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  • Question 1 - You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced...

    Correct

    • You're evaluating a 37-year-old woman who is 12 weeks pregnant. She has experienced vaginal bleeding.Which of the following anti-D statements is correct?

      Your Answer: Routine antenatal prophylaxis is recommended for RhD negative women at 28 and 34 weeks

      Explanation:

      Anti-D is an IgG antibody that targets the antigen Rhesus D (RhD). Plasma from rhesus-negative donors who have been immunised against the anti-D-antigen is used to make anti-D immunoglobulin.Only RhD negative women are given Anti-D Ig. Women who are RhD negative do not have the RhD antigen on their RBC. If a foetus has the RhD antigen (i.e. is RhD positive) and the mother is exposed to foetal blood, she may develop antibodies to RhD that pass through the placenta and attack foetal red cells (resulting in newborn haemolytic disease). Anti-D is given to bind and neutralise foetal red cells in the maternal circulation before an immune response is triggered. In the event of a sensitising event, 500 IU Anti-D Ig should be administered intramuscularly. The following are examples of potentially sensitising events:BirthHaemorrhage during pregnancyMiscarriageEctopic pregnancyDeath within the wombAmniocentesisChorionic villus samplingTrauma to the abdomenThe sooner anti-D is given in the event of a sensitising event, the better; however, it is most effective within 72 hours, and the BNF states that it is still likely to have some benefit if given outside of this time frame.At 28 and 34 weeks, RhD negative women should receive routine antenatal prophylaxis. This is regardless of whether they have previously received Anti-D for a sensitising event during the same pregnancy.Prophylactic anti-D is not necessary before 12 weeks gestation, as confirmed by scan, in uncomplicated miscarriage (where the uterus is not instrumented), or mild, painless vaginal bleeding, as the risk of foeto-maternal haemorrhage (FMH) is negligible. In cases of therapeutic termination of pregnancy, whether by surgical or medical means, 250 IU of prophylactic anti-D immunoglobulin should be given to confirmed RhD negative women who are not known to be RhD sensitised.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
      44.8
      Seconds
  • Question 2 - A 40-year-old woman presents with a fever and headache upon returning from an...

    Correct

    • A 40-year-old woman presents with a fever and headache upon returning from an overseas business trip. Upon further investigation, a diagnosis of Plasmodium falciparum malaria was made.All of the following statements is considered true regarding Plasmodium falciparum malaria, except:

      Your Answer: It is commonly the result of travel in the Indian subcontinent

      Explanation:

      The mean incubation period for P. falciparum is 12 days.WHO World Malaria Report 2019 states that an estimated 228 million cases of malaria occurred worldwide in 2018, and reports steadily decreasing the number of cases since 2010. In 2018, nineteen sub-Saharan African countries and India carried approximately 85% of the global malaria burden. The most prevalent and pathogenic malaria parasite, most commonly associated with severe illness and death, especially in the WHO African region, accounting for 99.7% malaria cases, is P. falciparum.The vector for Plasmodium spp. is a female Anopheles mosquito that inoculates sporozoites contained in her salivary glands into the puncture wound when feeding. Sporozoites enter peripheral bloodstream and are uptake by hepatocytes, where they undergo an asexual pre-erythrocytic liver-stage as liver schizonts lasting up to 2 weeks before the onset of the blood stage.Intravenous or intramuscular artesunate is the first-line treatment in all patients worldwide and should be used for at least 24 hours and until the oral medication is tolerated.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      32.2
      Seconds
  • Question 3 - Elevation of the eyeball is primarily produced by which of the following muscles:...

    Incorrect

    • Elevation of the eyeball is primarily produced by which of the following muscles:

      Your Answer: Inferior rectus and superior oblique

      Correct Answer: Superior rectus and inferior oblique

      Explanation:

      Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      27.2
      Seconds
  • Question 4 - Normal saline (sodium chloride 0.9%) contains which of the following: ...

