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  • Question 1 - Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is...

    Incorrect

    • Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is an increase in metabolic rate, the production of vasoactive metabolites increases. These metabolites act locally on the surrounding arterioles, causes vasodilation and an increase blood supply.

      Which of these metabolites is the most potent vasodilator in skeletal muscle?

      Your Answer: H +

      Correct Answer: K +

      Explanation:

      Hyperaemia is the process where the body adjusts blood flow to meet the metabolic needs of different tissues in health and disease. Vasoactive mediators that take part in this process include K+, adenosine, CO2, H+, phosphates and H2O2. Although the mechanism is not clear, all these mediators likely contribute to some extent at different points.

      Specific organs are more sensitive to specific metabolites:
      K+ and adenosine are the most potent vasodilators in skeletal muscles

      CO2 and K+ are the most potent vasodilators in cerebral circulation.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      27.8
      Seconds

  • Question 2 - Which of the following is where the rectovesical fascia is located: ...

    Correct

    • Which of the following is where the rectovesical fascia is located:

      Your Answer: Between the fundus of the bladder and the ampulla of the rectum

      Explanation:

      In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      9.5
      Seconds

  • Question 3 - 1-alpha-hydroxylase is a cytochrome p450 enzyme that is involved in the production of...

    Correct

    • 1-alpha-hydroxylase is a cytochrome p450 enzyme that is involved in the production of vitamin D's hormonally active metabolite.

      Which of the following promotes the activity of 1-alpha-hydroxylase?

      Your Answer: Parathyroid hormone

      Explanation:

      1-alpha-hydroxylase converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol in the kidney.

      The key regulatory point in the formation of 1,25-dihydroxycholecalciferol is 1-alpha-hydroxylase, which is promoted by parathyroid hormone or hypophosphatemia.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      13.3
      Seconds

  • Question 4 - A possible diagnosis of Cushing's illness is being investigated in an overweight patient...

    Incorrect

    • A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.

      Which of the following statements about corticotropin-releasing hormone is correct?

      Your Answer: It is secreted from the anterior pituitary

      Correct Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus

      Explanation:

      Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.

      The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.

      Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      35.2
      Seconds

  • Question 5 - A 72 year old man is brought to ED by ambulance with sudden...

    Correct

    • A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:

      Your Answer: Synchronised DC cardioversion

      Explanation:

      All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      11.8
      Seconds

  • Question 6 - You examine a child who has been admitted to the paediatric emergency department...

    Correct

    • You examine a child who has been admitted to the paediatric emergency department with a flu-like illness. His parents tell you that he was born with an inborn defect of steroid metabolism and that he was treated for it with hormone replacement therapy.

      Which of the following is classified as a steroid hormone?

      Your Answer: Aldosterone

      Explanation:

      Hormones can be classified into three categories depending on their chemical composition: amines, peptides (and proteins), and steroids. Amines are made up of single amino acids (for example, tyrosine), peptide hormones are made up of peptides (or proteins), and steroid hormones are made up of cholesterol.
      The table below lists some prominent instances of each of these three hormone classes:

      1. Peptide hormone:
      Adrenocorticotropic hormone (ACTH)
      Prolactin
      Vasopressin
      Oxytocin
      Glucagon
      Insulin
      Somatostatin
      Cholecystokinin

      2. Amine hormone:
      Adrenaline (epinephrine)
      Noradrenaline (norepinephrine)
      Dopamine

      3. Steroid hormone:
      Mineralocorticoids (e.g. aldosterone)
      Glucocorticoids (e.g. cortisol)
      Progestogens
      Androgens
      Oestrogens

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      14.1
      Seconds

  • Question 7 - A 26 year old horse rider has a bad fall and sustains a...

    Incorrect

    • A 26 year old horse rider has a bad fall and sustains a neck injury which displays the following signs:
      - ability to extend the wrist against gravity
      - paralysis of the hands, trunk, and legs
      - absent sensation in the fingers and medial upper arms
      - normal sensation over the thumbs
      - absent sensation in chest, abdomen, and legs

      What is the neurological level of the injury?

