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  • Question 1 - A 20-year-old male presents to the emergency department about 4 hours after ingesting...

    Incorrect

    • A 20-year-old male presents to the emergency department about 4 hours after ingesting 20g of paracetamol. N-acetyl cysteine was started immediately. What is the mechanism of action of N-acetyl cysteine?

      Your Answer: Neutralises mercapturic acid

      Correct Answer: Replenishes glutathione

      Explanation:

      N-acetylcysteine depletes glutathione reserves by providing cysteine, which is an essential precursor in glutathione production.Glutathione within the liver can normally detoxify these minuscule quantities of NAPQI and prevent tissue damage.N-acetylcysteine (NAC) is the mainstay of therapy for acetaminophen toxicity.Paracetamol overdose:The liver normally conjugates paracetamol with glucuronic acid/sulphate. During an overdose, the conjugation system becomes saturated leading to oxidation by cytochrome P450 (predominately CYP2E1) mixed-function oxidases. This produces a toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI).Normally glutathione acts as a defence mechanism by conjugating with the toxin forming the non-toxic mercapturic acid. If glutathione stores run-out, the toxin forms covalent bonds with cell proteins, denaturing them and leading to cell death.Other uses: In COPD, cystic fibrosis, and other lung conditions, nebulized NAC has mucolytic, anti-inflammatory, and antioxidant properties.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      30.8
      Seconds

  • Question 2 - Organophosphates, such as Sarin, have been used as chemical-warfare agents by terrorists. Which...

    Incorrect

    • Organophosphates, such as Sarin, have been used as chemical-warfare agents by terrorists. Which of the following statements is true concerning organophosphate poisoning?

      Your Answer: They are only absorbed through the respiratory tract

      Correct Answer: Atropine is useful in the management of organophosphate poisoning

      Explanation:

      The principal action of organophosphates is the inhibition of acetylcholinesterase’s, therefore leading to the accumulation of acetylcholine at muscarinic receptors (miosis, hypersalivation, sweating, diarrhoea, excessive bronchial secretions), nicotinic receptors (muscle fasciculations and tremor) and in the central nervous system (anxiety, loss of memory, headache, coma). Removal from the source of the organophosphate, adequate decontamination, supplemental oxygen and atropine are the initial treatment measures. Pralidoxime, an activator of cholinesterase, should be given to all symptomatic patients.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      36.6
      Seconds

  • Question 3 - A 30-year-old male with a history of premature cardiovascular disease in the family...

    Incorrect

    • A 30-year-old male with a history of premature cardiovascular disease in the family has come for review of his lab investigations. His fasting cholesterol is 8.4 mmol/l with high-density lipoprotein (HDL) of 1.6 mmol/l. You elect to commence him on atorvastatin 20 mg PO daily.Which of the following best describes the mechanism of action of the statins?

      Your Answer: They stimulate HMG CoA reductase

      Correct Answer: They inhibit HMG CoA reductase

      Explanation:

      Statins are a selective, competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase, which is the enzyme responsible for the conversion of HMG-CoA to mevalonate in the cholesterol synthesis pathway.Statins are usually well tolerated with myopathy, rhabdomyolysis, hepatotoxicity, and diabetes mellitus being the most common adverse reactions. This is the rate-limiting step in cholesterol synthesis, that leads to increased hepatic low-density lipoprotein (LDL) receptors and reduced hepatic VLDL synthesis coupled with increased very-low-density lipoprotein (VLDL) clearance.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      141.2
      Seconds

  • Question 4 - A 70-year-old male presents with chest pain. His past medical history includes hypertension...

    Incorrect

    • A 70-year-old male presents with chest pain. His past medical history includes hypertension and angina. He continues to smoke about 20 cigarettes per day despite being advised about lifestyle modifications.Blood investigations obtained in the emergency department show:Na+: 133 mmol/lK+: 3.3 mmol/lUrea: 4.5 mmol/lCreatinine: 90 μmol/lWhich among the following is the most likely explanation for the abnormalities seen in the above investigations?

      Your Answer: His smoking history

      Correct Answer: Bendroflumethiazide therapy

      Explanation:

      The blood investigations in this patient reveal hyponatremia as well as hypokalaemia. Among the options provided, Bendroflumethiazide therapy can cause the above presentation with the electrolyte disturbances. Note:- Spironolactone is a potassium-sparing diuretic that is associated with hyperkalaemia.- Enalapril therapy can cause side effects of dizziness, hypotension, cough, and rarely a rash.- Felodipine therapy can cause side effects of dizziness, headache, cough, and palpitations.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      24.1
      Seconds

  • Question 5 - A 53-year-old female teacher asks about hormone replacement therapy (HRT). What is the...

    Incorrect

    • A 53-year-old female teacher asks about hormone replacement therapy (HRT). What is the most compelling indication for starting HRT?

      Your Answer: Prevention of Alzheimer's disease

      Correct Answer: Control of vasomotor symptoms such as flushing

      Explanation:

      Hormone replacement therapy (HRT) involves the use of a small dose of oestrogen, combined with a progestogen (in women with a uterus), to help alleviate menopausal symptoms. The main indication is the control of vasomotor symptoms. The other indications, such as reversal of vaginal atrophy and prevention of osteoporosis, should be treated with other agents as first-line therapies.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      24.1
      Seconds

  • Question 6 - A 24-year-old women presents following an overdose. Which one of the following would...

    Incorrect

    • A 24-year-old women presents following an overdose. Which one of the following would suggest anticholinergic syndrome?

