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Question 1
Incorrect
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You've been summoned to the resuscitation area to assist a patient who is having a seizure. As part of the treatment protocol, a benzodiazepine dose is given.Which of the following statements about the use of benzodiazepines in seizures is correct?
Your Answer: IV diazepam is the first-line drug in UK hospitals
Correct Answer: Lorazepam can be given by the rectal route
Explanation:A single dose of IV benzodiazepine will terminate the seizure in 60 to 80 percent of patients who present with seizures.Because benzodiazepines are lipid-soluble, they cross the blood-brain barrier quickly. This explains their quick onset of action.As a first-line treatment, IV lorazepam should be given. If IV lorazepam is not available, IV diazepam can be used instead, and buccal midazolam can be used if intravenous access cannot be established quickly. Lorazepam can be administered via the rectal route, but it is less reliable and has a lower absorption rate and bioavailability.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 2
Incorrect
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You examine a 73-year-old patient who is experiencing a worsening of his chronic heart failure. Bumetanide was recently prescribed for him.Which of the following statements about bumetanide is correct?
Your Answer: It acts on the Na.Cl co-transporter in the distal convoluted tubule to inhibit sodium and chloride reabsorption
Correct Answer: It has better intestinal absorption than furosemide
Explanation:Bumetanide is a loop diuretic that inhibits sodium, chloride, and potassium reabsorption by acting on the Na.K.2Cl co-transporter in the ascending loop of Henlé. This reduces the osmotic gradient that forces water out of the collecting duct system and prevents the formation of a hypertonic renal medulla. This has a strong diuretic effect on the body.It’s primarily used in patients with heart failure who aren’t responding to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency.In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. Bumetanide is 40 times more potent than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide.Bumetanide also lowers the concentration of neuronal chloride, making GABA’s action more depolarizing. In the neonatal period, it is being studied as an antiepileptic.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 3
Incorrect
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Which of the following drugs is first line treatment for a stable regular broad-complex tachycardia:
Your Answer: Adenosine
Correct Answer: Amiodarone
Explanation:A regular broad-complex tachycardia is likely to be ventricular tachycardia or a regular supraventricular rhythm with bundle branch block. A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours. If previously confirmed as SVT with bundle branch block, the patient should be treated as for narrow-complex tachycardia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 4
Correct
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Salbutamol should be used with caution in patients with which of the following:
Your Answer: Susceptibility to QT-interval prolongation
Explanation:Beta-2 agonists should be used with caution in people with: Cardiovascular disease, including arrhythmias and hypertension (beta-2 agonists may cause an increased risk of arrhythmias and significant changes to blood pressure and heart rate)Diabetes(risk of hyperglycaemia and ketoacidosis, especially with intravenous use)Hyperthyroidism(beta-2 agonists may stimulate thyroid activity)Hypokalaemia(potentially serious hypokalaemia may result from beta-2 agonist therapy; this effect may be potentiated in severe asthma by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia)Susceptibility to QT-interval prolongationConvulsive disorders
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This question is part of the following fields:
- Pharmacology
- Respiratory
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Question 5
Incorrect
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Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?
Your Answer: The anterior spinothalamic tract
Correct Answer: The lateral spinothalamic tract
Explanation:The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 6
Incorrect
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A 7-year-old boy is brought to the emergency room with complaints of a red and painful left eye. Upon physical examination, it was noted that there is the presence of conjunctival erythema. A mucopurulent discharge and crusting of the lid was also evident. A diagnosis of bacterial conjunctivitis was made. According to the latest NICE guidelines, which of the following should NOT be a part of the management of this patient?
