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Question 1
Correct
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Cefotaxime (or ceftriaxone) is used first line for which of the following infections:
Your Answer: Blind treatment of suspected bacterial meningitis
Explanation:Cefotaxime (or ceftriaxone) are indicated first line in:- Blind treatment of meningitis in patients > 3 months (with amoxicillin if patient > 50 years)- Meningitis caused by meningococci- Meningitis caused by pneumococci- Meningitis caused by H. influenzae- Severe or invasive salmonellosis- Typhoid fever- Gonorrhoea- Gonococcal arthritis- Haemophilus influenzae epiglottitis
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 2
Correct
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A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?
Your Answer: ORT is sugar-free
Explanation:One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status. Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries. Some characteristics of Oral rehydration solutions are:- slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.- contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia. – also contains essential mineral saltsCurrent NICE guidance recommends that 50 ml/kg is given over 4 hours to treat mild dehydration.Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 3
Incorrect
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Which of the following is diagnostic for acute hepatitis B infection:
Your Answer: HBsAg
Correct Answer: anti-HBc IgM
Explanation:Anti-HBc IgM antibodies are diagnostic for acute hepatitis B infection. Anti-HBc IgG antibodies indicate previous exposure, either chronic state or cleared infection. HBsAg is also positive in acute infection but is not diagnostic as this remains positive in chronic infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 4
Incorrect
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Cryptococcus neoformans is primarily transmitted by which of the following routes:
Your Answer: Direct skin contact
Correct Answer: Inhalation of spores
Explanation:Cryptococcus neoformans is found in bird droppings and transmission is by inhalation of spores, thus the lung is the primary site of infection.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
Incorrect
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Which patients are particularly susceptible to infection with herpes simplex, those with:
Your Answer: Neutropaenia
Correct Answer: T-cell deficiency
Explanation:Cell-mediated immunity, especially the action of cytotoxic T-cells, is essential in the control of herpesvirus infections and patients with T-cell deficiency are at particular risk of reactivation and severe infection. T-cell deficiency may follow HIV infection, chemotherapy, corticosteroid therapy or organ transplantation.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 6
Incorrect
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A 20-year-old male has an anaphylactic reaction following a wasp sting.What type of hypersensitivity reaction is this?
Your Answer: Type IV
Correct Answer: Type I
Explanation:Anaphylaxis is an example of a type I hypersensitivity reaction. It is IgE mediated. It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.Massive calcium influx into the cells leads to mast cell degranulation. The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 7
Correct
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A dermatological examination on a patient presenting with a lump shows a solid, well circumscribed, lump measuring 0.8 cm in diameter.Which one of these best describes the lump you have found on examination?
Your Answer: Nodule
Explanation:A nodule is a solid, well circumscribed, raised area that lies in or under the skin and measures greater than 0.5 cm in diameter. They are usually painless.A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter. A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.A papule is a solid, well circumscribed, skin elevation measuring less than 0.5 cm in diameter.A plaque is a palpable skin lesion that is elevated and measures >1cm in diameter
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 8
Correct
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The following statements about cross-sectional studies are true EXCEPT?
Your Answer: They can be used to determine the relative risk of a condition
Explanation:The UK national census is an example of a cross-sectional study.Cross-sectional studies can be used to assess the prevalence of a condition, and support or refute inferences of cause and effect.Cross-sectional studies are observations of the frequency and characteristics of a disease in a given population at one particular point in time. Cross-sectional studies do not differentiate between cause and effect and also do not establish the sequence of events.Cross-sectional studies cannot be used to calculate the relative risk of a condition.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 9
Incorrect
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A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke. Which of the following is considered the best diagnosis for the case presented above?
Your Answer: Lateral medullary syndrome
Correct Answer: Medial medullary syndrome
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 10
Correct
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A 24 year old male sustained an insect bite and presents with a red hot arm and acute cellulitis has been diagnosed. The predominant white cells in this type of acute inflammation are:
Your Answer: Neutrophils
Explanation:Neutrophil polymorphs are the predominant type of white cells in an acute reaction. They pass between endothelial cell junctions to invade damaged tissue so that the effects of injury can be combated. Extravasation occurs with the movement of leukocytes out of the vessel lumen, and is achieved in five phases which are margination, ‘rolling’, adhesion, transmigration and chemotaxis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 11
Incorrect
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By what mechanism does Vibrio cholerae causes diarrhoea?