      Your Answer: C7

      Correct Answer: C6

      Explanation:

      C1 – C4 INJURY
      Most severe of the spinal cord injury levels; paralysis in arms, hands, trunk and legs; patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements; ability to speak is sometimes impaired or reduced

      C5 INJURY
      Person can raise his or her arms and bend elbows; likely to have some or total paralysis of wrists, hands, trunk and legs; can speak and use diaphragm, but breathing will be weakened

      C6 INJURY
      Nerves affect wrist extension; paralysis in hands, trunk and legs, typically; should be able to bend wrists back; can speak and use diaphragm, but breathing will be weakened

      C7 INJURY
      Nerves control elbow extension and some finger extension; most can straighten their arm and have normal movement of their shoulders

      C8 INJURY
      Nerves control some hand movement; should be able to grasp and release objects

      C5 – Elbow flexors (biceps, brachialis)
      C6 – Wrist extensors (extensor carpi radialis longus and brevis)
      C7 – Elbow extensors (triceps)
      C8 – Finger flexors (flexor digitorum profundus) to the middle finger

      C5 – Elbow flexed at 90 degrees, arm at the patient’s side and forearm supinated
      C6 – Wrist in full extension
      C7 – Shoulder is neutral rotation, adducted and in 90 degrees of flexion with elbow in 45 degrees of flexion
      C8 –Full flexed position of the distal phalanx with the proximal finger joints stabilized in a extended position

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      53
      Seconds

  • Question 8 - Regarding the heart sounds in the cardiac cycle, which of the following statements...

    Correct

    • Regarding the heart sounds in the cardiac cycle, which of the following statements is INCORRECT:

      Your Answer: The third heart sound is caused by filling of an abnormally stiff ventricle in atrial systole.

      Explanation:

      Heart Sound – Phase of Cardiac Cycle – Mechanical Event:
      First heart sound – Start of systole – Caused by closure of the atrioventricular (mitral & tricuspid) valves
      Second heart sound – End of systole – Caused by closure of the semilunar (aortic and pulmonary) valves
      Third heart sound – Early diastole – Caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase
      Fourth heart sound – Late diastole – Caused by filling of an abnormally stiff ventricle in atrial systole

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      24
      Seconds

  • Question 9 - A 7-year-old girl is admitted to the hospital with a persistently high temperature....

    Correct

    • A 7-year-old girl is admitted to the hospital with a persistently high temperature. To help her reduce her fever, you decide to give her paracetamol and ibuprofen.

      What are the effects of paracetamol and ibuprofen on fever?

      Your Answer: Reduction in prostaglandin synthesis

      Explanation:

      Interleukin-1, which is released by leukocytes and acts on the thermoregulatory centre of the hypothalamus, causes fever. Because prostaglandins mediate this process, antipyretics such as NSAIDs, paracetamol, and aspirin reduce prostaglandin levels by inhibiting cyclooxygenase enzymes. Malignant disease secretes interleukins, which cause the B-symptoms seen in lymphoma, for example. Bacterial toxins can also cause interleukins to be produced.

      Pyrexia of unknown origin (PUO) is defined as a fever of greater than 38.3 degrees Celsius that lasts for more than 2-3 weeks with no clear diagnosis despite extensive investigation.

      Investigation necessitates a thorough understanding of the conditions that can cause febrile illness, which may be missed during an initial investigation, as well as a thorough history, examination, and investigation centred on that list.

      Pyrexia of unknown origin has a wide differential diagnosis, which includes:
      Infection
      Bacterial
      Pyogenic abscess
      Tuberculosis
      Infective endocarditis
      Brucellosis
      Lyme disease
      Viral
      HIV
      Epstein Barr Virus
      Cytomegalovirus
      Parasite
      Toxoplasmosis
      Malignancy
      Leukaemia
      Lymphoma
      Renal cell carcinoma
      Hepatocellular carcinoma
      Vasculitides
      Still’s disease
      Granulomatosis with polyangiitis (formerly Wegener’s)
      Systemic lupus erythematosus
      Giant cell arteritis
      Rheumatoid arthritis
      Polymyalgia rheumatica
      Miscellaneous
      Drug induced fevers
      Familial Mediterranean fever
      Thyrotoxicosis
      Inflammatory bowel disease
      Sarcoidosis
      Factitious fever
      Exaggerated normal circadian fluctuation

      The patient might need to be admitted to the hospital for observation and further investigation. Because infection is still a possibility, blood cultures should be repeated on a regular basis, and inflammatory markers should be closely monitored. CT, PET, and MRI imaging have largely replaced diagnostic laparotomy as a diagnostic tool.

    • This question is part of the following fields:

      • Pathology
      • Pathology Of Infections
      23.7
      Seconds

  • Question 10 - A patient suffers a stab wound to the neck. The entry point of...

    Incorrect

    • A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.
      Which of the following muscles is most likely to be involved? Select ONE answer only.

      Your Answer: Anterior scalene

      Correct Answer: Sternothyroid

      Explanation:

      The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
      Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
      Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
      Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
      Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
      Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerve

      The posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
      Contents:
      Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
      Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      53.4
      Seconds

  • Question 11 - Which of the following is the most abundant peripheral blood leucocyte: ...

