and the development of infective endocarditis in both dental and non-dental procedures.

      Antibiotic prophylaxis against infective endocarditis is not advised or required in the following situations:

      Dental patients undergoing procedures
      Patients undergoing procedures involving the upper and lower gastrointestinal tracts, the genitourinary tract (including urological, gynaecological, and obstetric procedures, as well as childbirth), and the upper and lower respiratory tract (including ear, nose and throat procedures and bronchoscopy).

      Antibiotic resistance can be exacerbated by the indiscriminate use of prophylactic antibiotics, but this is not the primary reason for avoiding their use in these situations.

      To reduce the risk of endocarditis, any patient who is at risk of developing IE should be investigated and treated as soon as possible. Patients with the following conditions are at risk of developing IE:
      acquired valvular heart disease with regurgitation or stenosis
      previous valve replacement
      structural congenital heart disease
      past history of IE, or
      hypertrophic cardiomyopathy (HOCM)

      It would also be appropriate for high-risk dental procedures and those with severe gingival disease.

      Although this patient may not have structural heart disease, ABs should be administered on a case-by-case basis.

    • This question is part of the following fields:

      • Pharmacology
      31.3
      Seconds
  • Question 11 - Which of the following is true in the Kreb's cycle? ...

    Correct

    • Which of the following is true in the Kreb's cycle?

      Your Answer: Alpha-ketoglutarate is a five carbon molecule

      Explanation:

      Krebs’ cycle (tricarboxylic acid cycle or citric acid cycle) is a sequence of reactions to release stored energy through oxidation of acetyl coenzyme A (acetyl-CoA). Some of the products are carbon dioxide and hydrogen atoms.

      The sequence of reactions, known collectively as oxidative phosphorylation, only occurs in the mitochondria (not cytoplasm).

      The Krebs cycle can only take place when oxygen is present, though it does not require oxygen directly, because it relies on the by-products from the electron transport chain, which requires oxygen. It is therefore considered an aerobic process. It is the common pathway for the oxidation of carbohydrate, fat and some amino acids, required for the formation of adenosine triphosphate (ATP).

      Pyruvate enters the mitochondria and is converted into acetyl-CoA. Acetyl-CoA is then condensed with oxaloacetate, to form citrate which is a six carbon molecule. Citrate is subsequently converted into isocitrate, alpha-ketoglutarate, succinyl-CoA, succinate, fumarate, malate and finally oxaloacetate.

      The only five carbon molecule in the cycle is Alpha-ketoglutarate.

    • This question is part of the following fields:

      • Physiology
      22.7
      Seconds
  • Question 12 - Which of the following nerves is responsible for relaying sensory information from the...

    Correct

    • Which of the following nerves is responsible for relaying sensory information from the laryngeal mucosa?

      Your Answer: Laryngeal branches of the vagus

      Explanation:

      Sensory innervation of the larynx is controlled by branches of the vagus nerve.

      The internal and external bifurcations of the superior laryngeal nerve is responsible for sensory innervation of the aspect of the larynx superior to the vocal cords, while the recurrent laryngeal nerve is responsible for sensory innervation of the intrinsic musculature of the larynx except for the cricothyroid muscle.

    • This question is part of the following fields:

      • Anatomy
      17.2
      Seconds
  • Question 13 - What separates the tunica media from the tunica adventitia in a blood vessel?...

    Correct

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

      Your 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
      13.4
      Seconds
  • Question 14 - A 27-year old man loses 1000ml blood after being stabbed on his thigh....

    Correct

    • A 27-year old man loses 1000ml blood after being stabbed on his thigh. The most impactful physiological response occurring at the start to combat the decline in the intravascular blood volume of this man is?

      Your Answer: Venoconstriction

      Explanation:

      In contrast to the arterial system, which contains 15% of the circulating blood volume, the body’s veins contain 70% of it.

      In severe haemorrhage, when sympathetic stimulation causes venoconstriction, venous tone is important in maintaining the return of blood to the heart.

      Because the liver receives about 30% of the resting cardiac output, it is a very vascular organ. The hepatic vascular system is dynamic, which means it can store and release blood in large amounts – it acts as a reservoir within the general circulation.

      In a normal situation, the liver contains 10-15% of total blood volume, with the sinusoids accounting for roughly 60% of that. The liver dynamically adjusts its blood volume when blood is lost and can eject enough blood to compensate for a moderate amount of haemorrhage.

      In the portal venous and hepatic arterial systems, sympathetic nerves constrict the presinusoidal resistance vessels. More importantly, sympathetic stimulation lowers the portal system’s capacitance, allowing blood to flow more efficiently to the heart.

      Net transcapillary absorption of interstitial fluid from skeletal muscle into the intravascular space compensates for blood loss effectively during haemorrhage. The decrease in capillary hydrostatic pressure (Pc), caused by reflex adrenergic readjustment of the ratio of pre- to postcapillary resistance, is primarily responsible for fluid absorption. Within a few hours of blood loss, these fluid shifts become significant, further diluting haemoglobin and plasma proteins.

