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  • Question 1 - When an elderly dehydrated patient is moved from a supine to a standing...

    Incorrect

    • When an elderly dehydrated patient is moved from a supine to a standing position, her heart rate increases. Which of the following accounts for the increase in heart rate upon standing:

      Your Answer: Decreased total peripheral resistance

      Correct Answer: Decreased venous return

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      24.2
      Seconds

  • Question 2 - Clostridium difficile primarily causes which of the following infectious diseases: ...

    Incorrect

    • Clostridium difficile primarily causes which of the following infectious diseases:

      Your Answer: Gas gangrene

      Correct Answer: Pseudomembranous colitis

      Explanation:

      Clostridium difficile causes pseudomembranous colitis, an acute inflammatory diarrhoeal disease and an important cause of morbidity and mortality in hospitals. Gas gangrene is primarily caused by Clostridium perfringens. Tetanus is caused by Clostridium tetani. Toxic shock syndrome may be caused by Staphylococcus aureus or Streptococcus pyogenes. Necrotising fasciitis is most commonly caused by Streptococcus pyogenes but has a multitude of causes.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      6.1
      Seconds

  • Question 3 - The primary mechanism of action of ketamine is: ...

    Correct

    • The primary mechanism of action of ketamine is:

      Your Answer: N-methyl-D-aspartate (NMDA)-receptor antagonist

      Explanation:

      Ketamine is a non-competitive antagonist of the calcium-ion channel in the NMDA (N-methyl-D-aspartate) receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).Overdose may lead to panic attacks and aggressive behaviour; rarely seizures, increased ICP, and cardiac arrestVery similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      10
      Seconds

  • Question 4 - Gastric emptying is inhibited by all of the following EXCEPT for: ...

    Correct

    • Gastric emptying is inhibited by all of the following EXCEPT for:

      Your Answer: Parasympathetic stimulation

      Explanation:

      Gastric emptying is decreased by: Enterogastric inhibitory reflexes stimulated by – Distension of the duodenum, The presence of fats in the duodenum (by stimulating release of cholecystokinin), A fall in the pH of chyme in the duodenum, An increase in the osmolality of chyme in the duodenum, Irritation of the mucosal lining of the duodenum, Hormones: Cholecystokinin, Secretin

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      9.2
      Seconds

  • Question 5 - You examine a 48-year-old woman's blood results and notice that her glucose level...

    Incorrect

    • You examine a 48-year-old woman's blood results and notice that her glucose level is elevated. When you tell her about it, she tells you that her doctor recently ran some tests and discovered that she has impaired glucose tolerance.Which of the following medications has not been linked to a reduction in glucose tolerance?

      Your Answer: Bendroflumethiazide

      Correct Answer: Amlodipine

      Explanation:

      The following drugs have been linked to impaired glucose tolerance:Thiazide diuretics, e.g. BendroflumethiazideLoop diuretics, e.g. furosemideSteroids, e.g. prednisoloneBeta-blockers, e.g. atenolol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      15.5
      Seconds

  • Question 6 - You come across a 60-year-old woman with a history of chronic pancreatitis. Today...

    Incorrect

    • You come across a 60-year-old woman with a history of chronic pancreatitis. Today she is complaining of epigastric pain. She has blood tests done especially to review her cholecystokinin levels.Which of the following is a cholecystokinin (CCK) releasing site? 

      Your Answer: C-cells in the upper small intestine

      Correct Answer: I-cells in the upper small intestine

      Explanation:

      The I-cells in the duodenum generate and release cholecystokinin (CCK), a peptide hormone. It has a crucial role in the digestion process as a hormonal regulator.CCK cells are concentrated in the proximal small intestine, and when food is consumed, the hormone is produced into the bloodstream. The presence of partly digested lipids and proteins in the duodenum is one of the most powerful stimulus for CCK synthesis.CCK’s key physiological effects include:Encourages the pancreas to release digesting enzymes into the small intestine.Stimulates gallbladder contraction and sphincter of Oddi relaxation, resulting in bile delivery into the duodenum.Gastric emptying is inhibited, and gastric acid output is reduced.Satiety induction is a process that involves inducing a feeling of fullness.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      10.3
      Seconds

  • Question 7 - A 44 year old woman sustains an injury to the median nerve at...

    Incorrect

    • A 44 year old woman sustains an injury to the median nerve at the elbow after falling awkwardly. Which of the following clinical features are you LEAST likely to see on examination:

      Your Answer: Hand of Benediction appearance when the patient is asked to make a fist

      Correct Answer: Loss of flexion of the medial two digits

      Explanation:

      Flexion of the index and middle fingers at the IPJs is lost due to paralysis of the flexor digitorum superficialis and the lateral half of the flexor digitorum profundus. Flexion of the MCPJs of the index and middle fingers are lost due to paralysis of the lateral two lumbrical muscles. Flexion of the ring and little fingers are preserved as these are supported by the medial half of the flexor digitorum profundus and the medial two lumbrical muscles, innervated by the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      25.5
      Seconds

  • Question 8 - Regarding tapeworm, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding tapeworm, which of the following statements is CORRECT:

      Your Answer: Tapeworm infection typically results in a severe iron-deficient anaemia.

      Correct Answer: Diagnosis is by direct visualisation of characteristic eggs in the stool.

      Explanation:

      Diagnosis of tapeworm is by direct visualisation of characteristic eggs in stool. Humans may be infected by pork or beef tapeworm. Treatment is with praziquantel or niclosamide. Specialist advice should be sought for the management of neurocysticercosis.Iron-deficiency anaemia is typically seen in hookworm infection. Threadworms migrate from the intestine at night to lay eggs on the perianal skin. Mebendazole is first line treatment for threadworms.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      8.1
      Seconds

  • Question 9 - A patient who has a nerve injury has sparing of the upper half...

    Incorrect

    • A patient who has a nerve injury has sparing of the upper half of the orbicularis oculi muscle but not the lower half. Which branch of the facial nerve supplies the lower half of the orbicularis oculi?

