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Question 1
Correct
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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?Â
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.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 2
Correct
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A 57-year old man presented himself to the emergency room with persistent cough. During history taking, a record of his previous sputum sample was seen and the report stated that it tested positive for AFB (acid-fast bacilli). What is the most likely pathogen?
Your Answer: Mycobacterium tuberculosis
Explanation:M. tuberculosis is the causative agent of pulmonary tuberculosis (TB). The most commonly used diagnostic test for the diagnosis of pulmonary TB is the direct sputum smear microscopy (DSSM) wherein the presence of acid-fast bacilli (AFB) is tested. The most common method is the hot method or also known as Ziehl-Neelsen method. This is a staining method special for Mycobacteria species because they are known to be acid-fast which means that they are not easily decolorized by acid alcohol. Once the DSSM tests positive for acid-fast bacilli, this indicates possible infection with tuberculosis. The gold standard for diagnosis is still culture but Mycobacteria species are slow-growers that is why DSSM is considered the best diagnostic method. A positive AFB smear and correlation with symptoms is usually used by physicians to create a final diagnosis of pulmonary tuberculosis.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 3
Correct
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Regarding T helper cells, which of the following statements is CORRECT:
Your Answer: They form the vast majority (about 75%) of the total circulating T-cell population.
Explanation:CD4+ T-cells (Helper T cells)Recognise antigen only in association with HLA class II molecules (found on antigen presenting cells (APCs) e.g. dendritic cells, B-cells; present exogenous antigens that have been phagocytosed/endocytosed into intracellular vesicles)Form most of the circulating T-cell population (about 75%)Secrete cytokines (e.g. IFN-gamma) which are required for recruitment and activation of other immune cells such as macrophages, T cytotoxic cells and NK cells and for the activation of and production of immunoglobulin from B-cells
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 4
Correct
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Which of the following is a physiological function that is mediated by a hormone released by the posterior pituitary:
Your Answer: Water retention
Explanation:Antidiuretic hormone (ADH), released by the posterior pituitary, acts on the kidneys to increase water permeability in the distal nephron allowing greater water reabsorption and concentration of urine. Prolactin, from the anterior pituitary, is responsible for milk production. The thyroid hormones, from the thyroid gland, are responsible for an increase in basal metabolic rate (stimulated by TSH from the anterior pituitary). FSH/LH, from the anterior pituitary, are responsible for maturation of egg and sperm. Calcitonin, from the thyroid gland, is responsible for decreasing calcium levels.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 5
Incorrect
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Which of the following antibiotics is the first line of treatment for a patient who has been diagnosed with chlamydia infection?
Your Answer: Ceftriaxone
Correct Answer: Azithromycin
Explanation:The Centres for Disease Control and Prevention (CDC) recommends azithromycin, a single 1 g dose, and doxycycline, 100 mg bd for 7 days, as first-line medications for chlamydial infection treatment. Second-line medications (such as erythromycin, penicillins, and sulfamethoxazole) are less effective and have more side effects
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 6
Correct
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Common causes of exudates are infection, pericarditis, and malignancy.Which one statement about exudates is true?
Your Answer: LDH levels are usually high
Explanation:An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.Exudates are cloudy. It has high LDH levels, serum protein ratio >0.5, protein content >2.9g/dl, specific gravity of >1.020 and a serum-ascites albumin gradient (SAAG) of <1.2g/dl.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 7
Correct
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In a 7-year-old child with chickenpox, which of the following would you advise the mother NOT to do?
Your Answer: Give ibuprofen for the fever
Explanation:Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.Some recognized complications of chickenpox are:OrchitisHepatitisPneumoniaEncephalitisInfected spotsOtitis mediaMyocarditisGlomerulonephritisAppendicitisPancreatitisTreatment is symptomatic and includes using paracetamol to manage fever. There is a link between use of ibuprofen in patients with chicken-pox and necrotizing fasciitis so Ibuprofen should NOT be used. An emollient and antihistamine can be used to ease the itchy rash and oral hydration is encouraged.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 8
Correct
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A 35-year-old lady has suffered a serious brain injury. Her uvula has deviated to the right, according to inspection. Which of the following nerves is likely to be affected?