      Albumin synthesis begins to increase after 48 hours.

      The juxtamedullary complex releases renin in response to a drop in mean arterial pressure, which causes an increase in aldosterone level and, eventually, sodium and water resorption. Increased antidiuretic hormone (ADH) levels also contribute to water retention.

    • This question is part of the following fields:

      • Physiology
      22.1
      Seconds
  • Question 15 - A 50-year-old male is planned for elective parotidectomy for pleomorphic adenoma. The surgeon...

    Incorrect

    • A 50-year-old male is planned for elective parotidectomy for pleomorphic adenoma. The surgeon intends to use a nerve integrity monitor thus avoiding neuromuscular blockade. Which of the following nerves is liable to injury in parotidectomy?

      Your Answer: Glossopharyngeal nerve

      Correct Answer: Facial nerve

      Explanation:

      Parotidectomy is basically an anatomical dissection. Identification of the facial nerve trunk is essential during parotid gland surgery because facial nerve injury is the most daunting potential complication of parotid gland surgery owing to the close relation between the gland and the extratemporal course of the facial nerve. After exiting the stylomastoid foramen, the facial nerve enters the substance of the parotid gland and then gives off five terminal branches:
      From superior to inferior, these are the:
      – Temporal branch supplying the extrinsic ear muscles, occipitofrontalis and orbicularis oculi
      – Zygomatic branch supplying orbicularis oculi
      – Buccal branch supplying buccinator and the lip muscles
      – Mandibular branch supplying the muscles of the lower lip and chin
      – Cervical branch supplying platysma.

      There are two approaches to identify the facial nerve trunk during parotidectomy€”conventional antegrade dissection of the facial nerve, and retrograde dissection. Numerous soft tissue and bony landmarks have been proposed to assist the surgeon in the early identification of this nerve. Most commonly used anatomical landmarks to identify facial nerve trunk are stylomastoid foramen, tympanomastoid suture (TMS), posterior belly of digastric (PBD), tragal pointer (TP), mastoid process and peripheral branches of the facial nerve.

    • This question is part of the following fields:

      • Anatomy
      37.9
      Seconds
  • Question 16 - Which muscle separates the subclavian artery and the subclavian vein? ...

    Incorrect

    • Which muscle separates the subclavian artery and the subclavian vein?

      Your Answer: Scalenus medius

      Correct Answer: Scalenus anterior

      Explanation:

      The subclavian artery and vein have a similar path throughout their course, with the subclavian vein running anterior to the subclavian artery. The artery and vein are separated by the insertion of the scalenus anterior muscle.

      There are three scalene muscles, found on each side of the neck:
      1. Anterior scalene
      2. Middle scalene
      3. Posterior scalene

      The scalenus anterior muscle is the anterior most of the three scalene muscles. It originates from the transverse processes of vertebrae C3-C6 and is inserted in the first rib.

    • This question is part of the following fields:

      • Anatomy
      13.5
      Seconds
  • Question 17 - Which is the most appropriate statement describing the function of flowmeters? ...

    Correct

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

      Your Answer: Constant pressure, variable orifice - Heidbrink flowmeters

      Explanation:

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

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      30.6
      Seconds
  • Question 18 - A 30-year old lady has a sub total thyroidectomy. On the 5th post-operative...

    Correct

    • A 30-year old lady has a sub total thyroidectomy. On the 5th post-operative day, the wound becomes erythematous and there is a purulent discharge. The most likely organism causing this is:

      Your Answer: Staphylococcus aureus

      Explanation:

      Staphylococcus aureus infection is the most likely cause.

      Surgical site infections (SSI) occur when there is a breach in tissue surfaces and allow normal commensals and other pathogens to initiate infection. They are a major cause of morbidity and mortality.

      SSI comprise up to 20% of healthcare associated infections and approximately 5% of patients undergoing surgery will develop an SSI as a result.
      The organisms are usually derived from the patient’s own body.

      Measures that may increase the risk of SSI include:
      -Shaving the wound using a single use electrical razor with a disposable head
      -Using a non iodine impregnated surgical drape if one is needed
      -Tissue hypoxia
      -Delayed prophylactic antibiotics administration in tourniquet surgery, patients with a prosthesis or valve, in clean-contaminated surgery of in contaminated surgery.

      Measures that may decrease the risk of SSI include:
      1. Intraoperatively
      – Prepare the skin with alcoholic chlorhexidine (Lowest incidence of SSI)
      -Cover surgical site with dressing

      In contrast to previous individual RCT’s, a recent meta analysis has confirmed that administration of supplementary oxygen does not reduce the risk of wound infection and wound edge protectors do not appear to confer benefit.

      2. Post operatively
      Tissue viability advice for management of surgical wounds healing by secondary intention

      Use of diathermy for skin incisions
      In the NICE guidelines the use of diathermy for skin incisions is not advocated. Several randomised controlled trials have been undertaken and demonstrated no increase in risk of SSI when diathermy is used.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      11.4
      Seconds
  • Question 19 - Among the following options which one compares variance within the group and variance...