Your Answer: Inhibits cyclic adenosine monophosphate (cAMP) production in intestinal epithelial cells
Correct Answer: Increases Cl- secretory channels in crypt cells
Explanation:Cholera is a severe diarrheal illness caused by the Vibrio cholerae bacteria infecting the bowel. Ingesting cholera-infected food or drink is the a way to contract the disease. In the intestinal crypt cells, the toxigenic bacterium Vibrio cholera activates adenylate cyclase and raises cyclic adenosine monophosphate (cAMP). cAMP stimulates the Cl-secretory channels in crypt cells, resulting in the secretion of chloride with sodium ions and water. The toxin it produces causes the body to secrete massive amounts of water, resulting in diarrhoea and significant fluid and electrolyte loss.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 12
Incorrect
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A 45-year-old obese patient goes to the emergency department with a fever and significant right upper quadrant pain. The pain radiates to her right shoulder tip. Murphy's sign is positive and acute cholecystitis is diagnosed. The pain referred to the shoulder tip is caused by one of the following nerves:
Your Answer: Greater thoracic splanchnic nerve
Correct Answer: Phrenic nerve
Explanation:Gallbladder inflammation can cause pain in the right upper quadrant and right shoulder, which is caused by irritation of the diaphragmatic peritoneum. Pain from areas supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3-C5.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 13
Incorrect
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Which of the following cervical nerves is likely to be affected if your patient is complaining of elbow extension weakness and loss of sensation in her middle finger? She also has pain and tenderness in her cervical region, which is caused by a herniated disc, all after a whiplash-type injury in a car accident.
Your Answer: C8
Correct Answer: C7
Explanation:A C7 spinal nerve controls elbow extension and some finger extension. Damage to this nerve can result in a burning pain in the shoulder blade or back of the arms. The ability to extend shoulders, arms, and fingers may also be affected. Dexterity may also be compromised in the hands or fingers.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 14
Incorrect
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Regarding the power of a study, which of the following statements is INCORRECT:
Your Answer: The power of a study increases with sample size.
Correct Answer: The power of a study is not affected by data variability.
Explanation:A study should only be undertaken if the power is at least 80%; a study power set at 80% accepts a likelihood of 1 in 5 (20%) of missing a statistically significant difference where one exists.The determinants of power are:the sample size (the power increases with sample size)the variability of the observations (the power increases as the variability decreases)the effect size of interest (the power is greater for a larger expected effect size)and the significance level, α (the power is greater if the significance level is larger); therefore the probability of a type I error increases as the probability of a type II error decreases.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 15
Correct
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A 43 year old lady who has a previous medical history of hyperthyroidism presents to the emergency room with sweating, palpitations and agitation. On examination, she is tachycardic, hypertensive and hyperpyrexic. She recently had a stomach bug and has not been able to take her medication regularly. The best medication to immediately treat her symptoms is which of the following?
Your Answer: Propranolol
Explanation:There is a high suspicion of a thyroid crisis in this patient and emergent treatment should be initiated even before the results of TFT’s have returned. Antiadrenergic drugs like IV propranolol should be administered immediately to minimise sympathomimetic symptoms. Antithyroid medications like propylthiouracil or carbimazole should be administered to block further synthesis of thyroid hormones. After thionamide therapy has been started to prevent stimulation of new hormone synthesis, there should then be delayed administration of oral iodine solution. Hydrocortisone administration is also recommended as it treats possible relative adrenal insufficiency while also decreases peripheral conversion of T4 to T3.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 16
Incorrect
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A 60-year-old man comes to your department with complaints of epigastric pain. There is a history of rheumatoid arthritis and he has been taking ibuprofen 200 mg TDS for the last 2 weeks.The following scenarios would prompt you to consider the co-prescription of a PPI for gastroprotection with NSAIDs EXCEPT?