    Correct

    • Normal saline (sodium chloride 0.9%) contains which of the following:

      Your Answer: Sodium and chloride

      Explanation:

      Normal saline (sodium chloride 0.9%) contains:Na+150 mmol/LCl-150 mmol/L

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      6.1
      Seconds
  • Question 5 - A 25-year-old girl just got back from a trip to Northern India. She...

    Incorrect

    • A 25-year-old girl just got back from a trip to Northern India. She complains of headaches and intermittent fever. The fever starts with intense chills, then feels very hot, followed by profuse sweating. She is drowsy and is running a fever of 39.0°C. On examination, there are no palpable lymph nodes or rash seen. She has hepatosplenomegaly. Which one of the following is the most likely diagnosis?

      Your Answer: Chagas disease

      Correct Answer: Malaria

      Explanation:

      Malaria is a protozoal infection of red blood cells and the liver. It is caused by the parasite belonging to the genus Plasmodium. It is transmitted by the female mosquito Anopheles.Several species with distinct features:P. vivax/P. ovaleP. malariaeP. falciparumThe common symptoms of malaria are:Paroxysms of fever – a cyclical occurrence of:1) a cold phase – the patient experiences intense chills2) a hot stage – the patient feels extremely hot3) a sweating stage – the fever declines and the patient sweats profusely- Fever recurs at regular intervals (48hrs, 72hrs): Variable by species of PlasmodiumAnaemia (RBC infection)- Severity varies by species of Plasmodium- Haemolytic: sometimes jaundiceSplenomegalyAlso nonspecific symptoms:- Sweating- fatigue- malaise- arthralgias- headache- Sometimes cough, vomiting, diarrhoea

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      16.7
      Seconds
  • Question 6 - Regarding Clostridium tetani, which of the following statements is CORRECT: ...

    Correct

    • Regarding Clostridium tetani, which of the following statements is CORRECT:

      Your Answer: Metronidazole is usually the antibiotic of choice for tetanus infection.

      Explanation:

      Clostridium tetani infection is predominantly derived from animal faeces and soil.  Clostridium tetani has exotoxin-mediated effects, predominantly by tetanospasmin which inhibits the release of GABA at the presynaptic membrane throughout the central and peripheral nervous system. Metronidazole has overtaken penicillin as the antibiotic of choice for treatment of tetanus (together with surgical debridement, tetanus toxoid immunisation, and human tetanus immunoglobulin).

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      9.1
      Seconds
  • Question 7 - A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.Which...

    Incorrect

    • A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.Which of these statements about anaphylaxis is true?

      Your Answer: Prior exposure to the antigen is not required for it to occur

      Correct Answer: The immunoglobulin-antigen complex binds to Fc receptors on the surface of mast cells.

      Explanation:

      Anaphylaxis is an example of a type I hypersensitivity reaction. It is IgE mediated. It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.Massive calcium influx into the cells leads to mast cell degranulation. The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      19.9
      Seconds
  • Question 8 - You review a 34-year-old man with lower back pain and plan to prescribe...

    Correct

    • You review a 34-year-old man with lower back pain and plan to prescribe him ibuprofen and codeine phosphate. His only past medical history of note is depression, for which he takes fluoxetine.Which of the following scenarios would prompt you to consider the co-prescription of a PPI for gastro-protection? Select ONE answer only.

      Your Answer: Co-prescription of fluoxetine

      Explanation:

      Patients at risk of gastro-intestinal ulceration (including the elderly) who need NSAID treatment should receive gastroprotective treatment. The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:Using maximum recommended dose of an NSAIDAged 65 or olderHistory of peptic ulcer or GI bleedingConcomitant use of medications that increase risk:Low dose aspirinAnticoagulantsCorticosteroidsAnti-depressants including SSRIs and SNRIsRequirements for prolonged NSAID usage:Patients with OA or RA at any ageLong-term back pain if older than 45It is suggested that if required, either omeprazole 20 mg daily or lansoprazole 15-30 mg daily should be the PPIs of choice.This patient is on 400 mg of ibuprofen TDS, but the maximum recommended dose of ibuprofen is 2.4 g daily. Co-prescription of codeine, raised BMI, and a family history of peptic ulceration would also not prompt gastro-protection.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
      21.4
      Seconds
  • Question 9 - A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic...

