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Question 1
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Regarding Clostridium species, which of the following statements is INCORRECT:
Your Answer: They are facultative anaerobes.
Explanation:Clostridium spp. are obligatory anaerobic spore-forming Gram-positive bacilli. Toxin production is the main pathogenicity mechanism.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 2
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A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular medication.What is the dosage per inhalation of a standard metered dose salbutamol inhaler?
Your Answer: 100 micrograms
Explanation:The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 3
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An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:
Your Answer: Thick ascending limb
Explanation:Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 4
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A 32-year old male patient has been diagnosed with meningococcal meningitis and was given appropriate treatments. Because he is a family man, he fears that he might transmit the infection to the rest of his family members. The causative agent of meningococcal meningitis is spread via what mode of transmission?
Your Answer: Respiratory droplet route
Explanation:N. meningitidis, the causative agent of meningococcal meningitis, is considered both a commensal and a pathogen. It can be found in the surfaces of mucous membranes such as the nasopharynx and oropharynx. With this, it can be transmitted from a carrier to a new host via respiratory droplet secretions.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 5
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A patient with a central line in situ for the past 10 days now has erythema surrounding the catheter insertion site and shows signs of sepsis. You suspect line sepsis.Which of these antibacterial agents would be most appropriate to prescribe for this patient?
Your Answer: Vancomycin
Explanation:The current recommendation by NICE and the BNF is to use vancomycin as first-line in treatment of septicaemia related to vascular catheter. A broad-spectrum antipseudomonal beta-lactam antibiotic should be added to vancomycin if a Gram-negative sepsis is suspected especially in an immunocompromised patient.In any patient that has had a central venous catheter in situ for a period longer than a week, it should be suspected as the source of sepsis.The features suggesting the vascular catheter as the source of infection include:Presence of the catheter before onset of fever.The absence of another identifiable source of infection.Presence of inflammation or purulent material at the insertion site or along the tunnel.An immunocompetent patient without any underlying disease developing bacteraemia (or fungaemia).
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 6
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A 28 year old man presents with abdominal pain and constipation, and bloods show hypocalcaemia. Which of the following hormones is increased as a result of hypocalcaemia?
Your Answer: Parathyroid hormone
Explanation:Parathyroid hormone (PTH), also called parathormone or parathyrin, is a peptide hormone that is secreted by the parathyroid glands, which lie immediately behind the thyroid gland. In particular, this hormone is made by chief cells. It regulates the serum calcium concentration through its effects on bone, kidney, and intestine. This hormone is primarily released in response to decreasing plasma Ca2+ concentration and it serves to increase plasma calcium levels and decrease plasma phosphate levels.PTH activates Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane and as a result, increases calcium reabsorption in the distal tubule of the nephron. It inhibits reabsorption of phosphate and this increases its excretion by in the proximal tubule of the nephron.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 7
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Which one of these infectious diseases typically has an incubation period of between 1 and 3 weeks?
Your 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 8
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After an accidental fall, a 75-year-old patient complains of neck pain and weakness in his upper limbs. Select the condition that most likely caused the neck pain and weakness of the upper limbs of the patient.
Your Answer: Central cord syndrome
Explanation:The cervical spinal cord is the section of the spinal cord that goes through the bones of the neck. It is injured incompletely in the central cord syndrome (CCS). This will result in arm weakness more than leg weakness.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 9
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Needle thoracentesis in a patient with tension pneumothorax is performed at which anatomical landmark?
Your Answer: 4-5th intercostal space mid-axillary line
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.
Cadaver studies have shown improved success in reaching the thoracic cavity when the fourth or fifth intercostal space mid-axillary line is used instead of the second intercostal space mid-clavicular line in adult patients. ATLS now recommends this location for needle decompression in adult patients.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 10
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Intrinsic factor is vital for gastrointestinal absorption of which of the following:
Your Answer: Vitamin B12
Explanation:Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 11
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Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given:
Your Answer: At a concentration of 1 unit/mL at a fixed rate of 0.1 units/kg/hour
Explanation:An intravenous insulin infusion should be started at a concentration of 1 unit/mL, at a fixed rate of 0.1 units/kg/hour. Established subcutaneous long-acting insulin therapy should be continued concomitantly. Blood ketone and blood glucose concentrations should be checked hourly and the insulin infusion rate adjusted accordingly. Blood ketone concentration should fall by at least 0.5 mmol/litre/hour and blood glucose concentration should fall by at least 3 mmol/litre/hour.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 12
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A 57-year-old woman has presented with cough and shortness of breath. Her GP had done some blood tests recently and told her that she had a positive ANA result.Which of these statements is true about anti-nuclear antibodies (ANAs)? Select only ONE answer.
