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  • Question 1 - What statement about endotoxins is true? ...

    Incorrect

    • What statement about endotoxins is true?

      Your Answer: Are involved in botulism

      Correct 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
      43.5
      Seconds
  • Question 2 - A 59-year-old smoker booked for an emergency laparotomy is in the anaesthetic room...

    Incorrect

    • A 59-year-old smoker booked for an emergency laparotomy is in the anaesthetic room prior to intubation. He is breathing room air and an arterial blood gas is obtained on insertion of an arterial cannula and sent for analysis. The following results are available: Haemoglobin 75 g/L, PaO2 10.7 kPa, PaCO2 5.2 kPa. After intravenous induction, intubation is difficult and he rapidly begins to de-saturate. Which of the following is most effective in prolonging the oxygen de-saturation time?

      Your Answer: Pre-operative blood transfusion to a haemoglobin of 100 g/L

      Correct Answer: Pre-oxygenation with 100% O2 for three minutes

      Explanation:

      Breathing 100% oxygen for three minutes will provide the best reservoir of oxygen during apnoea by oxygenating the functional residual capacity (FRC).

      Sitting at 45 degrees might increase the FRC and improve oxygen reserve but not compared with 100% oxygenation.

      The following table compares the oxygen reserves in the body following pre-oxygenation with room air and 100% oxygen:

      Compartment Factors Room air (mL) 100% O2 (mL)
      Lung FAO2, FRC 630 2850
      Plasma PaO2, DF, PV 7 45
      Red blood cells Hb, TGV, SaO2 788 805
      Myoglobin – 200 200
      Interstitial space – 25 160

      FAO2 = alveolar fraction of oxygen.
      FRC = Functional residual capacity.
      PaO2 = partial pressure of oxygen dissolved in arterial blood
      DF = dissolved form.
      PV = plasma volume.
      TG = total globular volume .
      Hb = haemoglobin concentration.
      SaO2 = arterial oxygen saturation

      Stopping smoking one month prior to surgery will not be more effective than pre-oxygenation with 100% oxygen though it may reduce postoperative pulmonary complications. Note that both long term and short term abstinence reduces pulse rate and blood pressure thus reducing oxygen consumption and also reduce carboxyhaemoglobin levels.

      Blood transfusion will not make a big difference in oxygen reserve, particularly if a blood transfusion is administered within 12-24-hours before surgery.

      Heliox (79% helium and 21% oxygen) despite its lower viscosity is unlikely to be more effective than 100% oxygen .

    • This question is part of the following fields:

      • Pathophysiology
      76.2
      Seconds
  • Question 3 - The following statements are about the cervical plexus. Which one is true? ...

    Incorrect

    • The following statements are about the cervical plexus. Which one is true?

      Your Answer: Is formed by the anterior primary rami of C2 - C5

      Correct Answer: Recurrent laryngeal nerve block is a complication of a cervical plexus block

      Explanation:

      The cervical plexus is a complex network of nerves within the head and neck region, providing nerve innervation to regions within the head, neck and trunk.

      It is comprised of nerves arising from the anterior primary rami of the C1-C4 nerve roots.

      The cervical plexus gives off superficial and deep branches. The superficial branches penetrate through the deep fascia at the centre point of the posterior border of the sternocleidomastoid. It provides sensory innervation from the lower border of the mandible to the 2nd rib. The deep branches provide motor innervation to the neck and diaphragmatic muscles.

      Cervical plexus block is surgically relevant as it is used to provide regional anaesthesia for procedures in the neck region. The anaesthesia should be injected into the centre point of the posterior border of the sternocleidomastoid. Complications arise when anaesthesia is instead injected into the wrong point, including into the vertebral artery, subarachnoid and epidural spaces, blockade of phrenic and recurrent laryngeal nerves, and the cervical sympathetic plexus.

    • This question is part of the following fields:

      • Pathophysiology
      6.6
      Seconds
  • Question 4 - 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:

      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
      0
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  • Question 5 - Following a near drowning accident, a 5-year-old child is admitted to the emergency...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 6 - A 30-year old male has Von Willebrand's disease and attends the hospital to...