    Correct

    • A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?

      Your Answer: None of the other options

      Explanation:

      Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:Coronary artery disease (CAD) Coronary artery disease (CAD)  Second stage of labourHypertension that is uncontrolledSevere Ventricular arrhythmias

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      9.4
      Seconds
  • Question 10 - A 53 year old male is found to have megaloblastic anaemia secondary to...

    Correct

    • A 53 year old male is found to have megaloblastic anaemia secondary to folate deficiency. He has a known history of alcohol abuse. Which of the following is characteristic of this condition?

      Your Answer: Increased mean corpuscular volume (MCV)

      Explanation:

      Megaloblastic anaemia occurs when there is inhibition of DNA synthesis as red blood cells are produced. Impairment of DNA synthesis causes the cell cycle to be unable to progress from the growth stage to the mitosis stage. As a result, there is continuous cell growth without division, with an increase in mean corpuscular volume (MCV), which presents as macrocytosis. The most common cause of this defect in red cell DNA synthesis is hypovitaminosis, in particular, vitamin B12 deficiency or folate deficiency.Folate is an essential vitamin that can be found in most foods, and is highest in liver, green vegetables and yeast. 200 – 250 μg is found in the normal daily diet, and about 50% is absorbed. The daily adult requirement is about 100 μg and its absorption is principally from the duodenum and jejunum. Folate stores are normally only adequate for 4 months and so clinical features of folate deficiency usually become evident after this time.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      21.5
      Seconds
  • Question 11 - What is the effect of activated vitamin D on the renal handling of...

    Incorrect

    • What is the effect of activated vitamin D on the renal handling of calcium:

      Your Answer: Increases calcium reabsorption in the proximal tubule

      Correct Answer: Increases calcium reabsorption in the distal tubule

      Explanation:

      Activated vitamin D acts to:GUT:increase calcium and phosphate absorption in the small intestine (the main action)KIDNEYS:increase renal calcium reabsorption (in the distal tubule via activation of a basolateral Ca2+ATPase pump), increase renal phosphate reabsorption, inhibit 1-alpha-hydroxylase activity in the kidneys (negative feedback)PARATHYROID GLANDS:inhibit PTH secretion from the parathyroid glands

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      24.6
      Seconds
  • Question 12 - What is the main mechanism of action of metoclopramide: ...

    Correct

    • What is the main mechanism of action of metoclopramide:

      Your Answer: Dopamine antagonist

      Explanation:

      Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      12.3
      Seconds
  • Question 13 - Mast cells play a significant part in which of the following? ...

    Correct

    • Mast cells play a significant part in which of the following?

      Your Answer: Allergic disease

      Explanation:

      Mast cells play a central role in the response to allergen challenges. The activation of mast cells results in both an early and a delayed phase of inflammation. Mast cells have been implicated in both physiologic and pathogenic processes. Mast cells are important in defence against some bacteria and viruses and contribute to defence against parasites. They are key effector cells in both innate and acquired immunity and are capable of inducing and amplifying both types of responses. Specifically, mast cells are capable of detecting microbial products through surface pattern recognition receptors, and they are involved in the recruitment of other leukocytes, containment of bacterial infections, and tissue repair.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      5.6
      Seconds
  • Question 14 - Which of the following is NOT a notifiable disease: ...

    Incorrect

    • Which of the following is NOT a notifiable disease:

      Your Answer: Food poisoning

      Correct Answer: HIV

      Explanation:

      HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.HIV is not a notifiable disease.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      7.7
      Seconds
  • Question 15 - A patient is diagnosed with a Klebsiella pneumoniae infection.Which SINGLE statement regarding Klebsiella...

