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  • Question 1 - Which of the following statements is true about percutaneous needle aspiration? ...

    Incorrect

    • Which of the following statements is true about percutaneous needle aspiration?

      Your Answer: The conventional approach is anteriorly in the mid-clavicular line

      Correct Answer: The needle should be inserted just above the upper border of the chosen rib

      Explanation:

      Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.

      In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      34.2
      Seconds

  • Question 2 - A 30-year-old man presents with piriformis syndrome pain, tingling, and numbness in her...

    Incorrect

    • A 30-year-old man presents with piriformis syndrome pain, tingling, and numbness in her buttocks. He noted that the pain gets worse upon sitting down. He was seen by a physiotherapist and a diagnosis of piriformis syndrome was made.

      Which of the following nerves becomes irritated in piriformis syndrome?

      Your Answer: Nerve to piriformis

      Correct Answer: Sciatic nerve

      Explanation:

      Piriformis syndrome is a clinical condition of sciatic nerve entrapment at the level of the ischial tuberosity. While there are multiple factors potentially contributing to piriformis syndrome, the clinical presentation is fairly consistent, with patients often reporting pain in the gluteal/buttock region that may shoot, burn or ache down the back of the leg (i.e. sciatic-like pain). In addition, numbness in the buttocks and tingling sensations along the distribution of the sciatic nerve is not uncommon.

      The sciatic nerve runs just adjacent to the piriformis muscle, which functions as an external rotator of the hip. Hence, whenever the piriformis muscle is irritated or inflamed, it also affects the sciatic nerve, which then results in sciatica-like pain.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      25
      Seconds

  • Question 3 - A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 4 - The mechanism of action of abciximab is by: ...

    Incorrect

    • The mechanism of action of abciximab is by:

      Your Answer:

      Correct Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites

      Explanation:

      Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 5 - Which statement about cross-sectional studies is true? ...

    Incorrect

    • Which statement about cross-sectional studies is true?

      Your Answer:

      Correct Answer: They can be used to assess the prevalence of a condition

      Explanation:

      Cross-sectional studies can be used to assess the prevalence of a condition.

      Cross-sectional studies CANNOT be used to differentiate between cause and effect or establish the sequence of events.

      They can be used to study multiple outcomes but are NOT suitable for studying rare diseases.

    • This question is part of the following fields:

      • Evidence Based Medicine
      0
      Seconds

  • Question 6 - Regarding hepatitis C, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding hepatitis C, which of the following statements is INCORRECT:

      Your Answer:

      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.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 7 - Nitrous oxide is associated with which of the following adverse effects: ...

    Incorrect

    • Nitrous oxide is associated with which of the following adverse effects:

      Your Answer:

      Correct Answer: Megaloblastic anaemia

      Explanation:

      Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 8 - Which of the following is NOT an advantage of a case-control study used...

    Incorrect

    • 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:

      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

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      0
      Seconds

  • Question 9 - Typically, granulomatous inflammation is associated with one of the following infections: ...

    Incorrect

    • Typically, granulomatous inflammation is associated with one of the following infections:

      Your Answer:

      Correct Answer: Tuberculosis

      Explanation:

      Granulomatous inflammation is typically seen when an infective agent with a digestion-resistance capsule (e.g. Mycobacterium tuberculosis) or a piece of inert foreign material (such as suture or glass) is introduced into the tissue. A transient acute inflammatory response occurs and when this is ineffective in eradicating the stimulus, chronic inflammation occurs.

      Tuberculosis is the prototype of the granulomatous diseases, but sarcoidosis, cat-scratch disease, lymphogranuloma inguinale, leprosy, brucellosis, syphilis, some mycotic infections, berylliosis, reactions of irritant lipids, and some autoimmune diseases are also included

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      0
      Seconds

  • Question 10 - On his stool culture, a patient with a diarrhoeal illness grows Escherichia coli.

    What...

    Incorrect

    • On his stool culture, a patient with a diarrhoeal illness grows Escherichia coli.

      What SINGLE statement about Escherichia coli is true?

      Your Answer:

      Correct Answer: Most serotypes are harmless

      Explanation:

      Escherichia coli is a Gram-negative, non-spore forming, facultative anaerobic, rod-shaped bacterium.

      Although some can cause serious food poisoning, most serotypes are harmless.

