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Question 1
Incorrect
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You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.Which SINGLE statement regarding mannitol is true?
Your Answer: It crosses the blood-brain-barrier
Correct Answer: It is irritant to veins and causes phlebitis
Explanation:Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:Decreasing the rate of CSF formation,and;Withdrawing extracellular fluid from the brain across the BBBOther uses of mannitol include:Short-term management of glaucomaTreatment of rhabdomyolysisPreserve renal function in peri-operative jaundiced patientsTo initiate diuresis in transplanted kidneysBowel preparation prior to colorectal proceduresThe recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:AnuriaIntracranial bleeding (except during craniotomy)Severe cardiac failureSevere dehydrationSevere pulmonary oedema
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 2
Correct
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Regarding carbon dioxide transport in the blood, which of the following statements is CORRECT:
Your Answer: Deoxygenated haemoglobin acts as a buffer for H+ ions.
Explanation:CO2generated in the tissues and water combine to form carbonic acid which readily dissociates to form HCO3-and H+. The first part of this reaction is very slow in plasma, but is accelerated dramatically by the enzyme carbonic anhydrase present in red blood cells. Bicarbonate is therefore formed preferentially in red cells, from which it freely diffuses down its concentration gradient into plasma where it is transported to the lungs. The red cell membrane is impermeable to H+ions which remain in the cell. To maintain electroneutrality, Cl-ions diffuse into the cell to replace HCO3-, an effect known as the chloride shift. Deoxygenated haemoglobin acts as a buffer for H+, allowing the reaction to continue.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 3
Incorrect
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A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone. Which one of the following conditions will this woman NOT have?
Your Answer: Peripheral neuropathy
Correct Answer: Xanthopsia
Explanation:Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias. Side effects include:1. pulmonary fibrosis2. blue discolouration of the skin3. phototoxicity4. corneal deposits5. hepatic necrosis6. thyroid dysfunction7. sleep disturbances8. peripheral neuropathy. Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 4
Correct
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Which of the following is NOT a common side effect of adenosine:
Your Answer: Yellow vision
Explanation:Common side effects of adenosine include:ApprehensionDizziness, flushing, headache, nausea, dyspnoeaAngina (discontinue)AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur)
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 5
Incorrect
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Which of the following body location is the appropriate site to apply pressure when performing a carotid sinus massage?
Your Answer: Cricoid cartilage
Correct Answer: Thyroid cartilage
Explanation:The common carotid artery runs through the neck and divides into internal and external carotid arteries on both sides near the upper thyroid cartilage. In emergency situations, carotid sinus massage is also used to diagnose or treat paroxysmal supraventricular tachycardia. During the procedure, to maximize access to the carotid artery, the patient is put in a supine position with the neck extended (i.e. elevating the chin away from the chest). The carotid sinus is normally positioned inferior to the angle of the jaw, near the arterial impulse, at the level of the thyroid cartilage. For 5 to 10 seconds, pressure is administered to one carotid sinus. Although pulsatile pressure applied in a vigorous circular motion may be more effective, continuous pressure is preferred since it is more reproducible. If the predicted reaction is not obtained, the operation is repeated on the opposite side after a one- to two-minute wait.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 6
Correct
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A 20-year-old male who is a known patient of sickle cell disease presents to the Emergency Room with a sustained erection that is extremely painful. Out of the following clinical syndromes, which one does this patient most likely have?
Your Answer: Priapism
Explanation:Sickling of red blood cells can lead to several different clinical syndromes. If the sickling occurs in the corpora cavernosa, it can lead to a sustained, painful erection of the penis, referred to as priapism. One of the complications is long-term impotence. It is important to seek a urological opinion immediately in this case, but in the interim, treat with perineal ice packs and walk up and down the stairs.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 7
Correct
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A 44-year-old man with an acute episode of gout presents to you and you discuss treatment plan with him.Which one of these statements concerning the treatment of acute gout is true?
Your Answer: A common first-line treatment is Naproxen as a stat dose of 750 mg followed by 250 mg TDS
Explanation:High-dose NSAIDs are the first-line treatment for acute gout. In the absence of any contraindications, Naproxen 750 mg as a stat dose followed by 250 mg TDS is commonly used.Aspirin is contraindicated in gout. It reduces the urinary clearance of urate and also interferes with the action of uricosuric agents. Colchicine is preferred in patients with heart failure or in those who are intolerant of NSAIDs. It is as effective as NSAIDs in relieving acute attacks.Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. Where Allopurinol is not tolerated, it has a role in prophylactic treatment of gout.Allopurinol should not be started in the acute phase of gout as it increases the severity and duration of symptoms. It is used as a prophylaxis in preventing future attacks and acts by reducing serum uric acid levels.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 8
Incorrect
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You've been requested to give a discussion to a group of medical students about cardiovascular physiology. One of them inquires about cardiac output and asks if you can explain it.Which of the following statements is correct?
Your Answer: An average resting cardiac output in a man is 6 L/min
Correct Answer: An average resting cardiac output in a woman is 5 L/min
Explanation:The terminology cardiac output refers to the amount of blood pumped by the heart in one minute. Women’s rates are around 5 L/min, whereas men’s rates are somewhat higher, around 5.5 L/min.Cardiac output (CO) is calculated by multiplying stroke volume (SV) by heart rate (HR):CO = HR x SVAs a result, both stroke volume and heart rate are exactly proportional to cardiac output. There will be an increase in cardiac output if the stroke volume or heart rate increases, and a reduction in cardiac output if the stroke volume or heart rate lowers.
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This question is part of the following fields:
- Cardiovascular Physiology
- Physiology
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Question 9
Correct
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Where on the body is the radial artery pulsation best palpated?
Your Answer: At the wrist just lateral to the flexor carpi radialis tendon
Explanation:The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 10
Correct
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A patient who shows symptoms of infection and is admitted under supervision of the medical team. The organism which caused this, is a Gram-negative bacterium, according to the culture. A penicillin therapy is suggested by the microbiologist.Which of the penicillins listed below is the most effective against Gram-negative bacteria?
Your Answer: Amoxicillin
Explanation:Amoxicillin and Ampicillin are more hydrophilic (broad-spectrum) penicillins than benzylpenicillin and phenoxymethylpenicillin. Because they may penetrate through gaps in the outer phospholipid membrane, they are effective against Gram-negative bacteria. Amoxicillin and Ampicillin are resistant to penicillinase-producing microbes.Community-acquired pneumonia, otitis media, sinusitis, oral infections, and urinary tract infections are among the most prevalent conditions for which they are prescribed. The normal adult oral dose of Amoxicillin is 500 mg three times/day, which can be increased to 1 g three times/day if necessary. Ampicillin is given to adults in doses of 0.5-1 g every 6 hours.
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This question is part of the following fields:
- Infections
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
