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Question 1
Correct
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One of these statements about cohort studies is true:
Your Answer: They are longitudinal in nature
Explanation:A cohort study is a longitudinal, observational study. It follows a group of patients (the cohort) forward in time and monitors the effects of the aetiological factor under study upon them.Cohort studies are usually of longer duration and are more expensive than case-control studies. They, however, provide more useful and reliable information.Cohort studies follow a cohort of patients who don’t have a disease and evaluate the absolute and relative risk of contracting the disease after exposure to the aetiological agent.Cross-sectional studies are the best way to determine the prevalence of a disease. while Cohort studies are better at determining the incidence of a disease.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 2
Incorrect
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A young boy is carried by his friends to the Emergency Department in an unconscious state. He is quickly moved into the resuscitation room. He was at a party with friends and has injected heroin. On examination, his GCS is 6/15, and he has bilateral pinpoint pupils and a very low respiratory rate of 6 breaths per minute. Which of the following is the first-line treatment for this patient?
Your Answer:
Correct Answer: Naloxone 0.8 mg IV
Explanation:Heroin is injected into the veins and is the most commonly abused drug. Acute intoxication with opioid overuse is the most common cause of death by drug overdose. The clinical features of opioid overdose are:1. Decreased respiratory rate2. Reduced conscious level or coma3. Decreased bowel sounds4. Miotic (constricted) pupils5. Cyanosis6. Hypotension7. Seizures8. Non-cardiogenic pulmonary oedema (with IV heroin usage)The main cause of death secondary to opioid overdose is respiratory depression, which usually occurs within 1 hour of the overdose. Vomiting is also common, and aspiration can occur.Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity. It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.Naloxone has a shorter duration of action (6-24 hours) than most opioids, and so close monitoring according to the respiratory rate and depth of coma with repeated injections is necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg. If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 3
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 4
Incorrect
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Which of the following is typically used in diabetes mellitus as the cut-off to define hypoglycaemia?
Your Answer:
Correct Answer: < 4.0 mmol/L
Explanation:Hypoglycaemia is defined as plasma glucose of less than 4 mmol/L.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 5
Incorrect
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On her most recent blood tests, a 55 year-old female with a history of hypertension was discovered to be hypokalaemic. She is diagnosed with primary hyperaldosteronism.Which of the following is a direct action of aldosterone?
Your Answer:
Correct Answer: Secretion of H + into the distal convoluted tubule
Explanation:Aldosterone is a steroid hormone produced in the adrenal cortex’s zona glomerulosa. It is the most important mineralocorticoid hormone in the control of blood pressure. It does so primarily by promoting the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane of the nephron’s distal tubules and collecting ducts, as well as stimulating apical sodium and potassium channel activity, resulting in increased sodium reabsorption and potassium secretion. This results in sodium conservation, potassium secretion, water retention, and a rise in blood volume and blood pressure.Aldosterone is produced in response to the following stimuli:Angiotensin II levels have risen.Potassium levels have increased.ACTH levels have risen.Aldosterone’s principal actions are as follows:Na+ reabsorption from the convoluted tubule’s distal endWater resorption from the distal convoluted tubule (followed by Na+)Cl is reabsorbed from the distal convoluted tubule.K+ secretion into the convoluted distal tubule’s H+ secretion into the convoluted distal tubule’s
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 6
Incorrect
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Which of the following is the most likely causative organism of acute epiglottitis in a 6 year old?
Your Answer:
Correct Answer: Streptococcus pneumoniae
Explanation:Since the introduction of the HIB vaccine, most cases of acute epiglottitis are now caused by Streptococcus spp. The condition is now rare in children.
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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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The following statements are not true of the flexor digiti minimi brevis, except?
Your Answer:
Correct Answer: It is situated on the radial border of abductor digiti minimi
Explanation:Flexor digiti minimi brevis muscle is located on the ulnar side of the palm, lying on the radial border of the abductor digiti minimi. Together with the abductor digiti minimi and opponens digiti minimi muscles, it forms the hypothenar eminence. The muscle is situated inferior and lateral to adductor digiti minimi muscle and superior and medial to opponens digiti minimi muscle. The proximal parts of flexor digiti minimi brevis and abductor digiti minimi muscles form a gap through which deep branches of the ulnar artery and ulnar nerve pass.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 8
Incorrect
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Regarding probability distribution, which of the following statements is CORRECT:
Your Answer:
Correct Answer: In a negative skew, the mass of distribution is concentrated on the right.