    Correct

    • Which of the following is the most abundant peripheral blood leucocyte:

      Your Answer: Neutrophils

      Explanation:

      Neutrophils are the most abundant peripheral blood leucocyte, comprising about 50 – 70% of circulating white cells. Neutrophils have a characteristic dense nucleus consisting of between two and five lobes, and a pale cytoplasm with an irregular outline containing many fine pink-blue or grey-blue granules. The granules are divided into primary, which appear at the promyelocyte stage, and secondary, which appear at the myelocyte stage and predominate in the mature nucleus. Both types of granule are lysosomal in origin; the primary contains myeloperoxidase and other acid hydrolases; the secondary contains lactoferrin, lysozyme and other enzymes. The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      11.2
      Seconds

  • Question 12 - A 79-year-old male had a humeral shaft fracture during a road traffic accident...

    Correct

    • A 79-year-old male had a humeral shaft fracture during a road traffic accident and is being followed up in a fracture clinic. He complains of inability to use the limb 6 months after the injury. X-rays of that arm shows non union of his fracture.

      All the following are responsible for this non-union EXCEPT?

      Your Answer: Osteoporosis

      Explanation:

      An imbalance between bone resorption and formation is Osteoporosis. In normal bone, formation and resorption are roughly equal, and the density of bone matrix remains constant but there is more resorption in osteoporosis and the matrix density reduces and bones become weaker. Fractures are more likely to occur but healing is unaffected.

      Non-union of a fracture occurs when the two sides of a fracture fail to unite after 6 months. Causes include: infection, movement at the fracture site, avascular necrosis, tissue interposed between the fracture and gross misalignment.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      36.4
      Seconds

  • Question 13 - EMLA cream is a topical local anaesthetic containing which of the following: ...

    Correct

    • EMLA cream is a topical local anaesthetic containing which of the following:

      Your Answer: 50/50 mixture 2.5% lidocaine and 2.5% prilocaine

      Explanation:

      EMLA cream, an effective topical local anaesthetic, is a 50/50 mixture of 2.5% prilocaine and 2.5% lidocaine.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      8
      Seconds

  • Question 14 - The most common type of adult leukaemia is chronic lymphocytic leukaemia (CLL). It...

    Incorrect

    • The most common type of adult leukaemia is chronic lymphocytic leukaemia (CLL). It develops as a result of lymphocyte clonal proliferation. Which of the following statements about CLL is CORRECT?

      Your Answer: > 90% of cases are of T-cell lineage

      Correct Answer: It is most commonly discovered as an incidental finding

      Explanation:

      CLL (chronic lymphocytic leukaemia) is the most common type of chronic lymphoid leukaemia, with a peak incidence between the ages of 60 and 80. It is the most common type of leukaemia in Europe and the United States, but it is less common elsewhere.

      The CLL tumour cell is a mature B-cell with low immunoglobulin surface expression (IgM or IgD). The average age at diagnosis is 72 years, with only 15% of cases occurring before the age of 50.

      The male-to-female ratio is about 2:1. Over 80% of cases are identified by the results of a routine blood test, which is usually performed for another reason.

      Lymphocytic anaemia, thrombocytopenia, and normochromic normocytic anaemia are common laboratory findings. Aspiration of bone marrow reveals up to 95% lymphocytic replacement of normal marrow elements.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      29.3
      Seconds

  • Question 15 - Which of the following occurs primarily to produce passive expiration: ...

    Correct

    • Which of the following occurs primarily to produce passive expiration:

      Your Answer: Relaxation of diaphragm and external intercostal muscles

      Explanation:

      Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) and the elastic recoil of the lungs. In expiration, depression of the sternal ends of the ribs (‘pump handle’ movement), depression of the lateral shafts of the ribs (‘bucket handle’ movement) and elevation of the diaphragm result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in a decreased intrathoracic volume and increased intrathoracic pressure and thus air is forced out of the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      19
      Seconds

  • Question 16 - In which of the following would you NOT typically see a neutropaenia: ...

    Correct

    • In which of the following would you NOT typically see a neutropaenia:

      Your 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)
      Cyclical
      Immune (e.g. SLE, Felty’s syndrome, hypersensitivity and anaphylaxis)
      Leukaemia
      Infections (e.g. HIV, hepatitis, fulminant bacterial infection)
      General Pancytopaenia
      Hypersplenism, aplastic anaemia, malignant infiltration of bone marrow, megaloblastic anaemia, chemotherapy, myelodysplasia

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      58
      Seconds

  • Question 17 - A 52-year-old man presents to the emergency room with chest pain. He was...