      Your Answer: Temporal branch

      Correct Answer: Zygomatic branch

      Explanation:

      The facial nerve divides into five terminal branches once in the parotid gland. 1. The temporal branch innervates muscles in the temple, forehead and supraorbital areas.2. The zygomatic branch innervates muscles in the infraorbital area, the lateral nasal area and the upper lip.3. The buccal branch innervates muscles in the cheek, the upper lip and the corner of the mouth. 4. The marginal mandibular branch innervates muscles of the lower lip and chin. 5. The cervical branch innervates the platysma muscle.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      11
      Seconds

  • Question 10 - Following the administration of a drug that was started a few months earlier,...

    Correct

    • Following the administration of a drug that was started a few months earlier, a patient presents with features of peripheral neuropathy.Which of the following drugs is most likely to cause peripheral neuropathy?

      Your Answer: Isoniazid

      Explanation:

      Isoniazid, a first-line agent for the treatment of tuberculosis, has the commonest side effect of peripheral neuropathy. It occurs in up to 20% of patients taking the drug at a dose > 6 mg/kg daily. Isoniazid combines with pyridoxine (vitamin B6) to form hydrazone, which is excreted in the urine. This causes a deficiency of biologically active pyridoxine leading to peripheral neuropathy.Peripheral neuropathy of isoniazid is prevented by the co-administration of pyridoxine at a dose of 10 mg for each 100 mg of isoniazid given.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      8.5
      Seconds

  • Question 11 - Vitamin D is a group of secosteroids that play a role in calcium...

    Correct

    • Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.Which enzyme hydroxylates 25-hydroxycholecalciferol to form 1,25-dihydroxycholecalciferol? 

      Your Answer: 1-alpha-hydroxylase

      Explanation:

      The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.In the presence of UVB light, 7-dehydrocholesterol is converted to cholecalciferol in the epidermal layer of the skin, resulting in 1,25-dihydroxycholecalciferol.Cholecalciferol is then converted to 25-hydroxycholecalciferol in the endoplasmic reticulum of liver hepatocytes by 25-hydroxylase (calcifediol).Finally, 1-alpha-hydroxylase converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol in the kidney. The key regulatory point in the formation of 1,25-dihydroxycholecalciferol is 1-alpha-hydroxylase, which is induced by parathyroid hormone or hypophosphatemia.The following are the primary effects of 1,25-dihydroxycholecalciferol:Calcium and phosphate absorption in the small intestine is increased.Calcium reabsorption in the kidneys is increased.Increases phosphate reabsorption in the kidneys.Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      6.7
      Seconds

  • Question 12 - Which of the following lifestyle changes is not likely to improve symptoms of...

    Correct

    • Which of the following lifestyle changes is not likely to improve symptoms of gastro-oesophageal reflux disease (GORD):

      Your Answer: Lowering the head of the bed

      Explanation:

      The following approaches have some benefit in adult patients with reflux:Weight loss or weight management for individuals who are overweightHead of bed elevation is important for individuals with nocturnal or laryngeal symptoms, but its value for other situations is unclear.The following lifestyle approaches also are used frequently. There is some evidence that these lifestyle changes improve laboratory measures of reflux (such as lower oesophageal sphincter pressure).Dietary modification – A practical approach is to avoid a core group of reflux-inducing foods, including chocolate, peppermint, and alcohol, which may reduce lower oesophageal sphincter pressure. Acidic beverages, including colas with caffeine and orange juice also may exacerbate symptoms. Avoiding the supine position soon after eating.Promotion of salivation by either chewing gum or using oral lozenges. Salivation neutralizes refluxed acid, thereby increasing the rate of oesophageal acid clearance.Avoidance of tobacco (including passive exposure to tobacco smoke) and alcohol. Nicotine and alcohol reduce lower oesophageal sphincter pressure, and smoking also diminishes salivation.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      9.3
      Seconds

  • Question 13 - Which of the following is true regarding respiration? ...

    Incorrect

    • Which of the following is true regarding respiration?

      Your Answer: The ‘pump handle’ action of the ribs increases the transverse diameter of the chest

      Correct Answer: The diaphragm is responsible for abdominal breathing

      Explanation:

      The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      7.2
      Seconds

  • Question 14 - The results from the study investigating the accuracy of a new diagnostic test can be...

    Incorrect

    • The results from the study investigating the accuracy of a new diagnostic test can be displayed in the following format. How is the positive predictive value calculated:Those with diseaseThose without diseaseTotalTest positiveaba+bTest negativecdc+dTotala+cb+dn=a+b+c+d

      Your Answer: a/(a+c)

      Correct Answer: a/(a+b)

      Explanation:

      Positive predictive value (PPV) is the proportion of individuals with a positive test result who actually have the disease.PPV = a/(a+b)

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      11.9
      Seconds

  • Question 15 - Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism...

    Incorrect

    • Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism of action is best described by which of the following?

      Your Answer: Muscarinic acetylcholine receptor antagonist

      Correct Answer: Nicotinic acetylcholine receptor antagonist

      Explanation:

      Atracurium is a non-depolarizing neuromuscular blocker that is used to help with intubation and controlled ventilation by causing muscle relaxation and paralysis. At the neuromuscular junction’s post-synaptic membrane, atracurium competes with acetylcholine for nicotinic (N2) receptor binding sites. This prevents the receptors from being stimulated by acetylcholine. Muscle paralysis occurs gradually due to the competitive blockade.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      11
      Seconds

  • Question 16 - Which of the following microbes attaches to host cells by its haemagglutinin antigen:...

    Incorrect

    • Which of the following microbes attaches to host cells by its haemagglutinin antigen:

      Your Answer: Haemophilus influenzae

      Correct Answer: Influenza virus

      Explanation:

      Hemagglutinin (HA) or Haemagglutinin (BE) is an antigenic glycoprotein found on the surface of the influenza viruses. It is responsible for binding the virus to the cell that is being infected. The name hemagglutinin comes from the protein’s ability to cause red blood cells (erythrocytes) to clump together (agglutinate) in vitro.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      10.6
      Seconds

  • Question 17 - Which of the following statements regarding the infectivity periods of these corresponding diseases...