      Escherichia coli is transmitted via the faeco-oral route.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 11 - A 24 year old male sustained an insect bite and presents with a...

    Incorrect

    • A 24 year old male sustained an insect bite and presents with a red hot arm and acute cellulitis has been diagnosed. The predominant white cells in this type of acute inflammation are:

      Your Answer:

      Correct Answer: Neutrophils

      Explanation:

      Neutrophil polymorphs are the predominant type of white cells in an acute reaction. They pass between endothelial cell junctions to invade damaged tissue so that the effects of injury can be combated. Extravasation occurs with the movement of leukocytes out of the vessel lumen, and is achieved in five phases which are margination, ‘rolling’, adhesion, transmigration and chemotaxis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      0
      Seconds

  • Question 12 - The least likely feature of anaemia is: ...

    Incorrect

    • The least likely feature of anaemia is:

      Your Answer:

      Correct Answer: Narrow pulse pressure

      Explanation:

      Non-specific signs of anaemia include:
      1. pallor of mucous membranes or nail beds (if Hb < 90 g/L),
      2. tachycardia
      3. bounding pulse
      4. wide pulse pressure
      5. flow murmurs
      6. cardiomegaly
      7. signs of congestive cardiac failure (in severe cases)

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 13 - Which of the following is NOT typically present in the nasopharyngeal flora: ...

    Incorrect

    • Which of the following is NOT typically present in the nasopharyngeal flora:

      Your Answer:

      Correct Answer: Bacteroides spp.

      Explanation:

      Bacteroides spp. are typically found in the normal flora of the lower gastrointestinal tract. Species commonly found in the flora of the nasopharynx include: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Corynebacterium spp., Moraxella spp. and Candida spp.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      0
      Seconds

  • Question 14 - What is the interquartile range for these numbers: 11, 4, 6, 8, 3,...

    Incorrect

    • What is the interquartile range for these numbers: 11, 4, 6, 8, 3, 10, 8, 10, 4, 12, 31?

      Your Answer:

      Correct Answer: 7

      Explanation:

      We obtain 3, 4, 4, 6, 8, 8, 10, 11, 12, and 31, and sample size (n) = 11 when we order the data. [(n+1)/2] = median 6th value = (11+1)/2 = [(n+1)/4] represents the bottom (first) quartile. (3rd value = 4th value = (11 + 1)/4 3[(n+1)/4] for the top (third) quartile 3[(11 + 1)/4] = 9th value = 11th value = 11th value = 11th value = 11th value = 11th value = 11th value = 11th value = 11th The difference between the upper and lower quartiles is the interquartile range, which is equal to 11 minus 4 = 7.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      0
      Seconds

  • Question 15 - A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.

    Which...

    Incorrect

    • A 12-year-old boy presents to the ED with symptoms suggesting an anaphylactic reaction.

      Which of these statements about anaphylaxis is true?

      Your Answer:

      Correct Answer: The immunoglobulin-antigen complex binds to Fc receptors on the surface of mast cells.

      Explanation:

      Anaphylaxis is an example of a type I hypersensitivity reaction.

      It is IgE mediated.

      It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.

      Massive calcium influx into the cells leads to mast cell degranulation.

      The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 16 - A young male has presented to the Emergency Department with a sudden onset...

    Incorrect

    • A young male has presented to the Emergency Department with a sudden onset of severe palpitations, shortness of breath, and chest pain. A 12-lead ECG is recorded, and it shows a narrow complex tachycardia that points to a diagnosis of supraventricular tachycardia.

      Vagal manoeuvres are attempted but are unsuccessful in eliminating the arrhythmia. The next action plan is to use a drug to revert to sinus rhythm.

      Out of the following, which is the first-line treatment for supraventricular tachycardia?

      Your Answer:

      Correct Answer: Adenosine

      Explanation:

      Paroxysmal supraventricular tachycardia is an intermittent tachycardia (HR > 100 bpm) and has the following characteristics:
      1. Sudden onset/offset (Contrast with sinus tachycardia)
      2. Electrical activity originates above the ventricle (Contrast with ventricular tachycardia)
      3. Produces narrow QRS complex (<120ms) The most common cause of PSVT is Atrioventricular nodal re-entrant tachycardia (AVNRT), most common in young women with a mean age onset of 32 years old. There are recurrent episodes of palpitations, and most of the episodes spontaneously. Sometimes, some vagal manoeuvres are required:
      1. Valsalva manoeuvre
      2. immersing the face in ice-cold water
      3. carotid sinus massage.