    Incorrect

    • A 52-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.

      Which of the following is NOT a contraindication to abciximab (ReoPro) treatment?

      Your Answer: Stroke within the last 2 years

      Correct Answer: Major surgery within the last 6 months

      Explanation:

      Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.

      The use of abciximab is contraindicated in the following situations:
      Internal bleeding is present.
      Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
      Stroke in the previous two years
      Intracranial tumour
      Aneurysm or arteriovenous malformation
      Haemorrhagic diathesis is a type of haemorrhagic diathesis.
      Vasculitis
      Retinopathy caused by hypertension

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      50.8
      Seconds

  • Question 18 - Regarding hypernatraemia, which of the following statements is INCORRECT: ...

    Correct

    • Regarding hypernatraemia, which of the following statements is INCORRECT:

      Your Answer: In acute severe hypernatraemia, seizures and intracranial vascular haemorrhage can occur as a result of brain cell lysis.

      Explanation:

      Acute severe hypernatraemia is a medical emergency and requires inpatient management in a high dependency setting. Seizures and intracranial vascular haemorrhage as a result of brain cell crenation can occur. The cause is most commonly excessive water loss and the key aspect of treatment is aggressive fluid replacement (typically with normal saline as this is relatively hypotonic). If urine osmolality is low, diabetes insipidus (DI )should be considered and a trial of synthetic ADH given. In patients with known DI, it is essential to ensure synthetic ADH is given parenterally and that close fluid balance is observed.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      80.4
      Seconds

  • Question 19 - Which of the following is typically used in diabetes mellitus as the cut-off...

    Incorrect

    • Which of the following is typically used in diabetes mellitus as the cut-off to define hypoglycaemia?

      Your Answer: < 2.5 mmol/L

      Correct Answer:

      Explanation:

      Hypoglycaemia is defined as plasma glucose of less than 4 mmol/L.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      15.2
      Seconds

  • Question 20 - Which of the following is the most common cause of megaloblastic anaemia: ...

    Incorrect

    • Which of the following is the most common cause of megaloblastic anaemia:

      Your Answer: Alcohol

      Correct Answer: Vitamin B12 deficiency

      Explanation:

      Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the growth stage to the mitosis stage. This leads to continuing cell growth without division, which presents as macrocytosis, with an increase in mean corpuscular volume (MCV). The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency.
      Folate is an essential vitamin found in most foods, especially liver, green vegetables and yeast. The normal daily diet contains 200 – 250 μg, of which about 50% is absorbed. Daily adult requirements are about 100 μg. Absorption of folate is principally from the duodenum and jejunum. Stores of folate are normally only adequate for 4 months and so features of deficiency may be apparent after this time.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      12.3
      Seconds

  • Question 21 - Which of the following nerves innervates the gastrocnemius muscle? ...

    Correct

    • Which of the following nerves innervates the gastrocnemius muscle?

      Your Answer: Tibial nerve

      Explanation:

      The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      10.6
      Seconds

  • Question 22 - A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from...

    Correct

    • A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from the steering wheel of his car after falling asleep while driving headlong into an oncoming HGV lorry. Bruising around his sternum was observed, which appears to be the central point of impact.

      Which of the following structures is most likely injured by the blunt force trauma?

      Your Answer: Right ventricle

      Explanation:

      In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:

      Anterior (or sternocostal) – Right ventricle
      Posterior (or base) – Left atrium
      Inferior (or diaphragmatic) – Left and right ventricles
      Right pulmonary – Right atrium
      Left pulmonary – Left ventricle

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      18.5
      Seconds

  • Question 23 - In relation to ketamine, which of the following statements is TRUE: ...

    Correct

    • In relation to ketamine, which of the following statements is TRUE:

      Your 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.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      13.6
      Seconds

  • Question 24 - A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency...

    Correct

    • A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin.

      There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute.

      A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer: Nitrofurantoin

      Explanation:

      The NICE guidelines for men with lower UTIs are:
      1. Prescribe an antibiotic immediately, taking into account the previous urine culture and susceptibility results or avoiding antibiotics used previously that may have caused resistance
      2. Obtain a midstream urine sample before starting antibiotics and send for urine culture and susceptibility
      – Review the choice of antibiotic when the results are available AND
      – change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possible

      The first choice of antibiotics for men with lower UTIs is:
      1. Trimethoprim
      200 mg PO BD for seven days
      2. Nitrofurantoin
      100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute

      In men whose symptoms have not responded to a first-choice antibiotic, alternative diagnoses (such as acute pyelonephritis or acute prostatitis) should be considered. Second-choice antibiotics should be based on recent culture and susceptibility results.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      19
      Seconds

  • Question 25 - A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how...

