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Question 1
Incorrect
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You review a 56-year-old man who has recently been prescribed antibiotics for a chest infection. He suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, he has been experiencing nausea, vomiting and abdominal pain.Which of the following antibiotics is he MOST LIKELY to have been prescribed for his chest infection? Select ONE answer only .
Your Answer:
Correct Answer: Levofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:Drugs increasing plasma concentration of theophyllineDrugs decreasing plasma concentration of theophyllineCalcium channel blockers, e.g. VerapamilCimetidineFluconazoleMacrolides, e.g. erythromycinQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitolPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 2
Incorrect
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A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.The gastric ECL cells secrete which of the following substances?
Your Answer:
Correct Answer: Histamine
Explanation:Enterochromaffin-like cells (ECL cells) are a type of neuroendocrine cell located beneath the epithelium in the stomach glands. They’re most typically located near the parietal cells of the stomach. The ECL cells’ primary role is to produce histamine, which stimulates the formation of stomach acid by the parietal cells.The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:Cell type/ Substance secreted/ Function of secretionParietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogenParietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorptionChief cells/ Pepsinogen/ Protein digestionChief cells/ Gastric lipase/ Fat digestionG-cells/ Gastrin/ Stimulates gastric acid secretionEnterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretionMucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acidD-cells/ Somatostatin/ Inhibits gastric acid secretion
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 3
Incorrect
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Which of the following does NOT affect the rate of flow of a liquid through a tube:
Your Answer:
Correct Answer: Surface tension
Explanation:Flow through a tube is dependent upon:The pressure difference across the ends of the tube (P1– P2)The resistance to flow provided by the tube (R)This is Darcy’s law, which is analogous to Ohm’s law in electronics:Flow = (P1– P2) / RResistance in the tube is defined by Poiseuille’s law, which is determined by the diameter of the tube and the viscosity of the fluid. Poiseuille’s law is as follows:Resistance = (8VL) / (πR4)Where:V = The viscosity of the fluidL = The length of the tubeR = The radius of the tubeTherefore, in simple terms, resistance is directly proportional to the viscosity of the fluid and the length of the tube and inversely proportional to the radius of the tube. Of these three factors, the most important quantitatively and physiologically is vessel radius.It can be seen that small changes in the radius can have a dramatic effect on the flow of the fluid. For example, the constriction of an artery by 20% will decrease the flow by approximately 60%.Another important and frequently quoted example of this inverse relationship is that of the radius of an intravenous cannula. Doubling the diameter of a cannula increases the flow rate by 16-fold (r4). This is the reason the diameter of an intravenous cannula in resuscitation scenarios is so important.*Please note that knowledge of the detail of Poiseuille’s law is not a requirement of the RCEM Basic Sciences Curriculum.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 4
Incorrect
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A 59-year-old man presents to the emergency room with chest pain. The cardiology team recently discharged him. He underwent a procedure and was given several medications, including abciximab, during his stay. Which of the following statements about abciximab is correct?
Your Answer:
Correct Answer: The platelet count should be checked 2-4 hours after starting treatment
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.It’s approved for use as a supplement to heparin and aspirin in high-risk patients undergoing percutaneous transluminal coronary intervention to prevent ischaemic complications. Only one dose of abciximab should be given (to avoid additional risk of thrombocytopenia).
Before using, it is recommended that baseline prothrombin time, activated clotting time, activated partial thromboplastin time, platelet count, haemoglobin, and haematocrit be measured. 12 and 24 hours after starting treatment, haemoglobin and haematocrit should be measured again, as should platelet count 2-4 hours and 24 hours after starting treatment.
When used for high-risk patients undergoing angioplasty, the EPIC trial found that abciximab reduced the risk of death, myocardial infarction, repeat angioplasty, bypass surgery, and balloon pump insertion.The use of abciximab is contraindicated in the following situations:
Internal bleeding is present.
Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
Stroke in the previous two yearsIntracranial tumour
Aneurysm or arteriovenous malformation
Haemorrhagic diathesis
Vasculitis
Retinopathy caused by hypertension
The following are some of the most common abciximab side effects:
Manifestations of bleeding
Bradycardia
Back ache
Pain in the chest
Vomiting and nausea
Pain at the puncture site
Thrombocytopenia
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 5
Incorrect
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You examine a 79-year-old woman who has had hypertension and atrial fibrillation in the past. Her most recent blood tests show that she has severe renal impairment.Which medication adjustments should you make in this patient's case?
Your Answer:
Correct Answer: Reduce dose of digoxin
Explanation:Digoxin is excreted through the kidneys, and impaired renal function can lead to elevated digoxin levels and toxicity.The patient’s digoxin dose should be reduced in this case, and their digoxin level and electrolytes should be closely monitored.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Incorrect
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Regarding gas exchange at the alveolar-capillary membrane, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Transfer of oxygen is usually perfusion-limited.
Explanation:Gas exchange between alveolar air and blood in the pulmonary capillaries takes place by diffusion across the alveolar-capillary membrane. Diffusion occurs from an area of high partial pressure to an area of low partial pressure, thus the driving force for diffusion is the alveolar-capillary partial pressure gradient. Diffusion occurs until equilibrium is reached, but random movement of particles continues to occur and this is known as dynamic equilibrium. The diffusing capacity for oxygen (DLO2) cannot be measured directly but the rate of diffusion in the lungs can be estimated by measuring the diffusing capacity of the lungs for carbon monoxide (DLCO), not by measuring total lung capacity. The rate of transfer of a gas may be diffusion or perfusion limited; carbon monoxide transfer is diffusion-limited, oxygen transfer is usually perfusion-limited.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 7
Incorrect
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A 59-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.Which of the following is abciximab (ReoPro) mechanism of action?
Your Answer:
Correct Answer: Antagonism of the glycoprotein IIb/IIIa receptor
Explanation:Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 8
Incorrect
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A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?
Your Answer:
Correct Answer: None of the other options
Explanation:Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:Coronary artery disease (CAD) Coronary artery disease (CAD) Second stage of labourHypertension that is uncontrolledSevere Ventricular arrhythmias
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 9
Incorrect
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A new blood test is being developed to diagnose DVT. 1000 people presenting to ED with suspected DVT undergo the new blood test and the gold standard doppler ultrasound to confirm the diagnosis. Of the 1000 people, 77 are confirmed to have a DVT. Of the patients diagnosed with DVT, 75 test positive with the new diagnostic test and of the patients not diagnosed with DVT, 125 test positive with the new diagnostic test. What is the positive predictive value of this test:DVT YesDVT NoTotalPositive testa= 75b = 125200Negative testc = 2d = 798800Total779231000
Your Answer:
Correct Answer: 0.375
Explanation:Positive predictive value (PPV) is the proportion of individuals with a positive test result who actually have the disease.Positive predictive value (PPV) = a/(a+b) = 75/200= 0.375 = 37.5%This means there is a 37.5% chance, if the test is positive, that the patient actually has a DVT.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 10
Incorrect
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A 24-year-old student with red and painful right eye presents. Conjunctival erythema, mucopurulent discharge and lid crusting are seen on examination, and patient denies presence of itching of the eye. All his observations are normal, he has no fever and is otherwise well.Which of these is the most likely causative organism?
Your Answer:
Correct Answer: Haemophilus influenzae
Explanation:The most frequent cause of red eye is conjunctivitis. It is caused by inflammation of the conjunctiva which can be infective or allergic and accounts for about 35% of all eye problems presenting to general practice.Viral conjunctivitis is commonly caused by adenoviruses and it is the most common infectious conjunctivitis.The common bacterial causes of conjunctivitis are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.The clinical features of infective conjunctivitis include:Acute onset of conjunctival erythemaFeeling ‘grittiness’, ‘foreign body’ or ‘burning’ sensation in the eye.Watering and discharge which may cause transient blurring of visionThe discharge for viral conjunctivitis is less than that of bacterial conjunctivitis and usually watery.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 11
Incorrect
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Which of the following drugs is first line treatment for a stable regular broad-complex tachycardia:
Your Answer:
Correct Answer: Amiodarone
Explanation:A regular broad-complex tachycardia is likely to be ventricular tachycardia or a regular supraventricular rhythm with bundle branch block. A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours. If previously confirmed as SVT with bundle branch block, the patient should be treated as for narrow-complex tachycardia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Incorrect
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Identify the type of graph described below:This graph is a useful tool for evaluating the performance of diagnostic tests and more generally for evaluating the accuracy of a statistical model (e.g., logistic regression, linear discriminant analysis) that classifies subjects into 1 of 2 categories, diseased or non diseased. The closer the graph is to the upper left corner, which represents 100% sensitivity and 100% specificity, the more accurate the diagnostic test.