Your Answer: The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome
Explanation:Anti-nuclear antibodies are auto-antibodies directed against a variety of nuclear antigens. There are different staining patterns and each pattern is suggestive of a different disorder.Speckled staining is suggestive of mixed connective tissue disease.Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.Anti-double stranded DNA is suggestive of SLE while anti-histone antibodies are suggestive of drug-induced lupus.ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most accurate.The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome. Felty’s syndrome is characterized by a combination of rheumatoid arthritis, splenomegaly and neutropenia.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 13
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A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His GP had recently given him a new medication.Which one of these is the most likely medication responsible for the drug-induced anaphylactic reaction?
Your Answer: Penicillin
Explanation:The most common cause of drug-induced anaphylaxis is penicillin.The second commonest cause are NSAIDs. Other drugs associated with anaphylaxis are ACE inhibitors and aspirin.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 14
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Glucagon is the main catabolic hormone of the body and raises the concentration of glucose and fat in the bloodstream.Which pancreatic islet cells secretes glucagon?
Your Answer: Alpha
Explanation:Glucagon, secreted from the pancreatic islet alpha cells, is considered to be the main catabolic hormone of the body. It raises the concentration of glucose and fat in the bloodstreamThere are five different pancreatic islet cells:Alpha cells (20%) – produce glucagonBeta cells (70%) – produce insulin and amylinDelta cells (<10%) – produce somatostatinGamma cells (<5%) – produce pancreatic polypeptideEpsilon cells (<1%) – produce ghrelin
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 15
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A patient sustains an injury to the proximal median nerve after falling through a glass door. Which of the following muscles would you not expect to be affected:
Your Answer: Flexor carpi ulnaris
Explanation:All of the muscles in the anterior forearm are innervated by the median nerve, except for the flexor carpi ulnaris and the medial half of the flexor digitorum profundus which are innervated by the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
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You contact the intensive care outreach team to inquire about a severely hypotensive resuscitated patient. They make the decision to start a dopamine infusion.Dopamine primarily has which of the following effects at high doses (>15 g/kg/min)?
Your Answer: Alpha-adrenergic stimulation
Explanation:Dopamine is a catecholamine that occurs naturally and is used to treat low cardiac output, septic shock, and renal failure. It is both adrenaline and noradrenaline’s immediate precursor.Dopamine acts on D1 and D2 dopamine receptors in the renal, mesenteric, and coronary beds at low doses (1-5 g/kg/min). Dopamine causes a significant decrease in renal vascular resistance and an increase in renal blood flow at these doses. Within this dose range, it is also involved in central modulation of behaviour and movement.Dopamine stimulates beta- and alpha-adrenergic receptors directly and indirectly at higher doses. Beta-stimulation predominates at a rate of 5-10 g/kg/min, resulting in a positive inotropic effect that increases cardiac output and coronary blood flow. Alpha-stimulation predominates at infusion rates greater than 15 g/kg/min, resulting in peripheral vasoconstriction and an increase in venous return and systolic blood pressure.Because clearance varies greatly in critically ill patients, plasma concentrations cannot be predicted reliably from infusion rates.Dopamine is given as an intravenous infusion, and because extravasation can cause tissue necrosis and sloughing, a central line is usually used (especially at higher doses >240 g/min). In an emergency, however, dopamine can be administered through a large vein (cephalic or basilic) while a central line is being prepared. Alkaline intravenous solutions inactivate it, so sodium bicarbonate should not be infused with it.The following are the most common dopamine side effects:Nausea and vomitingTachycardiaDysrhythmiasAnginaHypertension
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 17
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If the ejection fraction increases, there will be a decrease in:
Your Answer: End-systolic volume
Explanation:An increase in ejection fraction means that a higher fraction of the end-diastolic volume is ejected in the stroke volume (e.g. because of the administration of a positive inotropic agent). When this situation occurs, the volume remaining in the ventricle after systole, the end-systolic volume, will be reduced. Cardiac output, stroke volume, and mean arterial pressure will be increased.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 18
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In the foetus at 4 months gestation, where does haematopoiesis mainly occur?
Your Answer: Liver and spleen
Explanation:The first place that haematopoiesis occurs in the foetus is in the yolk sac. Later on, it occurs in the liver and spleen, which are the major hematopoietic organs from about 6 weeks until 6 – 7 months gestation. At this point, the bone marrow becomes the most important site. Haemopoiesis is restricted to the bone marrow in normal childhood and adult life.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 19
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You see a patient in the Emergency Department with features consistent with a diagnosis of type I diabetes mellitus.Which of these is MOST suggestive of type I diabetes mellitus?
Your Answer: History of recent weight loss
Explanation:A history of recent weight loss is very suggestive of an absolute deficiency of insulin seen in type I diabetes mellitus.An age of onset of less than 20 years makes a diagnosis of type I diabetes mellitus more likely. However, an increasing number of obese children and young people are being diagnosed with type II diabetes.Microalbuminuria, peripheral neuropathy, and retinopathy all occur in both type I and type II diabetes mellitus. They are not more suggestive of type I DM.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 20
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When a person changes from a supine to an upright position, which of the followingcompensatory mechanismsoccurs:
Your Answer: Increased contractility
Explanation:On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
