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Question 1
Correct
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Which of the following drug classes may cause bronchoconstriction:
Your Answer: Beta-blockers
Explanation:Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 2
Correct
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Antinuclear antibodies (ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus.Which ONE of these statements about ANAs is true?
Your Answer: They can be of any immunoglobulin class
Explanation:Anti-nuclear antibodies(ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus. They can be of any immunoglobulin class.CREST syndrome is usually associated with anti-centromere antibodies.ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most reliable.Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.Anti-dsDNA antibodies are found in 80 – 90% of patients with SLE
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 3
Incorrect
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The enzyme protein gastric lipase is responsible for the breakdown of lipids in the stomach.Which of the following cell types secretes gastric lipase?
Your Answer: Parietal cells
Correct Answer: Chief cells
Explanation:Gastric lipase, commonly known as LIPF, is an acidic lipase released by gastric chief cells, which are found deep within the stomach lining’s mucosal layer. It’s an enzymatic protein that’s in charge of fat digestion in the stomach.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 4
Incorrect
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Which of the following is an example of continuous data:
Your Answer: Disease staging system
Correct Answer: Height
Explanation:Continuous data is data where there is no limitation on the numerical value that the variable can take e.g. weight, height.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 5
Correct
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In ventricular myocytes, the plateau phase of the action potential comes about through which of the following:
Your Answer: Opening of voltage-gated Ca 2+ channels
Explanation:After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 6
Correct
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Doxycycline is indicated first line for treatment of which of the following infections:
Your Answer: Chlamydia
Explanation:Doxycycline may be used first line for chlamydia, pelvic inflammatory disease (with metronidazole and ceftriaxone), acute bacterial sinusitis, exacerbation of chronic bronchitis, moderate-severity community acquired pneumonia and high-severity community acquired pneumonia (with benzylpenicillin).
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 7
Correct
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A 5-year-old girl is brought into the Paediatric ER for acute seizures. She has been convulsing for the past 18 minutes now and was already two doses of lorazepam in the ambulance. Now, you prepare a phenytoin infusion to abolish the seizures. According to the APLS algorithm, what dose of phenytoin is advised for a convulsing child at this stage?
Your Answer: 20 mg/kg over 20 minutes
Explanation:Advanced paediatric life support (APLS) recommends phenytoin as the first choice for second-line anticonvulsant in a patient that continues to seize ten minutes after the second dose of the first-line anticonvulsant (benzodiazepine). (step 3 of the APLS algorithm)The recommended dose of phenytoin infusion is up at 20 mg/kg over 20 minutes. If the patient has already taken phenytoin as maintenance therapy or is allergic to phenytoin, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 8
Incorrect
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Which of the following classes of drugs may predispose to lithium toxicity:
Your Answer: Statins
Correct Answer: Thiazide diuretics
Explanation:Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 9
Incorrect
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A 32-year-old woman presents with abdominal pain and bloody diarrhoea that has been going on for 3 days.Among the following microorganisms, which is considered to be a cause of infectious bloody diarrhoea?
Your Answer: Enterotoxigenic Escherichia coli
Correct Answer: Entamoeba histolytica
Explanation:The following are organisms that are capable of producing acute, bloody diarrhoea:- Campylobacter jejuni- Escherichia coli O157:H7- Salmonella species- Shigella species- Yersinia species- Entamoeba histolyticaOther E. coli strains, Giardia, Vibrio, and other parasites are associated with watery, but not bloody, diarrhoea.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 10
Incorrect
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What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?
Your Answer: 0.5 ml of 1 in 10,000 adrenaline solution
Correct Answer: 10 ml of 1 in 10,000 adrenaline solution
Explanation:Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm. IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm. For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 11
Incorrect
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The least likely feature expected to be seen in a lesion of the frontal lobe is which of the following?
Your Answer: Personality change
Correct Answer: Loss of two-point discrimination
Explanation:Lesions in different areas give rise to different symptoms. Lesions of the parietal lobe give rise to loss of two-point discrimination. Lesions to Broca’s area give rise to expressive dysphasia results from damage Lesions to the primary motor cortex give rise to contralateral weakness of the face and arm. Lesions to the prefrontal cortex give rise to personality change. Lesions to the frontal eye field give rise to conjugate eye deviation towards side of lesion.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 12
Incorrect
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Regarding fibrinolytics, which of the following statements is INCORRECT:
Your Answer: Reteplase is a genetically engineered form of human tPA.
Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.