Your Answer:
Correct Answer: ROC curve
Explanation:Receiver-operating characteristic (ROC) analysis was originally developed during World War II to analyse classification accuracy in differentiating signal from noise in radar detection. Recently, the methodology has been adapted to several clinical areas heavily dependent on screening and diagnostic tests, in particular, laboratory testing, epidemiology, radiology, and bioinformatics. ROC analysis is a useful tool for evaluating the performance of diagnostic tests and more generally for evaluating the accuracy of a statistical model (e.g., logistic regression, linear discriminant analysis) that classifies subjects into 1 of 2 categories, diseased or non diseased. Its function as a simple graphical tool for displaying the accuracy of a medical diagnostic test is one of the most well-known applications of ROC curve analysis.The closer the ROC curve is to the upper left corner, which has 100% sensitivity and 100% specificity, the higher the overall accuracy of the diagnostic test.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 13
Incorrect
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Which of the following laboratory findings are suggestive of functional hyposplenism:
Your Answer:
Correct Answer: Howell-Jolly bodies
Explanation:Functional hyposplenism is characterised by the blood film findings of Howell-Jolly bodies or siderotic granules on iron staining. The most frequent cause is surgical removal of the spleen e.g. after traumatic rupture, but hyposplenism can also occur in sickle cell anaemia, gluten-induced enteropathy, amyloidosis and other conditions.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 14
Incorrect
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Aplastic crises in sickle cell anaemia is classically precipitated by which of the following infections:
Your Answer:
Correct Answer: Parvovirus B19
Explanation:A serious complication in sickle cell disease (SCD) is the aplastic crisis. This may be caused by infection with Parvovirus B-19 (B19V). This virus causes fifth disease, a normally benign childhood disorder associated with fever, malaise, and a mild rash. This virus infects RBC progenitors in bone marrow, resulting in impaired cell division for a few days. Healthy people experience, at most, a slight drop in hematocrit, since the half-life of normal erythrocytes in the circulation is 40-60 days. In people with SCD, however, the RBC lifespan is greatly shortened (usually 10-20 days), and a very rapid drop in Hb occurs. The condition is self-limited, with bone marrow recovery occurring in 7-10 days, followed by brisk reticulocytosis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Incorrect
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A 40-year-old man has been admitted for alcohol detoxification. You are asked to review the patient's treatment chart and notice that he has been prescribed Pabrinex by one of your colleagues.Out of the following, which vitamin is not found in Pabrinex?
Your Answer:
Correct Answer: Vitamin B12
Explanation:Pabrinex is indicated in patients that require rapid therapy for severe depletion or malabsorption of water-soluble vitamins B and C, particularly in alcoholism detoxification. Pabrinex has the following: 1. Thiamine (vitamin B1) 2. Riboflavin (vitamin B2)3. Nicotinamide (Vitamin B3, niacin and nicotinic acid)4. Pyridoxine (vitamin B6)5. Ascorbic acid (vitamin C)6. GlucoseSuspected or established Wernicke’s encephalopathy is treated by intravenous infusion of Pabrinex/ The dose is 2-3 pairs three times a day for three to five days, followed by one pair once daily for an additional three to five days or for as long as improvement continues.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pharmacology
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Question 16
Incorrect
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ACE inhibitors are indicated for all of the following EXCEPT for:
Your Answer:
Correct 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 17
Incorrect
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A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago. Which ONE of the following options is FALSE with regards to this disorder?