    Correct

    • Which of the following statements regarding the infectivity periods of these corresponding diseases is correct?

      Your Answer: Rubella is infectious until 5 days after the rash appears

      Explanation:

      Rubella can be contagious from 7 days before to 7 days after the rash appears.Patients with measles are contagious from 1-2 days before the onset of symptoms.A person with chickenpox is considered contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted (scabbed). The infectious period of mumps is considered from 2 days before to 5 days after parotitis onset.Hepatitis A is highly transmissible and has an average incubation period of 28 to 30 days (range 15–50 days). The maximum infectivity is during the second half of the incubation period (i.e. while asymptomatic) and most cases are considered non-infectious after the first week of jaundice.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      13.8
      Seconds

  • Question 18 - A patent has weakness of humeral flexion and extension. A CT scan reveals...

    Incorrect

    • 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: Lateral pectoral nerve and long thoracic nerve

      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

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      18.5
      Seconds

  • Question 19 - You are instructed by a senior to administer Mannitol to an RTA patient...

    Incorrect

    • You are instructed by a senior to administer Mannitol to an RTA patient with increased intracranial pressure. Mannitol is a low molecular weight compound that freely filters at the glomerulus and is not reabsorbed.Out of the following, which is a contraindication to the use of mannitol?

      Your Answer: Jaundice

      Correct Answer: Severe pulmonary oedema

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure. It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Mannitol has several contraindications and some of them are listed below:1. Anuria due to renal disease2. Acute intracranial bleeding (except during craniotomy)3. Severe cardiac failure4. Severe dehydration5. Severe pulmonary oedema or congestion6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      13.2
      Seconds

  • Question 20 - Most of the lymph from vessels that drain the breast is collected in...

    Correct

    • Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?

      Your Answer: Axillary nodes

      Explanation:

      Lymph is the fluid that flows through the lymphatic system. Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly. The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      6.3
      Seconds

  • Question 21 - Regarding the UK routine childhood immunisation schedule which of the following vaccines is...

    Incorrect

    • Regarding the UK routine childhood immunisation schedule which of the following vaccines is NOT given at 12 months:

      Your Answer: Pneumococcal conjugate vaccine (PCV)

      Correct Answer: Polio

      Explanation:

      At 12 months the following vaccines are given:Hib (4th dose) and Meningococcal group CPneumococcal (13 serotypes) (2nd dose)Measles, mumps and rubellaMeningococcal group B (3rd dose)

    • This question is part of the following fields:

      • Immunoglobulins And Vaccines
      • Pharmacology
      4.4
      Seconds

  • Question 22 - What is the average healing time for a femoral shaft fracture under normal...

    Correct

    • What is the average healing time for a femoral shaft fracture under normal circumstances? Choose ONE answer.

      Your Answer: 12 weeks

      Explanation:

      The process of fracture healing occurs naturally after traumatic bone disruption and begins with haemorrhage, then progresses through Inflammatory, reparative, and remodelling stagesAverage healing times of common fractures are:Femoral shaft: 12 weeksTibia: 10 weeksPhalanges: 3 weeksMetacarpals: 4-6 weeksDistal radius: 4-6 weeksHumerus: 6-8 weeks

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      5.4
      Seconds

  • Question 23 - A 67-year-old woman arrives at the Emergency Department with chest pain. Flecainide is...

    Incorrect

    • A 67-year-old woman arrives at the Emergency Department with chest pain. Flecainide is one of the medications she is taking.Which of the following statements about flecainide mechanism of action is correct?

      Your Answer: Opens K + channels in the heart

      Correct Answer: Blocks Na+ channels in the heart

      Explanation:

      Flecainide is an antiarrhythmic drug of class Ic that works by blocking the Nav1.5 sodium channel in the heart, prolonging the cardiac action potential and slowing cardiac impulse conduction. It has a significant impact on accessory pathway conduction, particularly retrograde conduction, and significantly reduces ventricular ectopic foci.Many different arrhythmias can be treated with flecainide, including:Pre-excitation syndromes (e.g. Wolff-Parkinson-White)Acute atrial arrhythmiasVentricular arrhythmiasChronic neuropathic painThe use of flecainide is contraindicated in the following situations:Abnormal left ventricular functionAtrial conduction defects (unless pacing rescue available)Bundle branch block (unless pacing rescue available)Distal block (unless pacing rescue available)Haemodynamically significant valvular heart diseaseHeart failureHistory of myocardial infarctionLong-standing atrial fibrillation where conversion to sinus rhythm not attemptedSecond-degree or greater AV block (unless pacing rescue available)Sinus node dysfunction (unless pacing rescue available)Flecainide should only be used in people who don’t have a structural heart problem. The CAST trial found a significant increase in sudden cardiac death and all-cause mortality in patients with an ejection fraction of less than 40% after a myocardial infarction, where it tended to be pro-arrhythmic.Anti-arrhythmic drugs have a limited and ineffective role in the treatment of atrial flutter. It’s important to keep in mind that flecainide shouldn’t be used by itself to treat atrial flutter. When used alone, there is a risk of inducing 1:1 atrioventricular conduction, which results in an increase in ventricular rate that is paradoxical. As a result, it should be used in conjunction with a beta-blocker or a calcium channel blocker with a rate-limiting effect.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      5.1
      Seconds

  • Question 24 - Which of the following statements regarding the pituitary gland is CORRECT: ...

    Incorrect

    • Which of the following statements regarding the pituitary gland is CORRECT:

      Your Answer: Oxytocin release from the posterior pituitary is controlled primarily by negative feedback mechanisms.

      Correct Answer: Cortisol inhibits release of adrenocorticotropic hormone (ACTH) from the anterior pituitary.

