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Question 1
Incorrect
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A 64-year-old man presents with an acute episode of gout. He has a history of chronic heart failure and hypertension. His current medications include ramipril and furosemide.Which of the following statements regarding the treatment of gout is true? Select ONE answer only.
Your Answer: NSAIDs are the treatment of choice for patients with a history of heart failure
Correct Answer: Colchicine has a role in prophylactic treatment
Explanation:In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 2
Correct
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A new blood test is being developed to diagnose DVT. 1000 people presenting to ED with suspected DVT undergo the new blood test and the gold standard doppler ultrasound to confirm the diagnosis. Of the 1000 people, 77 are confirmed to have a DVT. Of the patients diagnosed with DVT, 75 test positive with the new diagnostic test and of the patients not diagnosed with DVT, 125 test positive with the new diagnostic test. What is the positive predictive value of this test:DVT YesDVT NoTotalPositive testa= 75b = 125200Negative testc = 2d = 798800Total779231000
Your Answer: 0.375
Explanation:Positive predictive value (PPV) is the proportion of individuals with a positive test result who actually have the disease.Positive predictive value (PPV) = a/(a+b) = 75/200= 0.375 = 37.5%This means there is a 37.5% chance, if the test is positive, that the patient actually has a DVT.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 3
Incorrect
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Gastrin release from antral G-cells is stimulated by all but which one of the following:
Your Answer: Vagal stimulation
Correct Answer: Secretin
Explanation:Gastrin secretion is stimulated by: The presence of small peptides and amino acids in chymeGastric distensionVagal stimulation directly via acetylcholine and indirectly via gastrin-releasing peptide (GRP)Raised gastric pH
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 4
Incorrect
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A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs. Which one is a nucleic acid synthesis inhibitor?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.The following is a summary of the many modes of action of various types of antimicrobial agents:Action Mechanisms-Â Examples:Cell wall production is inhibitedVancomycinVancomycinCephalosporinsThe function of the cell membrane is disrupted NystatinPolymyxinsAmphotericin BÂ Inhibition of protein synthesisChloramphenicolMacrolidesAminoglycosidesTetracyclinesNucleic acid synthesis inhibitionQuinolonesTrimethoprimRifampicin5-nitroimidazolesSulphonamidesAnti-metabolic activityIsoniazid
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 5
Incorrect
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An 18-year-old patient was brought to the ER after falling off of his skateboard. He is unable to flex the distal interphalangeal joint of his index finger. You suspect that he suffers from a supracondylar fracture. Which of the following conditions would confirm supracondylar fracture?
Your Answer:
Correct Answer: Inability to oppose the thumb
Explanation:A supracondylar fracture is a fracture that occurs through the thin section of the distal humerus above the growth plate. A supracondylar fracture is most usually associated with median nerve injury. A medial nerve damage causes paralysis of the thenar muscles, as well as loss of thumb opposition.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 6
Incorrect
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Which of the following muscles is NOT involved in depression of the mandible:
Your Answer:
Correct Answer: Masseter
Explanation:Depression of the mandible is generated by the digastric, geniohyoid, mylohyoid and lateral pterygoid muscles on both side, assisted by gravity. The lateral pterygoid muscles are also involved as this movement also involves protraction of the mandible. The masseter muscle is a powerful elevator of the mandible.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 7
Incorrect
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What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer:
Correct Answer: Beta1-receptor agonist
Explanation:Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 8
Incorrect
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A new test is being developed to diagnose chlamydia. 1000 people aged 15 – 35 years attending a GUM clinic undergo the new test and the current gold standard nucleic acid amplification test (NAAT) to confirm the diagnosis. Of the 1000 people, 250 are diagnosed with chlamydia. Of the patients diagnosed with chlamydia, 240 test positive with the new diagnostic test and of the patients not diagnosed with chlamydia, 150 test positive with the new diagnostic test. What is the negative predictive value of this test:Chlamydia YesChlamydia NoTotalPositive testa= 240b = 150390Negative testc = 10d = 600610Total2507501000
Your Answer:
Correct Answer: 0.98
Explanation:Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.Negative predictive value (NPV) = d/(c+d) = 600/610 = 0.98 = 98%This means there is a 98% chance, if the test is negative, that the patient does not have chlamydia.