Explanation:Distribution of data is usually unimodal (one peak) but may be bimodal (two peaks) or uniform (no peaks, each value equally likely). The normal distribution is a symmetrical bell-shaped curve. The mean, median, and mode of a normal distribution are equal. In a positive skew, the right tail is longer and the mass of distribution is concentrated on the left; mean > median > mode. In a negative skew, the left tail is longer and the mass of distribution is concentrated on the right; mean < median < mode.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 9
Incorrect
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Regarding flucloxacillin, which of the following statements is CORRECT:
Your Answer:
Correct Answer: It is resistant to bacterial beta-lactamases.
Explanation:Flucloxacillin is unique in that it is beta-lactamase stable and it can be used in infections caused by beta-lactamase producing staphylococci e.g. S. aureus. It is acid-stable and can therefore be given by mouth as well as by injection. It is used first line for treatment of widespread impetigo infection, cellulitis, mastitis, osteomyelitis, septic arthritis, severe erysipelas, severe/spreading otitis externa and infective endocarditis caused by staphylococci. The most common adverse effects of flucloxacillin include nausea, vomiting, skin rash, and diarrhoea. Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. First line treatment of animal and human bites is co-amoxiclav.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 10
Incorrect
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Since the fluid that enters the loop of Henle is isotonic, what is its estimated osmolality?
Your Answer:
Correct Answer: 300 mOsm
Explanation:The loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It is consists of three major segments, the thin descending limb, the thin ascending limb, and the thick ascending limb. The segments are differentiated based on structure, anatomic location, and function. The main action of the loop of Henle is to recover water and sodium chloride from urine. The liquid entering the loop of Henle is a solution of salt, urea, and other substances traversed along by the proximal convoluted tubule, from which most of the dissolved components are needed by the body, particularly glucose, amino acids, and sodium bicarbonate that have been reabsorbed into the blood. This fluid is isotonic. Isotonic fluids generally have an osmolality ranging from 270 to 310 mOsm/L. With the fluid that enters the loop of Henle, it is estimated to be 300 mOsm/L. However, after passing the loop, fluid entering the distal tubule is hypotonic to plasma since it has been diluted during its passage.
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 11
Incorrect
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Which of the following is NOT a typical effect caused by adrenaline:
Your Answer:
Correct Answer: Bronchoconstriction
Explanation:Actions of adrenaline:Cardiovascular system- Increased rate and force of cardiac contraction- Vasoconstriction of vessels in skin, mucous membranes and splanchnic bed- Vasodilation of skeletal muscle vessels- Increased cardiac output and blood pressureRespiratory system- Bronchodilation- Increased ventilation rateGastrointestinal system- Smooth muscle relaxation- Contraction of sphincters- Metabolism- Decreased insulin release- Increased glucagon release- Increased thermogenesis- Increased glycolysis- Increased lipolysisEye- Pupillary dilation
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 12
Incorrect
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A 60-year-old patient with a history of hypertension and chronic kidney disease (CKD) walks into the clinic to discuss her most recent blood results indicating an accelerated progression of CKD.Which of the following is the correct definition for accelerated progression of CKD?
Your Answer:
Correct Answer: A sustained decrease in GFR of 15 ml/minute/1.73 m 2 per year
Explanation:Chronic kidney disease (CKD) is a disorder in which kidney function gradually deteriorates over time. It’s fairly prevalent, and it typically remains unnoticed for years, with only advanced stages of the disease being recognized. There is evidence that medication can slow or stop the progression of CKD, as well as lessen or prevent consequences and the risk of cardiovascular disease (CVD).CKD is defined as kidney damage (albuminuria) and/or impaired renal function (GFR 60 ml/minute per 1.73 m2) for three months or longer, regardless of clinical diagnosis.A prolonged decline in GFR of 25% or more with a change in GFR category within 12 months, or a sustained drop in GFR of 15 ml/minute/1.73 m² per year, is considered accelerated CKD progression.End-stage renal disease (ESRD) is defined as severe irreversible kidney impairment with a GFR of less than 15 ml/minute per 1.73 m² and a GFR of less than 15 ml/minute per 1.73 m².
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This question is part of the following fields:
- Physiology
- Renal Physiology
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Question 13
Incorrect
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What is the most common application of Nitrates?
Your Answer:
Correct Answer: Angina
Explanation:In patients with exertional stable angina, nitrates improve exercise tolerance, time to onset of angina, and ST-segment depression during exercise testing. In combination with beta-blockers or calcium channel blockers, nitrates produce greater anti-anginal and anti-ischemic effects.While they act as vasodilators, coronary vasodilators, and modest arteriolar dilators, the primary anti ischemic effect of nitrates is to decrease myocardial oxygen demand by producing systemic vasodilation more than coronary vasodilation. This systemic vasodilation reduces left ventricular systolic wall stress.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 14
Incorrect
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Which one of these infectious diseases typically has an incubation period of between 1 and 3 weeks?