      If PSVT keeps persisting or is causing severe symptoms, the treatment of choice is intravenous adenosine. The patient’s ECG should be continuously monitored throughout the treatment.

      The recommended doses in adults are as follows:
      – Initial dose of adenosine is 6 mg by rapid IV bolus
      – If unsuccessful, give another dose of adenosine 12 mg by rapid IV bolus
      – If unsuccessful, give a further dose of adenosine 12 mg by rapid IV bolus
      The latest ALS guidelines advocate 18 mg for the third dose, whereas the BNF/NICE guidelines advocate 12 mg.

      If adenosine fails or is contraindicated, intravenous verapamil can be used as an alternative, but it should be avoided in patients recently treated with beta-blockers.

      Synchronized electrical cardioversion will be necessary with signs of hemodynamic instability or if drug treatment has failed to restore sinus rhythm.
      Recurrent episodes of paroxysmal supraventricular tachycardia can be treated by catheter ablation or prevented with drugs such as flecainide, sotalol, diltiazem, or verapamil.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 17 - Which of the following side effects has limited the use of etomidate as...

    Incorrect

    • Which of the following side effects has limited the use of etomidate as an intravenous induction agent:

      Your Answer:

      Correct Answer: Adrenocortical suppression

      Explanation:

      Etomidate causes the least cardiovascular depression of the intravenous induction agents, with only a small reduction in the cardiac output and blood pressure. In the past, etomidate was widely used to induce anaesthesia in the shocked, elderly or cardiovascularly unstable patient. However, more recently it has become less popular as a single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4 – 8 hours, and up to 24 hours in elderly and debilitated patients. Although no increase in mortality has been identified following a single dose during induction of anaesthesia, the use of etomidate has declined due to a perceived potential morbidity.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 18 - A 24-year-old waiter cuts his hand on a dropped plate that smashed and...

    Incorrect

    • A 24-year-old waiter cuts his hand on a dropped plate that smashed and damages the nerve that innervates opponens digiti minimi.
      The opponens digiti minimi muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: The deep branch of the ulnar nerve

      Explanation:

      Opponens digiti minimi is a triangular-shaped muscle in the hand that forms part of the hypothenar eminence. It originates from the hook of the hamate bone and the flexor retinaculum and inserts into the medial border of the 5thmetacarpal.
      Opponens digiti minimi is innervated by the deep branch of the ulnar nerve and receives its blood supply from the ulnar artery.
      Opponens digiti minimi draws the fifth metacarpal bone anteriorly and rotates it, bringing the fifth digiti into opposition with the thumb.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 19 - Which of the following is NOT a side effect of phenytoin: ...

    Incorrect

    • Which of the following is NOT a side effect of phenytoin:

      Your Answer:

      Correct Answer: Ototoxicity

      Explanation:

      Adverse effects of phenytoin include:
      Nausea and vomiting
      Drowsiness, lethargy, and loss of concentration
      Headache, dizziness, tremor, nystagmus and ataxia
      Gum enlargement or overgrowth
      Coarsening of facial features, acne and hirsutism
      Skin rashes
      Blood disorders

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 20 - A patient with pronounced tremor, muscle contractions, muscle spasms, and slowness of movement...

    Incorrect

    • A patient with pronounced tremor, muscle contractions, muscle spasms, and slowness of movement is brought in by his family. He has a long history of mental health issues for which he is currently treated with a variety of medications.

      Which of the medications listed below is most likely to be the cause of these side effects?

      Your Answer:

      Correct Answer: Haloperidol

      Explanation:

      Acute dyskinesias and dystonic reactions, tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw), Parkinsonism (tremor, bradykinesia, and rigidity), akinesia, akathisia, and neuroleptic malignant syndrome are all examples of extrapyramidal side effects. They are caused by dopamine depletion or blockade in the basal ganglia; this lack of dopamine frequently mimics idiopathic extrapyramidal pathologies.

      The first-generation antipsychotics, which are strong dopamine D2 receptor antagonists, are the drugs most commonly associated with extrapyramidal side effects. Haloperidol and fluphenazine are the two drugs in this class that are most commonly associated with extrapyramidal side effects. Extrapyramidal adverse effects are less common in second-generation antipsychotics (e.g., olanzapine) than in first-generation antipsychotics.