    Incorrect

    • A 30-year old male has Von Willebrand's disease and attends the hospital to get an infusion of desmopressin acetate. The way this works is by stimulating the release of von Willebrand factor from cells, which in turn increases factor VIII and platelet plug formation in clotting. In patients that have no clotting abnormalities, the substance that keeps the blood soluble and prevents platelet activation normally is which of these?

      Your Answer:

      Correct Answer: Prostacyclin

      Explanation:

      Even though aprotinin reduces fibrinolysis and therefore bleeding, there is an associated increased risk of death. It was withdrawn in 2007.
      Protein C is dependent upon vitamin K and this may paradoxically increase the risk of thrombosis during the early phases of warfarin treatment.

      The coagulation cascade include two pathways which lead to fibrin formation:
      1. Intrinsic pathway – these components are already present in the blood
      Minor role in clotting
      Subendothelial damage e.g. collagen
      Formation of the primary complex on collagen by high-molecular-weight kininogen (HMWK), prekallikrein, and Factor 12
      Prekallikrein is converted to kallikrein and Factor 12 becomes activated
      Factor 12 activates Factor 11
      Factor 11 activates Factor 9, which with its co-factor Factor 8a form the tenase complex which activates Factor 10

      2. Extrinsic pathway – needs tissue factor that is released by damaged tissue)
      In tissue damage:
      Factor 7 binds to Tissue factor – this complex activates Factor 9
      Activated Factor 9 works with Factor 8 to activate Factor 10

      3. Common pathway
      Activated Factor 10 causes the conversion of prothrombin to thrombin and this hydrolyses fibrinogen peptide bonds to form fibrin. It also activates factor 8 to form links between fibrin molecules.

      4. Fibrinolysis
      Plasminogen is converted to plasmin to facilitate clot resorption

    • This question is part of the following fields:

      • Physiology And Biochemistry
      0
      Seconds
  • Question 7 - What can an outbreak of flu that has spread globally be termed as?...

    Incorrect

    • What can an outbreak of flu that has spread globally be termed as?

      Your Answer:

      Correct Answer: Pandemic

      Explanation:

      An epidemic is declared when the increase in a give disease is above a certain level in a specific interval of time.

      An endemic is the general, usual level of a disease in a population at a particular time.

      A pandemic is an epidemic that is spread across many countries and continents.

    • This question is part of the following fields:

      • Statistical Methods
      0
      Seconds
  • Question 8 - The following are pairs of neurotransmitters with their corresponding synthesising enzymes. Which pair...

    Incorrect

    • The following are pairs of neurotransmitters with their corresponding synthesising enzymes. Which pair is correct?

      Your Answer:

      Correct Answer: Glutamic acid decarboxylase and gamma-aminobutyric acid (GABA)

      Explanation:

      Glutamic acid decarboxylase is responsible for the catalyses of glutamate to gamma-aminobutyric acid (GABA)

      Catechol-o-methyl transferase catalyses the degradation and inactivation of dopamine into 3-methoxytyramine, epinephrine into metanephrine, and norepinephrine into normetanephrine and vanylmethylmandelic acid (VMA).

      Monoamine oxidase catalyses the oxidation of norepinephrine to vanylmethylmandelic acid (VMA) and serotonin to 5-hydeoxyindole acetic acid (5-HIAA).

      Cholinesterase functions to catalyse the split of acetylcholine into choline and acetic acid.

    • This question is part of the following fields:

      • Pathophysiology
      0
      Seconds
  • Question 9 - A 58-year-old man is being operated on for a radical gastrectomy for carcinoma...

    Incorrect

    • A 58-year-old man is being operated on for a radical gastrectomy for carcinoma of the stomach. Which structure needs to be divided to gain access to the coeliac axis?

      Your Answer:

      Correct Answer: Lesser omentum

      Explanation:

      The lesser omentum will need to be divided. This forms one of the nodal stations that will need to be taken during a radical gastrectomy.

      The celiac axis is the first branch of the abdominal aorta and supplies the entire foregut (mouth to the major duodenal papilla). It arises at the level of vertebra T12. It has three major branches:
      1. Left gastric
      2. Common hepatic
      3. Splenic arteries.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 10 - Which of the following is the maximum volume of 0.5% bupivacaine that should...