Your Answer: Left vagus nerve
Explanation:When the vagus nerve is damaged, the soft palate is paralyzed and the uvula is shifted away from the affected side. The vagus nerve innervates the uvulae muscle, which forms the uvula’s core. If only one side is innervated, contraction of the active muscle will draw the uvula towards it.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 9
Incorrect
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A 17-year-old patient with a headache, fever, and a non-blanching rash is brought to the emergency room. Meningococcal infection is confirmed by a lumbar puncture. Neisseria meningitidis uses one of the following immune evasion mechanisms:
Your Answer: Produces exotoxin
Correct Answer: Secretes IgA protease
Explanation:Meningococci have 3 important virulence factors, as follows:Polysaccharide capsule – Individuals with immunity against meningococcal infections have bactericidal antibodies against cell wall antigens and capsular polysaccharides; a deficiency of circulating anti meningococcal antibodies is associated with the disease.Lipo-oligosaccharide endotoxin (LOS)Immunoglobulin A1 (IgA1)
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This question is part of the following fields:
- Microbiology
- Principles
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Question 10
Incorrect
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Following the administration of a medication for a heart condition, a 69-year-old man develops hypothyroidism.Which of the following drugs is most likely to be the cause?
Your Answer: Propranolol
Correct Answer: Amiodarone
Explanation:Amiodarone has a chemical structure that is similar to that of thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, though hypothyroidism is far more common, with 5-10% of patients suffering from it.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 11
Incorrect
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A 35-year-old man suffered a severe road traffic accident and has been brought to the hospital. As part of his treatment, he requires a blood transfusion and experiences a transfusion reaction.The most common type of transfusion reaction is which of the following?
Your Answer: Acute haemolytic reaction
Correct Answer: Febrile transfusion reaction
Explanation:During or shortly after transfusion, febrile transfusion reactions, also known as non-haemolytic transfusion reactions, present with an unexpected temperature rise (38oC or 1oC above baseline, if baseline is 37oC). This is usually a one-off occurrence. The fever is sometimes accompanied by chills.The most common type of transfusion reaction is febrile transfusion reactions, which occur in about 1 in every 8 transfusions.The most common event leading to symptoms of febrile transfusion reactions is cytokine accumulation during storage of cellular components (especially platelet units). White cells secrete cytokines, and pre-storage leucodepletion has reduced this risk.Recipient antibodies (raised as a result of previous transfusions or pregnancies) reacting to donor human leukocyte antigen (HLA) or other antigens can also cause febrile transfusion reactions. Donor lymphocytes, granulocytes, and platelets all contain these antigens.Treatment is reassuring. Other causes should be ruled out, and antipyretics like paracetamol can help with fever relief. If another cause of fever is suspected, the transfusion should be stopped; however, if other causes of fever have been ruled out, it can be restarted at a slower rate.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 12
Correct
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A 23-year-old student presents to the emergency department with a terrible headache, photophobia, and a fever. On her lower limbs, you see a non-blanching purpuric rash. In the department, a lumbar puncture is conducted. What do you think you'll notice on Gram stain:
Your Answer: Gram negative diplococci
Explanation:Bacterial meningitis and septicaemia are most commonly caused by meningococcal bacteria. The Gram-negative diplococci Neisseria Meningitidis causes meningitis. Gram stain and culture of CSF identify the etiologic organism, N meningitidis. In bacterial meningitis, Gram stain is positive in 70-90% of untreated cases, and culture results are positive in as many as 80% of cases.
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This question is part of the following fields:
- Infections
- Microbiology
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Question 13
Incorrect
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Regarding flow through a tube, which of the following statements is CORRECT:
Your Answer: High gauge cannulas have the fastest rate of flow.
Correct Answer: Polycythaemia will decrease the rate of blood flow through a vessel.
Explanation:Darcy’s law states that flow through a tube is dependent on the pressure differences across the ends of the tube (P1 – P2) and the resistance to flow provided by the tube (R). Resistance is due to frictional forces and is determined by the length of the tube (L), the radius of the tube (r) and the viscosity of the fluid flowing down that tube (V). The radius of the tube has the largest effect on resistance and therefore flow – this explains why smaller gauge cannulas with larger diameters have a faster rate of flow. Increased viscosity, as seen in polycythemia, will slow the rate of blood flow through a vessel.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 14
Incorrect
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Which of the following diseases is caused by a build-up of lymphoblasts in the bone marrow?