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This question is part of the following fields:
- Evidence Based Medicine
- Statistics
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Question 9
Incorrect
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A young male has presented to you with respiratory depression and small pupils on examination. You diagnose opioid overdose and immediately start therapy with Naloxone.Which of the following statements is TRUE regarding naloxone?
Your Answer:
Correct Answer: It can be given by a continuous infusion if repeated doses are required
Explanation:Naloxone is a short-acting, specific antagonist of mu(μ)-opioid receptors. It is used to reverse the effects of opioid toxicity. It can be given by a continuous infusion if repeated doses are required and the infusion rate is adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.Naloxone has a shorter duration of action (6-24 hours) than most opioids and so close monitoring according to the respiratory rate and depth of coma and repeated injections are necessary. When repeated doses are needed in opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.An initial dose of 0.4 to 2 mg can be given intravenously and can be repeated at 2 to 3-minute intervals to a maximum of 10mg. If the intravenous route is inaccessible, naloxone can be administered via an IO line, subcutaneously (SQ), IM, or via the intranasal (IN) route.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 10
Incorrect
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You're currently treating an infection in a patient and trying to figure out which antibiotic would be best.Which of the following antimicrobial drugs inhibits the formation of cell walls?
Your Answer:
Correct Answer: Cefuroxime
Explanation:Cefuroxime and other cephalosporin antibiotics are bactericidal ĂŸ-lactam antibiotics. They work similarly to penicillins in that they prevent cross-linking between the linear peptidoglycan polymer chains that make up the bacterial cell wall. As a result, they prevent the formation of cell walls.The following is a summary of the various mechanisms of action of various types of antimicrobial agents:1) Inhibition of cell wall synthesisPenicillinsCephalosporinsVancomycin2) Disruption of cell membrane functionPolymyxinsNystatinAmphotericin B3) Inhibition of protein synthesisMacrolidesAminoglycosidesTetracyclinesChloramphenicol4) Inhibition of nucleic acid synthesisQuinolonesTrimethoprim5-nitroimidazolesRifampicin5) Anti-metabolic activitySulphonamidesIsoniazid
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 11
Incorrect
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Which of the following statements is correct regarding paracetamol?
Your Answer:
Correct Answer: Liver damage peaks 3 to 4 days after paracetamol ingestion.
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 12
Incorrect
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Regarding haemoglobin, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Haemoglobin synthesis occurs in mature erythrocytes.
Explanation:Haemoglobin is composed of four polypeptide globin chains each with its own iron containing haem molecule. Haem synthesis occurs largely in the mitochondria by a series of biochemical reactions commencing with the condensation of glycine and succinyl coenzyme A under the action of the key rate-limiting enzyme delta-aminolevulinic acid (ALA) synthase. The globin chains are synthesised by ribosomes in the cytosol. Haemoglobin synthesis only occurs in immature red blood cells.There are three types of haemoglobin in normal adult blood: haemoglobin A, A2 and F:- Normal adult haemoglobin (HbA) makes up about 96 – 98 % of total adult haemoglobin, and consists of two alpha (α) and two beta (β) globin chains. – Haemoglobin A2 (HbA2), a normal variant of adult haemoglobin, makes up about 1.5 – 3.5 % of total adult haemoglobin and consists of two α and two delta (δ) globin chains.- Foetal haemoglobin is the main Hb in the later two-thirds of foetal life and in the newborn until approximately 12 weeks of age. Foetal haemoglobin has a higher affinity for oxygen than adult haemoglobin. Red cells are destroyed by macrophages in the liver and spleen after , 120 days. The haem group is split from the haemoglobin and converted to biliverdin and then bilirubin. The iron is conserved and recycled to plasma via transferrin or stored in macrophages as ferritin and haemosiderin. An increased rate of haemoglobin breakdown results in excess bilirubin and jaundice.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 13
Incorrect
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A 42-year-old woman presents with face swelling prominently affecting her upper lip and hands. She has previously been diagnosed with hereditary angioedema.Which of these is the most appropriate management option for this acute attack?