    Correct

    • Among the following options which one compares variance within the group and variance between groups?

      Your 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
      33.9
      Seconds
  • Question 20 - What statement about endotoxins is true? ...

    Correct

    • What statement about endotoxins is true?

      Your Answer: Can often survive autoclaving

      Explanation:

      Endotoxins are the lipopolysaccharides found in the outer cell wall of Gram-negative bacteria. They are responsible for providing the structure and stability of the cell wall.

      They cannot be destroyed by normal sterilisation as they are heat stable molecules. They require the use of certain sterilant such as superoxide, peroxide and hypochlorite to be neutralised.

      They stimulate strong immune responses, but can only be destroyed partially by specific antibodies. Repeat infections occur as memory T cells cannot be formed.

      It can cause septicaemia and associated symptoms such as fever, shock, hypotension and nausea.

      It activates the alternative complement pathway and the coagulation pathway using secreted cytokines.

      It is not involved in botulism as clostridium botulinum, the responsible organism, secretes a neurotoxic exotoxin.

    • This question is part of the following fields:

      • Pathophysiology
      7.3
      Seconds
  • Question 21 - Which statement is correct concerning breathing systems? ...

    Correct

    • Which statement is correct concerning breathing systems?

      Your Answer: The reservoir bag can limit the pressure in the breathing system to about 40 cm of water

      Explanation:

      Mapleson classified breathing systems into A, B, C, D and E. Jackson-Rees subsequently modified the Mapleson E by adding a double-ended bag to the end of the reservoir tubing, creating the Mapleson F. A Mapleson E or T-piece does not have a reservoir bag.

      A Mapleson A system is a very efficient system for use during spontaneous ventilation. However, it is not suitable for use with patients less than 25 kg, due to the increased dead space at the distal / patient end. This system can be modified into a Lack system or coaxial Mapleson A, where the fresh gas flows through an outer tube (30 mm) and exhaled gases flow through the inner tube (14 mm).

      The adjustable pressure limiting valve (APL) or expiratory valve allows exhaled gas and excess fresh gas to leave the breathing system. It is a one-way, adjustable spring-loaded valve, and gases escape when the pressure in the system exceeds the valve opening pressure. During spontaneous ventilation a pressure of less than 1 cm of water (0.1 kPa) is needed when the valve is in the open position (not 2 cm of H2O).

      The reservoir bag is highly compliant and when over inflated, the rubber bag can limit the pressure in the system to about 40 cm of H2O.

      This is due to the law of Laplace, which states that the pressure will fall as the radius of the bag increases:

      Pressure = 2 x tension/radius.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      24.2
      Seconds
  • Question 22 - What structure is most critical in providing support for the duodenojejunal flexure? ...

    Correct

    • What structure is most critical in providing support for the duodenojejunal flexure?

      Your Answer: Ligament of Treitz

      Explanation:

      The duodenojejunal flexure is the point where the duodenum becomes the jejunum.

      The ligament of Treitz, which arises from the right crus of diaphragm, provides suspension for support.

      Between the ileum and the caecum is the ligament of Treves.

    • This question is part of the following fields:

      • Anatomy
      6.9
      Seconds
  • Question 23 - You are shown the summary of a publication recommending use of their company's...

    Correct

    • You are shown the summary of a publication recommending use of their company's antiemetic to prevent postoperative nausea and vomiting by a pharmaceutical representative. You read the article, which is in a peer reviewed journal, and consider whether to change your current practice of using cyclizine intraoperatively. Which type of publication will provide the best evidence on which to base changes to your practice?

      Your Answer: A prospective randomised double blind controlled trial against cyclizine in multiple centres

      Explanation:

      A prospective randomised double blind controlled trial against cyclizine in multiple centres is the most likely to change your practice.

      Case controlled studies are efficient in identifying an association between a drug treatment and outcome and are usually conducted retrospectively. They are generally less valued than prospective randomised trials. They cannot generate incidence data, are subject to bias, have difficult selection of controls and can be made more difficult if note keeping is not reliable.

      The gold standard in intervention-based studies is randomised controlled double blind trials. Its features are:

      Treating all intervention groups identically
      Reduction of bias by random allocation to intervention groups
      Patients and researchers unaware of which treatment was given until at completion of study
      Patients analysed within the group to which they were allocated, and
      Analysis focused on estimating the size of the difference in predefined outcomes between intervention groups.

      New healthcare interventions should be evaluated through properly designed randomised controlled trials (though there are some potential ethical disadvantages)

      Conducting trials in multiple centres is an accepted way of evaluating a new drug as it may be the only way of recruiting sufficient number of patients within a reasonable time frame to satisfy the objectives of the trial. Type II statistical errors will occur if a small numbers of patients is used in study group.