    Incorrect

    • Which of the following is the maximum volume of 0.5% bupivacaine that should be administered to a 10kg child?

      Your Answer:

      Correct Answer: 1 ml

      Explanation:

      Bupivacaine is used to decrease feeling in a specific area. It is injected around a nerve that supplies the area, or into the spinal canal’s epidural space.

      The maximum volume of 0.5% bupivacaine that should be administered to a 10kg child is 5 ml

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 11 - Which of the following correctly explains the mechanism of sevoflurane preconditioning? ...

    Incorrect

    • Which of the following correctly explains the mechanism of sevoflurane preconditioning?

      Your Answer:

      Correct Answer: Closure of sarcolemmal KATP channels

      Explanation:

      Sevoflurane is highly fluorinated methyl isopropyl ether widely used as an inhalational anaesthetic. It is suggested that sevoflurane preconditioning occurs via the opening of mitochondrial Potassium ATP dependent channel similar to that of Ischemic Preconditioning protection.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 12 - An 80-year-old man has a swelling in his left groin with moderate pain...

    Incorrect

    • An 80-year-old man has a swelling in his left groin with moderate pain and discomfort complaints. Diagnosed with an inguinal hernia, he is scheduled for elective surgery to repair the defect. Of the following, which nerve runs in the inguinal canal and is at risk of being damaged during surgery?

      Your Answer:

      Correct Answer: Ilioinguinal nerve

      Explanation:

      The inguinal canal is a passage in the lower anterior abdominal wall just above the inguinal ligament. It transmits the following structures:
      1. genital branch of genitofemoral nerve
      2. ilioinguinal nerve
      3. spermatic cord (males only)
      4. round ligament of the uterus (females only)

      The ilioinguinal is a direct branch of the first lumbar nerve. The ilioinguinal nerve enters the inguinal canal via the abdominal musculature (and not through the deep (internal) inguinal ring) and exits through the superficial (or external) inguinal ring.

      The openings for the other nerves in the answer options are:
      Sciatic nerve – exits the pelvis via the greater sciatic foramen
      Obturator nerve – descends into pelvis via the obturator foramen
      Femoral nerve – descends from the abdomen through the pelvis behind the inguinal canal

      The Iliohypogastric nerve also arises from the first lumbar root with the ilioinguinal nerve but pierces the transversus abdominis muscle posteriorly, just above the iliac crest, and continues anteriorly between the transversus abdominis and the internal abdominal oblique muscles.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 13 - Which of the following statements about the central venous pressure (CVP) waveform is...

    Incorrect

    • Which of the following statements about the central venous pressure (CVP) waveform is true?

      Your Answer:

      Correct Answer: Third degree heart block causes canon A waves

      Explanation:

      The central venous pressure (CVP) waveform depicts changes of pressure within the right atrium. Different parts of the waveform are:

      A wave: which represents atrial contraction. It is synonymous with the P wave seen during an ECG. It is often eliminated in the presence of atrial fibrillation, and increased tricuspid stenosis, pulmonary stenosis and pulmonary hypertension.

      C wave: which represents right ventricle contraction at the point where the tricuspid valve bulges into the right atrium. It is synonymous with the QRS complex seen on ECG.

      X descent: which represents relaxation of the atrial diastole and a decrease in atrial pressure, due to the downward movement of the right ventricle as it contracts. It is synonymous with the point before the T wave on ECG.

      V wave: which represents an increase in atrial pressure just before the opening of the tricuspid valve. It is synonymous with the point after the T wave on ECG. It is increased in the background of a tricuspid regurgitation.

      Y descent: which represents the emptying of the atrium as the tricuspid valve opens to allow for blood flow into the ventricle in early diastole.

      Canon waves: which refer to large waves present on the trace that do not correspond to the A, V or C waves. They usually occur in a background of complete heart blocks or junctional arrythmias.

    • This question is part of the following fields:

      • Clinical Measurement
      0
      Seconds
  • Question 14 - An 82-year-old male has severe abdominal pain that is out of proportion to...