Your Answer: Hodgkin lymphoma
Correct Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is a clonal (malignant) bone marrow disorder in which early lymphoid precursors multiply and replace the marrow’s normal hematopoietic cells. ALL is most common between the ages of 3 and 7, with 75 percent of cases occurring before the age of 6.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Correct
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A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.At the moment, he is completely symptom-free. When it comes to this type of overdose, how long does it usually take for symptoms to appear?
Your Answer: 1-2 hours
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.>10 tablets of verapamil (160 mg or 240 mg immediate or sustained-release capsules) or diltiazem can cause serious toxicity (180 mg, 240 mg or 360 mg immediate or sustained-release capsules)In children, 1-2 tablets of verapamil or diltiazem (immediate or sustained-release)Symptoms usually appear within 1-2 hours of ingestion with standard preparations. However, with slow-release preparations, significant toxicity may take 12-16 hours to manifest, with peak effects occurring after 24 hours.The following are the main clinical features of calcium-channel blocker overdose:Nausea and vomitingHypotensionBradycardia and first-degree heart blockMyocardial ischaemia and strokeRenal failurePulmonary oedemaHyperglycaemiaThe following are some of the most important bedside investigations to conduct:Blood glucoseECGArterial blood gasOther investigations that can be helpful includeUrea & electrolytesChest X-ray (pulmonary oedema)Echocardiography
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Correct
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Cystic fibrosis patients have a weakened lung surfactant system. Which of the following cell types is in charge of surfactant secretion?
Your Answer: Type II pneumocytes
Explanation:Alveolar type II cells are responsible for four primary functions: surfactant synthesis and secretion, xenobiotic metabolism, water transepithelial transport, and alveolar epithelium regeneration following lung injury.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 17
Incorrect
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Which of the following represents ventricular repolarisation on the ECG:
Your Answer: QRS complex
Correct Answer: T wave
Explanation:P wave = Atrial depolarisationQRS complex = Ventricular depolarisationT wave = Ventricular repolarisation
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 18
Incorrect
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A fracture on which of the following structures is associated with a posterior elbow dislocation?
Your Answer: Supracondylar
Correct Answer: Radial head
Explanation:Fracture dislocations of the elbow appear extremely complex, and identification of the basic injury patterns can facilitate management. The simplest pattern of elbow fracture dislocation is posterior dislocation of the elbow with fracture of the radial head. Addition of a coronoid fracture, no matter how small, to elbow dislocation and radial head fracture is called the terrible triad of the elbow.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Incorrect
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Which of the following is NOT an advantage of a case-control study used to identify past exposure to a risk factor in patients with a disease:
Your Answer: Relative quick, cheap and easy to perform
Correct Answer: Can directly measure absolute and relative risk of a disease
Explanation:Advantages:relatively quickrelatively cheap and easy to performparticularly suitable for studying associations between an exposure and an outcome when the outcome is uncommon or if the outcome occurs decades after exposurea wide range of risk factors can be investigated in each studyDisadvantages:subject to recall biasunlike in a whole population study, absolute risk cannot be quantifiedtemporal relationship between exposure and outcome can be difficult to establishunsuitable for rare risk factorsprone to confounding
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 20
Correct
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Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 21
Incorrect
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Which of the following clinical features is NOT a typical feature of haemolytic anaemias:
Your Answer: Leg ulcers
Correct Answer: Angular cheilitis
Explanation:Features include: AnaemiaJaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)Pigment gallstonesSplenomegalyAnkle ulcersExpansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia majorAplastic crisis caused by parvovirus
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This question is part of the following fields:
- Haematology
- Pathology
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Question 22
Correct
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An increased anion gap metabolic acidosis is typically caused by which of the following?
Your Answer: Propylene glycol overdose
Explanation:Causes of a raised anion gap acidosis can be remember using the mnemonic MUDPILES:-Methanol-Uraemia (in renal failure)-Diabetic ketoacidosis-Propylene glycol overdose-Infection/Iron overdose/Isoniazid/Inborn errors of metabolism-Lactic acidosis-Ethylene glycol overdose-Salicylate overdose
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This question is part of the following fields:
- Physiology
- Renal
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Question 23
Correct
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A patient with abdominal pain, vomiting and bloody diarrhoea develops a low platelet count and deranged renal function. A diagnosis of haemolytic uraemic syndrome is made.Which of the following organisms is a recognised cause of haemolytic uraemic syndrome? Select ONE answer only.
