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Question 1
Incorrect
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Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.Which of the following drugs is most likely to have caused her symptoms?
Your Answer: Aspirin
Correct Answer: Ramipril
Explanation:Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.Other medications that are less frequently linked to angioedema include:Angiotensin-receptor blockers (ARBs)Nonsteroidal anti-inflammatory drugs (NSAIDs)Bupropion (e.g. Zyban and Wellbutrin)Beta-lactam antibioticsStatinsProton pump inhibitorsThe majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 2
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:
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 3
Incorrect
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Which of the following muscles acts as an extensor of the shoulder joint?
Your Answer:
Correct Answer: Teres major
Explanation:The glenohumeral joint possesses the capability of allowing an extreme range of motion in multiple planes.Flexion – Defined as bringing the upper limb anterior in the sagittal plane. The usual range of motion is 180 degrees. The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.Extension—Defined as bringing the upper limb posterior in a sagittal plane. The normal range of motion is 45 to 60 degrees. The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.Internal rotation—Defined as rotation toward the midline along a vertical axis. The normal range of motion is 70 to 90 degrees. The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.External rotation – Defined as rotation away from the midline along a vertical axis. The normal range of motion is 90 degrees. Primarily infraspinatus and teres minor are responsible for the motion.Adduction – Defined as bringing the upper limb towards the midline in the coronal plane. Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.Abduction – Defined as bringing the upper limb away from the midline in the coronal plane. The normal range of motion is 150 degrees. Due to the ability to differentiate several pathologies by the range of motion of the glenohumeral joint in this plane of motion, it is essential to understand how different muscles contribute to this action.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Incorrect
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You review an 18-months-old child who seems to be having a reaction following an immunisation she took earlier in the day.Which statement concerning immunity and vaccination is true?
Your Answer:
Correct Answer: The strongest immunological response is seen with natural immunity
Explanation:Vaccination induces ACTIVE adaptive immunity. Actively acquired immunity involves the development of an immune response either due to vaccination or natural exposure to a pathogen and leads to long-lasting resistance to infection.Immediate protection is achieved with injection of immunoglobulin. The protection is transient lasting only a few weeks and is useful as post-exposure prophylaxis. Passively acquired immunity usually leads to short-lasting resistance to infection because it does not involve a host immune response. With inactivated bacteria, a series of primary vaccinations is usually required to induce an adequate immune response. In most cases, boosters are required to sustain adequate immunity.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 5
Incorrect
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You suspected typhoid disease in a patient who had recently returned from South America and presented to the emergency department with fever, constipation, and a rose spot rash. Which of the following antibiotics will be administered to this patient?
Your Answer:
Correct Answer: Cefotaxime
Explanation:Typhoid fever, often known as enteric fever, is a potentially fatal multi-systemic sickness caused predominantly by Salmonella enterica serotype typhi and, to a lesser extent, paratyphi A, B, and C. Cefotaxime is the first-line treatment for typhoid fever (or ceftriaxone). In cases of mild or moderate sickness caused by multiresistant pathogens, azithromycin is an option. If the bacterium is sensitive, ciprofloxacin is an option.
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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 60-year-old female with a past history of rheumatic fever and a prosthetic mitral valve presents to you with fever and an episode of expressive dysphasia that lasted around 30 minutes. There is no history of known drug allergies On examination you note a systolic murmur and you suspect it is infective endocarditis.Which antibacterial agents would be the most appropriate to prescribe in this case?
Your Answer:
Correct Answer: Vancomycin, rifampicin and gentamicin
Explanation:Endocarditis is infective or non infective inflammation (marantic endocarditis) of the inner layer of the heart and it often involves the heart valves.Risk factors include:Prosthetic heart valvesCongenital heart defectsPrior history of endocarditisRheumatic feverIllicit intravenous drug useIn the presentation of endocarditis, the following triad is often quoted:Persistent feverEmbolic phenomenaNew or changing murmurA combination of vancomycin, rifampicin and gentamicin is advised if the patient has a cardiac prostheses, is penicillin allergic, or if methicillin-resistant Staphylococcus aureus (MRSA) is suspected. In this case the patient has a prosthetic valve making this the most appropriate initial treatment regimen.Flucloxacillin and gentamicin are current recommended by NICE and the BNF for the initial ‘blind’ therapy in endocarditis. This patient has prostheses and this is not the most appropriate initial treatment regimen.Other features that may be present include heart failure, splenomegaly, finger clubbing, renal features (haematuria, proteinuria, nephritis), and vasculitic features (splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth’s spots).
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Incorrect
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In relation to ketamine, which of the following statements is TRUE:
Your Answer:
Correct Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.
Explanation:Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 8
Incorrect
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Which of the following antibiotics may be used for malaria prophylaxis:
Your Answer:
Correct Answer: Doxycycline
Explanation:Doxycycline may be used for malaria prophylaxis and as an adjunct to quinine in the treatment of Plasmodium falciparum malaria.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 9
Incorrect
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An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:
Your Answer:
Correct Answer: Weakness of medial rotation of the arm
Explanation:Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus. The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 10
Incorrect
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At rest, saliva is produced predominantly by which of the following:
Your Answer:
Correct Answer: Submandibular gland
Explanation:At rest, most saliva is produced by the submandibular gland (65%). When stimulated by the autonomic nervous system, about 50% of saliva is produced by the parotid gland with only 30% produced by the submandibular gland.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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