    Incorrect

    • An 82-year-old male has severe abdominal pain that is out of proportion to the examination. He is a known case of atrial fibrillation and diverticulitis. Suspecting mesenteric ischemia, he was thoroughly investigated, and a mesenteric angiography shows ischemia of the left colic flexure. Which artery gives off branches that supply this region directly?

      Your Answer:

      Correct Answer: Inferior mesenteric artery (IMA)

      Explanation:

      Mesenteric ischemia is ischemia of the blood vessels of the intestines. It can be life-threatening, especially if the small intestine is involved.

      The inferior mesenteric artery originates 3-4 cm above the bifurcation of the abdominal aorta.
      The left colic artery branches off the inferior mesenteric artery to supply the following:
      – distal 1/3 of the transverse colon
      – descending colon

      At approximately the left colic flexure (splenic flexure), a transition occurs in the blood supply of the GI tract. The SMA supplies the proximal part to the flexure, and the IMA supplies the part distal to the flexure. This is why the left colic flexure is a watershed area and is prone to ischemia exacerbated by atherosclerotic changes or hypotension. The dominant arterial supply of the splenic flexure is usually from the left colic artery, but it may also get collaterals from the left branch of the middle colic artery.

      The AMA and PMA do not exist.
      The splenic artery directly supplies the spleen and has branches that supply the stomach and the pancreas.
      The proximal two-thirds of the transverse colon is supplied by the middle colic artery, a branch of the SMA.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 15 - A 50-year-old woman is brought into the emergency department in an ambulance. She...

    Incorrect

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

      Your Answer:

      Correct Answer: The base of the pons

      Explanation:

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

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

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 16 - Which statement is true of albumin? ...

    Incorrect

    • Which statement is true of albumin?

      Your Answer:

      Correct Answer: Is synthesised and stored in the liver

      Explanation:

      Major surgery induces the systemic inflammatory response and this causes endothelial leakage and a low albumin level.

      Albumin is a single polypeptide which is made but not stored in the liver. Therefore, levels are a reflection of synthetic activity. It is negatively charged and very soluble.

      Only 40% of albumin is intravascular, and the rest in the in interstitial compartment.

      If there was normal liver function during starvation, albumin will be maintained and proteolysis will occur elsewhere.
      It is not catabolised during starvation.
      Starvation and malnutrition may, however, present as part of other disease processes that are associated with hypalbuminaemia.

      Causes of low albumin are

      1. Decreased production (hepatic dysfunction)
      2. Increased loss (renal dysfunction)
      3. Redistribution (endothelial leak/damage)
      4. Increased catabolism (very rare)

    • This question is part of the following fields:

      • Physiology And Biochemistry
      0
      Seconds
  • Question 17 - A 28-year-old man is admitted to the critical care unit. He has been...

    Incorrect

    • A 28-year-old man is admitted to the critical care unit. He has been diagnosed with adult respiratory distress syndrome and is being ventilated. His haemodynamic condition is improved using a pulmonary artery flotation. His readings are listed below: Haemoglobin concentration: 10 g/dL, Mixed venous oxygen saturation: 70%, Mixed venous oxygen tensions (PvO2): 50 mmHg. Estimate his mixed venous oxygen content (mL/100mL).

      Your Answer:

      Correct Answer: 9.5

      Explanation:

      Mixed venous oxygen content (CvO2) is the oxygen concentration in 100mL of mixed venous blood taken from the pulmonary artery. It is usually 12-17 mL/dL (70-75%). It is represented mathematically as:

      CvO2 = (1.34 x Hgb x SvO2 x 0.01) + (0.003 x PvO2)

      Where,

      1.34 = Huffner’s constant
      Hgb = Haemoglobin level (g/dL)
      SvO2 = % oxyhaemoglobin saturation of mixed venous blood
      PvO2 = 0.0225 = mL of O2 dissolved per 100mL plasma per kPa, or 0.003 mL per mmHg

      Therefore,

      CvO2 = (1.34 x 10 x 70 x 0.01) + (0.003 x 50)

      CvO2 = 9.38 + 0.15 = 9.53 mL/100mL.

