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  • Question 1 - Which of the following drugs is first line treatment for a stable regular...

    Incorrect

    • Which of the following drugs is first line treatment for a stable regular broad-complex tachycardia:

      Your Answer: Adenosine

      Correct Answer: Amiodarone

      Explanation:

      A regular broad-complex tachycardia is likely to be ventricular tachycardia or a regular supraventricular rhythm with bundle branch block. 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. If previously confirmed as SVT with bundle branch block, the patient should be treated as for narrow-complex tachycardia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      13.7
      Seconds
  • Question 2 - Adrenocorticotropic hormone release from the anterior pituitary is stimulated by which of the...

    Correct

    • Adrenocorticotropic hormone release from the anterior pituitary is stimulated by which of the following:

      Your Answer: Corticotropin-releasing hormone

      Explanation:

      ACTH secretion is stimulated by corticotropin-releasing hormone (CRH) from the hypothalamus.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      46.7
      Seconds
  • Question 3 - A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain,...

    Correct

    • A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain, and breathlessness. A bedside echocardiogram was performed and revealed a large pericardial effusion. Due to this finding, a pericardiocentesis was to be performed.Which of the following statements is considered true regarding pericardiocentesis?

      Your Answer: The needle should be aimed at the midpoint of the left clavicle

      Explanation:

      Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      59.1
      Seconds
  • Question 4 - Regarding hepatitis A, which of the following statements is CORRECT: ...

    Correct

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

      Your 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
      85
      Seconds
  • Question 5 - Which of the following statements about neutrophils is TRUE: ...

    Correct

    • Which of the following statements about neutrophils is TRUE:

      Your Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.

      Explanation:

      Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      23
      Seconds
  • Question 6 - A 71-year-old man treated with antibiotics for a chest infection returns with a...

    Incorrect

    • A 71-year-old man treated with antibiotics for a chest infection returns with a profuse, offensive smelling diarrhoea. A diagnosis of Clostridium difficile diarrhoea is made after investigations.Which antibiotic is associated with the greatest risk of causing Clostridium Difficile diarrhoea?

      Your Answer: Doxycycline

      Correct Answer: Ciprofloxacin

      Explanation:

      Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile infection (CDI) occurs. About 80% of Clostridium Difficile infections are seen in people over the age of 65 and its main clinical features are:Abdominal cramps, severe bloody and/or watery diarrhoea, offensive smelling diarrhoea, and fever. CDI is the most severe consequence of antibiotic treatment and is a major cause of morbidity and mortality. Risk for CDI has been found to be greatest with clindamycin followed by fluoroquinolones Tetracyclines are not associated with risk for CDI.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      226.4
      Seconds
  • Question 7 - Which of the following nerves is responsible for the symptoms of a patient...

    Correct

    • Which of the following nerves is responsible for the symptoms of a patient who presented with ophthalmic herpes zoster and a few vesicles on the nose?

      Your Answer: Trigeminal nerve

      Explanation:

      Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve. The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      14.3
      Seconds
  • Question 8 - Captopril should not be used if you have any of the following conditions:...

    Correct

    • Captopril should not be used if you have any of the following conditions:

      Your Answer: Renal artery stenosis

      Explanation:

      Contraindications indications of Captopril include:- Bilateral renal artery stenosis- Hypersensitivity to ACE inhibitors- Anuria- History of ACEI-induced angioedema- Hereditary or idiopathic angioedema- Co-administration of Neprilysin inhibitors (e.g., sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan.If ACE inhibitors are used, they should be initiated only under specialist supervision and renal function should be monitored regularly. ACE inhibitors should also be used with particular caution in patients who may have undiagnosed and clinically silent renovascular disease. This includes patients with peripheral vascular disease or those with severe generalised atherosclerosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      40.4
      Seconds
  • Question 9 - A man working as a waiter cuts his arm on a glass while...

    Incorrect

    • A man working as a waiter cuts his arm on a glass while he was working. The palmaris longus muscle was damaged as a consequence of his injury.Which of the following statements regarding the palmaris longus muscle is considered correct?