    • This question is part of the following fields:

      • Statistical Methods
      50.4
      Seconds
  • Question 24 - 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
      46.5
      Seconds
  • Question 25 - A 58-year-old man, visits his general practitioner complaining of a lump in his...

    Correct

    • A 58-year-old man, visits his general practitioner complaining of a lump in his groin. He explains he is otherwise well and reports no other symptoms. The lump is examined and is found to be soft, and can be reduced without causing the patient pain. The GP diagnoses an inguinal hernia. To determine the nature of the hernia, the GP reduced the lump and applies pressure on the deep inguinal ring. The deep inguinal ring has what anatomical landmark?

      Your Answer: Superior to the midpoint of the inguinal ligament

      Explanation:

      The deep inguinal ring lies approximately 1.5-2cm above the midpoint of the inguinal ligament, the halfway point between the anterior superior iliac spine and the pubic tubercle, next to the epigastric vessels.

      It is an important point in determining the nature of an inguinal hernia (direct or indirect). The patient is asked to cough after the hernia is reduced, with pressure applied to the deep inguinal ring. The hernia reappearing indicates it is direct, moving through the posterior wall of the inguinal canal.

      Inferior and lateral to the pubic tubercle is the normal anatomical position of the neck of a femoral hernia.

      Superior and medial to the pubic tubercle is the site of the superficial inguinal ring, and the normal anatomical position of the neck of an inguinal hernia.

      The mid-inguinal point is located halways between the pubic symphysis and the anterior superior iliac spine. It is the surface marking for taking the femoral pulse.

    • This question is part of the following fields:

      • Anatomy
      29.9
      Seconds
  • Question 26 - 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
      26.5
      Seconds
  • Question 27 - A 46-year old man was taken to the emergency room due to slow,...

    Incorrect

    • A 46-year old man was taken to the emergency room due to slow, laboured breathing. A relative reported that he's maintained on codeine 60 mg, taken orally every 6 hours for severe pain from oesophageal cancer. His creatinine was elevated, and glomerular filtration rate was severely decreased at 27 ml/minute. Given the scenario above, which of the metabolites of codeine is the culprit for his clinical findings?

      Your Answer: Morphine-3-glucuronide

      Correct Answer: Morphine-6-glucuronide

      Explanation:

      Accumulation of morphine-6-glucuronide is a risk factor for opioid toxicity during morphine treatment. Morphine is metabolized in the liver to morphine-6-glucuronide and morphine-3-glucuronide, both of which are excreted by the kidneys. In the setting of renal failure, these metabolites can accumulate, resulting in a lowering of the seizure threshold. However, it does not occur in all patients with renal insufficiency, which is the most common reason for accumulation of morphine-6-glucuronide; this suggests that other risk factors can contribute to morphine-6-glucuronide toxicity.

      The active metabolites of codeine are morphine and the morphine metabolite morphine-6-glucuronide. The enzyme systems responsible for this metabolism are: CYP2D for codeine and UGT2B7 for morphine, codeine-6-gluronide, and morphine-6-glucuronide. Both of these systems are subject to genetic variation. Some patients are ultrarapid metabolizers of codeine and produce higher levels of morphine and active metabolites in a very short period of time after administration. These increased levels will produce increased side effects, especially drowsiness and central nervous system depression.

    • This question is part of the following fields:

      • Pharmacology
      15.2
      Seconds
  • Question 28 - Which of the following anaesthetic agents is most suitable for inhalational induction in...

    Correct

    • Which of the following anaesthetic agents is most suitable for inhalational induction in an 8-year-old child for inhalational induction of anaesthesia before routine surgery?

      Your Answer: Sevoflurane at 4%

      Explanation:

      The ideal agent for this case should have low blood: gas coefficient, pleasant smell, and high oil: gas coefficient (potent with a low Minimum alveolar coefficient (MAC)). Among the given options, Sevoflurane is perfect with 0.692 blood: gas partition coefficient and is low pungency, and is sweet.

      Other drugs with their blood: gas partition coefficient and their smell are given as:
      Blood/gas partition coefficient MAC Smell
      Enflurane 1.8 1.68 Pungent, ethereal
      Desflurane 0.42 7 Pungent, ethereal
      Halothane 2.54 0.71 Sweet
      Isoflurane 1.4 1.15 Pungent, ethereal

    • This question is part of the following fields:

      • Pharmacology
      6.7
      Seconds
  • Question 29 - Out of the following, which artery is NOT a branch of the hepatic...

    Correct

    • Out of the following, which artery is NOT a branch of the hepatic artery?

      Your Answer: Pancreatic artery

      Explanation:

      The common hepatic artery arises from the celiac artery and has the following branches:
      1. hepatic artery proper that branches into –
      a. cystic artery to supply the gallbladder
      b. left and right hepatic arteries to supply the liver
      2. gastroduodenal artery that branches into
      a. right gastroepiploic artery
      b. superior pancreaticoduodenal artery
      3. right gastric artery

      The pancreatic artery is a branch of the splenic artery.