Your Answer:
Correct Answer: Acute haemolysis can be triggered by cephalosporin antibiotics
Explanation:Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.Triggers include: 1) Fava beans2) Sulphonamides3) Primaquine4) Anti-TB drugs5) Infections Most individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 18
Incorrect
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Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:
Your Answer:
Correct Answer: Hyponatraemia
Explanation:Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 19
Incorrect
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Which of the following is NOT a pharmacological effect of beta-blockers:
Your Answer:
Correct 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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A 54-year-old woman has been visiting her GP with symptoms of tiredness, muscle weakness and headaches. She is known to be hypertensive and takes amlodipine to control this. Her blood results today show that her potassium level is low at 3.0 mmol/L, and her sodium level is slightly elevated at 146 mmol/L.Which of the following is the SINGLE most appropriate INITIAL investigation?
Your Answer:
Correct Answer: Plasma renin and aldosterone levels
Explanation:Primary hyperaldosteronism occurs when there are excessive levels of aldosterone independent of the renin-angiotensin axis. Secondary hyperaldosteronism occurs due to high renin levels.The causes of primary hyperaldosteronism include:Adrenal adenoma (Conn’s syndrome) – the most common cause of hyperaldosteronism (,80% of all cases). These are usually unilateral and solitary and are more common in women.Adrenal hyperplasia – this accounts for ,15% of all cases. Usually, bilateral adrenal hyperplasia (BAH) but can be unilateral rarely. More common in men than women.Adrenal cancer – a rare diagnosis but essential not to missFamilial aldosteronism – a rare group of inherited conditions affecting the adrenal glandsThe causes of secondary hyperaldosteronism include:Drugs – diureticsObstructive renal artery disease – renal artery stenosis and atheromaRenal vasoconstriction – occurs in accelerated hypertensionOedematous disorders – heart failure, cirrhosis and nephrotic syndromePatients are often asymptomatic. When clinical features are present, the classically described presentation of hyperaldosteronism is with:HypertensionHypokalaemiaMetabolic alkalosisSodium levels can be normal or slightly raisedOther, less common, clinical features include:LethargyHeadachesMuscle weakness (from persistent hypokalaemia)Polyuria and polydipsiaIntermittent paraesthesiaTetany and paralysis (rare)Often the earliest sign of hyperaldosteronism is from aberrant urea and electrolytes showing hypokalaemia and mild hypernatraemia. If the patient is taking diuretics, and the diagnosis is suspected, these should be repeated after the patient has taken off diuretics.If the diagnosis is suspected, plasma renin and aldosterone levels should be checked. Low renin and high aldosterone levels (with a raised aldosterone: renin ratio) is suggestive of primary aldosteronism.If the renin: aldosterone ratio is high, then the effect of posture on renin, aldosterone and cortisol can be investigated to provide further information about the underlying cause of primary hyperaldosteronism. Levels should be measured lying at 9 am and standing at noon:If aldosterone and cortisol levels fall on standing, this is suggestive of an ACTH dependent cause, e.g. adrenal adenoma (Conn’s syndrome)If aldosterone levels rise and cortisol levels fall on standing, this is suggestive of an angiotensin-II dependent cause, e.g. BAHOther investigations that can help to distinguish between an adrenal adenoma and adrenal hyperplasia include:CT scanMRI scanSelective adrenal venous sampling
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 21
Incorrect
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A patent has weakness of humeral flexion and extension. A CT scan reveals that he has suffered damage to the nerve that innervates pectoralis major.Pectoralis major receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Lateral and medial pectoral nerves
Explanation:Pectoralis major is a thick, fan-shaped muscle situated in the chest. It makes up the bulk of the chest musculature in the male and lies underneath the breast in the female. It overlies the thinner pectoralis minor muscle.Superficial muscles of the chest and arm showing pectoralis major (from Gray’s Anatomy)Pectoralis major has two heads; the clavicular head and the sternocostal head. The clavicular head originates from the anterior border and medial half of the clavicle. The sternocostal head originates from the anterior surface of the sternum, the superior six costal cartilages and the aponeurosis of the external oblique muscle. It inserts into the lateral lip of the bicipital groove of the humerus.Pectoralis major receives dual innervation from the medial pectoral nerve and the lateral pectoral nerve.Its main actions are as follows:Flexes humerus (clavicular head)Extends humerus (sternocostal head)Adducts and medially rotates the humerusDraws scapula anteriorly and inferiorly
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 22
Incorrect
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A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus longus.Peroneus longus receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.Peroneus longus is innervated by the superficial peroneal nerve.Peroneus tertius is innervated by the deep peroneal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 23
Incorrect
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Question 24
Incorrect
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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:
Correct 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 25
Incorrect
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A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?