      Your Answer: Damage to it will cause a significant functional deficit at the wrist

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

      Explanation:

      The palmaris longus is a small, fusiform-shaped muscle located on the anterior forearm of the human upper extremity. The palmaris longus muscle is commonly present but may be absent in a small percentage of the population, ranging from 2.5% to 26% of individuals, depending on the studied population.The palmaris longus belongs to the anterior forearm flexor group in the human upper extremity. The muscle attaches proximally to the medial humeral epicondyle and distally to the palmar aponeurosis and flexor retinaculum. The blood supply to the palmaris longus muscle is via the ulnar artery, a branch of the brachial artery in the human upper extremity.The palmaris longus muscle receives its innervation via branches of the median nerve containing nerve roots C5-T1. Median nerve injury at or above the elbow joint (including brachial plexus and nerve root injury) can lead to deficits in the palmaris longus and other forearm flexor muscles, leading to weakened elbow flexion, wrist flexion, radial deviation, finger flexion, thumb opposition, flexion, and abduction, in addition to the loss of sensory function in the distribution of the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      53.6
      Seconds
  • Question 10 - A 25-year-old female arrives at the emergency room with a severe case of asthma....

    Correct

    • A 25-year-old female arrives at the emergency room with a severe case of asthma. When she doesn't seem to be improving after initial treatment, you decide to start an aminophylline infusion.From the options below, which is Aminophylline's main mechanism of action? 

      Your Answer: Phosphodiesterase inhibition

      Explanation:

      Theophylline and Ethylenediamine are combined in a 2:1 ratio to form Aminophylline. Its solubility is improved by the addition of Ethylenediamine. It has a lower potency and a shorter duration of action than Theophylline.It is used to treat the following conditions: Heart failureIt is used to treat the following conditions: COPDBradycardiasAminophylline has the following properties:Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.It has slight positive inotropic and chronotropic effects, increasing cardiac output and decreasing systemic vascular resistance, lowering arterial blood pressure. It has been used historically in the treatment of refractory heart failure and is indicated by the current ALS guidelines as a substitute treatment for bradycardia. The daily oral dose for adults is 900 mg, divided into 2-3 doses. For severe asthma or COPD, a loading dosage of 5 mg/kg over 10-20 minutes is given, followed by a continuous infusion of 0.5 mg/kg/hour. The therapeutic range is small (10-20 microgram/ml), hence assessments of aminophylline plasma concentrations are useful during long-term treatment.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      25.7
      Seconds
  • Question 11 - What is the interquartile range of the following data set: 5, 10, 15,...

    Incorrect

    • What is the interquartile range of the following data set: 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70

      Your Answer: 35

      Correct Answer: 30

      Explanation:

      5, 10, 15 /20, 25, 30 /35, 40, 45 /50, 60, 70Sample size (n) = 12Median = [(n+1)/2]th value = (12+1)/2 = 6.5 = halfway between 6th and 7th value = (30 +35)/2 = 32.5The lower (first) quartile = halfway between 15 and 20 = 17.5The upper (third) quartile = halfway between 45 and 50 = 47.5The interquartile range is the difference between the upper quartile and lower quartile = 47.5 – 17.5 = 30

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      30.1
      Seconds
  • Question 12 - Which of the following statements is correct with regards to immunoglobulin? ...

    Incorrect

    • Which of the following statements is correct with regards to immunoglobulin?

      Your Answer: Only the heavy chain has a variable region, the light chain is constant.

      Correct Answer: The isotype of immunoglobulin is determined by the heavy chain.

      Explanation:

      The composition of immunoglobulin molecules is two identical heavy and two identical light chains. These chains are linked by disulphide bridges and are each have highly variable regions which give the immunoglobulin its specificity. In addition, they have constant regions and there is virtual complete correspondence in amino acid sequence in all antibodies of a given isotype. Five isotypes of immunoglobulin exist – these are IgG, IgA, IgM, IgE and IgD. They are determined by the heavy chain (gamma, alpha, mu, epsilon or delta respectively). The light chains are either kappa or lambda.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      100.5
      Seconds
  • Question 13 - Identify the type of graph described below: A graph that is a useful summary...