Your Answer: Advise that no school exclusion is necessary
Correct Answer: Topical antibiotics should be prescribed routinely
Explanation:The following are the NICE guidelines on the management of bacterial conjunctivitis:- Infective conjunctivitis is a self-limiting illness that usually settles without treatment within 1-2 weeks. If symptoms persist for longer than two weeks they should return for review.- Seek medical attention urgently if marked eye pain or photophobia, loss of visual acuity, or marked redness of the eye develop.- Remove contact lenses, if worn, until all symptoms and signs of infection have completely resolved and any treatment has been completed for 24 hours.- Lubricant eye drops may reduce eye discomfort; these are available over the counter, as well as on prescription.- Clean away infected secretions from eyelids and lashes with cotton wool soaked in water.- Wash hands regularly, particularly after touching the eyes.- Avoid sharing pillows and towels.- It is not necessary to exclude a child from school or childcare if they have infective conjunctivitis, as mild infectious illnesses should not interrupt school attendance. An exception would be if there is an outbreak of infective conjunctivitis, when advice should be sought from the Health Protection Agency by the school. – Adults who work in close contact with others, or with vulnerable patients, should avoid such contact until the discharge has settled.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Correct
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Intrinsic factor is vital for gastrointestinal absorption of which of the following:
Your Answer: Vitamin B12
Explanation:Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 8
Incorrect
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The muscles of the soft palate (other than the tensor veli palatini) are innervated by which of the following nerves:
Your Answer: Glossopharyngeal nerve
Correct Answer: Vagus nerve
Explanation:All of the muscles of the soft palate are innervated by the vagus nerve (from the pharyngeal plexus), except for the tensor veli palatini, which is innervated by a branch of the mandibular nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 9
Correct
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External haemorrhoids may cause anal pain. When explaining to your patient why it does so, which of the following nerves will you point out as being affected?
Your Answer: Pudendal nerve
Explanation:The pain associated with external haemorrhoids is carried by a branch of the pudendal nerve, specifically the somatic fibres (S2-S4). It innervates the external anal sphincter and most of the skin over the perineum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Incorrect
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Which of the following is the most potent stimulus of fibrinolysis:
Your Answer: Antithrombin
Correct Answer: Tissue plasminogen activator
Explanation:Fibrinolysis is a normal haemostatic response to vascular injury. Plasminogen, a proenzyme in blood and tissue fluid, is converted to plasmin by activators either from the vessel wall (intrinsic activation) or from the tissues (extrinsic activation). The most important route follows the release of tissue plasminogen activator (TPA) from endothelial cells.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 11
Correct
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Regarding autoregulation of local blood flow, which of the following statements is CORRECT:
Your Answer: An increase in blood flow dilutes locally produced vasodilating factors causing vasoconstriction.
Explanation:Autoregulation is the ability to maintain a constant blood flow despite variations in blood pressure (between 50 – 170 mmHg). It is particularly important in the brain, kidney and heart. There are two main methods contributing to autoregulation:The myogenic mechanism involves arterial constriction in response to stretching of the vessel wall, probably due to activation of smooth muscle stretch-activated Ca2+channels and Ca2+entry. A reduction in pressure and stretch closes these channels, causing vasodilation. The second mechanism of autoregulation is due to locally produced vasodilating factors; an increase in blood flow dilutes these factors causing vasoconstriction, whereas decreased blood flow has the opposite effect.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 12
Incorrect
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A 66-year-old female who is a known case of atrial fibrillation comes to the Emergency Department with the complaint of fever and vomiting for the past two days. When her medical chart is reviewed, you see that she takes Warfarin for her arrhythmia. Which ONE of the following medications cannot be prescribed to this patient?
Your Answer: Codeine
Correct Answer: Ibuprofen
Explanation:Like other non-steroidal anti-inflammatory drugs, Ibuprofen cannot be given with Warfarin as it would increase the bleeding risk of this patient.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 13
Incorrect
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Regarding an avulsion fracture, a sudden contraction of which muscle may lead to fracture of the head of the fibula?