Your Answer:
Correct Answer: Chickenpox
Explanation:The incubation period for Chickenpox is 7-23 days (usually around 2 weeks).Incubation period of botulism is 18-36 hoursIncubation period of Meningococcaemia is 1-7 days.Incubation period of Gonorrhoea is 3-5 days.Incubation period of Hepatitis A is 3-5 weeks.Other infectious with an incubation period of between 1 and 3 weeks are:Whooping cough (7-10 days)Brucellosis (7-21 days)Leptospirosis (7-12 days)Malaria (7-40 days depending on strain)Typhoid (8-21 days)Measles (10-18 days)Mumps (14-18 days)Rubella (14-21 days)
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 15
Incorrect
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A 2nd-year medical student is solving an exam paper with questions about the immune system. She comes across a question regarding innate immunity. Innate immunity is the immunity naturally present within the body from birth. Which ONE of the following is not a part of this type of immunity?
Your Answer:
Correct Answer: Antibody production
Explanation:Innate immunity, also called non-specific immunity, refers to the components of the immune system naturally present in the body at birth. The components of innate immunity include: 1) Natural Killer Cells 2) Neutrophils 3) Macrophages 4) Mast Cells 5) Dendritic Cells 6) Basophils. Acquired or adaptive immunity is acquired in response to infection or vaccination. Although the response takes longer to develop, it is also a more long-lasting form of immunity. The components of this system include: 1) T lymphocytes 2) B lymphocytes 3) Antibodies
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 16
Incorrect
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All of the following statements are correct with regards to protection of the gastric mucosa except which of the following?
Your Answer:
Correct Answer: NSAIDs directly stimulate increased parietal cell acid production.
Explanation:Prostaglandin production, which usually inhibits acid secretion and increases mucus and bicarbonate secretion, is inhibited by NSAIDs.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 17
Incorrect
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A 18 year old with known asthma presents himself to ED with acute breathlessness and wheeze for the past 20 minutes. On examination he is tachypneic and tachycardic. His oxygen saturations are 96% on air. What is the first line treatment for acute asthma:
Your Answer:
Correct Answer: Salbutamol
Explanation:High-dose inhaled short-acting beta2-agonists are the first line treatment for acute asthma(salbutamol or terbutaline). Oxygen should only been given to hypoxaemic patients (to maintain oxygen saturations of 94 – 98%). A pressurised metered dose inhaler with spacer device is preferred in patients with moderate to severe asthma (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). The oxygen-driven nebuliser route is recommended for patients with life-threatening features or poorly responsive severe asthma (salbutamol 5 mg at 15 – 30 minute intervals). Continuous nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose (salbutamol at 5 – 10 mg/hour) The intravenous route should be reserved for those in whom inhaled therapy cannot be used reliably.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 18
Incorrect
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A 29-year-old woman presents with night sweats, fever, and haemoptysis. A diagnosis of tuberculosis was suspected.Which of the following statements regarding the diagnosis of tuberculosis is considered correct?
Your Answer:
Correct Answer: Mycobacteria tuberculosis can be typed using a RFLP method
Explanation:Although a variety of clinical specimens may be submitted to thelaboratory to recover MTB and NTM, respiratory secretions suchas sputum and bronchial aspirates are the most common. Anearly-morning specimen should be collected on three consecutivedays, although recent studies have suggested that the addition ofa third specimen does not significantly increase the sensitivityof detecting Mycobacteria.Mycobacterium tuberculosis appear red on acid-fast staining because they take up the primary stain, which is carbolfuchsin, and is not decolorized by the acid alcohol anymore.Culture on Lowenstein-Jensen medium should be read within 5 to 7 days after inoculation and once a week thereafter for up to 8 weeks.Nucleic acid amplification assays designed to detect M. tuberculosis complexbacilli directly from patient specimens can be performed in as little as 6 to 8 hours on processed specimens.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 19
Incorrect
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Fat necrosis is typically seen in which of the following:
Your Answer:
Correct Answer: Acute pancreatitis
Explanation:Fat necrosis typically occurs following either direct trauma or from enzymatic lipolysis in acute pancreatitis, where release of triglyceride elicits a rapid inflammatory response and fat is phagocytosed by neutrophils and macrophages with subsequent fibrosis.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 20
Incorrect
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A 69-year-old woman with new-onset back pain was diagnosed with osteopenia, osteolytic lesions, and vertebral collapse after undergoing a radiographic examination. Her laboratory results revealed anaemia and hypercalcemia. These findings most likely indicate what condition?
Your Answer:
Correct Answer: Myeloma
Explanation:Bone pain, pathologic fractures, weakness, anaemia, infection, hypercalcemia, spinal cord compression, and renal failure are all signs and symptoms of multiple myeloma (MM). The patient’s condition matched the signs and symptoms of myeloma.
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This question is part of the following fields:
- Haematology
- Pathology
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