      Other drugs are linked to extrapyramidal symptoms as well, but at a lower rate. Some antidepressants, lithium, various anticonvulsants, antiemetics, and, in rare cases, oral contraceptive agents are among them.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 21 - How does aspirin mediate its antiplatelet effect: ...

    Incorrect

    • How does aspirin mediate its antiplatelet effect:

      Your Answer:

      Correct Answer: It irreversibly inhibits cyclo-oxygenase

      Explanation:

      Aspirin irreversibly inhibits cyclooxygenase and blocks the platelet production of thromboxane A2 (TXA2), thus inhibiting platelet aggregation.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 22 - What is the mechanism of action of captopril: ...

    Incorrect

    • What is the mechanism of action of captopril:

      Your Answer:

      Correct Answer: Angiotensin-converting enzyme inhibitor

      Explanation:

      Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 23 - Which of the following medications can block the effect of adrenaline? ...

    Incorrect

    • Which of the following medications can block the effect of adrenaline?

      Your Answer:

      Correct Answer: Beta-blockers

      Explanation:

      Beta-blockers may reduce the response to adrenaline in the treatment of anaphylactic reactions.

      Noncardioselective beta-blockers in particular can antagonize the broncho dilating and cardio stimulatory effects of adrenaline by blocking beta-2 adrenergic receptors in the smooth muscles of the bronchial tree and in the heart muscles.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      0
      Seconds

  • Question 24 - C5 - C9 deficiency increases susceptibility to infection with which of the following:...

    Incorrect

    • C5 - C9 deficiency increases susceptibility to infection with which of the following:

      Your Answer:

      Correct Answer: Neisseria spp.

      Explanation:

      If the complement sequence is completed, an active phospholipase (the membrane attack complex, MAC) is produced, which punches holes in the cell membrane and causes cell lysis. Because the MAC appears to be the sole means to destroy the Neisseria family of bacteria, C5 – C9 deficiency increases susceptibility to Neisseria infections.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 25 - An unrelated medical condition brings a 28-year-old asthmatic man to the Emergency Department....

    Incorrect

    • An unrelated medical condition brings a 28-year-old asthmatic man to the Emergency Department. When you look over his meds, you notice that he is taking Theophylline to help with his asthma.

      Which of the following medicines should you NOT prescribe?

      Your Answer:

      Correct Answer: Ciprofloxacin

      Explanation:

      Ciprofloxacin is a cytochrome P450 enzyme inhibitor that raises theophylline levels in the blood. As a result, co-prescribing theophylline should be avoided.

      The medicines that typically impact theophylline’s half-life and plasma concentration are listed in the table below:
      Drugs that increase the levels of theophylline in the blood
      Drugs that lower theophylline levels in the blood
      Calcium channel blockers e.g. Verapamil
      Fluconazole
      Cimetidine
      Quinolones, e.g. ciprofloxacin
      Methotrexate
      Barbiturates
      Carbamazepine
      Phenobarbital
      Macrolides, e.g. erythromycin
      Phenytoin (and fosphenytoin)
      Rifampicin
      St. John’s wort

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      0
      Seconds

  • Question 26 - Platelet alpha granules release which of the following? ...

    Incorrect

    • Platelet alpha granules release which of the following?

      Your Answer:

      Correct Answer: Von Willebrand factor (VWF)

      Explanation:

      There are three types of storage granules contained in platelets. These are dense granules which contain the following:
      -ATP
      -ADP
      -serotonin and calcium alpha granules containing clotting factors
      -von Willebrand factor (VWF)
      -platelet-derived growth factor (PDGF)
      – other proteins lysosomes containing hydrolytic enzymes.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 27 - Which of the following immunoglobulin molecules is the most abundant in secretions (such...

    Incorrect

    • Which of the following immunoglobulin molecules is the most abundant in secretions (such as saliva and breast milk):

      Your Answer:

      Correct Answer: IgA

      Explanation:

      IgA is the predominant antibody class in secretions and tremendous quantities are secreted into various body spaces and onto mucosal surfaces (the gut lumen, the pharynx and sinuses, the larger airways, although not the alveoli).
      Because of its size, the majority of IgM is found in the circulation.