Explanation:Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 13
Incorrect
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What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer: 300 mg IV over 20 - 60 minutes, followed by further 300 mg IV infusion over 20 - 60 minutes if no response
Correct Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours
Explanation: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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 14
Correct
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Herpes simplex encephalitis has a predilection for which of the following sites:
Your Answer: Temporal lobe
Explanation:Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 15
Correct
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A 37-year-old man presents with breathlessness on exertion and dry cough, fever for the past 2 days and bilateral pleuritic chest pain. He had been diagnosed with HIV and commenced on HAART but due to side effects, his compliance has been poor over the last few months.On examination you note scattered crackles and wheeze bilaterally, cervical and inguinal lymphadenopathy, and oral thrush. At rest his oxygen saturation is 97% but this drops to 87% on walking. There is perihilar fluffy shadowing seen on his chest X-ray.Which of these organisms is the most likely causative organism?
Your Answer: Pneumocystis jirovecii
Explanation:All of the organisms listed above can cause pneumonia in immunocompromised individuals but the most likely cause in this patient is Pneumocystis jirovecii.It is a leading AIDS-defining infection in HIV-infected individuals and causes opportunistic infection in immunocompromised individuals. HIV patients with a CD4 count less than 200 cells/mm3 are more prone.The clinical features of pneumonia caused by Pneumocystis jirovecii are:Fever, chest pain, cough (usually non-productive), exertional dyspnoea, tachypnoea, crackles and wheeze.Desaturation on exertion is a very sensitive sign of Pneumocystis jirovecii pneumonia.Chest X-ray can show perihilar fluffy shadowing (as is seen in this case) but can also be normal.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 16
Incorrect
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An increased anion gap metabolic acidosis is typically caused by which of the following?
Your Answer: Renal tubular acidosis
Correct Answer: Propylene glycol overdose
Explanation:Causes of a raised anion gap acidosis can be remember using the mnemonic MUDPILES:-Methanol-Uraemia (in renal failure)-Diabetic ketoacidosis-Propylene glycol overdose-Infection/Iron overdose/Isoniazid/Inborn errors of metabolism-Lactic acidosis-Ethylene glycol overdose-Salicylate overdose
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This question is part of the following fields:
- Physiology
- Renal
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Question 17
Correct
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You examine a 50-year-old female who has a swollen, painful right big toe. She has a history of gout, and this discomfort is identical to prior relapses, according to her. She is currently taking 200 mg of allopurinol per day and has been for the last year. This is her second round of acute gout within this time period. She has no prior medical history to speak of and does not take any other medications. She doesn't have any known drug allergies.Which of the following management options is the SINGLE MOST APPROPRIATE?
Your Answer: Continue with the allopurinol and commence naproxen
Explanation:Allopurinol should not be started during an acute gout episode because it can both prolong and trigger another acute attack. Allopurinol should be continued in patients who are currently taking it, and acute attacks should be treated as usual with NSAIDs or colchicine, as needed.Non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen, are the first-line treatment for acute gout attacks. Colchicine can be used in situations where NSAIDs are contraindicated, such as in patients with hypertension or those who have had a history of peptic ulcer disease. Because there is no reason for this patient to avoid NSAIDs, naproxen would be the medicine of choice from the list above.It would be reasonable to titrate up the allopurinol dose once the acute episode has subsided, targeting <6 mg/dl (<360 µmol/l) plasma urate levels .Febuxostat (Uloric) is a drug that can be used instead of allopurinol to treat persistent gout.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 18
Incorrect
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Which of the following best describes the popliteal artery's course?
Your Answer: Exits the popliteal fossa between the gastrocnemius and plantaris muscles
Correct Answer: After exiting the popliteal fossa terminates at the lower border of the popliteus muscle
Explanation:The popliteal artery divides into the anterior and posterior tibial arteries at the lower border of the popliteus after exiting the popliteal fossa between the gastrocnemius and popliteus muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 19
Incorrect
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Which of the following blood groups is the least common in the UK:
Your Answer: O
Correct Answer: AB
Explanation:Blood group O is the most common in the UK (46 %), followed by group A (42 %), group B (9 %) and finally group AB (3 %).Blood group O has no antigens, but both anti-A and anti-B antibodies and thus is the universal donor. Blood group AB has both A and B antigens but no antibodies and thus is the universal recipient.Blood group A has A antigens and anti-B antibodies and blood group B has B antigens and anti-A antibodies.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 20
Correct
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Which of the following best describes the typical rash of measles:
Your Answer: The typical rash of measles is maculopapular, starting behind the ears and spreading downwards to the trunk.
Explanation:A prodromal 2 – 4 day coryzal illness (fever, cough, conjunctivitis, irritability) normally occurs associated with Koplik’s spots (small white papules found on the buccal mucosa near the first premolars), before a morbilliform maculopapular rash appears, first behind the ears and then spreading downwards to whole body.The rash peels off or fades about about 7 – 10 days. The chickenpox rash is characterised by a maculopapular rash progressing to vesicles and then crusting over. Scarlet fever is characterised by a sandpaper like rash associated with a strawberry tongue.
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This question is part of the following fields:
- Microbiology
- Pathogens
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SESSION STATS - PERFORMANCE PER SPECIALTY