Your Answer: Escherichia coli
Explanation:E.Colistrain 0157 causes enterohaemorrhagic diarrhoea and can be followed by haemolytic uraemic syndrome (renal failure, haemolytic anaemia and thrombocytopenia).
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 24
Correct
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Discontinuous capillaries are typically found where in the body:
Your Answer: Reticuloendothelial system
Explanation:Discontinuous capillaries, found in the reticuloendothelial system (bone marrow, liver and spleen), have large gaps between endothelial cells and are permeable to red blood cells.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 25
Correct
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A 70-year-old woman presents with exacerbation of her chronic obstructive pulmonary disease (COPD), increased cough, wheeze and chest tightness. On examination, she is tachypnoeic and oxygen saturation is 86%. You plan to administer supplemental oxygen.Which oxygen delivery system is most appropriate to use initially?
Your Answer: Venturi mask
Explanation:In life-threatening emergencies, oxygen should be started immediately otherwise, it should be prescribed like any other drug. The prescription should include a target saturation range.Until blood gases can be measured, initial oxygen should be administered using a controlled concentration of 24% or 28%. The ideal mask is a Venturi mask. The other mask are not ideal for initial use
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 26
Correct
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Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?
Your Answer: Auriculotemporal nerve
Explanation:Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 27
Correct
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Regarding Clostridium perfringens, which of the following statements is CORRECT:
Your Answer: It can cause exotoxin-mediated food poisoning.
Explanation:Clostridium perfringens is an obligate anaerobe and has exotoxin mediated effects. It is the most common cause of gas gangrene. C. perfringens is also implicated in food poisoning, cellulitis, enteritis necrotican (life-threatening infection involving ischaemic necrosis of the jejunum), and rarely, CNS infections such as meningitis and encephalitis.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 28
Correct
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Arterial baroreceptors are located primarily in which of the following:
Your Answer: Carotid sinus and aortic arch
Explanation:Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 29
Incorrect
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Amoxicillin is used first line for all of the following infections EXCEPT for:
Your Answer: Dental abscess
Correct Answer: Cellulitis
Explanation:Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI). Flucloxacillin is used first line for acute cellulitis.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 30
Correct
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Which of the following clinical features is most suggestive of a lesion of the occipital lobe:
Your Answer: Homonymous hemianopia
Explanation:Homonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. It is caused by lesions of the retrochiasmal visual pathways, ie, lesions of the optic tract, the lateral geniculate nucleus, the optic radiations, and the cerebral visual (occipital) cortex
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 31
Correct
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A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon observation and examination, it was noted that he is febrile and Kernig's sign is positive. A diagnosis of meningitis was suspected and a lumbar puncture was to be performed.Which of the following statements regarding meningitis is true?
Your Answer: The dura mater is the outermost layer
Explanation:Meningitis is defined as the inflammation of the meninges due to an infection caused by a bacteria or a virus. Symptoms usually include stiffness of the neck, headache, and fever. There are 3 meningeal layers that surround the spinal cord and they are the dura mater, arachnoid matter, and pia mater. The dura mater is the outermost and thickest layer out of all the 3 layers. The arachnoid atter is the middle layer, and is very thin.The third and deepest meningeal layer is the pia mater that is bound tightly to the surface of the spinal cord.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 32
Correct
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A 50-year-old woman with painful joints had some blood tests done with her GP. The test showed she had anti-double stranded DNA antibodies.Which one of these disorders is most likely to be associated with anti-double stranded DNA antibodies?
Your Answer: Systemic lupus erythematosus (SLE)
Explanation:CREST syndrome is usually associated with anti-centromere antibodies.Primary biliary cirrhosis is associated with anti-mitochondrial antibodies.Sjogren’s syndrome is associated with anti-Ro and anti-La antibodies.Polymyositis is associated with anti-Jo1 antibodies.Anti-double stranded DNA antibodies are highly characteristic of systemic lupus erythematosus (SLE). They are a group of anti-nuclear antibodies (ANA) that target double stranded DNA and are implicated in the pathogenesis of lupus nephritis.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 33
Incorrect
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Which of the following is NOT a feature characteristic of intravascular haemolysis:
Your Answer: Methaemalbuminaemia
Correct Answer: Bilirubinuria
Explanation:Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria
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This question is part of the following fields:
- Haematology
- Pathology
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Question 34
Incorrect
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Which of the following statements about propofol is TRUE:
Your Answer: Propofol increases the intracranial pressure.