    Correct

    • A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how to deal with her symptoms. In the first instance, the pharmacist advises her to take an over-the-counter antacid. She buys an antacid that contains aluminium hydroxide, which relieves her symptoms but has a negative side effect.

      She's most likely to have developed which of the following side effects?

      Your Answer: Constipation

      Explanation:

      Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.

      When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.

      Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.

      Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      12.2
      Seconds

  • Question 26 - A 64-year-old woman had a humerus midshaft fracture due to tripping on a...

    Correct

    • A 64-year-old woman had a humerus midshaft fracture due to tripping on a curb and falling on her left arm. She might also have damaged which of the following structures?

      Your Answer: Radial nerve and deep brachial artery

      Explanation:

      The radial nerve and brachial artery are most likely to be damaged in humerus fractures. They are tethered together to the bone and cannot withstand the forces applied to it as a result of the displacement.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      66
      Seconds

  • Question 27 - Insulin is produced by which of the following pancreatic cells: ...

    Correct

    • Insulin is produced by which of the following pancreatic cells:

      Your Answer: β cells

      Explanation:

      Insulin is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas. Insulin is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds. Proinsulin is synthesised as a single-chain peptide. Within storage granules, a connecting peptide (C peptide) is removed by proteases to yield insulin. Insulin release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin, but most output is driven by the rise in plasma glucose concentration that occurs after a meal. The effects of insulin are mediated by the receptor tyrosine kinase.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      5.8
      Seconds

  • Question 28 - You are instructed by a senior to administer Mannitol to an RTA patient...

    Correct

    • You are instructed by a senior to administer Mannitol to an RTA patient with increased intracranial pressure.

      Mannitol is a low molecular weight compound that freely filters at the glomerulus and is not reabsorbed.
      Out of the following, which is a contraindication to the use of mannitol?

      Your Answer: Severe pulmonary oedema

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      It is recommended to use mannitol for the reduction of CSF pressure/cerebral oedema in a dose of 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.

      Mannitol has several contraindications and some of them are listed below:
      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      11.6
      Seconds

  • Question 29 - You plan to use plain 1% lidocaine for a ring block on a...

    Correct

    • You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.
      Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?

      Your Answer: Lidocaine works by blocking fast voltage-gated sodium channels

      Explanation:

      Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
      Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals.
      Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
      The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
      Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      16.4
      Seconds

  • Question 30 - Which of the following statements is considered correct regarding Klebsiella infections? ...

    Incorrect

    • Which of the following statements is considered correct regarding Klebsiella infections?

      Your Answer: Klebsiella pneumoniae is most commonly associated with chronic bronchiectasis

      Correct Answer: Klebsiella spp. are non-motile

      Explanation:

      Klebsiella is a Gram-negative, rod-shaped, non-motile bacteria. The absence of motility distinguishes Klebsiella spp. from most other members of the family Enterobacteriaceae.

      K. pneumoniae is the most commonly isolated species and has the distinct feature of possessing a large polysaccharide capsule. The capsule offers the organism protection against phagocytosis and antimicrobial absorption,
      contributing to its virulence.

      Colonization of gram-negative bacilli in the respiratory tracts of hospitalized patients, particularly by K. pneumoniae, increases with the length of hospital stay. It is a frequent cause of lower respiratory tract infections among hospitalized patients and in immunocompromised hosts such as newborns,
      elderly patients, and seriously ill patients on respirators.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      32.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Physiology (0/1) 0%
Physiology (5/8) 63%
Abdomen (1/1) 100%
Anatomy (5/7) 71%
Endocrine Physiology (2/3) 67%
Cardiovascular (2/2) 100%
Pharmacology (7/8) 88%
Central Nervous System (0/1) 0%
Pathology (4/6) 67%
Pathology Of Infections (1/1) 100%
Head And Neck (0/1) 0%
Immune Responses (2/2) 100%
General Pathology (1/1) 100%
Anaesthesia (3/3) 100%
Haematology (0/2) 0%
Thorax (2/2) 100%
Cardiovascular Pharmacology (1/2) 50%
Endocrine (2/3) 67%
Lower Limb (1/1) 100%
Infections (1/1) 100%
Gastrointestinal Pharmacology (1/1) 100%
Upper Limb (1/1) 100%
Microbiology (0/1) 0%
Specific Pathogen Groups (0/1) 0%
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