    Correct

    • A patient is diagnosed with a Klebsiella pneumoniae infection.Which SINGLE statement regarding Klebsiella pneumoniae is FALSE?

      Your Answer: Species with ESBLs are sensitive to cefotaxime

      Explanation:

      Klebsiellais a genus of non-motile,Gram-negative, rod-shaped bacteriawith a prominent polysaccharide-based capsule. They are routinely found in the nose, mouth and gastrointestinal tract as normal flora, however, they can also behave as opportunistic pathogens.Infections with Klebsiella spp. areusually nosocomial. They are an important cause of ventilator-associated pneumonia (VAP), urinary tract infection, wound infection and bacteraemia. Outbreaks of infections with Klebsiellaspp. in high-dependency units have been described and are associated with septicaemia and high mortality rates. Length of hospital stay and performance of invasive procedures are risk factors forKlebsiellainfections.Primary pneumonia withKlebsiella pneumoniaeis a rare,severe, community-acquired infection associated with a poor outcome.Klebsiella rhinoscleromatis causes a progressive granulomatous infection of the nasal passages and surrounding mucous membranes. This infection is mainly seen in the tropics.Klebsiella ozanae is a recognised cause of chronic bronchiectasis.Klebsiella organisms are resistant to multiple antibiotics including penicillins. This is thought to be a plasmid-mediated property. Agents with high intrinsic activity againstKlebsiellapneumoniaeshould be selected for severely ill patients. Examples of such agents include third-generation cephalosporins (e.g cefotaxime), carbapenems (e.g. imipenem), aminoglycosides (e.g. gentamicin), and quinolones (e.g. ciprofloxacin). These agents may be used as monotherapy or combination therapy. Aztreonam may be used in patients who are allergic to beta-lactam antibiotics.Species with ESBLs (Extended spectrum beta-lactamase) are resistant to penicillins and also cephalosporins such as cefotaxime and ceftriaxone.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      26.1
      Seconds
  • Question 16 - A 43-year-old woman presented to the emergency room after an incident of slipping...

    Correct

    • A 43-year-old woman presented to the emergency room after an incident of slipping and falling onto her back and left hip. Upon physical examination, it was noted that she has pain on hip abduction, but normal hip extension. Which of the following muscles was most likely injured in this case?

      Your Answer: Gluteus medius

      Explanation:

      The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      49
      Seconds
  • Question 17 - A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood...

    Correct

    • A 42-year-old male patient, presenting with polyuria and polydipsia symptoms had normal blood test results. Upon interview, he had mentioned being in a car accident in which he had a head injury. His polyuria and polydipsia symptoms are most likely associated with which of the following conditions?

      Your Answer: Cranial diabetes insipidus

      Explanation:

      Polydipsia is the feeling of extreme thirstiness. It is often linked to polyuria, which is a urinary condition that causes a person to urinate excessively. The cycle of these two processes makes the body feel a constant need to replace the fluids lost in urination. In healthy adults, a 3 liter urinary output per day is considered normal. A person with polyuria can urinate up to 15 liters of urine per day. Both of these conditions are classic signs of diabetes. The other options are also types of diabetes, except for psychogenic polydipsia (PPD), which is the excessive volitional water intake seen in patients with severe mental illness or developmental disability. However, given the patient’s previous head injury, the most likely diagnosis is cranial diabetes insipidus. By definition, cranial diabetes insipidus is caused by damage to the hypothalamus or pituitary gland after an infection, operation, brain tumor, or head injury. And the patient’s history confirms this diagnosis. To define the other choices, nephrogenic diabetes insipidus happens when the structures in the kidneys are damaged and results in an inability to properly respond to antidiuretic hormone. Kidney damage can be caused by an inherited (genetic) disorder or a chronic kidney disorder. As with cranial diabetes insipidus, nephrogenic diabetes insipidus can also cause an elevated urine output. Diabetes mellitus is classified into two types, and the main difference between them is that type 1 diabetes is a genetic disorder, and type 2 diabetes is diet-related and develops over time. Type 1 diabetes is also known as insulin-dependent diabetes, in which the pancreas produces little or no insulin. Type 2 diabetes is termed insulin resistance, as cells don’t respond customarily to insulin.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      15.6
      Seconds
  • Question 18 - Regarding airway resistance, which of the following statements is CORRECT: ...