Correct Answer: Propofol has some antiemetic action.
Explanation:Propofol has some antiemetic properties. It’s for this reason that it’s used to treat postoperative nausea and vomiting. Propofol is mostly processed in the liver, with the kidneys excreting just around 1% of it unaltered. Propofol, unlike thiopental, does not produce tissue necrosis when it is extravasated. Propofol lowers intracranial pressure via lowering brain metabolic rate and cerebral blood flow. Propofol is thought to be safe for people with bronchial asthma and chronic obstructive pulmonary disease.
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 35
Correct
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An ambulance transports a 23-year-old woman who has taken a witnessed overdose of her mother's diazepam tablets. She has no significant medical history and does not take any medications on a regular basis.In this case, what is the SINGLE MOST APPROPRIATE FIRST DRUG TREATMENT?
Your Answer: Flumazenil IV 200 μg
Explanation:Flumazenil is a benzodiazepine antagonist that can be helpful in some overdose situations. It works quickly (in less than a minute), but the effects are fleeting, lasting less than an hour. The dose is 200 micrograms every 1-2 minutes with a maximum dose of 3 milligrams per hour.Flumazenil should be avoided by patients who are addicted to benzodiazepines or who take tricyclic antidepressants because it can cause withdrawal symptoms. It can cause seizures or cardiac arrest in these situations.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 36
Correct
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Which of the following best describes an intention to treat analysis:
Your Answer: All patients are included in the analysis according to the group into which they were randomised even if they are withdrawn from the study.
Explanation:An intention to treat (ITT) analysis is one in which all patients are included in the analysis, classified according to the group into which they were randomised, even if they were withdrawn from the study and did not actually receive the treatment, did not comply with treatment or drop-out. Intention to treat analysis is a more reliable estimate of true treatment effectiveness by replicating what happens in the ‘real world’ (e.g. noncompliance and protocol violations commonly affect therapies).
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This question is part of the following fields:
- Evidence Based Medicine
- Study Methodology
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Question 37
Incorrect
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On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP reading of 152/96 mmHg (ABPM).Which of the following would be the patient's first-line drug treatment?
Your Answer: No medication is required at this stage
Correct Answer: Ramipril
Explanation:An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 48-year-old Afro-Caribbean man.An ACE inhibitor, such as ramipril, or a low-cost angiotensin-II receptor blocker (ARB), such as losartan, would be the most appropriate medication for a 48-year-old Caucasian man.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 38
Correct
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Which of the following causes type 1 diabetes mellitus?
Your Answer: Autoimmune destruction of beta-cells results in insulin deficiency
Explanation:Type 1 diabetes mellitus results from autoimmune destruction of the insulin-producing beta cells in the islets of Langerhans. This process occurs in genetically susceptible subjects, is probably triggered by one or more environmental agents, and usually progresses over many months or years during which the subject is asymptomatic and euglycemic.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 39
Incorrect
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Regarding hepatitis C, which of the following statements is INCORRECT:
Your Answer: Treatment often involves combination therapy with ribavirin and pegylated interferon.
Correct Answer: Anti-HCV IgG antibodies are diagnostic of acute infection.
Explanation:Anti-HCV IgG antibodies indicate exposure to hepatitis C but this could be acute, chronic or resolved infection. If the antibody test is positive, HCV RNA should be tested for, which if positive indicates that a person has current infection with active hepatitis C.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 40
Correct
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Regarding the renin-angiotensin-aldosterone system (RAAS), which of the following statements is CORRECT:
Your Answer: Angiotensin II has a predominant vasoconstrictor effect on the efferent arteriole.
Explanation:Angiotensin II constricts both the afferent and efferent arterioles, but preferentially increases efferent resistance. The net effect of the more prominent increase in efferent tone is that the intraglomerular pressure is stable or increased, thereby tending to maintain or even raise the GFR. Renin is produced by granular cells of the juxtaglomerular apparatus. Renin cleaves plasma angiotensinogen (produced in the liver) into angiotensin I. Angiotensin I is converted by angiotensin-converting enzyme (ACE) on pulmonary endothelial cells to angiotensin II. Angiotensin II acts to potentiate sympathetic activity (positive feedback).