Your Answer: Peroneus brevis
Correct Answer: Biceps femoris
Explanation:Avulsion fractures of the fibular head are rare and are so-called the arcuate signal. The “arcuate signal” is used to describe an avulsed bone fragment related to the insertion site of the tendon of the biceps femoris associated with the arcuate complex, which consists of the fabellofibular, popliteofibular, and arcuate ligaments. Such lesions are typically observed in direct trauma to the knee with excessive varus and internal rotation forces or indirect trauma with the same direction of the force.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 14
Incorrect
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Antinuclear antibodies (ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus.Which ONE of these statements about ANAs is true?
Your Answer: Anti-dsDNA antibodies are found in around 15% of patients with SLE
Correct Answer: They can be of any immunoglobulin class
Explanation:Anti-nuclear antibodies(ANAs) also referred to as anti-nuclear factors (ANFs) are autoantibodies that bind to contents of the cell nucleus. They can be of any immunoglobulin class.CREST syndrome is usually associated with anti-centromere antibodies.ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most reliable.Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.Anti-dsDNA antibodies are found in 80 – 90% of patients with SLE
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 15
Incorrect
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Regarding shingles, which of the following statements is CORRECT:
Your Answer: You can catch shingles from a patient with shingles.
Correct Answer: You can catch chickenpox from a patient with shingles.
Explanation:After primary infection, VZV remains latent in sensory ganglia and in about 20% of patients will reactivate resulting in shingles, a painful vesicular rash in the related dermatome. Shingles usually affects older people and the immunocompromised. Shingles lesions are infectious to non-immune individuals who are at risk of developing chickenpox. Shingles can not be contracted directly from chickenpox, or from other cases of shingles. Shingles is treated with systemic antiviral treatment to reduce the severity and duration of pain, reduce complications, and reduce viral shedding.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 16
Incorrect
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A 35-year-old woman has complaints of nausea, abdominal pain and dark urine. On examination, you notice she has jaundice. She tells you she recently started a new medication.Which drug is NOT likely to cause cholestatic jaundice out of the following?
Your Answer: Nitrofurantoin
Correct Answer: Isoniazid
Explanation:Isoniazid is an antibiotic used in the treatment of tuberculosis. It can cause acute, dose-dependent, hepatitis but is not a recognised cause of cholestatic jaundice.The drugs that cause cholestatic jaundice are the following:1. Nitrofurantoin2. Erythromycin3. Cephalosporins4. Verapamil5. NSAIDs6. ACE inhibitors7. Tricyclic antidepressants8. Phenytoin9. Azathioprine10. Carbamazepine11. Oral contraceptive pills12. Diazepam13. Ketoconazole14. Tamoxifen
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 17
Incorrect
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Regarding the extensor carpi ulnaris muscle, which of the following statements is true?
Your Answer: It is innervated by the median nerve
Correct Answer: It receives its blood supply from the ulnar artery
Explanation:Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.
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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 patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer: The palmar digital branch of the median nerve
Correct Answer: The recurrent branch of the median nerve
Explanation:Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Correct
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When treating diabetic ketoacidosis (DKA), which of the following should be given if the systolic blood pressure is initially less than 90 mmHg:
Your Answer: 500 mL sodium chloride 0.9% intravenous infusion over 10 - 15 minutes
Explanation:If SBP is less than 90 mmHg , 500 mL sodium chloride 0.9 percent should be administered intravenously over 10–15 minutes, and repeated if SBP remains less than 90 mmHg. When SBP is greater than 90 mmHg, sodium chloride infusion must be maintained at a rate that replaces the deficit.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 20
Incorrect
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A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.Which of the following statements regarding the pectoralis minor muscle is considered correct?
Your Answer: It flexes the humerus
Correct Answer: It stabilises the scapula
Explanation:The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 21
Correct
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A 57-year-old woman receives vitamin B12 injections following a gastrectomy.Which of the following cell types, if absent, is responsible for her vitamin B12 deficiency?