    • This question is part of the following fields:

      • Anatomy
      19.8
      Seconds
  • Question 30 - A 23-year-old man, has just undergone surgery under general anaesthesia. He has experienced...

    Incorrect

    • A 23-year-old man, has just undergone surgery under general anaesthesia. He has experienced a severe reaction to the anaesthetic agent resulting in malignant hyperthermia (MH) for which he has been referred for treatment. What investigation can be conducted to determine a patient's susceptibility to malignant hyperthermia?

      Your Answer: Chromosomal analysis

      Correct Answer: In vitro muscle contraction test using caffeine

      Explanation:

      Malignant hyperthermia (MH) is a autosomal dominant inherited medical condition which predisposes affected individuals to a clinical syndrome of hypermetabolism which involves abnormal ryanodine receptors in skeletal muscle causing a deregulation of calcium in muscle.

      It is a life threatening condition requiring immediate medical intervention. It often lies dormant until triggered in susceptible individuals mostly by volatile inhaled anaesthetic agents and succinylcholine which is a muscle relaxant.

      The signs and symptoms of MH are related to this hypermetabolism, which includes an increase in carbon dioxide production, metabolic and respiratory acidosis, accelerated oxygen consumption, heat production, activation of the sympathetic nervous system, hyperkalaemia, disseminated intravascular coagulation (DIC), and multiple organ dysfunction and failure.

      Early signs of MH to look out for in patients includes an uptick in end-tidal carbon dioxide (even with increasing minute ventilation), tachycardia, muscle rigidity, tachypnoea, and hyperkalaemia. Later signs include fever, myoglobinuria, and multiple organ failure.

      In vitro muscle contracture test (IVCT) is the standard for determining individual susceptibility to MH. It is conducted by measuring the force of muscle contraction after exposing the patient’s muscle sample to halothane and caffeine., the sample is normally taken from the vastus medialis or lateralis under regional anaesthesia.

    • This question is part of the following fields:

      • Clinical Measurement
      23.8
      Seconds
  • Question 31 - Given the following hormones, which of these will stimulate glycogenesis and gluconeogenesis? ...

    Incorrect

    • Given the following hormones, which of these will stimulate glycogenesis and gluconeogenesis?

      Your Answer: Growth hormone

      Correct Answer: Corticosteroids

      Explanation:

      Insulin is the primary anabolic hormone that dominates regulation of metabolism during digestive phase. It promotes glucose uptake in skeletal myocytes and adipocytes, and other insulin-target cells. It promotes glycogenesis and inhibits gluconeogenesis.

      Glucagon is the primary counterregulatory hormone that increases blood glucose levels, primarily through its effects on liver glucose output.

      Similar to glucagon, growth hormone, catecholamines and corticosteroids are also counterregulatory factors released in response to decreased glucose concentrations. Growth hormone promotes glycogenolysis and inhibits gluconeogenesis; catecholamines stimulate glycogenolysis and gluconeogenesis; while corticosteroids stimulate glycogenesis and gluconeogenesis.

    • This question is part of the following fields:

      • Pathophysiology
      46.6
      Seconds
  • Question 32 - A 50-year-old woman is brought into the emergency department in an ambulance. She...

    Incorrect

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

      Your Answer: The base of the thalamus

      Correct Answer: The base of the pons

      Explanation:

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

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

    • This question is part of the following fields:

      • Anatomy
      8.6
      Seconds
  • Question 33 - The leading cause of perioperative anaphylaxis per hundred thousand administrations currently in the...

    Correct

    • The leading cause of perioperative anaphylaxis per hundred thousand administrations currently in the UK is?

      Your Answer: Teicoplanin

      Explanation:

      The leading cause of perioperative anaphylaxis in the UK currently are antibiotics. They account for 46% of cases with identified causative agents. Co-amoxiclav and teicoplanin between them account for 89% of antibiotic-induced perioperative anaphylaxis

      Neuromuscular blocking agents (NMBAs) are the second leading cause and account for 33% of case.

      Chlorhexidine (0.78/100,000 administrations)
      Co-amoxiclav (8.7/100,000 administrations)Suxamethonium (11.1/100,000 administrations)
      Patent blue dye (14.6/100,000 administrations)
      Teicoplanin (16.4/100,000 administrations)

      Anaphylaxis to chlorhexidine periop poses a significant risk in the healthcare setting because of its widespread use with some being fatal.

    • This question is part of the following fields:

      • Pharmacology
      32.6
      Seconds
  • Question 34 - Suppose a diabetic patient is to undergo an elective surgery under general anaesthesia,...

    Incorrect

    • Suppose a diabetic patient is to undergo an elective surgery under general anaesthesia, which of the following will most effectively prevent a hyperglycaemic stress response during the surgical procedure?