    Correct

    • Regarding airway resistance, which of the following statements is CORRECT:

      Your Answer: Airway resistance is predominantly determined by the radius of the airway as described by Poiseuille's law.

      Explanation:

      Flow through airways is described by Darcy’s law which states that flow is directly proportional to the mouth-alveolar pressure gradient and inversely proportional to airway resistance. Airway resistance is primarily determined by the airway radius according to Poiseuille’s law, and whether the flow is laminar or turbulent. Parasympathetic stimulation causes bronchoconstriction and sympathetic stimulation causes bronchodilation, but mediated by beta2-adrenoceptors. Muscarinic antagonists e.g. ipratropium bromide cause bronchodilation.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      12.1
      Seconds
  • Question 19 - Reed-Sternberg cells are characteristic of which of the following malignancies: ...

    Correct

    • Reed-Sternberg cells are characteristic of which of the following malignancies:

      Your Answer: Hodgkin lymphoma

      Explanation:

      Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      6.9
      Seconds
  • Question 20 - A 31-year-old man with sickle-cell disease receives a blood transfusion for symptomatic anaemia....

    Incorrect

    • A 31-year-old man with sickle-cell disease receives a blood transfusion for symptomatic anaemia. He presents to the Emergency Department three weeks later with a rash, fever, and diarrhoea. He has pancytopenia and abnormal liver function results on blood tests.Which of the transfusion reactions is most likely to have happened?

      Your Answer: Delayed haemolytic reaction

      Correct Answer: Graft-vs-host disease

      Explanation:

      Blood transfusion can be a life-saving treatment with significant clinical benefits, but it also comes with a number of risks and potential complications, including:Immunological side effectsErrors in administration (episodes of ‘wrong blood’)Viruses and Infections (bacterial, viral, possibly prion)ImmunodilutionA culture of better safety procedures as well as steps to reduce the use of transfusion has emerged as a result of growing awareness of avoidable risk and improved reporting systems. Transfusion errors, on the other hand, continue to occur, and some serious adverse reactions go unreported.Transfusion-associated graft-vs-host disease (TA-GVHD) is a rare blood transfusion complication that causes fever, rash, and diarrhoea 1-4 weeks after the transfusion. Pancytopenia and liver function abnormalities are common laboratory findings.TA-GVHD, unlike GVHD following allogeneic marrow transplantation, causes profound marrow aplasia with a mortality rate of >90%. Survival is uncommon, with death occurring within 1-3 weeks of the onset of symptoms.Because of immunodeficiency, severe immunosuppression, or shared HLA antigens, viable T lymphocytes in blood components are transfused, engraft, and react against the recipient’s tissues, and the recipient is unable to reject the donor lymphocytes.The following is a list of the most common transfusion reactions and complications:1) Reaction to a febrile transfusionThe temperature rises by one degree from the baseline. Chills and malaise are also possible symptoms.The most common response (1 in 8 transfusions).Cytokines from leukocytes in transfused red cell or platelet components are usually to blame.Only supportive. The use of paracetamol is beneficial.2) Acute haemolytic reaction is a type of haemolytic reaction that occurs when theFever, chills, pain at the transfusion site, nausea, vomiting, and dark urine are all symptoms of a transfusion reaction.Early on, many people report a sense of ‘impending doom.’The most serious reaction. ABO incompatibility is frequently caused by a clerical error.STOP THE TRANSFUSION OF INFORMATION. IV fluids should be given. It’s possible that diuretics will be required.3) Haemolytic reaction that is delayedIt usually happens 4 to 8 days after a blood transfusion.Fever, anaemia, jaundice, and haemoglobinuria are all symptoms that the patient has.Positive Coombs test for direct antiglobulin.Because of the low titre antibody, it is difficult to detect in a cross-match, and it is unable to cause lysis at the time of transfusion.The majority of delayed haemolytic reactions are harmless and do not require treatment.Anaemia and renal function should be monitored and treated as needed.4) Reaction to allergensForeign plasma proteins are usually to blame, but anti-IgA could also be to blame.Urticaria, pruritus, and hives are typical allergic reactions. It’s possible that it’s linked to laryngeal oedema or bronchospasm.Anaphylaxis is a rare occurrence.Antihistamines can be used to treat allergic reactions symptomatically. It is not necessary to stop transfusions.If the patient develops anaphylaxis, the transfusion should be stopped and the patient should be given adrenaline and treated according to the ALS protocol.5) TRALI (Transfusion Related Acute Lung Injury)Within 6 hours of transfusion, there was a sudden onset of non-cardiogenic pulmonary oedema.It’s linked to the presence of antibodies to recipient leukocyte antigens in the donor blood.The most common cause of death from transfusion reactions is this.STOP THE TRANSFUSION OF INFORMATION. Oxygen should be given to the patient. Around 75% of patients will require aggressive respiratory support.The use of diuretics should be avoided.6) TACO (Transfusion Associated Circulatory Overload)Acute or worsening respiratory distress within 6 hours of a large blood transfusion. Fluid overload and pulmonary and peripheral oedema can be seen. Rapid blood pressure rises are common. BNP is usually 1.5 times higher than it was before the transfusion. It is most common in the elderly and those who have chronic anaemia.Blood transfusions should be given slowly, over the course of 3-4 hours.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      9.2
      Seconds
  • Question 21 - Blood flows from the left atrium into the left ventricle via: ...