      Your Answer: Tricyclic antidepressants are not a cause

      Correct Answer: Mydriasis occurs

      Explanation:

      Anticholinergic syndrome results from the inhibition of muscarinic cholinergic neurotransmission. Clinical manifestations can be remembered by the mnemonic, red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, and full as a flask. The mnemonic refers to the symptoms of flushing, dry skin and mucous membranes, mydriasis (dilated pupil) with loss of accommodation, altered mental status, fever, and urinary retention, respectively.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      82
      Seconds

  • Question 7 - A 25-year-old female presents to the emergency department with severe breathlessness and tinnitus....

    Incorrect

    • A 25-year-old female presents to the emergency department with severe breathlessness and tinnitus. She is under treatment for asthma and depression with albuterol and amitriptyline respectively.On examination, she seems agitated with a BP of 100/44, a pulse rate of 112 bpm, a respiratory rate of 30 cycles/min, and a temperature of 37.8'C.An arterial blood gas performed reveals:pH: 7.48 (7.36 – 7.44)pO2: 11.2 kPa (11.3 – 12.6 kPa)pCO2: 1.9 kPa (4.7 – 6.0 kPa)Bicarbonate: 13 mmol/l (20 – 28 mmol/L)What is the most probable diagnosis?

      Your Answer: Acute asthma exacerbation

      Correct Answer: Salicylate poisoning

      Explanation:

      The blood gas analysis provided above is suggestive of a mixed respiratory alkalosis and metabolic acidosis characteristic of salicylate overdose.Pathophysiology:The direct stimulation of the cerebral medulla causes hyperventilation and respiratory alkalosis.As it is metabolized, it causes an uncoupling of oxidative phosphorylation in the mitochondria. Lactate levels then increase due to the increase in anaerobic metabolism. This, along with a slight contribution from the salicylate metabolites result in metabolic acidosis.Tinnitus is characteristic and salicylate ototoxicity may produce deafness. Other neurological sequelae include encephalopathy and agitation, seizures and CNS depression and coma. Cardiovascular complications include tachycardia, hypotension, and dysrhythmias (VT, VF, and asystole).

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      64.2
      Seconds

  • Question 8 - A 30-year-old female presented with upper abdominal pain. She was diagnosed with an...

    Incorrect

    • A 30-year-old female presented with upper abdominal pain. She was diagnosed with an unknown coagulopathy and has a previous history of stroke. She has been on warfarin therapy for the past 4 months. Her international normalised ratio (INR) was stabilised between 2.5 and 3.0. Noticing abnormal coagulation results, her surgeon has requested a medical consult.Her blood investigations revealed:White cell count: 13 × 109/lHaemoglobin (Hb): 11 g/dlActivated partial thromboplastin time (APTT): NormalPlatelets: 140 × 109/lINR: 6.0Pancreatic enzymes and liver function tests were normal.Other investigations:An ultrasound of the abdomen was normal.An upper GI endoscopy revealed mild gastritis. What is the most appropriate step to be taken regarding warfarin therapy?

      Your Answer: Give vitamin K 5.0 mg intravenously

      Correct Answer: Stop warfarin and observe

      Explanation:

      The most appropriate treatment in this patient would be to stop warfarin therapy and keep the patient under observation.The drugs that lead to enhanced potency of warfarin include: disulfiram, trimethoprim-sulphamethoxazole, metronidazole, phenylbutazone, aspirin, heparin, and clofibrate. Liver disease, thrombocytopenia, hyperthyroidism also increase the oral anticoagulant potency.If the patient has minor bleeding and the international normalized ratio (INR) is >6.0, warfarin should be stopped; the INR should be rechecked daily and in addition to the stoppage of warfarin, vitamin K 2.5 mg oral or 0.5 mg intravenously should also be administered.In a patient with INR of 2.0 or 3.0, it takes two or three times longer for that individual’s blood to clot than someone who is not taking any anticoagulants. Most patients on warfarin have an INR goal of 2 to 3.If there is major bleeding then prothrombin complex concentrates 50 u/kg or fresh-frozen plasma 15 ml/kg may be considered.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      14.9
      Seconds

  • Question 9 - What is the mode of action of amiodarone? ...

    Incorrect

    • What is the mode of action of amiodarone?

      Your Answer: B-adrenoreceptor blocker

      Correct Answer: Potassium channel blocker

      Explanation:

      Amiodarone is a class III antiarrhythmic drug. Class III antiarrhythmics are potassium channel blockers, they prolong duration of action potential with resulting prolongation of effective refractory period.

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      23.3
      Seconds

  • Question 10 - In the event of an overdose, haemodialysis is ineffective as a treatment modality...

    Incorrect

    • In the event of an overdose, haemodialysis is ineffective as a treatment modality for which of the following drugs?

      Your Answer:

      Correct Answer: Tricyclics

      Explanation:

      Tricyclic compounds can’t be cleared by haemodialysis.Drugs that can be cleared with haemodialysis include: (BLAST)- Barbiturate- Lithium- Alcohol (inc methanol, ethylene glycol)- Salicylates- Theophyllines (charcoal hemoperfusion is preferable)Drugs which cannot be cleared with haemodialysis include:- Tricyclics- Benzodiazepines- Dextropropoxyphene (Co-proxamol)- Digoxin- Beta-blockers

    • This question is part of the following fields:

      • Medicine
      • Pharmacology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Medicine (5/9) 56%
Pharmacology (5/9) 56%
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