      Along with IgM, IgD is predominant among the surface receptors of mature B cells, where it plays a key role in B cells activation.

      IgE has the lowest concentration in normal human serum. It plays a prominent role in immune responses to helminth parasites, and in allergic reactions.
      IgG is the most abundant immunoglobulin and constitutes 75 percent of serum immunoglobulin in an adult human

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 28 - The functional residual capacity (FRC) will be increased in which of the following:...

    Incorrect

    • The functional residual capacity (FRC) will be increased in which of the following:

      Your Answer:

      Correct Answer: Emphysema

      Explanation:

      Factors increasing FRC:
      Emphysema
      Air trapping in asthma
      Ageing (due to loss of elastic properties)
      Increasing height of patient

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds

  • Question 29 - A 26 year old male presents to emergency room with a 2 day...

    Incorrect

    • A 26 year old male presents to emergency room with a 2 day history of burning pain when passing urine, accompanied by a green urethral discharge. Gonorrhoea is suspected. The first line antibiotic for this condition is which of the following?

      Your Answer:

      Correct Answer: Ceftriaxone

      Explanation:

      When there is a high suspicion of gonorrhoea from clinical features, empiric treatment should be commenced whilst waiting for laboratory confirmation.
      The first line treatment for uncomplicated anogenital and pharyngeal disease includes ceftriaxone 500 mg IM (single dose) + azithromycin 1 g orally as a single dose. This covers concomitant chlamydia infection. For all people who have been treated for gonorrhoea, a test of cure is recommended

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 30 - One of your patients is in resuscitation and is suffering from kidney failure....

    Incorrect

    • One of your patients is in resuscitation and is suffering from kidney failure. The intensive care outreach team arrives to assess them and determines that a dopamine infusion is necessary.

      Dopamine primarily acts on which of the following receptors at low doses?

      Your Answer:

      Correct Answer: Dopamine receptors

      Explanation:

      Dopamine is a catecholamine that occurs naturally and is used to treat low cardiac output, septic shock, and renal failure. It is both adrenaline and noradrenaline’s immediate precursor.

      Dopamine acts on D1 and D2 dopamine receptors in the renal, mesenteric, and coronary beds at low doses (1-5 g/kg/min). Dopamine causes a significant decrease in renal vascular resistance and an increase in renal blood flow at these doses. Within this dose range, it is also involved in central modulation of behaviour and movement.

      Dopamine stimulates beta- and alpha-adrenergic receptors directly and indirectly at higher doses. Beta-stimulation predominates at a rate of 5-10 g/kg/min, resulting in a positive inotropic effect that increases cardiac output and coronary blood flow. Alpha-stimulation predominates at infusion rates greater than 15 g/kg/min, resulting in peripheral vasoconstriction and an increase in venous return and systolic blood pressure.

      Below is a summary of the mechanisms and effects of various inotropic agents:
      Inotrope
      Mechanism
      Effects
      Adrenaline (epinephrine)
      Beta-1 and -2 agonist at increasing doses;
      Alpha-agonist at high doses
      Increased cardiac output;
      Vasoconstriction at higher doses
      Noradrenaline (norepinephrine)
      Mainly alpha-agonist;
      Beta-1 and -2 agonist at increasing doses
      Vasoconstriction;
      Some increased cardiac output
      Dopamine
      Dopamine agonist at low doses;
      Beta-1 and -2 agonist at increasing doses;
      Alpha-agonist at high doses
      Increased cardiac output;
      Vasoconstriction at higher doses
      Dobutamine
      Mainly beta-1 agonist
      Increased cardiac output

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 31 - The most common source of healthcare-associated bacteraemia is: ...

    Incorrect

    • The most common source of healthcare-associated bacteraemia is:

      Your Answer:

      Correct Answer: Intravenous cannula

      Explanation:

      Healthcare-associated bacteraemia is most commonly caused by intravenous access. Any intravenous device that is left in place for a long time increases the risk of infection. It allows bacteria like Staphylococcus aureus and Staphylococcus epidermidis to enter the body.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      0
      Seconds

  • Question 32 - A patient with rash is examined. He has some redness of the skin...

    Incorrect

    • A patient with rash is examined. He has some redness of the skin that blanches when finger pressure is applied.

      What is the best description of this rash that you have found on examination?