Your Answer:
Correct Answer: Fresh frozen plasma
Explanation:Hereditary angioedema is inherited as an autosomal dominant disorder and is caused by deficiency of C1 esterase inhibitor, a protein that forms part of the complement system.Attacks can be precipitated by stress and minor surgical procedures. Clinical features of hereditary angioedema include oedema of the skin and mucous membranes commonly affecting the face, tongue and extremities.Angioedema and anaphylaxis due to a deficiency of C1 esterase inhibitor are resistant to adrenaline, steroids and antihistamines. Treatment is with fresh frozen plasma or C1 esterase inhibitor concentrate, which contains C1 esterase inhibitor.Short-term prophylaxis for events that may precipitate angioedema attack is achieved with C1 esterase inhibitor or fresh frozen plasma infusions before the event while long-term prophylaxis can be achieved with antifibrinolytic drugs (tranexamic acid) or androgenic steroids.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 14
Incorrect
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Dehydration causes a significant increase in the amount of this hormone?
Your Answer:
Correct Answer: Antidiuretic hormone
Explanation:Antidiuretic hormone induces the kidneys to release less water, resulting in reduced urine production. In the case of dehydration, ADH levels rise, resulting in a considerable decrease in urine output as well as an increase in plasma protein, blood Hct, and serum osmolality.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 15
Incorrect
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Among the following infectious diseases, which is typically considered to have an incubation period of 3 weeks and longer?
Your Answer:
Correct Answer: Infectious mononucleosis
Explanation:Infectious mononucleosis is caused by Epstein-Barr virus (EBV). The incubation period for EBV varies from 2 weeks to 2 months.The usual incubation period for rubella is 14 days; with a range of 12 to 23 days.Gonorrhoea has a short incubation period of approximately 2 to 7 days.The mumps virus can be isolated from infected saliva and swabs rubbed over the Stensen’s duct from 9 days before onset of symptoms until 8 days after parotitis appears.Scarlet fever, which appears within 1 to 2 days after bacterial infection, is characterized by a diffuse red rash that appears on the upper chest and spreads to the trunk and extremities. The rash disappears over the next 5 to7 days and is followed by desquamation.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 16
Incorrect
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A 16-year old boy is brought to the emergency room after suffering a traffic accident. Upon examination, there is noted ipsilateral loss of proprioception and vibration, ipsilateral motor loss, and contralateral loss of pain and temperature sensation. A spinal cord injury is given as a diagnosis.Which of the following is the most probable cause of this manifestation?
Your Answer:
Correct Answer: Brown-SĂ©quard syndrome
Explanation:Brown-Sequard Hemicord Syndrome consists of ipsilateral weakness (corticospinal tract) and loss of joint position and vibratory sense (posterior column), with contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex, are unilateral. Partial forms are more common than the fully developed syndrome.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 17
Incorrect
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Regarding the flexor digitorum profundus muscle, which of the following is true?
Your Answer:
Correct 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).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 18
Incorrect
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A 70 year old man who has a previous history of small cell lung cancer was found to have severe hyponatraemia on a recent blood test and he is sent to the emergency room. In the nephron, where is the likely cause of this abnormality?