      Explanation:

      Anterior pituitary hormones are released under the control of hypothalamic releasing or inhibiting hormones originating from small neurons with their cell bodies in the hypothalamus and released into the blood at the median eminence. These hypothalamic hormones are transported directly to the anterior pituitary via hypophyseal portal vessels. The anterior pituitary hormones (and the hormones released by their target organs) inhibit further release of hypothalamic and anterior pituitary hormones by negative feedback mechanisms e.g. cortisol inhibits the release of ACTH. Prolactin release from the anterior pituitary is inhibited by dopamine.The posterior pituitary is really a direct extension of the hypothalamus. Oxytocin and ADH are manufactured in the cell bodies of large neurons in the hypothalamus and are transported down the axons of these cells to their terminals on capillaries originating from the inferior hypophyseal artery within the posterior pituitary gland. ADH release is controlled by negative feedback mechanisms based on plasma osmolality and blood volume, oxytocin however is involved in positive feedback mechanisms.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      11.7
      Seconds

  • Question 25 - As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction...

    Incorrect

    • As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction by activating which receptor?

      Your Answer: Beta1

      Correct Answer: Alpha1

      Explanation:

      The rate of baroreceptor firing slows down when blood pressure falls too low. This causes an increase in sympathetic stimulation of the heart, resulting in an increase in cardiac output. It also causes vasoconstriction by activating alpha 1 receptors in smooth muscle, which causes sympathetic stimulation of peripheral vessels. Alpha2 receptors can be found in both the brain and the peripheral nervous system. They control sympathetic outflow in the brain stem. Beta1 receptors, which are found on the cell membrane of cardiac muscle cells, stimulate heart rate and myocardial contractility. The smooth muscle cell membrane contains beta2 receptors, which promote smooth muscle relaxation in the lungs causing bronchodilation, GI tract, and peripheral blood vessels.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      4.5
      Seconds

  • Question 26 - All of the following statements are considered true regarding likelihood ratios, except: ...

    Incorrect

    • All of the following statements are considered true regarding likelihood ratios, except:

      Your Answer: They are a number between zero and infinity

      Correct Answer: If less than one, indicates that the information increases the likelihood of the suspected diagnosis

      Explanation:

      The Likelihood Ratio (LR) is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.The LR is used to assess how good a diagnostic test is and to help in selecting an appropriate diagnostic tests or sequence of tests. They have advantages over sensitivity and specificity because they are less likely to change with the prevalence of the disorder, they can be calculated for several levels of the symptom/sign or test, they can be used to combine the results of multiple diagnostic test and they can be used to calculate post-test probability for a target disorder.A LR greater than 1 produces a post-test probability which is higher than the pre-test probability. An LR less than 1 produces a post-test probability which is lower than the pre-test probability. When the pre-test probability lies between 30 and 70 per cent, test results with a very high LR (say, above 10) rule in disease. An LR below 1 produces a post-test probability les than the pre-test probability. A very low LR (say, below 0.1) virtually rules out the chance that the patient has the disease.

    • This question is part of the following fields:

      • Evidence Based Medicine
      11.3
      Seconds

  • Question 27 - A 34-year-old man arrives at the department befuddled. He has a history of...

    Incorrect

    • A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.Which of the following statements about antipsychotic drug side effects is correct?

      Your Answer: Haloperidol is the safest antipsychotic drug to use in elderly patients with dementia-related psychosis

      Correct Answer: Haloperidol is the most common causative antipsychotic drug

      Explanation:

      Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.Renal impairment causes increased cerebral sensitivity, so lower doses should be used.In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.The following are some of the antipsychotic drugs’ contraindications:Reduced level of consciousness/comaDepression of the central nervous systemPhaeochromocytoma

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      14.2
      Seconds

  • Question 28 - Regarding hepatitis A, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hepatitis A, which of the following statements is CORRECT:

      Your Answer: Transmission is by the parenteral route.

      Correct Answer: Anti-HAV IgM antibodies are diagnostic.

      Explanation:

      Anti-HAV IgM antibodies are diagnostic. Disease in children is more commonly asymptomatic, risk of symptomatic disease increases with age. Transmission is by the faecal-oral route. Faecal shedding has been demonstrated for 2 – 3 weeks before and about a week after, the onset of jaundice. Infection confers lifelong immunity.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      11.7
      Seconds

  • Question 29 - A young man develops an infection spread via aerosol transmission.Which of these organisms...

    Incorrect

    • A young man develops an infection spread via aerosol transmission.Which of these organisms is commonly spread by aerosol transmission?

      Your Answer: Staphylococcus aureus

      Correct Answer: Measles virus

      Explanation:

      Aerosols are airborne particles less than 5 µm in size, containing infective organisms that usually cause infection of the upper or lower respiratory tract.Examples of organisms commonly spread by aerosol transmission are:Measles virusVaricella zoster virusMycobacterium tuberculosisThe following table summarises the various routes of transmission with example organisms:Route of transmissionExample organismsAerosol (airborne particle < 5 µm)Mycobacterium tuberculosisVaricella zoster virusMeasles virusHepatitis A and Rotavirus are spread by the faeco-oral route.Neisseria gonorrhoea is spread by sexual route.Staphylococcus aureus is spread by direct contact.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      8.2
      Seconds

  • Question 30 - How is filtered K+mainly reabsorbed in the thick ascending limb of the loop...

    Incorrect

    • How is filtered K+mainly reabsorbed in the thick ascending limb of the loop of Henle:

      Your Answer: Primary active transport via Na + /K + ATPase

      Correct Answer: Secondary active transport via Na + /K + /2Cl - cotransporter

      Explanation:

      Around 30% of filtered K+is reabsorbed in the thick ascending limb of the loop of Henle, primarily via the luminal Na+/K+/2Cl-cotransporter, but there is also significant paracellular reabsorption, encouraged by the positive potential in the tubular lumen.

    • This question is part of the following fields:

      • Physiology
      • Renal
      3.5
      Seconds

  • Question 31 - An elderly man with chronic heart and lung disease develops Legionnaires' disease. Which...