      Your Answer:

      Correct Answer: Erythema

      Explanation:

      Erythema is redness of the skin or mucous membranes caused by hyperaemia of superficial capillaries caused by skin injury, infection or inflammation. Erythema blanches when pressure is applied whereas ecchymosis, purpura and petechiae do not.

      Ecchymosis are discolouration of the skin or mucous membranes caused by extravasation of blood. They are usually red or purple in colour and measure greater than 1 cm in diameter and do not blanch on applying pressure.

      A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.

      Petechiae are discolouration of the skin measuring less than 3 mm in diameter

      Purpura are discolouration of the skin measuring between 0.3 cm and 1 cm in diameter.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 33 - One of the following statements about acute lymphoblastic leukaemia(ALL) is true. ...

    Incorrect

    • One of the following statements about acute lymphoblastic leukaemia(ALL) is true.

      Your Answer:

      Correct Answer: It is classified using the FAB classification

      Explanation:

      ALL affects children predominantly.

      The CNS is commonly involved in ALL.

      The Philadelphia chromosome is present in 25% of adult ALL and 5% of childhood ALL cases.

      The cure rate in children is approximately 80% in children and 50% in adults.

      ALL is classified into 3 groups using the French-American-British (FAB) classification:
      ALL-L1: small uniform cells
      ALL-L2: large varied cells
      ALL-L3: large varied cells with vacuoles.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 34 - A six-year-old boy presents with coryzal symptoms that have persisted for more than...

    Incorrect

    • A six-year-old boy presents with coryzal symptoms that have persisted for more than two weeks. He was born and raised in the Middle East. His mother claims he has been tired and has complained of various 'aches and pains.' On examination, you find splenomegaly and enlarged cervical lymph nodes. His legs and arms are covered in petechiae.

      In this case, what is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute lymphoblastic leukaemia (ALL)

      Explanation:

      ALL is the most common leukaemia in children, with a peak incidence between the ages of 2 and 5.
      ALL has a wide range of clinical symptoms, but many children present with an acute illness that resembles coryza or a viral infection. ALL also has the following features:
      Weakness and sluggishness all over
      Muscle, joint, and bone pain that isn’t specific
      Anaemia
      Petechiae and unexplained bruising
      Oedema
      Lymphadenopathy
      Hepatosplenomegaly

      The following are typical features of a full blood count in patients with ALL:
      Anaemia (normocytic or macrocytic)
      Leukopenia affects about half of the patients (WCC 4 x 109/l).
      Around 25% of patients have leucocytosis (WCC > 10 x 109/l).
      Around 25% of patients have hyperleukocytosis (WCC > 50 x 109/l).
      Thrombocytopaenia

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 35 - Which nerve supplies the muscle flexor hallucis longus? ...

    Incorrect

    • Which nerve supplies the muscle flexor hallucis longus?

      Your Answer:

      Correct Answer: Tibial nerve

      Explanation:

      Flexor hallucis longus is innervated by the tibial nerve, composed of spinal roots L4, L5, S1, S2, and S3.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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  • Question 36 - Your consultant decides to use ketamine for a patient requiring procedural sedation in...

    Incorrect

    • 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:

      Correct 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).

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 37 - Gastric emptying is inhibited by all of the following EXCEPT for: ...

    Incorrect

    • Gastric emptying is inhibited by all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Parasympathetic stimulation

      Explanation:

      Gastric emptying is decreased by:
      Enterogastric inhibitory reflexes stimulated by – Distension of the duodenum, The presence of fats in the duodenum (by stimulating release of cholecystokinin), A fall in the pH of chyme in the duodenum, An increase in the osmolality of chyme in the duodenum, Irritation of the mucosal lining of the duodenum, Hormones: Cholecystokinin, Secretin

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
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  • Question 38 - Which of the following is NOT a typical complication associated with mumps: ...

    Incorrect

    • Which of the following is NOT a typical complication associated with mumps:

      Your Answer:

      Correct Answer: Subacute sclerosing panencephalitis

      Explanation:

      Complications of mumps include meningitis, post meningitis deafness, encephalitis, pancreatitis, orchitis and oophoritis. Subacute sclerosing panencephalitis is a complication typically associated with measles infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 39 - A 55-year-old female is urgently rushed into the Emergency Department as she complains...

    Incorrect

    • A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.

      She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.

      Which of the following statements is true regarding heparin?