    • This question is part of the following fields:

      • Clinical Measurement
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  • Question 18 - Which among the given options can be used to find out the number...

    Incorrect

    • Which among the given options can be used to find out the number needed to treat?

      Your Answer:

      Correct Answer: 1 / (Absolute risk reduction)

      Explanation:

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

      It can be found as:

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

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 19 - Substitution at different positions of the barbituric ring give rise to different pharmacologic...

    Incorrect

    • Substitution at different positions of the barbituric ring give rise to different pharmacologic properties. Substitution with and at which specific site of the ring affects lipid solubility the most?

      Your Answer:

      Correct Answer: Sulphur atom at position 2

      Explanation:

      Barbiturates are derived from barbituric acid, which itself is nondepressant, but appropriate side-chain substitutions result in CNS depressant activity that varies in potency and duration with carbon chain length, branching, and saturation.

      Oxybarbiturates retain an oxygen atom on number 2-carbon atom of the barbituric acid ring.

      Thiobarbiturates replace this oxygen atom with a sulphur atom, which confers greater lipid solubility. Generally speaking, a substitution such as sulphuration that increases lipid solubility is associated with greater hypnotic potency and more rapid onset, but shorter duration of action.

      Addition of a methyl group to the nitrogen atom of the barbituric acid ring, as with oxybarbiturate methohexital, also results in a compound with a short duration of action.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 20 - Which is the most appropriate statement describing the function of flowmeters? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Constant pressure, variable orifice - Heidbrink flowmeters

      Explanation:

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

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
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  • Question 21 - During the analysis phase, which of the provided options serves to control confounding...

    Incorrect

    • During the analysis phase, which of the provided options serves to control confounding factors?

      Your Answer:

      Correct Answer: Stratification

      Explanation:

      During analytical stage a technique called stratification is used for controlling confounding variables. This technique involves sorting out the data into discernible groups.

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 22 - Which of the following statements about a cervical rib is correct? ...

    Incorrect

    • Which of the following statements about a cervical rib is correct?

      Your Answer:

      Correct Answer: It originates from the 7th cervical vertebra

      Explanation:

      The costal elements of the seventh cervical vertebrae form projections known as cervical ribs, which are present in approximately 0.5% – 1 % individuals.

      A cervical rib commonly comprises of a head, neck and tubercle. The body of the rib varies from person to person. It extends into the posterior triangle of the neck, where it is either free anteriorly, or attached to the first rib / sternum.

      Patients with a cervical rib mostly are asymptomatic and it is usually diagnosed as an incidental finding on chest x-ray. However, in some cases, the subclavian artery and the lower trunk of the brachial plexus are compressed where they pass over the cervical rib. This leads to a condition known as ”neurovascular compression syndrome,” in which these neurovascular structures are compressed between the cervical rib and scalenus anterior.

      The most common cause of neurogenic symptoms in approximately 80% of the patients with cervical rib is neck trauma.

      In most cases, the tingling, numbness and impaired circulation to the upper limb appears only after puberty. This is because the neck elongates, and the shoulders droop slightly.

    • This question is part of the following fields:

      • Anatomy
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  • Question 23 - Which vessel is the first to branch from the external carotid artery? ...

    Incorrect

    • Which vessel is the first to branch from the external carotid artery?

      Your Answer:

      Correct Answer: Superior thyroid artery

      Explanation:

      The superior thyroid artery is the first branch of the external carotid artery. The other branches of the external carotid artery are:
      1. Superior thyroid artery
      2. Ascending pharyngeal artery
      3. Lingual artery
      4. Facial artery
      5. Occipital artery
      6. Posterior auricular artery
      7. Maxillary artery
      8. Superficial temporal artery

      The inferior thyroid artery is derived from the thyrocervical trunk.

    • This question is part of the following fields:

      • Anatomy
      0
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  • Question 24 - A 26-year old male patient was admitted to the surgery department for appendectomy....

    Incorrect

    • 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:

      Correct 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
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  • Question 25 - Conclusive evidence suggests that rate for the prevalence of schizophrenia in United Kingdom...