    Incorrect

    • An elderly man with chronic heart and lung disease develops Legionnaires' disease. Which of the following clinical features is NOT typical of Legionnaires' disease:

      Your Answer: Nausea, vomiting and diarrhoea

      Correct Answer: Haemoptysis

      Explanation:

      Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.The clinical features of the pneumonic form of Legionnaires’ disease include:Mild flu-like prodrome for 1-3 daysCough (usually non-productive and occurs in approximately 90%)Pleuritic chest painHaemoptysisHeadacheNausea, vomiting and diarrhoeaAnorexiaLegionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      5.6
      Seconds

  • Question 32 - The patients listed below have had wounds or injuries and were treated as...

    Correct

    • The patients listed below have had wounds or injuries and were treated as described in a local walk-in clinic.Which of the following patients has had adequate tetanus protection?

      Your Answer: 80-year-old diabetic, a rusty nail went through his shoe and into his foot when walking in the woods, uncertain of vaccination history - receives vaccination and immunoglobulin

      Explanation:

      25-year-old receives immunoglobulin and vaccination after cutting her hand on a drinking glass and not knowing her vaccination history.Because this is not a tetanus-prone wound, immunoglobulin is not recommended. Because you can’t be sure about her vaccination history, now is the best time to start a tetanus vaccination course to ensure coverage later in life. The first vaccination should be administered at the time of presentation; the patient’s own GP should then review the patient’s vaccination history and schedule the rest of the course as needed.8-year-old whose hand was cut with a kitchen knife, received her first round of vaccinations as a baby and a booster at the age of four – receives vaccination:The tetanus vaccinations for this child are up to date, and the next booster should not be given too soon. Immunoglobulin is not required because this is not a tetanus-prone wound.80-year-old diabetic, a rusty nail went through his shoe and into his foot while walking in the woods, and he was uncertain of his vaccination history – he received vaccination and immunoglobulin:A tetanus vaccination course may not have been completed by an 80-year-old UK resident (the vaccination was introduced in 1961). The vaccination should be given at a walk-in clinic, and the patient’s own GP should be contacted to confirm vaccination history and to schedule the rest of the course as needed. Because this is a tetanus-prone wound (puncture wound and potential soil contact), immunoglobulin would be recommended in a patient with incomplete tetanus vaccinations.A 28-year-old Polish man cuts his leg while working in the garden, the wound is heavily contaminated with soil, and his vaccination history is unknown – he receives vaccination:In a patient with an unknown vaccination history, this is a tetanus-prone wound. In this case, the best course of action would be to administer both the vaccination and immunoglobulin at the walk-in clinic, then contact the patient’s own GP to check his or her vaccination history and schedule the rest of the course as needed.30-year-old with a large amount of devitalized tissue in the torso from an electrical burn – has had all vaccinations, so no need for vaccination or immunoglobulin:Because this is a high-risk tetanus wound (with a lot of devitalized tissue), even if the patient has had a full course of vaccinations in the past, immunoglobulin is recommended. There is no need for any additional vaccinations.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
      25.2
      Seconds

  • Question 33 - You are asked to review the blood results on a 56-year-old man who...

    Incorrect

    • You are asked to review the blood results on a 56-year-old man who appears to be acutely unwell. His results show that he is neutropenic.Which ONE of the following is NOT a recognized cause of a neutropenia?

      Your Answer: Carbimazole

      Correct Answer: Hyposplenism

      Explanation:

      Neutropenia is defined as a total neutrophil count of < 2.0 x 109/l.It can be caused by:Viral infectionsCollagen disease e.g. SLE and RAChemotherapy and radiotherapyHypersplenismMarrow infiltrationVitamin and folate deficiencyDrug reactionsDrugs that cause neutropenia include flecainide, phenytoin, carbimazole, indomethacin and co-trimoxazole.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      9.6
      Seconds

  • Question 34 - All of the following statements are considered true regarding nominal variables, except: ...

    Incorrect

    • All of the following statements are considered true regarding nominal variables, except:

      Your Answer: They are categorical variables

      Correct Answer: The central tendency of a nominal variable is given by its median

      Explanation:

      A nominal variable is a type of variable that is used to name, label or categorize particular attributes that are being measured. It takes qualitative values representing different categories, and there is no intrinsic ordering of these categories.A nominal variable is one of the 2 types of categorical variables and is the simplest among all the measurement variables. Some examples of nominal variables include gender, name, phone, etc.A nominal variable is qualitative, which means numbers are used here only to categorize or identify objects. They can also take quantitative values. However, these quantitative values do not have numeric properties. That is, arithmetic operations cannot be performed on them. If the variable is nominal, the mode is the only measure of central tendency to use.

    • This question is part of the following fields:

      • Evidence Based Medicine
      9.4
      Seconds

  • Question 35 - A 30-year-old male with a known allergy to natural latex rubber presents with...

    Correct

    • A 30-year-old male with a known allergy to natural latex rubber presents with an allergic reaction to a food he has just eaten. Which ONE of these foods is most likely to cause an associated hypersensitivity in him?

      Your Answer: Banana

      Explanation:

      About one third of patients with allergy to natural latex rubber (NRL) have an associated allergy to some plant-derived foods. It is known as the latex-fruit syndrome and occurs commonly with consumption of fresh fruits. Banana and avocado are the most implicated fruits but it can also be seen with tomato, kiwi and chestnut.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      6.3
      Seconds

  • Question 36 - Which of the following does NOT increase free ionised calcium levels: ...

    Incorrect

    • Which of the following does NOT increase free ionised calcium levels:

      Your Answer: Metabolic acidosis

      Correct Answer: Calcitonin

      Explanation:

      Calcium homeostasis is primarily controlled by three hormones: parathyroid hormone, activated vitamin D and calcitonin.Parathyroid hormone acts on the kidneys to increase calcium reabsorption in the distal tubule by activating Ca2+entry channels in the apical membrane and the Ca2+ATPase pump in the basolateral membrane (and to decrease phosphate reabsorption in the proximal tubule).Activated vitamin D acts to increase calcium reabsorption in the distal tubule via activation of a basolateral Ca2+ATPase pump (and to increase phosphate reabsorption).Calcitonin acts to inhibit renal reabsorption of calcium (and phosphate).