    Correct

    • Blood flows from the left atrium into the left ventricle via:

      Your Answer: The mitral valve

      Explanation:

      Blood flows from the right atrium into the right ventricle via the tricuspid atrioventricular valve and from the left atrium into the left ventricle via the mitral atrioventricular valve. Blood is ejected from the right ventricle through the pulmonary semilunar valve into the pulmonary artery and from the left ventricle via the aortic semilunar valve into the aorta.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      15.2
      Seconds
  • Question 22 - 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
      27.2
      Seconds
  • Question 23 - The extensor digitorum longus is supplied by which nerve? ...

    Incorrect

    • The extensor digitorum longus is supplied by which nerve?

      Your Answer: Tibial nerve

      Correct Answer: Deep peroneal nerve

      Explanation:

      The extensor digitorum longus is innervated by the deep fibular nerve (L5, S1), a branch of the common fibular nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      8.5
      Seconds
  • Question 24 - A 58-year-old patient presents with sputum production and worsening exertional breathlessness. A spirometry...

    Correct

    • A 58-year-old patient presents with sputum production and worsening exertional breathlessness. A spirometry is done and his results leads to a diagnosis of obstructive lung disease with mild airflow obstruction.What FEV1 value would correspond with mild airflow obstruction according to the NICE guidelines?

      Your Answer: FEV 1 >80%

      Explanation:

      Airflow obstruction according to the latest NICE guidelines, is defined as: Mild airflow obstruction = an FEV 1 of >80% in the presence of symptoms Moderate airflow obstruction = FEV 1 of 50-79% Severe airflow obstruction = FEV 1 of 30-49% Very severe airflow obstruction = FEV1<30%.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      13.2
      Seconds
  • Question 25 - Dysuria and urinary frequency are symptoms of a 29-year-old woman. A urine dipstick...

    Incorrect

    • Dysuria and urinary frequency are symptoms of a 29-year-old woman. A urine dipstick is used to detect the presence of blood, protein, leucocytes, and nitrites in the urine. You diagnose a urinary tract infection and give antibiotics to the patient.In the United Kingdom, which of the following antibiotics has the highest percentage of E.coli resistance?