    Incorrect

    • Conclusive evidence suggests that rate for the prevalence of schizophrenia in United Kingdom is around 1%. Which term can be used to describe that?

      Your Answer:

      Correct Answer: Endemic

      Explanation:

      An epidemic is declared when the increase in a give disease is above a certain level in a specific interval of time.

      An endemic is the general, usual level of a disease in a population at a particular time.

      A pandemic is an epidemic that is spread across many countries and continents.

    • This question is part of the following fields:

      • Statistical Methods
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  • Question 26 - Which of the following is a feature of a central venous pressure waveform?...

    Incorrect

    • Which of the following is a feature of a central venous pressure waveform?

      Your Answer:

      Correct Answer: An a wave due to atrial contraction

      Explanation:

      The central venous pressure (CVP) waveform depicts changes of pressure within the right atrium. Different parts of the waveform are:

      A wave: which represents atrial contraction. It is synonymous with the P wave seen during an ECG. It is often eliminated in the presence of atrial fibrillation, and increased tricuspid stenosis, pulmonary stenosis and pulmonary hypertension.

      C wave: which represents right ventricle contraction at the point where the tricuspid valve bulges into the right atrium. It is synonymous with the QRS complex seen on ECG.

      X descent: which represents relaxation of the atrial diastole and a decrease in atrial pressure, due to the downward movement of the right ventricle as it contracts. It is synonymous with the point before the T wave on ECG.

      V wave: which represents an increase in atrial pressure just before the opening of the tricuspid valve. It is synonymous with the point after the T wave on ECG. It is increased in the background of a tricuspid regurgitation.

      Y descent: which represents the emptying of the atrium as the tricuspid valve opens to allow for blood flow into the ventricle in early diastole.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 27 - Following an uneventful laparoscopic right hemicolectomy, a previously fit and well 75-year-old male...

    Incorrect

    • Following an uneventful laparoscopic right hemicolectomy, a previously fit and well 75-year-old male is admitted to the critical care unit. You've been summoned to examine the patient because he's become oliguric. Which of the following is most likely to indicate that acute kidney injury is caused by a prerenal cause?

      Your Answer:

      Correct Answer: Serum urea: creatinine ratio 200

      Explanation:

      Prerenal failure has a serum urea: creatinine ratio of >100, while acute kidney injury has a ratio of 40.
      In prerenal failure, ADH levels are typically high, resulting in water, urea, and sodium resorption. The fractional sodium excretion is less than 1%, but it is greater than 2% in acute tubular necrosis.
      Prerenal azotaemia has higher serum urea nitrogen/serum creatinine ratios (>20), whereas acute tubular necrosis has lower ratios (10-15). The normal range is between 12 and 20.
      Urinary sodium is less than 20 in prerenal failure and greater than 40 in acute tubular necrosis.
      Prerenal failure has a urine osmolality of >500, while acute tubular necrosis has an osmolality of 350.
      Prerenal failure has a urine/serum creatinine ratio of >40, while acute tubular necrosis has a urine/serum creatinine ratio of 20.

      The concentrations of serum urea or creatinine change in inverse proportion to glomerular filtration. Changes in serum creatinine concentrations are more reliable than changes in serum urea concentrations in predicting GFR. Creatinine is produced at a constant rate from creatine, and blood concentrations are almost entirely determined by GFR.

      A number of factors influence urea formation, including liver function, protein intake, and protein catabolism rate. Urea excretion is also influenced by hydration status, the amount of water reabsorption, and GFR.

      A high serum creatinine level, as well as a urine output of less than 10 mL/hour and the production of concentrated looking urine, do not necessarily indicate a specific cause of oliguria.

    • This question is part of the following fields:

      • Pathophysiology
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  • Question 28 - A 55-year-old man has been diagnosed with transitional cell carcinoma involving the ureter....

    Incorrect

    • A 55-year-old man has been diagnosed with transitional cell carcinoma involving the ureter. He is due to undergo a left nephroureterectomy. Which structure has no relation to the left ureter's anatomy?