    • This question is part of the following fields:

      • Physiology
      • Renal
      7.5
      Seconds

  • Question 37 - What is the recommended dosing regime for amiodarone in the treatment of a...

    Correct

    • What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      4.2
      Seconds

  • Question 38 - At rest, saliva is produced predominantly by which of the following: ...

    Incorrect

    • At rest, saliva is produced predominantly by which of the following:

      Your Answer: Parotid gland

      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.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      5.6
      Seconds

  • Question 39 - Which of the following is a clinical effect of hyperkalaemia: ...

    Correct

    • Which of the following is a clinical effect of hyperkalaemia:

      Your Answer: Muscle weakness

      Explanation:

      Clinical features of hyperkalaemia may include: paraesthesia, muscle weakness or paralysis, cardiac conduction abnormalities and dysrhythmias. Clinical features of hypokalaemia may include: muscle weakness, muscle cramps, rhabdomyolysis and myoglobinuria, ascending paralysis resulting in respiratory failure, constipation, gut ileus with distension, anorexia, nausea and vomiting, impaired ADH action with polyuria and polydipsia, ECG changes and cardiac arrhythmias.

    • This question is part of the following fields:

      • Physiology
      • Renal
      7.3
      Seconds

  • Question 40 - An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her...

    Incorrect

    • An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her complaints of dizziness and nausea. Two days later, she returned to the clinic with no improvement in the symptoms. Which one of the following is the mechanism of action of prochlorperazine?

      Your Answer: 5-HT 3 receptor antagonism

      Correct Answer: Dopamine receptor antagonism

      Explanation:

      Prochlorperazine is a phenothiazine drug as it is categorized as a first-generation antipsychotic. It mainly blocks the D2 (dopamine 2) receptors in the brain. Along with dopamine, it also blocks histaminergic, cholinergic, and noradrenergic receptors.It exerts its antiemetic effect via dopamine (D2) receptor antagonist. It is used to treat nausea and vomiting of various causes, including labyrinthine disorders.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      20
      Seconds

  • Question 41 - You're in resus with a 69-year-old woman who is very sick. You decide...

    Incorrect

    • You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.Which of the following statements about dobutamine is correct?

      Your Answer: Its primary activity results from stimulation of beta 2 -adrenergic receptors

      Correct Answer: It may be infused via a peripheral line

      Explanation:

      Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:Nausea and vomitingTachycardiaDysrhythmiasAnginaHypertensionHeadache

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      10.9
      Seconds

  • Question 42 - A patient suffers from an injury and as a consequence, the nerve that...

    Incorrect

    • A patient suffers from an injury and as a consequence, the nerve that was damaged innervates the obturator internus muscle.In which of the following nerves is the obturator internus muscle innervated by?

      Your Answer: Superior gluteal nerve

      Correct Answer: Nerve to obturator internus

      Explanation:

      The obturator internus is innervated by the obturator internus nerve (L5–S2), a branch of sacral plexus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      5.5
      Seconds

  • Question 43 - Regarding relationships between two variables, what does a negative correlation coefficient indicate: ...

    Incorrect

    • Regarding relationships between two variables, what does a negative correlation coefficient indicate:

      Your Answer: Correlation is poor between the two variables

      Correct Answer: The two variables are inversely related

      Explanation:

      A negative correlation coefficient means that the two variables are inversely related e.g. socio-economic class and mortality.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      5.8
      Seconds

  • Question 44 - Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?...

    Incorrect

    • Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?

      Your Answer: HIT is a type 1 hypersensitivity reaction.

      Correct Answer: HIT typically develops 5-10 days after starting heparin.

      Explanation:

      Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. HIT is frequently considered in the differential diagnosis of thrombocytopenia occurring in patients on heparin therapy. HIT is a challenging diagnosis because of routine heparin use in hospitalized patients, the common occurrence of thrombocytopenia. The process of heparin dependent IgG antibodies binding to heparin/platelet factor 4 complexes activates platelets and produces a hypercoagulable state. This syndrome typically develops 5-10 days (range 4-15 days) after heparin is commenced. It can occur with unfractionated heparin, low molecular weight heparin, or, rarely, fondaparinux. The diagnosis of HIT requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent platelet activating HIT antibodies. Discontinuation of heparin alone or initiation of a vitamin K antagonist alone like warfarin, is not sufficient to stop the development of thrombosis in patients with acute HIT. If there is moderate clinical suspicion for HIT, all sources of heparin must be discontinued and there must be consideration of anticoagulant treatment with a non-heparin drug.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      8.6
      Seconds

  • Question 45 - Which of the following best describes the popliteal artery's course? ...

    Correct

    • Which of the following best describes the popliteal artery's course?

      Your 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.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      5.3
      Seconds

  • Question 46 - A 20-year-old male receives a small cut over his hand while climbing a...

    Correct

    • A 20-year-old male receives a small cut over his hand while climbing a fence causing it to bleed. Upon applying pressure for a few minutes, the bleeding stops. Which one of the following physiological components of the blood is responsible for the primary haemostasis reaction, such as in this case?

      Your Answer: Platelet plug formation

      Explanation:

      Haemostasis is your body’s defence against an injury that causes bleeding. It stops bleeding in three main steps: 1) Primary haemostasis – formation of a weak platelet plug- The primary reaction of the body is to cause local vasoconstriction at the site of injury and decrease blood flow to the affected area- the release of cytokines and inflammatory markers lead to adhesion of platelets and aggregation at the site of injury forming a platelet plug- the injured vessel wall has exposed subendothelial collagen that releases von Willebrand factor Any damage to the vessel wall causes the release of the Von Willebrand factor, which is necessary for platelet adhesion. Tissue Thromboplastin is also released, which activates the coagulation pathway, a component of secondary haemostasis. The coagulation cascade ultimately results in the conversion of fibrinogen to fibrin.2) Secondary haemostasis 3) Fibrinolysis

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      8.3
      Seconds

  • Question 47 - A 42-year-old man presented to the emergency room with complains of a dry...