      Your Answer: Etomidate 20 mg IV

      Correct Answer: Spinal block to T4

      Explanation:

      Every surgical procedure is associated with a stress response which comprises a number of endocrine, metabolic, and immunological changes triggered by neuronal activation of the hypothalamic-pituitary-adrenal axis. The overall metabolic effect of the stress response to surgery includes an increase in secretion of catabolic hormones, such as cortisol and catecholamine, and a decrease in secretion of anabolic hormones, such as insulin and testosterone. The increase in levels of catabolic hormones in plasma stimulates glucose production, and there is a relative lack of insulin together with impaired tissue insulin sensitivity and glucose utilization, which is called insulin resistance. Consequently, blood glucose concentrations will increase, even in the absence of pre-existing diabetes.

      A study compared the effects of spinal and general anaesthesia on changes in blood glucose concentrations during surgery in nondiabetic patients. Although mean blood glucose concentrations showed a significant proportional increase during surgery in both groups, this effect was much more significant with general anaesthesia than with spinal anaesthesia. These results indicate that spinal anaesthesia is more effective than general anaesthesia in attenuating the hyperglycaemic response to surgery.

    • This question is part of the following fields:

      • Pathophysiology
      15.7
      Seconds
  • Question 35 - The production of carbon dioxide and water occurs during cellular respiration, which involves...

    Incorrect

    • The production of carbon dioxide and water occurs during cellular respiration, which involves an energy substrate and oxygen. For a patient, the respiratory quotient is calculated as 0.7. Which of the following energy substrate combinations is the most likely in this patient's diet?

      Your Answer: High carbohydrate, high fat and high protein

      Correct Answer: Low carbohydrate, high fat and low protein

      Explanation:

      The respiratory quotient (RQ) is the proportion of CO2 produced by the body to O2 consumed per unit of time.

      CO2 produced / O2 consumed = RQ

      CO2 is produced at a rate of 200 mL per minute, while O2 is consumed at a rate of 250 mL per minute. An RQ of around 0.8 is typical for a mixed diet.

      The RQ will change depending on the energy substrates consumed in the diet.

      Granulated sugar is a refined carbohydrate that contains 99.999 percent carbohydrate and no lipids, proteins, minerals, or vitamins.

      Glucose and other hexose sugars – RQ = 1
      Fats – RQ = 0.7
      Proteins – RQ is 0.9
      Ethyl alcohol – RQ = 0.67

    • This question is part of the following fields:

      • Pathophysiology
      15.8
      Seconds
  • Question 36 - A patient's ECG is abnormal, with an abnormal broad complex QRS complexes. This...

    Incorrect

    • A patient's ECG is abnormal, with an abnormal broad complex QRS complexes. This means either a ventricular origin problem or aberrant conduction. The normal resting membrane potential of the heart's ventricular contractile fibres is which of the following?

      Your Answer: +50mV

      Correct Answer: -90mV

      Explanation:

      The cardiac muscle’s contractile fibres have a much more stable resting potential than its conductive fibres. In the ventricular fibres it is -90mV and in the atrial fibres it is -80mV.

      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. (QRS complex)

      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
      23.7
      Seconds
  • Question 37 - All of the following statements are false regarding propranolol except: ...

    Correct

    • All of the following statements are false regarding propranolol except:

      Your Answer: Has a plasma half life of 3-6 hours.

      Explanation:

      Propranolol is a nonselective beta-blocker with a half-life of 3 to 6 hours.

      Since it is lipid-soluble it crosses the blood-brain barrier and causes Central Nervous System side effects like sedation, nightmares, and depression.

      They are contraindicated in asthma, Congestive heart failure, and diabetes.

      It has a large volume of distribution with no intrinsic sympathomimetic action.

    • This question is part of the following fields:

      • Pharmacology
      11.5
      Seconds
  • Question 38 - Which term among the following is used for the proportion of a particular...

    Incorrect

    • Which term among the following is used for the proportion of a particular disease that would be eradicated from a population if the rate of disease were to be reduced to that of the group that has not been exposed to it?

      Your Answer: Checkov factor

      Correct Answer: Attributable proportion

      Explanation:

      The attributable risk is the rate of a disease in an exposed group to that of a group that has not been exposed to it. It involves the measure of association that is pertinent to making decisions for the individuals.

    • This question is part of the following fields:

      • Statistical Methods
      54
      Seconds
  • Question 39 - A study involving 64 patients of diabetes mellitus type 2 was performed. Weight...

    Incorrect

    • A study involving 64 patients of diabetes mellitus type 2 was performed. Weight of each patient was recorded and the mean weight of the patients was found to be 81 kg. The data set had a standard deviation of 12 kg. The value of standard error associated with the mean is:

      Your Answer: Square root (64 / 12)

      Correct Answer: 1.5

      Explanation:

      Standard error can be calculated by the following formula:

      Standard Error= (Standard Deviation)/ˆš(Sample Size)
      = (12) / ˆš(64)
      = 12 / 8
      = 1.5

    • This question is part of the following fields:

      • Statistical Methods
      13
      Seconds
  • Question 40 - Drug toxicity when using bupivacaine is most likely to occur when this local...