    Incorrect

    • Identify the type of graph described below: A graph that is a useful summary of a set of bivariate data (two variables), usually drawn before working out a linear correlation coefficient or fitting a regression line.

      Your Answer: Forest plot

      Correct Answer: Scatterplot

      Explanation:

      A scatterplot is a useful summary of a set of bivariate data (two variables), usually drawn before working out a linear correlation coefficient or fitting a regression line. It gives a good visual picture of the relationship between the two variables, and aids the interpretation of the correlation coefficient or regression model. Each unit contributes one point to the scatterplot, on which points are plotted but not joined. The resulting pattern indicates the type and strength of the relationship between the two variables.

    • This question is part of the following fields:

      • Evidence Based Medicine
      32.3
      Seconds
  • Question 14 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Incorrect

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer: 0.5 ml of 1 in 10,000 adrenaline solution

      Correct Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm. IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm. For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      16.4
      Seconds
  • Question 15 - Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding Campylobacter gastroenteritis, which of the following statements is INCORRECT:

      Your Answer: It is associated with the subsequent development of Reiter's syndrome.

      Correct Answer: Infection usually requires antibiotic treatment.

      Explanation:

      Campylobacter jejuni is the primary human pathogen, typically causing dysentery (bloody diarrhoea illness) following ingestion of contaminated meat, especially poultry. Infection is typically self-limiting and does not require antibiotic therapy. Campylobacter gastroenteritis is associated with the immune-mediated complications of Guillain-Barre syndrome, reactive arthritis and Reiter’s syndrome.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      67.6
      Seconds
  • Question 16 - A 72-year-old man has a past medical history of diverticular disease. He now...

    Correct

    • A 72-year-old man has a past medical history of diverticular disease. He now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, you do not agree with this medication, as you can see on his chart that the patient has several other comorbidities. Out of the following, what is NOT a contraindication to using hyoscine butyl bromide?

      Your Answer: Prostatic hyperplasia

      Explanation:

      Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.It has the following contraindications: 1. Closed-angle glaucoma2. Gastrointestinal obstruction3. Intestinal atony4. Paralytic ileus5. Toxic megacolon6. Severe ulcerative colitis7. Significant bladder outflow obstruction8. Urinary retention9. Myasthenia gravisUse cautiously in the following conditions: 1. Acute myocardial infarction (in adults)2. Arrhythmias (may be worsened)3. Autonomic neuropathy4. Hypertension5. Cardiac insufficiency (due to association with tachycardia)6. Congestive cardiac failure (maybe worsened)7. Cardiac surgery (due to association with tachycardia)8. Gastro-oesophageal reflux disease9. Ulcerative colitis10. Prostatic hyperplasia11. Use in children (increased risk of side effects)

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      58.4
      Seconds
  • Question 17 - Regarding the cardiac cycle, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding the cardiac cycle, which of the following statements is INCORRECT:

      Your Answer: The length of diastole decreases with increasing heart rate.

      Correct Answer: The second heart sound occurs in late diastole caused by closure of the atrioventricular valves.

      Explanation:

      Diastole is usually twice the length of systole at rest, but decreases with increased heart rate. During systole, contraction of the ventricles compresses the coronary arteries and suppresses blood flow. This is particularly evident in the left ventricle, where during systole the ventricular pressure is the same as or greater than that in the arteries and as a result more than 85% of left ventricular perfusion occurs during diastole. This becomes a problem if the heart rate is increased as the diastolic interval is shorter and can result in ischaemia. The second heart sound, caused by closure of the semilunar valves, marks the end of systole.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      53.1
      Seconds
  • Question 18 - The QRS duration of a broad-complex tachyarrhythmia is: ...

    Incorrect

    • The QRS duration of a broad-complex tachyarrhythmia is:

      Your Answer: Greater than 0.12 s

      Correct Answer: Greater than or equal to 0.12 s

      Explanation:

      It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.  