Your Answer: Parietal cells
Explanation:Intrinsic factor, produced by the parietal cells of the stomach, is essential for the absorption of vitamin B12 from the terminal ileum. After a gastrectomy, the absorption of vitamin B12 is markedly reduced, and a deficiency will occur.
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 22
Correct
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A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. Which of these blood vessels has most likely been occluded?
Your Answer: Posterior inferior cerebellar artery
Explanation:Posterior inferior cerebellar artery (PICA) occlusion is characterised by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. PICA occlusion causes infarction of the posterior inferior cerebellum, inferior cerebellar vermis and lateral medulla.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 23
Incorrect
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A 45-year-old obese patient goes to the emergency department with a fever and significant right upper quadrant pain. The pain radiates to her right shoulder tip. Murphy's sign is positive and acute cholecystitis is diagnosed. The pain referred to the shoulder tip is caused by one of the following nerves:
Your Answer: Greater thoracic splanchnic nerve
Correct Answer: Phrenic nerve
Explanation:Gallbladder inflammation can cause pain in the right upper quadrant and right shoulder, which is caused by irritation of the diaphragmatic peritoneum. Pain from areas supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3-C5.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 24
Correct
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You see a patient in the ED with photophobia, petechial rash, headache and neck stiffness, and suspect a diagnosis of meningococcal meningitis.What is the most appropriate initial management?
Your Answer: Give ceftriaxone 2 g IV
Explanation:Treatment should be commenced with antibiotics immediately before laboratory confirmation due to the potentially life-threatening nature of the disease.In a hospital setting, 2g of IV ceftriaxone (80 mg/kg for a child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the drugs of choice. In the prehospital setting, IM benzylpenicillin can be given as an alternative.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 25
Correct
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Amoxicillin is used first line for all of the following infections EXCEPT for:
Your 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 26
Incorrect
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Lidocaine's antiarrhythmic mode of action is as follows:
Your Answer: Blocks open Na+ channels
Correct Answer: Blocks inactivated Na+ channels
Explanation:Lidocaine is a class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity. However, in ischaemic areas, where anoxia causes depolarisation and arrhythmogenic activity, many Na+ channels are inactivated and therefore susceptible to lidocaine.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 27
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 28
Incorrect
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In which of the following would you NOT typically see a neutropaenia:
Your Answer: Chloramphenicol therapy
Correct Answer: Asplenism
Explanation:Causes of neutropaenia:Drug-induced (e.g. chemotherapy, chloramphenicol, co-trimoxazole, phenytoin, carbamazepine, carbimazole, furosemide, chloroquine, clozapine, some DMARDs)Benign (racial or familial)CyclicalImmune (e.g. SLE, Felty’s syndrome, hypersensitivity and anaphylaxis)LeukaemiaInfections (e.g. HIV, hepatitis, fulminant bacterial infection)General PancytopaeniaHypersplenism, aplastic anaemia, malignant infiltration of bone marrow, megaloblastic anaemia, chemotherapy, myelodysplasia
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 29
Incorrect
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Which of these increases osteoclast activity?
Your Answer: Calcitonin
Correct Answer: Parathyroid hormone
Explanation:Osteoclasts are bone cell that break down bone tissue. Parathyroid hormone increases osteoclastic activity.1,25-dihydroxycholecalciferol increases osteoclastic activityCalcitonin inhibits osteoclastic activityBisphosphonates are osteoclast inhibitors.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 30
Correct
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Normal human immunoglobulin is mostly used to protect against which of the following infectious diseases?
Your Answer: Measles and hepatitis A
Explanation:Immune globulin IM is indicated for prophylaxis following exposureto hepatitis A, to prevent or modify measles (rubeola) in a susceptible person exposed fewer than 6 days previously,for susceptible household contacts of measles patients,particularly contacts <1 year and pregnant women without evidence of immunity, and to modify rubella in exposed pregnant women who will not consider a therapeutic abortion.
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This question is part of the following fields:
- Immunoglobulins And Vaccines
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