    Correct

    • Drug toxicity when using bupivacaine is most likely to occur when this local anaesthetic technique is performed.

      Your Answer: Intercostal nerve block

      Explanation:

      An intercostal nerve block is used for therapeutic and diagnostic purposes. Intercostal nerve blocks manage acute and chronic pain in the chest area. Common indications are chest wall surgery and shingles or postherpetic neuralgia.

      An intercostal nerve block is also an effective option for the management of pain associated with chest trauma and rib fractures. These blocks have been shown to improve oxygenation and respiratory mechanics, and offer pain relief that is comparable to that of epidural analgesia.

      This technique, however, is limited by the relatively large doses of local anaesthetic required, and relatively high intravascular uptake from the intercostal space, increasing risk of local anaesthetic toxicity.

    • This question is part of the following fields:

      • Pharmacology
      14.9
      Seconds
  • Question 41 - Which of the following statement is true regarding the mechanism of action of...

    Correct

    • Which of the following statement is true regarding the mechanism of action of macrolides?

      Your Answer: Inhibits protein synthesis

      Explanation:

      The mechanism of action of macrolides is inhibition of bacterial protein synthesis by preventing peptidyltransferase from adding to the growing peptide which is attached to tRNA to the next amino acid.

    • This question is part of the following fields:

      • Pharmacology
      50.9
      Seconds
  • Question 42 - A project is being planned to assess the effects of a new anticoagulant...

    Incorrect

    • A project is being planned to assess the effects of a new anticoagulant on the coagulation cascade. The intrinsic pathway is being studied and the best measurement to be recorded is which of the following?

      Your Answer: Prothrombin time (PT)

      Correct Answer: aPTT

      Explanation:

      The intrinsic pathway is best assessed by the aPTT time.

      D-dimer is a fibrin degradation product which is raised in the presence of blood clots.

      A 50:50 mixing study is used to assess if a prolonged PT or aPTT is due to factor deficiency or a factor inhibitor.

      The thrombin time is a test used to assess fibrin formation from fibrinogen in plasma. Factors that prolong the thrombin time include heparin, fibrin degradation products, and fibrinogen deficiency.

      Intrinsic pathway – Best assessed by APTT. Factors 8,9,11,12 are involved. Prolonged aPTT can be seen in haemophilia and use of heparin.

      Extrinsic pathway – Best assessed by Increased PT. Factor 7 involved.

      Common pathway – Best assessed by APTT & PT. Factors 2,5,10 involved.

      Vitamin K dependent factors are factors 2,7,9,10

    • This question is part of the following fields:

      • Physiology And Biochemistry
      37.9
      Seconds
  • Question 43 - Concerning drug dose and response, one of the following statements is correct? ...

    Correct

    • Concerning drug dose and response, one of the following statements is correct?

      Your Answer: Intrinsic activity determines maximal response

      Explanation:

      Dose response curves are plotted as % response to drug against Logarithm of drug concentration. The graph is usually sigmoid shaped.

      Any drug that has high affinity and high intrinsic activity is likely an agonist. A drug with high affinity but no intrinsic activity will act as an antagonist. Displacement of an agonist also depends on the relative concentrations of the two drugs at the receptor sites.

      Maximal response may be achieved by activation of a small proportion of receptor sites.

    • This question is part of the following fields:

      • Pharmacology
      27.1
      Seconds
  • Question 44 - A 23-year-old man who is currently on fluoxetine for depression was anaesthetized two...

    Incorrect

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

      Your Answer: Residual anaesthetic effects

      Correct Answer: Tramadol

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Pharmacology
      40.6
      Seconds
  • Question 45 - Which of the following is incorrect with regards to atrial natriuretic peptide? ...

    Incorrect

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

      Your Answer: Lowers blood pressure

      Correct Answer: Secreted mainly by the left atrium

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Physiology And Biochemistry
      16.5
      Seconds
  • Question 46 - A 25-year-old man, has been scheduled for a splenectomy. For this procedure, he...

    Incorrect

    • A 25-year-old man, has been scheduled for a splenectomy. For this procedure, he requires a urethral catheter. Where does resistance first occur during the insertion of a catheter?

      Your Answer: Bladder neck

      Correct Answer: Membranous urethra

      Explanation:

      The membranous urethra is the shortest part of the urethra and the least dilatable part of it.

      This is as a result of it being surrounded by the external urethral sphincter which is made up of striated muscle and controls voluntary urine flow from the bladder to the urethra.

    • This question is part of the following fields:

      • Anatomy
      71.7
      Seconds
  • Question 47 - With a cervical dilation of 7 cm, a 33-year-old term primigravida is in...

    Incorrect

    • With a cervical dilation of 7 cm, a 33-year-old term primigravida is in labour. She is otherwise in good health. She's been in labour for 14 hours and counting. The cardiotocograph shows late foetal pulse decelerations, and a pH of 7.24 was found in the recent foetal scalp blood sample. Which of the following is true about this patient's care and management?