      Your Answer: Ciprofloxacin

      Correct Answer: Trimethoprim

      Explanation:

      In the United Kingdom, antibiotic resistance is becoming a significant factor in the treatment of urinary tract infections and pyelonephritis. E. coli (the main causative organism of both urinary tract infections and acute pyelonephritis) resistance to the following antibiotics in laboratory-processed urine specimens is:30.3 percent trimethoprim (varies by area from 27.1 to 33.4 percent )19.8 percent co-amoxiclav (varies by area from 10.8 to 30.7 percent )Ciprofloxacin (Cipro): 10.6% (varies by area from 7.8 to 13.7 percent )Cefalexin has a concentration of 9.9%. (varies by area from 8.1 to 11.4 percent )

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      24
      Seconds
  • Question 26 - A patient who is taking ramipril for high blood pressure complains of a...

    Correct

    • A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:

      Your Answer: Decreased bradykinin breakdown

      Explanation:

      Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      15
      Seconds
  • Question 27 - Which of the following states that the total pressure exerted by a mixture...

    Correct

    • Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:

      Your Answer: Dalton's law

      Explanation:

      Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      9.8
      Seconds
  • Question 28 - A 23-year-old male presents to his family physician with the complaint of repeated...

    Correct

    • A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia. Which one of the following disorders is this patient most likely to have?

      Your Answer: Paroxysmal nocturnal haemoglobinuria

      Explanation:

      Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight. Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections. Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections. Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      32.2
      Seconds
  • Question 29 - A 29-year-old female with a swollen red finger presents to your clinic and...

    Correct

    • A 29-year-old female with a swollen red finger presents to your clinic and you suspect that the underlying process is of acute inflammation. You request for some bloods investigations.Which statement about histamine as a chemical mediator of the acute inflammatory response is TRUE?

      Your Answer: It increases vascular permeability

      Explanation:

      Histamine increases vascular permeability in the acute inflammatory response.Histamine causes vasodilation.It is released from Mast cells and basophils, eosinophils and platelets. Mast cells and basophils are its primary source Nitric oxide (not histamine) is a major factor in endotoxic shock

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      27.1
      Seconds
  • Question 30 - Which of the following clotting factors is NOT vitamin K-dependent: ...

    Incorrect

    • Which of the following clotting factors is NOT vitamin K-dependent:

      Your Answer: X

      Correct Answer: V

      Explanation:

      Fat-soluble vitamin K is obtained from green vegetables and bacterial synthesis in the gut. Deficiency may present in the newborn (haemorrhagic disease of the newborn) or in later life. Deficiency may be caused by an inadequate diet, malabsorption or inhibition of vitamin K by drugs such as warfarin. The activity of factors II, VII, IX and X are vitamin K dependent as well as that of protein C and protein S. Both PT and APTT are prolonged.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Immunological Products & Vaccines (1/1) 100%
Pharmacology (6/8) 75%
Microbiology (3/4) 75%
Specific Pathogen Groups (2/3) 67%
Anatomy (1/3) 33%
Head And Neck (0/1) 0%
Fluids And Electrolytes (1/1) 100%
Pathogens (1/1) 100%
General Pathology (1/2) 50%
Pathology (5/8) 63%
Musculoskeletal Pharmacology (1/1) 100%
Respiratory Pharmacology (1/1) 100%
Haematology (3/5) 60%
Endocrine (0/1) 0%
Physiology (5/6) 83%
Central Nervous System (1/1) 100%
Immune Responses (1/1) 100%
Infections (0/2) 0%
Lower Limb (1/2) 50%
Renal Physiology (1/1) 100%
Respiratory (2/2) 100%
Cardiovascular (2/2) 100%
Evidence Based Medicine (0/1) 0%
Statistics (0/1) 0%
Respiratory Physiology (1/1) 100%
Passmed