Your Answer: Short-term prescribing in a patient aged 67
Correct Answer: Long-term use for chronic back pain in a patient aged 30
Explanation:The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:Aged 65 or older- Using maximum recommended dose of an NSAID- History of peptic ulcer or GI bleeding- Concomitant use of: antidepressants like SSRIs and SNRIs, Corticosteroids, anticoagulants and low dose aspirin- Long-term NSAID usage for: long-term back pain if older than 45 and patients with OA or RA at any ageThe maximum recommended dose of ibuprofen is 2.4 g daily and this patient is on 400 mg of ibuprofen TDS.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 17
Incorrect
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A 73-year-old woman arrives at the emergency department 48 hours after being discharged from the hospital after a two-week stay for sepsis treatment. She has fever, productive cough with thick green sputum, and shortness of breath. An X-ray shows left lower lobe pneumonia. Which of the bacteria listed below is more likely to be the causative agent:
Your Answer: Streptococcus pneumoniae
Correct Answer: Pseudomonas aeruginosa
Explanation:Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection that was not incubating at the time of hospital admission and that presents clinically 2 or more days after hospitalization. Pneumonia that presents sooner should be regarded as community acquired pneumonia. VAP refers to nosocomial pneumonia that develops among patients on ventilators. Ventilator-associated pneumonia (VAP) is defined as pneumonia that presents more than 48 hours after endotracheal intubation.Common bacteria involved in hospital-acquired pneumonia (HAP) include the following [10] :Pseudomonas AeruginosaStaphylococcus aureus, including methicillin-susceptible S aureus (MSSA) and methicillin-resistant S aureus (MRSA)Klebsiella pneumoniaeEscherichia coli
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This question is part of the following fields:
- Infections
- Microbiology
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Question 18
Incorrect
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An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.Which of the following valve disorders is an absolute contraindication to the use of GTN?
Your Answer: Aortic regurgitation
Correct Answer: Mitral stenosis
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine. Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are: 1. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)The nitrate drugs cause vasodilation via the action of nitric oxide. The contraindications to the use of nitrate are the following: 1. Allergy to nitrates2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil3. Right ventricular infarction4. Hypertrophic cardiomyopathy5. Cardiac tamponade6. Constrictive pericarditis7. Hypotensive conditions8. Hypovolaemia9. Marked anaemia10. Mitral stenosis11. Raised intracranial pressure due to cerebral haemorrhage or head trauma12. Toxic pulmonary oedema
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 19
Correct
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Which of the following is NOT a pharmacological effect of beta-blockers:
Your Answer: Reduced AV conduction time
Explanation:Effects of beta-blockers:Cardiovascular system: Reduce blood pressureReduce heart rate, contractility and cardiac outputIncrease AV conduction time, refractoriness and suppress automaticityEye:Reduce intraocular pressureRespiratory system:Cause bronchoconstriction
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 20
Incorrect
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Water is reabsorbed in which portion of the Henle loop:
Your Answer: All of it
Correct Answer: Thin descending limb
Explanation:The loop of Henle consists of three functionally distinct segments: the thin descending segment, the thin ascending segment, and the thick ascending segment. About 20 percent of the filtered water is reabsorbed in the loop of Henle and almost all of this occurs in the thin descending limb. Na+ and Cl-ions are actively reabsorbed from the tubular fluid in the thick ascending limb via the Na+/K+/2Cl-symporter on the apical membrane. Because the thick ascending limb is water-impermeable, ion reabsorption lowers tubular fluid osmolality while raising interstitial fluid osmolality, resulting in an osmotic difference. Water moves passively out of the thin descending limb as the interstitial fluid osmolality rises, concentrating the tubular fluid. This concentrated fluid descends in the opposite direction of fluid returning from the deep medulla still higher osmolality areas.
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This question is part of the following fields:
- Physiology
- Renal
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Question 21
Correct
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In the emergency department, a 50-year-old female appears with a lack of sensation over the front two-thirds of her tongue. Taste and salivation are both present. The patient might have damage which of her nerves?
Your Answer: Lingual nerve
Explanation:The lingual nerve, a branch of the mandibular nerve, transmits sensation to the anterior two-thirds of the tongue. The chorda tympani, a branch of the facial nerve, transmits taste to the front two-thirds of the tongue as well as secretomotor innervation to the submandibular and sublingual glands. As a result, any damage to the lingual nerve can cause changes in salivary secretion on the affected side, as well as a loss of taste in the anterior two-thirds of the tongue and temporary or permanent sensory changes in the anterior two-thirds of the tongue and the floor of the mouth.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 22
Correct
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After eating a peanut, a 24-year-old lady develops an anaphylactic reaction.Which of the following should be the first step to manage the situation?Â
Your Answer: Administer IM adrenaline
Explanation:The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.In anaphylaxis, age-related dosages of IM adrenaline are given:150 mcg (0.15 mL of 1:1000) for children under the age of six  300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years 500 mcg (0.5 mL of 1:1000) for children aged 12 and above500 mcg (0.5 mL of 1:1000) for adultsÂ
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 23
Incorrect
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A 30-year-old woman was involved in a road traffic accident and had a class I haemorrhage.Which physiological parameter is consistent with a diagnosis of class I haemorrhage?