Your Answer:
Correct Answer: Distal nephron
Explanation:In the cancer patient, hyponatremia is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH). This develops more frequently with small cell lung cancer (SCLC) than with other malignancies. The pathogenesis of this is as a result of the process whereby ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, resulting in elevation of cAMP levels. Increased cAMP levels cause fusion of intracellular vesicles with the apical membrane. There are water channels called aquaporins in their membranes of these vesicles, and these increase the water permeability, thus facilitating increased water reabsorption and urine concentration. Thus, by increasing water retention, ADH causes blood to be diluted, which then decreases the concentration of solutes like sodium.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 19
Incorrect
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You suspected a fungal nail infection in a 50-year-old man who presented with an itchy, scaly rash between his toes and a thicker, discoloured nail on his big toe that has been there for almost one month already. Which of the following tests is most likely to confirm your suspected diagnosis?
Your Answer:
Correct Answer: Nail clippings for microscopy and culture
Explanation:Nail clippings for microscopy and culture are a diagnostic test for fungal infection. Because some fungi are restricted to the lower parts of the nail, clippings should be taken from the discoloured or brittle parts and cut back as far as possible from the free edge.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 20
Incorrect
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An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:No. of patients who took Ticagrelor: 300No. of patients who took Ticagrelor and suffered a stroke: 30No. of patients who took Warfarin: 500No. of patients who took Warfarin and suffered a stroke: 20Compute for the absolute risk in the Ticagrelor group.
Your Answer:
Correct Answer: 0.1
Explanation:The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.AR = 30/300 = 0.1
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This question is part of the following fields:
- Evidence Based Medicine
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Question 21
Incorrect
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Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?
Your Answer:
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 22
Incorrect
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A 32 year old woman presents with episodes of flushing, headaches and palpitations. On examination her blood pressure is significantly elevated. Which of the following is the most likely diagnosis:
Your Answer:
Correct Answer: Pheochromocytoma
Explanation:Phaeochromocytomas are catecholamine-secreting tumours which occur in about 0.1% of patients with hypertension. In about 90% of cases they arise from the adrenal medulla. The remaining 10%, which arise from extra-adrenal chromaffin tissue, are termed paragangliomas. Common presenting symptoms include one or more of headache, sweating, pallor and palpitations. Less commonly, patients describe anxiety, panic attacks and pyrexia. Hypertension, whether sustained or episodic, is present in at least 90% of patients. Left untreated phaeochromocytoma can occasionally lead to hypertensive crisis, encephalopathy, hyperglycaemia, pulmonary oedema, cardiac arrhythmias, or even death.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 23
Incorrect
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A 26-year old female comes to the Emergency Room with complaints of bloody stools. She reports that prior to the passage of bloody stools, she experienced a sharp pain during defecation. Medical history reveals that she has been experiencing constipation for the past 2 weeks. After completing her medical history and physical examination, the attending physician gives an initial diagnosis of an anal fissure.Which of the following nerves transmit painful sensation from the anus, resulting in the pain associated with anal fissure?
Your Answer:
Correct Answer: Inferior rectal nerve
Explanation:A fissure in ano is a tear in the anoderm distal to the dentate line. The pathophysiology of anal fissure is thought to be related to trauma from either the passage of hard stool or prolonged diarrhoea. A tear in the anoderm causes spasm of the internal anal sphincter, which results in pain, increased tearing, and decreased blood supply to the anoderm. The site of the anal fissure in the sensitive lower half of the anal canal, which is innervated by the inferior rectal nerve, results in reflex spasm of the external anal sphincter, aggravating the condition. Because of the intense pain, anal fissures may have to be examined under local anaesthesia.The inferior rectal nerve is a branch of the pudendal nerve. This nerve runs medially across the ischiorectal fossa and supplies the external anal sphincter, the mucous membrane of the lower half of the anal canal, and the perianal skin.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 24
Incorrect
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On which of the following is preload primarily dependent?