      Your Answer:

      Correct Answer: Round ligament of the uterus

      Explanation:

      The ureter starts from the hilum of the kidney and has different relations with structures along its journey to the bladder.
      It runs anterior to the psoas major muscle.
      The testicular vessels (males) or the ovarian vessels (females) cross in front of the ureter.
      The ureter passes in front of the common iliac artery where it bifurcates into the internal and external iliac arteries.
      The ureter passes medial to the branches of the internal iliac vessel downwards and forwards to towards the bladder.
      In males, the ductus deferens crosses the pelvic ureter medially.
      In females. the ureter passes through the base of the broad ligament
      In females, the pelvic part initially has the same relations as in males but, anterior to the internal iliac artery, it is immediately behind the ovary, forming the posterior boundary of the ovarian fossa. It is in extraperitoneal connective tissue in the inferomedial part of the broad ligament of the uterus. In the broad ligament, the uterine artery is anterosuperior to the ureter for approximately 2.5 cm and then crosses to its medial side to ascend alongside the uterus. The ureter turns forwards slightly above the lateral vaginal fornix and is, generally, 2 cm lateral to the supravaginal part of the uterine cervix in this location. It then inclines medially to reach the bladder.

    • This question is part of the following fields:

      • Anatomy
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  • Question 29 - A current flows through a simple electric circuit. Which of the following electrical...

    Incorrect

    • A current flows through a simple electric circuit. Which of the following electrical component configurations has the greatest potential difference?

      Your Answer:

      Correct Answer: Two 5 ohm resistors in series with a passing current of 10 ampere

      Explanation:

      According to the Ohm’s law, the potential difference is defined as

      V(potential difference) = I(current) x (R) resistance

      So, for one resistor of 5 ohms, a 10 ampere current will generate:

      V = I x R
      V = 10 x 5
      V = 50 volts

      The formula for resistors in series can be defined as:

      R(total) = R1+R2

      Hence, when a current of 10 amperes passes through two 5 ohms resistors that are connected in series, the potential difference is:

      V = I x (R1+R2)
      V = 10 x (5+5)
      V = 10 x 10
      V = 100 volts

      The formula for resistors that are connected in a parallel circuit is:

      1/ Rtotal = 1/R1 + 1/R2

      Hence, when a current of 10 amperes passes through two 5 Ω resistors that are connected in a parallel circuit, the potential difference is:

      Rtotal = R1 × R2/ R1 + R2
      Rtotal = 25/10
      Rtotal = 2.5
      V = I x R
      V = 10 x (R1xR2 / R1 + R2)
      V = 10 x (25/10)
      V = 10 x 2.5
      V = 25 volts

      Capacitors are electronic components that have the ability to store energy and charge (Q). The derived SI unit of capacitance (C) is the farad (F), which is equivalent to one coulomb per volt (V). The typical capacitors usually have a very small capacitance range, that ranges from pico to microfarads. On the contrary, supercapacitors can have a capacitance of up to 1-5000 F.

      There are a number of factors that eventually determine the capacitance (C). They are as follows:

      – Larger plate area (A)
      – Closer plate spacing (d)
      – Permittivity (ε) of the material (dielectric) between the plates (vacuum<<<glass), – C = ε × A/d

      The units of stored charge are coulombs (Q), which is equal to the pathway of one ampere of current per second.
      Stored charge, capacitance and voltage can be defined by the following equation:

      V (potential difference across capacitor) = Q(charge) / C (capacitance)

      In a parallel circuit, the formula of capacitors is:

      Ctotal = C1 + C2

      Hence, two 5 farad capacitors in a parallel circuit arrangement with a charge of 100 coulomb and capacitance 10 F will give a potential difference of::

      V = 100/10
      V = 10 volts

      In a series circuit, the formula for capacitors is:

      1/Ctotal = 1/C1 + 1/C2

      Hence, two 5 farad capacitors with a charge of 100 coulomb will give:

      Ctotal = C1 × C2/C1 + C2

      In the example total capacitance = 25/10 = 2.5 F

      V = 100/2.5
      V = 40 volts.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
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  • Question 30 - Regarding the treatment of bladder cancer, a study concerned with the usage of...

    Incorrect

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

      Your Answer:

      Correct Answer: Forest plots can present data from multiple studies

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Statistical Methods
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