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This question is part of the following fields:
- Physiology
- Renal
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Question 41
Incorrect
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Regarding the lacrimal apparatus, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
Explanation:Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 42
Incorrect
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Regarding pressures and airflow during the normal breathing cycle, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Negative intrapleural pressure causes dynamic compression of the airways.
Explanation:Dynamic compression occurs during forced expiration, when as the expiratory muscles contract, all the structures within the lungs, including the airways, are compressed by the positive intrapleural pressure. Consequently the smaller airways collapse before the alveoli empty completely and some air remains within the lungs (the residual volume).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 43
Incorrect
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A patient presents with increased breathlessness and worsening of his chronic cough and. He has a chronic lung disorder and is on long-term oxygen therapy (LTOT).Which of these is an indication for LTOT?
Your Answer:
Correct Answer: A non-smoker with COPD and a PaO 2 of 7.5 kPa when stable with secondary polycythaemia
Explanation:Long-term administration of oxygen, usually at least 15 hours daily, improves survival in COPD patients who have severe hypoxaemia. Long-term oxygen therapy should be considered in:A non-smoker with COPD and a PaO2<7.3 kPa when stableA non-smoker with COPD and PaO27.3–8 kPa when stable and with secondary polycythaemia, peripheral oedema, or evidence of pulmonary hypertensionSevere chronic asthma with PaO2<7.3 kPa or persistent disabling breathlessnessA patient with Interstitial lung disease with PaO28 kPa with disabling dyspnoeaA patient with cystic fibrosis when PaO2<7.3 kPa or if PaO27.3–8 kPa in the presence of secondary polycythaemia, nocturnal hypoxaemia, pulmonary hypertension, or peripheral oedemaPulmonary hypertension, without parenchymal lung involvement when PaO2<8 kPaNeuromuscular or skeletal disorders, after specialist assessmentObstructive sleep apnoea despite continuous positive airways pressure therapy, after specialist assessmentPulmonary malignancy or other terminal disease with disabling dyspnoeaHeart failure with daytime PaO2<7.3 kPa when breathing air or with nocturnal hypoxaemia
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 44
Incorrect
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Regarding the lung roots, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.
Explanation:Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 45
Incorrect
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Regarding iron handling, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).
Explanation:Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 46
Incorrect
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Which of the following is NOT one of the cardinal features of acute inflammation:
Your Answer:
Correct Answer: Discharge
Explanation:Classic signs:Rubor (redness)Calor (heat)Dolour (pain)Tumour (swelling)Functio laesa (loss of function)These classic signs are produced by a rapid vascular response and cellular events. The main function of these events is to bring elements of the immune system to the site of injury and prevent further tissue damage.
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This question is part of the following fields:
- Inflammatory Responses
- Pathology
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Question 47
Incorrect
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When the pulmonary artery is completely blocked, what is the ventilation over perfusion ratio for the area that it supplies?
Your Answer:
Correct Answer: Infinity
Explanation:The ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching ventilation and perfusion. A pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. When a large pulmonary embolus completed blocked a pulmonary artery the alveoli were ventilated but not perfused at all, then the V/Q ratio would be infinity.
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This question is part of the following fields:
- Physiology
- Respiratory Physiology
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Question 48
Incorrect
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The extensor digitorum longus is supplied by which nerve?
Your Answer:
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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 49
Incorrect
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A 58-year-old man with a traumatic brain injury is brought into the ER. A medical student asks you about the processes that occur in the brain following a traumatic injury.One of these best describes the central nervous systems response to injury.
Your Answer:
Correct Answer: Degeneration of the axon occurs proximally before it occurs distally
Explanation:Following neuronal injury, as seen in traumatic brain injury, the axon undergoes anterograde degeneration. Degradation starts from the cell body (proximally) and progresses distally. The axon becomes fragmented and degenerates. The brain shows no reactive changes to injury is incorrect. Following major injury such as stroke, the brain undergoes a process of liquefactive degeneration, which leaves cystic spaces within the brain.Axonal regeneration does not occur to any significant extent within the central nervous system unlike what is seen in the peripheral nervous system. Astrocytes undergo reactive gliosis, leaving behind a firm translucent tissue around sites of damage.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 50
Incorrect
SESSION STATS - PERFORMANCE PER SPECIALTY