      Your Answer: The patient requires a category 1 caesarean section under general anaesthetic

      Correct Answer: Monitor for downward trend in fetal scalp blood pH as caesarean section is not indicated at the present time

      Explanation:

      Once the decision to deliver a baby by caesarean section has been made, it should be carried out with a level of urgency commensurate with the baby’s risk and the mother’s safety.

      There are four types of caesarean section urgency:

      Category 1: A threat to the life of the mother or the foetus. 30 minutes to make a delivery decision
      Category 2 : Maternal or foetal compromise that is not immediately life threatening. In most cases, the decision to deliver is made within 75 minutes.
      Category 3 – Early delivery is required, but there is no risk to the mother or the foetus.
      Category 4: Elective delivery at a time that is convenient for both the mother and the maternity staff.

      There may be evidence of foetal compromise in the example above (late foetal pulse decelerations and a borderline pH).

      Blood samples from the foetus:
      normal: 7.25 or above
      borderline: 7.21 to 7.24
      abnormal: 7.20 or below

      When a foetal deceleration occurs, the mother should be given oxygen, kept in a left lateral position, and given a tocolytic if the foetal deceleration is hyper stimulating. Maintaining adequate hydration will reduce the likelihood of a caesarean section.

    • This question is part of the following fields:

      • Pathophysiology
      142.3
      Seconds
  • Question 48 - Drug X, a new intravenous induction drug, is being administered as a bolus...

    Incorrect

    • Drug X, a new intravenous induction drug, is being administered as a bolus at regular time intervals, and the following data were observed: Time following injection (hours) vs Plasma concentration of drug X (mcg/mL) 2 / 400 6 / 100 10 / 25 14 / 6.25 Which of the following values estimate the plasma half-life (T½) of drug X?

      Your Answer: 4 hours

      Correct Answer: 2 hours

      Explanation:

      Half life (T½) is the time required to change the amount of drug in the body by one-half (or 50%) during elimination. The time course of a drug in the body will depend on both the volume of distribution and the clearance.

      Extrapolating the values from the plasma concentration vs time:

      Plasma concentration at 0 hours = 800 mcg/mL
      Plasma concentration at 2 hours = 400 mcg/mL
      Plasma concentration at 4 hours = 200 mcg/mL
      Plasma concentration at 6 hours = 100 mcg/mL
      Plasma concentration at 8 hours = 50 mcg/mL
      Plasma concentration at 10 hours = 25 mcg/mL
      Plasma concentration at 12 hours = 12.5 mcg/mL
      Plasma concentration at 14 hours = 6.25 mcg/mL

    • This question is part of the following fields:

      • Statistical Methods
      22.1
      Seconds
  • Question 49 - A 57-year old woman, presents to her general practitioner. She has a 2...

    Incorrect

    • A 57-year old woman, presents to her general practitioner. She has a 2 week history of a vaginal hysterectomy for which she was placed under general anaesthesia. On examination, she has notable weakness of dorsiflexion of her left foot and a high stepping gait. Which nerve was most likely injured during her surgery?

      Your Answer: Tibial nerve

      Correct Answer: Common peroneal nerve

      Explanation:

      The common peroneal (fibular) nerve is a peripheral nerve in the lower limb. It arises of the L4-S2 nerve roots and has sensory and motor innervations:

      Sensory: Provides innervation of the lateral leg and foot dorsum.

      Motor: Provides innervation of the short head of the biceps femoris, as well as muscles of the anterior and lateral leg compartments.

      It is the most commonly damaged nerve in the lower extremity, as it is easily compressed by a plaster cast or injured when the fibula is fractured.

      Damage to the common peroneal nerve will result in loss of dorsiflexion at ankle (footdrop, as feet are permanently plantarflexed), with the accompanying high stepping gait.

      The saphenous and sural nerve only provide sensory innervation.

      The tibial nerve arises from the sciatic nerve (like the common peroneal), but it provides motor innervation to the posterior leg compartments and intrinsic foot muscles. Injury to the tibial nerve will cause loss of plantar flexion, toe flexion and weakened foot inversion.

      Extreme hip flexion into the lithotomy or Lloyd-Davies position can result in stretch damage to the neurones (sciatic and obturator nerves) or by applying direct pressure (femoral nerve compression).

    • This question is part of the following fields:

      • Pathophysiology
      13.9
      Seconds
  • Question 50 - In endurance athletes, which of the following physiological adaptations to exercise is the...

    Incorrect

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

      Your Answer:

      Correct Answer: Velocity of blood lactate accumulation

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Pathophysiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Physiology (5/5) 100%
Pharmacology (8/13) 62%
Statistical Methods (7/8) 88%
Anaesthesia Related Apparatus (3/3) 100%
Anatomy (4/8) 50%
Physiology And Biochemistry (2/4) 50%
Pathophysiology (5/7) 71%
Clinical Measurement (0/1) 0%
Passmed