Your Answer: 25% of blood volume lost
Correct Answer: Increased pulse pressure
Explanation:There are 4 classes of haemorrhage. Classification is based on clinical signs and physiological parameters.In CLASS I:Blood loss (ml) is < or = 750Blood loss(% blood volume) < or = 15%Pulse rate (bpm) is 30Pulse pressure is normal or increasedSystolic BP is normalCNS/mental status patient is slightly anxious In CLASS II:Blood loss (ml) is 750 – 1500Blood loss(% blood volume) is 15 – 30%Pulse rate (bpm) is 100 – 120Respiratory rate is 20-30Urine output (ml/hr) is 20-30Pulse pressure is decreasedSystolic BP is normalCNS/mental status patient is mildly anxiousIn CLASS III:Blood loss (ml) is 1500 – 2000Blood loss(% blood volume) is 30- 40%Pulse rate (bpm) is 120 – 140Respiratory rate is 30-40Urine output (ml/hr) is 5-15Pulse pressure is decreasedSystolic BP is decreasedCNS/mental status patient is anxious, confusedIn CLASS IV:Blood loss (ml) is >2000Blood loss(% blood volume) is >40%Pulse rate (bpm) is >140Respiratory rate is >40Urine output (ml/hr) is negligiblePulse pressure is decreasedSystolic BP is decreasedCNS/mental status patient is confused, lethargic
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 24
Correct
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You are planning on starting antibiotic therapy for a patient with a diagnosis of gonorrhoea.Which of these is the MOST appropriate antibiotic combination?
Your Answer: Ceftriaxone and azithromycin
Explanation:Currently, ceftriaxone in combination with azithromycin or doxycycline is the combination of antibiotics used in the treatment of gonorrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 25
Incorrect
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Gastrin release from antral G-cells is inhibited by all but which one of the following:
Your Answer: Low gastric pH
Correct Answer: Vagal stimulation
Explanation:Gastrin secretion is inhibited by:Low gastric pH (negative feedback mechanism)SomatostatinSecretinGastric inhibitory polypeptide (GIP)Cholecystokinin
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 26
Incorrect
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A 15-year-old girl took almost 20 tablets of paracetamol almost 4 hours ago to show anger towards her mother for denying permission to go on a girl's trip. The girl is healthy and has no known comorbids or drug history. Which one of the following is TRUE regarding paracetamol?
Your Answer: It is primarily metabolised via the cytochrome p450 enzyme system
Correct Answer: It is excreted renally
Explanation:Acetaminophen is an acetanilide derivative and is a widely used non-prescription analgesic and antipyretic medication for mild-to-moderate pain and fever.The route of elimination: Metabolites are mainly excreted in the urine. 90% of the dose administered is excreted within 24 hours. It is thought to work by selectively inhibiting COX-1 receptors in the brain and spinal cord: It is categorized by the FDA as an NSAID as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord. COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.Toxicity is primarily due to glutathione production: Acetaminophen metabolism by the CYP2E1 pathway releases a toxic metabolite known as N-acetyl-p-benzoquinoneimine (NAPQI). NAPQI primarily contributes to the toxic effects of acetaminophen. NAPQI is an intermediate metabolite that is further metabolized by fast conjugation with glutathione. The conjugated metabolite is then excreted in the urine as mercapturic acid. High doses of acetaminophen (overdoses) can lead to hepatic necrosis due to depleting glutathione and high binding levels of reactive metabolite (NAPQI) to important parts of liver cells.It has a half-life of 6-8 hours: Acetaminophen can be administered orally, rectally, or intravenously. It is predominantly metabolized in the liver, and the elimination half-life is 1-3 hours after a therapeutic dose. But maybe greater than 12 hours after an overdose.It is primarily metabolized via the cytochrome p450 enzyme system: It is predominantly metabolized in the liver by three main metabolic pathways:1. Glucuronidation (45-55%)2. Sulphate conjugation (30-35%)3. N-hydroxylation via the hepatic cytochrome p450 enzyme system (10-15%)
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 27
Incorrect
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Which of the following statements about neutrophils is TRUE:
Your Answer: Neutrophil granules mostly contain perforins and granzymes.