    Correct

    • A 42-year-old man presented to the emergency room with complains of a dry cough and fever that has been going on for the past few days. Upon history taking and observation, it was established that he works as a Jacuzzi and whirlpool installer and smokes 15 cigarettes per day. The presence of a non-productive cough, several episodes of diarrhoea, developed bilateral pleuritic chest pain, and shortness of breath most notably on exertion were also noted.Which of the following is most likely the causative agent of the case presented above?

      Your Answer: Legionella pneumophila

      Explanation:

      Legionella species are ubiquitous, Gram-negative bacilli acquired primarily through inhalation. Infections caused by Legionella spp. produce a spectrum of symptoms ranging from mild upper respiratory tract infections to pneumonia. Legionella spp. are responsible for 2% to 15% of community-acquired pneumonia.Clinical manifestations of Legionella infections include febrile disease with pneumonia (legionnaires’ disease), febrile disease without pulmonary involvement (Pontiac fever), and asymptomatic infection.The mode of transmission and the number of infecting organisms in the inoculum play a role in the clinical features of the infection. In addition, host factors, such as a suppressed immune system, chronic lung disease, alcoholism, and heavy smoking, predispose individuals to legionnaires’ disease.Legionella spp. can tolerate chlorine concentrations of 3 mg/L, they resist water treatment and subsequently gain entry into and colonize human-made water supplies and distribution systems. Hot water systems, cooling towers, and evaporative condensers are major reservoirs. Other sources include cold water systems, ornamental fountains, whirlpool spas, humidifiers, respiratorytherapy equipment, and industrial process waters.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      9.3
      Seconds

  • Question 48 - For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the...

    Incorrect

    • For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:

      Your Answer: Amiodarone

      Correct Answer: Synchronised DC shock

      Explanation:

      If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      20.7
      Seconds

  • Question 49 - Haemoptysis, weight loss, and night sweats are symptoms of a patient. You believe...

    Correct

    • Haemoptysis, weight loss, and night sweats are symptoms of a patient. You believe you've been diagnosed with tuberculosis. He works at an asylum seeker hostel, but due to a contraindication, he did not receive a BCG vaccination when he first started there.Which of the following patient groups would the BCG vaccine be safe to administer?

      Your Answer: The patient is asplenic

      Explanation:

      In patients with asplenia, all vaccines, whether live or inactivated, are recommended.Anaphylaxis following any vaccination is a contraindication to receiving that vaccine again.The BCG vaccine is a live vaccine. The following situations are generally contraindicated for live vaccinations:PregnancyHIV infection can be asymptomatic or symptomatic.If it’s been less than three weeks since the last live vaccine (although two live vaccinations can be given together at different sites of the body)Other illnesses that wreak havoc on the immune systemMalignancies of the blood

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
      15.6
      Seconds

  • Question 50 - A 33-year-old woman who is investigated for recurrent renal stones is discovered to...

    Correct

    • A 33-year-old woman who is investigated for recurrent renal stones is discovered to have a markedly elevated parathyroid hormone (PTH) level.Which of the following would stimulate PTH release under normal circumstances? Select ONE answer only.

      Your Answer: Decreased plasma calcium concentration

      Explanation:

      Parathyroid hormone (PTH) is a polypeptide containing 84 amino acids. It is the principal controller of free calcium in the body.PTH is synthesised by and released from the chief cells of the four parathyroid glands that are located immediately behind the thyroid gland.PTH is released in response to the following stimuli:Decreased plasma calcium concentrationIncreased plasma phosphate concentration (indirectly by binding to plasma calcium and reducing the calcium concentration)PTH release is inhibited by the following factors:Normal/increased plasma calcium concentrationHypomagnesaemiaThe main actions of PTH are:Increases plasma calcium concentrationDecreases plasma phosphate concentrationIncreases osteoclastic activity (increasing calcium and phosphate resorption from bone)Increases renal tubular reabsorption of calciumDecreases renal phosphate reabsorptionIncreases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      9.7
      Seconds

  • Question 51 - An elderly female has a bacterial infection and you are asked to prescribe...

    Incorrect

    • An elderly female has a bacterial infection and you are asked to prescribe an antibiotic to her. This antibiotic is a nucleic acid synthesis inhibitor.Which of the following antimicrobial drugs will be prescribed to this patient?

      Your Answer: Erythromycin

      Correct Answer: Metronidazole

      Explanation:

      Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA. Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors. Erythromycin inhibits protein synthesis and blocks translocation by binding to the 23S rRNA of the 50S ribosomal subunit.Chloramphenicol blocks peptidyl transferase at 50S ribosomal subunit.Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA and thus preventing initiation of protein synthesis.An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:1. Inhibition of cell wall synthesis- Penicillins- Cephalosporins- Vancomycin2. Disruption of cell membrane function- Polymyxins- Nystatin- Amphotericin B3. Inhibition of protein synthesis- Macrolides- Aminoglycosides- Tetracyclines- Chloramphenicol4. Inhibition of nucleic acid synthesis- Quinolones- Trimethoprim- 5-nitroimidazoles- Rifampicin5. Anti-metabolic activity- Sulphonamides- Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      16.8
      Seconds

  • Question 52 - A new chemotherapy drug is being tested. The intervention reduces the risk of...

    Correct

    • A new chemotherapy drug is being tested. The intervention reduces the risk of death from 10 in 1000 to 5 in 1000. What is the number needed to treat to prevent one death:

      Your Answer: 200

      Explanation:

      Absolute risk reduction (ARR) of treatment = risk of death in control group – risk of death in treatment groupARR = (10/1000) – (5/1000) = 5/1000 = 0.005Number needed to treat (NNT) = 1/ARR = 1/0.005 = 200Therefore 200 people would need to be treated to prevent one extra death.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      22.9
      Seconds

  • Question 53 - After collapsing at home, a 62-year-old man is transported in an ambulance. He...