      Your Answer:

      Correct Answer: It activates antithrombin III

      Explanation:

      Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
      1. Unfractionated: widely varying polymer chain lengths
      2. Low molecular weight: Smaller polymers only

      Heparin works by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.

      Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.

      Heparin is used for:
      1. Prevention and treatment of venous thromboembolism
      2. Treatment of disseminated intravascular coagulation
      3. Treatment of fat embolism
      4. Priming of haemodialysis and cardiopulmonary bypass machines

      There is no evidence that heparin is superior to low-molecular-weight heparins in preventing mortality from thrombosis.

      Vitamin K is used to reverse the effects of warfarin but not heparin. For heparin, protamine sulphate is used to counteract its effects.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 40 - A 30 year old man presents to ED after a road traffic accident....

    Incorrect

    • A 30 year old man presents to ED after a road traffic accident. Free intraperitoneal fluid is found on FAST (Focussed assessment for sonography in trauma) done in the supine position.

      Which of these is most likely to be affected?

      Your Answer:

      Correct Answer: Hepatorenal recess

      Explanation:

      Fluid accumulates most often in the hepatorenal pouch (of Morrison) in a supine patient. The hepatorenal pouch is located behind the liver and anterior to the right kidney and is the lowest space in the peritoneal cavity in the supine position.

      Although the vesicouterine and rectouterine spaces are also potential spaces for fluid accumulation, fluid accumulation in them occur in the erect position.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
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  • Question 41 - You are giving a presentation on the immune system as part of your...

    Incorrect

    • You are giving a presentation on the immune system as part of your peer-to-peer teaching sessions. Yu are currently discussing phagocytes. Macrophages are derived from which of the following cells:

      Your Answer:

      Correct Answer: Monocytes

      Explanation:

      Monocytes spend only a short time in the marrow and, after circulating for 20-40 hours, leave the blood to enter the tissues where they become macrophages. Macrophages form the reticuloendothelial system in the liver, spleen and lymph nodes. The lifespan of macrophages may be as long as several months or even years. In tissues the macrophages become self-replicating without replenishment from the blood. They assume specific functions in different tissues e.g. dendritic cells which are involved in antigen presentation to T-cells. Macrophages may be activated by cytokines such as IFN-gamma, contact with complement or direct contact with the target cell through leucocyte adhesion molecules.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 42 - A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath,...

    Incorrect

    • A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.

      Your Answer:

      Correct Answer: Atelectasis is an example of a perfusion defect

      Explanation:

      Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
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  • Question 43 - You're in resus with a 69-year-old woman who is very sick. You decide...

    Incorrect

    • You're in resus with a 69-year-old woman who is very sick. You decide to contact the intensive care outreach team because she appears to be in septic shock. They decide to start a dobutamine infusion as soon as they arrive.

      Which of the following statements about dobutamine is correct?

      Your Answer:

      Correct Answer: It may be infused via a peripheral line

      Explanation:

      Dobutamine is a synthetic isoprenaline derivative that is used to provide inotropic support to patients with low cardiac output caused by septic shock, myocardial infarction, or other cardiac conditions.

      Dobutamine is a sympathomimetic drug that stimulates beta-1 adrenergic receptors in the heart to produce its primary effect. As a result, it has inotropic properties that increase cardiac contractility and output. It also has a small amount of alpha1- and beta-2-adrenergic activity.

      It is infused intravenously after being diluted to a volume of at least 50 ml in a suitable crystalloid solution. The dose is titrated to response and ranges from 0.5 to 40 g/kg/min. Extravasation-induced skin necrosis is uncommon, and dobutamine can be administered through a peripheral line.

      At doses below 10 g/kg/min, side effects are rare, but at higher doses, they can include:
      Nausea and vomiting
      Tachycardia
      Dysrhythmias
      Angina
      Hypertension
      Headache

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 44 - A paediatric patient comes to the emergency room with complaints of right lower...

    Incorrect

    • A paediatric patient comes to the emergency room with complaints of right lower quadrant pain. The attending physician is considering appendicitis. Inside the operating room, the surgeon asks the medical student to locate the McBurney's point prior to the first incision.

      Which of the following is the surface anatomy of the McBurney's point?