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      10
      Seconds
  • Question 19 - Which of the following is most likely affected in De Quervain's tenosynovitis? ...

    Correct

    • Which of the following is most likely affected in De Quervain's tenosynovitis?

      Your Answer: Extensor pollicis brevis

      Explanation:

      De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. It is a condition which involves tendon entrapment affecting the first dorsal compartment of the wrist. With this condition thickening of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis develops where the tendons pass in through the fibro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial and ulnar deviation of the wrist.The estimated prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties. It may be seen more commonly in individuals with a history of medial or lateral epicondylitis. Bilateral involvement is often reported in new mothers or child care providers in whom spontaneous resolution typically occurs once lifting of the child is less frequent.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      107.4
      Seconds
  • Question 20 - 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
      40.2
      Seconds
  • Question 21 - A 18 year old with known asthma presents himself to ED with acute...

    Incorrect

    • A 18 year old with known asthma presents himself to ED with acute breathlessness and wheeze for the past 20 minutes. On examination he is tachypneic and tachycardic. His oxygen saturations are 96% on air. What is the first line treatment for acute asthma:

      Your Answer: Oxygen

      Correct Answer: Salbutamol

      Explanation:

      High-dose inhaled short-acting beta2-agonists are the first line treatment for acute asthma(salbutamol or terbutaline). Oxygen should only been given to hypoxaemic patients (to maintain oxygen saturations of 94 – 98%). A pressurised metered dose inhaler with spacer device is preferred in patients with moderate to severe asthma (4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs, whole process repeated every 10 – 20 minutes if necessary). The oxygen-driven nebuliser route is recommended for patients with life-threatening features or poorly responsive severe asthma (salbutamol 5 mg at 15 – 30 minute intervals). Continuous nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose (salbutamol at 5 – 10 mg/hour) The intravenous route should be reserved for those in whom inhaled therapy cannot be used reliably.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      28.4
      Seconds
  • Question 22 - A 52-year old male comes to the out-patient department for a groin mass...

    Incorrect

    • A 52-year old male comes to the out-patient department for a groin mass that protrudes when standing. The patient notes that it is reducible when lying down. On physical examination, there is presence of a cough impulse. The initial assessment is hernia. Further investigation reveals that the mass lies lateral to the epigastric vessels.Among the types of hernia, which is the most likely diagnosis of the case above?

      Your Answer: Incisional hernia

      Correct Answer: Indirect inguinal hernia

      Explanation:

      Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.Groin hernias are categorized into 2 main categories: inguinal and femoral.Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      48.5
      Seconds
  • Question 23 - Regarding the flexor digitorum profundus muscle, which of the following is true? ...

    Correct

    • Regarding the flexor digitorum profundus muscle, which of the following is true?

      Your Answer: The medial aspect of the muscle is innervated by the ulnar nerve

      Explanation:

      Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.Flexor digitorum profundus has a dual innervation:(1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);(2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      35
      Seconds
  • Question 24 - A 36-year-old man presented to the emergency room with a two-week history of...

    Incorrect

    • A 36-year-old man presented to the emergency room with a two-week history of shortness of breath, fevers, and malaise. A chest X-ray was ordered and the results confirmed the diagnosis of a right middle lobe pneumonia. Which of the following structures of the heart lies closest to the consolidation?

      Your Answer: Apex

      Correct Answer: Right atrium

      Explanation:

      In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:Anterior (or sternocostal) – Right ventriclePosterior (or base) – Left atriumInferior (or diaphragmatic) – Left and right ventriclesRight pulmonary – Right atriumLeft pulmonary – Left ventricleThe silhouette sign of Felson is with respect to the right middle lobe. The right heart border should have a distinct appearance due to the right atrium abutting aerated right middle lobe. The consolidation in the right middle lobe has resulted in loss of this silhouette.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      28.5
      Seconds
  • Question 25 - You see a patient in the ED with photophobia, petechial rash, headache and...

    Incorrect

    • You see a patient in the ED with photophobia, petechial rash, headache and neck stiffness, and suspect a diagnosis of meningococcal meningitis.What is the most appropriate initial management?