Your Answer:
Correct Answer: End-diastolic volume
Explanation:Preload refers to the initial stretching of the cardiac myocytes before contraction. It is therefore related to muscle sarcomere length. The sarcomere length cannot be determined in the intact heart, and so, other indices of preload are used, like ventricular end-diastolic volume or pressure. The end-diastolic pressure and volume of the ventricles increase when venous return to the heart is increased, and this stretches the sarcomeres, which increase their preload.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 25
Incorrect
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Regarding fibrinolytics, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.
Explanation:Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 26
Incorrect
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A 35 year old patient presents to ED having sustained an injury to his right hand whilst playing cricket. He is unable to fully straighten his right middle finger as the distal phalanx remains flexed. Which of the following structures within the digit was most likely injured:
Your Answer:
Correct Answer: Insertion of terminal extensor digitorum tendon
Explanation:Damage to the insertion of the terminal extensor digitorum tendon would result in loss of extension at the distal interphalangeal joint causing a fixed flexion deformity, called the Mallet deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 27
Incorrect
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In relation to ketamine, which of the following statements is TRUE:
Your Answer:
Correct Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.
Explanation:Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 28
Incorrect
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A young male has presented to the Emergency Department with a sudden onset of severe palpitations, shortness of breath, and chest pain. A 12-lead ECG is recorded, and it shows a narrow complex tachycardia that points to a diagnosis of supraventricular tachycardia. Vagal manoeuvres are attempted but are unsuccessful in eliminating the arrhythmia. The next action plan is to use a drug to revert to sinus rhythm. Out of the following, which is the first-line treatment for supraventricular tachycardia?
Your Answer:
Correct Answer: Adenosine
Explanation:Paroxysmal supraventricular tachycardia is an intermittent tachycardia (HR > 100 bpm) and has the following characteristics:1. Sudden onset/offset (Contrast with sinus tachycardia)2. Electrical activity originates above the ventricle (Contrast with ventricular tachycardia)3. Produces narrow QRS complex (<120ms) The most common cause of PSVT is Atrioventricular nodal re-entrant tachycardia (AVNRT), most common in young women with a mean age onset of 32 years old. There are recurrent episodes of palpitations, and most of the episodes spontaneously. Sometimes, some vagal manoeuvres are required:1. Valsalva manoeuvre2. immersing the face in ice-cold water3. carotid sinus massage.If PSVT keeps persisting or is causing severe symptoms, the treatment of choice is intravenous adenosine. The patient’s ECG should be continuously monitored throughout the treatment. The recommended doses in adults are as follows:- Initial dose of adenosine is 6 mg by rapid IV bolus- If unsuccessful, give another dose of adenosine 12 mg by rapid IV bolus- If unsuccessful, give a further dose of adenosine 12 mg by rapid IV bolusThe latest ALS guidelines advocate 18 mg for the third dose, whereas the BNF/NICE guidelines advocate 12 mg.If adenosine fails or is contraindicated, intravenous verapamil can be used as an alternative, but it should be avoided in patients recently treated with beta-blockers.Synchronized electrical cardioversion will be necessary with signs of hemodynamic instability or if drug treatment has failed to restore sinus rhythm.Recurrent episodes of paroxysmal supraventricular tachycardia can be treated by catheter ablation or prevented with drugs such as flecainide, sotalol, diltiazem, or verapamil.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 29
Incorrect
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A suspicious growth on the posterior tongue of a 40-year-old man was discovered by his dentist and was immediately referred for possible oral cancer. The lymph from the posterior tongue will drain to which of the following nodes?
Your Answer:
Correct Answer: Deep cervical nodes
Explanation:Lymph from the medial anterior two thirds of the tongue travels to the deep cervical lymph nodes.Lymph from the lateral anterior tongue goes to the submandibular nodes.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 30
Incorrect
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How does dipyridamole mediate its antiplatelet effect:
Your Answer:
Correct Answer: It is a phosphodiesterase inhibitor.
Explanation:Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.
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This question is part of the following fields:
- Haematology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