Correct Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.
Explanation:Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 28
Incorrect
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A 28-year-old female arrives after taking an unknown chemical in excess. She is tired and her speech is slurred. The following are her observations and results: HR 118, BP 92/58, SaO2 96%HR 118, 11/15  The following are the results of his arterial blood gas (ABG):pH: 7.24 pO 2 : 9.4 kPa PCO2 : 3.3 kPa HCO 3 -: 22 mmol/l Na + : 143 mmol/l Cl – : 99 mmol/l Lactate: 5 IU/lWhich of the following statements about this patient is TRUE?
Your Answer: She has metabolic alkalosis
Correct Answer: Her anion gap is elevated
Explanation:The interpretation of arterial blood gas (ABG) aids in the measurement of a patient’s pulmonary gas exchange and acid-base balance. The normal values on an ABG vary a little depending on the analyser, but they are roughly as follows:Variable RangepH 7.35 – 7.45PaO2 10 – 14 kPaPaCO2 4.5 – 6 kPaHCO3- 22 – 26 mmol/lBase excess -2 – 2 mmol/lThe patient’s history indicates that she has taken an overdose in this case. Because her GCS is 11/15 and she can communicate with slurred speech, she is clearly managing her own airway, there is no current justification for intubation.The following are the relevant ABG findings:Hypoxia (mild)pH has been lowered (acidaemia)PCO2 levels are low.bicarbonate in its natural stateLactate levels have increasedThe anion gap represents the concentration of all the unmeasured anions in the plasma. It is the difference between the primary measured cations and the primary measured anions in the serum. It can be calculated using the following formula:Anion gap = [Na+] – [Cl-] – [HCO3-]The reference range varies depending on the technique of measurement, but it is usually between 8 and 16 mmol/L.The following formula can be used to compute her anion gap:Anion gap = [143] – [99] – [22]Anion gap = 22As a result, it is clear that she has a metabolic acidosis with an increased anion gap.The following are some of the causes of type A and type B lactic acidosis:Type A lactic acidosisType B lactic acidosisShock (including septic shock)Left ventricular failureSevere anaemiaAsphyxiaCardiac arrestCO poisoningRespiratory failureSevere asthma and COPDRegional hypoperfusionRenal failureLiver failureSepsis (non-hypoxic sepsis)Thiamine deficiencyAlcoholic ketoacidosisDiabetic ketoacidosisCyanide poisoningMethanol poisoningBiguanide poisoning
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 29
Correct
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ACE inhibitors are indicated for all of the following EXCEPT for:
Your Answer: Angina
Explanation:ACE inhibitors have many uses and are generally well tolerated. They are indicated for:Heart failureHypertensionDiabetic nephropathySecondary prevention of cardiovascular events
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 30
Incorrect
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A 24-year-old patient is suspected to have a possible acute hepatitis B infection and is currently under investigation.Which of the following markers is considered the earliest indicator of acute infection in acute Hepatitis B?
Your Answer: Hepatitis B surface antibody
Correct Answer: Hepatitis B surface Ag
Explanation:HBsAg is the serological hallmark of HBV infection. After an acute exposure to HBV, HBsAg appears in serum within 1 to 10 weeks. Persistence of this marker for more than 6 months implies chronic HBV infection.Anti-HBs is known as a neutralizing antibody, and confers long-term immunity. In patients with acquired immunity through vaccination, anti-HBs is the only serological marker detected in serum.HBcAg is an intracellular presence in infected hepatocyte, thus it is not identified in the serum. During acute infection, anti-HBc IgM and IgG emerges 1–2 weeks after the presence of HBsAg along with raised serum aminotransferase and symptoms. After 6 months of acute infection, anti-HBc IgM wears off. Anti-HBc IgG continues to detect in both patients with resolved HBV infection and chronic hepatitis B.Hepatitis D virus, also known as the delta hepatitis virus, is a defective ssRNA virus that requires HBV for replication. The infection can occur in one of two clinical forms, co-infection or superinfection. In a co-infection, the patient is simultaneously infected with HBV and HDV. In a superinfection, an HDV infection develops in a patient with a chronic HBV infection.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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SESSION STATS - PERFORMANCE PER SPECIALTY