      Your Answer: Perform an LP and await results of Gram-staining

      Correct Answer: Give ceftriaxone 2 g IV

      Explanation:

      Treatment should be commenced with antibiotics immediately before laboratory confirmation due to the potentially life-threatening nature of the disease.In a hospital setting, 2g of IV ceftriaxone (80 mg/kg for a child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the drugs of choice. In the prehospital setting, IM benzylpenicillin can be given as an alternative.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      74.9
      Seconds
  • Question 26 - The cutaneous circulation's principal role is thermoregulation. This process is aided by the...

    Incorrect

    • The cutaneous circulation's principal role is thermoregulation. This process is aided by the existence of arteriovenous anastomoses.Which of the following anatomical areas has the greatest number of arteriovenous anastomoses? 

      Your Answer: Buttocks

      Correct Answer: Pinna of the ear

      Explanation:

      Short vessels called arteriovenous anastomoses (AVAs) link tiny arteries and veins. They have a large lumen diameter. The strong and muscular walls allow AVAs to completely clog the vascular lumen, preventing blood flow from artery to vein (acting like a sphincter). When the AVAs open, they create a low-resistance connection between arteries and veins, allowing blood to flow into the limbs’ superficial venous plexuses. There is no diffusion of solutes or fluid into the interstitium due to their strong muscle walls.AVAs are densely innervated by adrenergic fibres from the hypothalamic temperature-regulation centre. High sympathetic output occurs at normal core temperatures, inducing vasoconstriction of the AVAs and blood flow through the capillary networks and deep plexuses. When the temperature rises, sympathetic output decreases, producing AVA vasodilation and blood shunting from the artery to the superficial venous plexus. Heat is lost to the environment as hot blood rushes near to the skin’s surface.AVAs are a specialized anatomical adaptation that can only be found in large quantities in the fingers, palms, soles, lips, and pinna of the ear.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      32.6
      Seconds
  • Question 27 - One of these statements about significance tests is true. ...

    Incorrect

    • One of these statements about significance tests is true.

      Your Answer: Statistical significance is the same as clinical significance

      Correct Answer: A p value of less than 1 in 20 is considered ‘statistically significant’

      Explanation:

      The p value is statistically significant when it is less than 0.05 (5% or 1 in 20).Statistical significance is not the same as clinical significance. The null hypothesis states that there is no difference between the groups.The power of a study is the probability of correctly rejecting the null hypothesis when it is false.A type I error occurs when the null hypothesis has been rejected when it is true. A type II error occurs when the null hypothesis has been accepted when it is actually false.

    • This question is part of the following fields:

      • Evidence Based Medicine
      10.3
      Seconds
  • Question 28 - A 30-year-old male with a known allergy to natural latex rubber presents with...

    Incorrect

    • 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: Pear

      Correct 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
      38.4
      Seconds
  • Question 29 - Which of the following statements is incorrect regarding the electron transfer system? ...

    Correct

    • Which of the following statements is incorrect regarding the electron transfer system?

      Your Answer: The electron transfer system occurs in anaerobic respiration.

      Explanation:

      The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      15.9
      Seconds
  • Question 30 - Which of the following types of food is most commonly implicated in anaphylactic...

    Incorrect

    • Which of the following types of food is most commonly implicated in anaphylactic reactions:

      Your Answer: Eggs

      Correct Answer: Nuts

      Explanation:

      Anaphylaxis can be triggered by any of a very broad range of triggers, but those most commonly identified include food, drugs, latex and venom. Of foods, nuts are the most common cause; muscle relaxants, antibiotics, NSAIDs and aspirin are the most commonly implicated drugs. Food is the commonest trigger in children and drugs the commonest in adults. A significant number of cases are idiopathic. Most reactions occur over several minutes; rarely, reactions may be slower in onset. The speed of onset of the reaction depends on the trigger e.g. intravenous medications will cause a more rapid onset than stings which in turn will cause a more rapid onset than ingestion of food.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      18.5
      Seconds

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