Your Answer:
Correct Answer: 500 micrograms of adrenaline intramuscularly
Explanation:Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils. If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution). In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh. Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 26
Incorrect
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Glucagon may be used as an antidote for overdose with which of the following:
Your Answer:
Correct Answer: Beta blockers
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline. Glucagon then causes:GlycogenolysisGluconeogenesisLipolysis in adipose tissueThe secretion of glucagon is also stimulated by:AdrenalineCholecystokininArginineAlanineAcetylcholineThe secretion of glucagon is inhibited by:InsulinSomatostatinIncreased free fatty acidsIncreased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 27
Incorrect
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A patient who is a known case of rheumatoid arthritis presents to the clinic as his grandson was recently diagnosed with chickenpox. His grandson spent the weekend with her, and he was in close contact with him. He takes 50 mg of prednisolone once daily and has been for the past six months. There is no history of chickenpox.Out of the following, which is TRUE regarding the next plan of action for her care?
Your Answer:
Correct Answer: She should receive prophylactic varicella-zoster Immunoglobulin (VZIG)
Explanation:Varicella-zoster immunoglobulin (VZIG) is indicated for post exposure prevention and treatment of varicella. It is recommended as prophylaxis for high-risk patients with no known immunity (i.e. no known previous chickenpox) who have had a significant exposure to varicella-zoster (considered >4 hours close contact).The high-risk groups are:1. Neonates2. Pregnant women3. The immunocompromised (e.g. cancer, immunosuppressive therapies)4. Those on high dose steroids (children on more than 2 mg/kg/day for more than 14 days, or adults on 40 mg/day for more than a week)This patient is at high risk of developing adrenal insufficiency and may need a temporary increase in her steroid dose during infection or stress. It would be inappropriate to stop or wean down her dose of prednisolone and can cause side effects.Since he is on steroids without immunity for chickenpox, he is at risk of developing severe varicella infection, with possible complications including pneumonia, hepatitis and DIC. If he develops a varicella infection, he will need to be admitted and require a specialist review and intravenous Acyclovir.
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This question is part of the following fields:
- Immunological Products & Vaccines
- Pharmacology
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Question 28
Incorrect
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A 36-year-old woman is 22-weeks pregnant and is investigated for a possible thyroid disorder. When her total thyroid hormone levels does not correlate with her thyrometabolic status, her thyroid-binding globulin levels are checked.What percentage of circulating thyroid hormones is bound to thyroid-binding globulin?
Your Answer:
Correct Answer: 70%
Explanation:Only a very small fraction of the thyroid hormones circulating in the blood are free. The majority is bound to transport proteins. Only the free thyroid hormones are biologically active, and measurement of total thyroid hormone levels can be misleading. The relative percentages of bound and unbound thyroid hormones are:Bound to thyroid-binding globulin -70%Bound to albumin -15-20%Bound to transthyretin -10-15%Free T3 -0.3%Free T4 -0.03%
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 29
Incorrect
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Which of the following is NOT a typical electrolyte disturbance caused by furosemide:
Your Answer:
Correct Answer: Hypercalcaemia
Explanation:Adverse effects of loop diuretics include:Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathyHyperglycaemiaAcute urinary retentionWater and electrolyte imbalanceHyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolismMetabolic alkalosisHyperuricaemiaBlood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)Visual disturbance, tinnitus and deafnessHypersensitivity reactions
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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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Regarding endothelin-1, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Endothelin-1 release is inhibited by noradrenaline.
Explanation:Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