      Your Answer:

      Correct Answer: One-third of the distance from the anterior superior iliac spine to the umbilicus

      Explanation:

      Inflammation of the appendix is a significant public health problem with a lifetime incidence of 8.6% in men and 6.7% in women, with the highest incidence occurring in the second and third decade of life. While the rate of appendectomy in developed countries has decreased over the last several decades, it remains one of the most frequent emergent abdominal operations. Appendicitis can often result in anorexia, nausea, vomiting, and fever.

      McBurney’s point, which is found one-third of the distance between the anterior superior iliac spine and the umbilicus, is often the point of maximal tenderness in a patient with an anatomically normal appendix. A McBurney’s incision is chiefly used for cecostomy and appendectomy. It gives a limited exposure only, and should any doubt arise about the diagnosis, an infraumbilical right paramedian incision should be used instead.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
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  • Question 45 - A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate,...

    Incorrect

    • A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate, nasal regurgitation of food, and nasal quality to the voice.

      Which of the following cranial nerves is most likely responsible for the aforementioned features?

      Your Answer:

      Correct Answer: Vagus nerve

      Explanation:

      The vagus nerve, ‘the wanderer’, contains motor fibres (to the palate and vocal cords), sensory components (posterior and floor of external acoustic meatus) and visceral afferent and efferent fibres.

      Palatal weakness can cause nasal speech and nasal regurgitation of food. The palate moves asymmetrically when the patient says ‘ahh’. Recurrent nerve palsy results in hoarseness, loss of volume and ‘bovine cough’.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 46 - Which of the following best describes pathogenicity: ...

    Incorrect

    • Which of the following best describes pathogenicity:

      Your Answer:

      Correct Answer: The ability to cause disease

      Explanation:

      Pathogenicity is the ability to cause disease.

    • This question is part of the following fields:

      • Microbiology
      • Principles
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  • Question 47 - Since the fluid that enters the loop of Henle is isotonic, what is...

    Incorrect

    • Since the fluid that enters the loop of Henle is isotonic, what is its estimated osmolality?

      Your Answer:

      Correct Answer: 300 mOsm

      Explanation:

      The loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It is consists of three major segments, the thin descending limb, the thin ascending limb, and the thick ascending limb.

      The segments are differentiated based on structure, anatomic location, and function. The main action of the loop of Henle is to recover water and sodium chloride from urine. The liquid entering the loop of Henle is a solution of salt, urea, and other substances traversed along by the proximal convoluted tubule, from which most of the dissolved components are needed by the body, particularly glucose, amino acids, and sodium bicarbonate that have been reabsorbed into the blood.

      This fluid is isotonic. Isotonic fluids generally have an osmolality ranging from 270 to 310 mOsm/L. With the fluid that enters the loop of Henle, it is estimated to be 300 mOsm/L. However, after passing the loop, fluid entering the distal tubule is hypotonic to plasma since it has been diluted during its passage.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
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  • Question 48 - A patient had a left Colles' fracture, which you were able to repair. It...

    Incorrect

    • A patient had a left Colles' fracture, which you were able to repair. It was their second fragility fracture this year, and you'd like to provide them some tips on how to keep their bones healthy.

      What percentage of the calcium in the body is kept in the bones? Only ONE response is acceptable.

      Your Answer:

      Correct Answer: 99%

      Explanation:

      Calcium is stored in bones for nearly all of the body’s calcium, but it is also found in some cells (most notably muscle cells) and the blood. The average adult diet comprises roughly 25 mmol of calcium per day, of which the body absorbs only about 5 mmol.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 49 - What is the pathophysiology of Cushing's syndrome: ...

    Incorrect

    • What is the pathophysiology of Cushing's syndrome:

      Your Answer:

      Correct Answer: Glucocorticoid excess

      Explanation:

      Cushing’s syndrome is the name given to the clinical symptoms and signs induced by chronic glucocorticoid excess.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
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  • Question 50 - Which of the following is NOT mainly characterised by intravascular haemolysis: ...

    Incorrect

    • Which of the following is NOT mainly characterised by intravascular haemolysis:

      Your Answer:

      Correct Answer: Beta-Thalassaemia

      Explanation:

      Causes of intravascular haemolysis:
      Haemolytic transfusion reactions
      G6PD deficiency
      Red cell fragmentation syndromes
      Some severe autoimmune haemolytic anaemias
      Some drug-and infection-induced haemolytic anaemias
      Paroxysmal nocturnal haemoglobinuria

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

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