    Incorrect

    • After collapsing at home, a 62-year-old man is transported in an ambulance. He is now awake, but he is experiencing palpitations and chest pain. He is rushed to resuscitation and placed on a cardiac monitor, which reveals ventricular tachycardia. An amiodarone infusion is set up.Which of these statements about amiodarone is correct?

      Your Answer: It has a short plasma half-life

      Correct Answer: It is expressed in breast milk

      Explanation:

      Antiarrhythmic drug amiodarone is used to treat both ventricular and atrial arrhythmias. It’s a class III antiarrhythmic that works by prolonging the repolarization phase of the cardiac action potential, where potassium permeability is normally high and calcium permeability is low.Dronedarone is sometimes used instead of amiodarone in certain situations. Although amiodarone is more effective than dronedarone, dronedarone has fewer side effects.Grapefruit juice inhibits the metabolism of amiodarone.The plasma half-life of amiodarone is very long, ranging from 2 weeks to 5 months. The half-life is about 2 months on average.Because amiodarone is excreted in breast milk, it should be avoided by breastfeeding mothers.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      13.5
      Seconds

  • Question 54 - A 33 year old lady with a known nut allergy was having dinner...

    Correct

    • A 33 year old lady with a known nut allergy was having dinner at a Thai restaurant. She suddenly complained of lip and tongue swelling and difficulty breathing and is brought to ED by ambulance with suspected anaphylaxis. She received intramuscular adrenaline in the ambulance.The most appropriate doses of the second line treatments for anaphylaxis are which of the following?

      Your Answer: 10 mg chlorphenamine and 200 mg hydrocortisone

      Explanation:

      Second line drugs to reduce the severity and duration of anaphylactic symptoms are intravenous or intramuscular chlorpheniramine and hydrocortisone. The recommended dose is 10 mg chlorpheniramine and 200 mg hydrocortisone in adults.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      10.4
      Seconds

  • Question 55 - The first line drug for oral candidiasis is: ...

    Correct

    • The first line drug for oral candidiasis is:

      Your Answer: Nystatin

      Explanation:

      Treatment for oral candidiasis is with nystatin mouthwash. In unresponsive cases, oral fluconazole is used

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      3.3
      Seconds

  • Question 56 - What kind of function loss do you anticipate in a 22-year-old guy who...

    Incorrect

    • What kind of function loss do you anticipate in a 22-year-old guy who had a laceration to his arm, resulting in nerve damage in the antecubital fossa?

      Your Answer: Extension of fingers

      Correct Answer: Opposition of thumb

      Explanation:

      The symptoms of median nerve injury include tingling or numbness in the forearm, thumb, and three adjacent fingers, as well as gripping weakness and the inability to move the thumb across the palm. Because the thenar muscles and the flexor pollicis longus are paralyzed, flexion, abduction, and opposition of the thumb at the MCPJ and IPJ are gone.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      14
      Seconds

  • Question 57 - A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a...

    Incorrect

    • A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.Which statement about ipratropium bromide is true?

      Your Answer: It is a muscarinic agonist

      Correct Answer: It can trigger acute closed-angle glaucoma

      Explanation:

      Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD. It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists. It can trigger acute closed-angle glaucoma in patients that are susceptible. First-line treatment for moderate asthma attacks is short-acting β2agonists.The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      10.3
      Seconds

  • Question 58 - A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness....

    Correct

    • A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitreOut of the following, which drug is most likely responsible for the baby's condition?

      Your Answer: Lithium

      Explanation:

      In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period. If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly. If given in the 2nd and 3rd-trimesters, there is a risk of the following:1. hypotonia2. lethargy3. feeding problems4. hypothyroidism5. goitre6. nephrogenic diabetes insipidus in the neonate

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      8.9
      Seconds

  • Question 59 - A 22-year-old man arrives at the emergency department with a sore throat, low-grade...

    Correct

    • A 22-year-old man arrives at the emergency department with a sore throat, low-grade fever, and malaise. His partner has infectious mononucleosis, which was recently diagnosed. In this situation, which of the following cells is the most proliferative:

      Your Answer: Lymphocytes

      Explanation:

      Histologic findings in EBV infectious mononucleosis: Oropharyngeal epithelium demonstrates an intense lymphoproliferative response in the cells of the oropharynx. The lymph nodes and spleen show lymphocytic infiltration primarily in the periphery of a lymph node.Relative lymphocytosis (≥ 60%) plus atypical lymphocytosis (≥ 10%) are the characteristic findings of Epstein Barr virus (EBV) infectious mononucleosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      11.4
      Seconds

  • Question 60 - The following statements are not true of the extensor carpi radialis brevis muscle,...

    Incorrect

    • The following statements are not true of the extensor carpi radialis brevis muscle, except?

      Your Answer: It is innervated by the posterior interosseous nerve

      Correct Answer: It receives its blood supply from the radial artery

      Explanation:

      Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      7.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (1/5) 20%
Physiology (4/11) 36%
Microbiology (3/9) 33%
Pathogens (1/5) 20%
Anaesthesia (1/2) 50%
Pharmacology (8/21) 38%
Gastrointestinal (2/3) 67%
Cardiovascular Pharmacology (0/5) 0%
Gastrointestinal Physiology (0/1) 0%
Anatomy (2/9) 22%
Upper Limb (1/5) 20%
Cranial Nerve Lesions (0/1) 0%
Infections (1/2) 50%
Endocrine Physiology (2/2) 100%
Thorax (0/1) 0%
Evidence Based Medicine (1/5) 20%
Statistics (1/3) 33%
Principles (0/1) 0%
Specific Pathogen Groups (2/2) 100%
Immunoglobulins And Vaccines (0/1) 0%
General Pathology (3/3) 100%
Pathology (4/5) 80%
Endocrine (0/1) 0%
CNS Pharmacology (1/3) 33%
Principles Of Microbiology (0/1) 0%
Renal (1/3) 33%
Immunological Products & Vaccines (2/2) 100%
Haematology (0/1) 0%
Lower Limb (1/2) 50%
Respiratory (1/1) 100%
Respiratory Pharmacology (0/1) 0%
Immune Responses (1/1) 100%
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