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  • Question 1 - Which of the following is the most common cause of hyperthyroidism: ...

    Correct

    • Which of the following is the most common cause of hyperthyroidism:

      Your Answer: Graves disease

      Explanation:

      Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disease in which autoantibodies against TSH receptors are produced. These antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Therefore, the signs and symptoms of Graves disease are the same as those of hyperthyroidism, reflecting the actions of increased circulating levels of thyroid hormones: increased heat production, weight loss, increased 02 consumption and cardiac output and exophthalmos (bulging eyes, not drooping eyelids). TSH levels will be decreased (not increased) as a result of the negative feedback effect of increased T3 levels on the anterior pituitary.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      8.7
      Seconds
  • Question 2 - A 29-year-old volunteer returns from a recent trip to the middle east with...

    Incorrect

    • A 29-year-old volunteer returns from a recent trip to the middle east with profuse watery diarrhoea. You make a diagnosis of cholera and organize a hospital admission for rehydration with intravenous fluids.

      What is the mechanism of action of cholera toxin?

      Your Answer: Inhibition of adenyl cyclase

      Correct Answer: ADP-ribosylation of the G regulatory protein

      Explanation:

      Cholera is caused by Vibrio cholerae, a motile, Gram-negative, curved bacillus. It is transmitted through water and food (especially seafood) and is primarily a disease seen in developing countries where there is poor sanitation and lack of safe water supplies.

      The cholera toxin leads to stimulation of adenyl cyclase, ADP-ribosylation of the G regulatory protein, inactivation of GTPase leading to active outpouring of NaCl.

      The cholera toxin consists of an A (the toxin) and B subunit. The B subunit attaches to the gut mucosa and presents the A subunit to the cell. The toxin stimulates adenyl cyclase by irreversible ADP-ribosylation of the GTP binding domain of adenyl cyclase leading to the opening of chloride channels resulting in an outpouring of NaCl and water into the lumen of the gut and causing secretory diarrhoea.

      Incubation period is between 2 and 5 days, but can be as short as just a few hours.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      585.4
      Seconds
  • Question 3 - How does dipyridamole mediate its antiplatelet effect: ...

    Correct

    • How does dipyridamole mediate its antiplatelet effect:

      Your Answer: It is a phosphodiesterase inhibitor.

      Explanation:

      Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      14.5
      Seconds
  • Question 4 - A 57-year-old woman receives vitamin B12 injections following a gastrectomy.

    Which of the following...

    Correct

    • A 57-year-old woman receives vitamin B12 injections following a gastrectomy.

      Which of the following cell types, if absent, is responsible for her vitamin B12 deficiency?

      Your Answer: Parietal cells

      Explanation:

      Intrinsic factor, produced by the parietal cells of the stomach, is essential for the absorption of vitamin B12 from the terminal ileum.
      After a gastrectomy, the absorption of vitamin B12 is markedly reduced, and a deficiency will occur.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      14.3
      Seconds
  • Question 5 - What is the interquartile range of the following data set: 5, 10, 15,...

    Incorrect

    • What is the interquartile range of the following data set: 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70

      Your Answer: 20

      Correct Answer: 30

      Explanation:

      5, 10, 15 /20, 25, 30 /35, 40, 45 /50, 60, 70
      Sample size (n) = 12
      Median = [(n+1)/2]th value
      = (12+1)/2 = 6.5
      = halfway between 6th and 7th value
      = (30 +35)/2 = 32.5
      The lower (first) quartile = halfway between 15 and 20
      = 17.5
      The upper (third) quartile = halfway between 45 and 50
      = 47.5
      The interquartile range is the difference between the upper quartile and lower quartile
      = 47.5 – 17.5 = 30

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      3.5
      Seconds
  • Question 6 - A trauma victim who has been intubated is tachycardic, hypotensive, and has a...

    Incorrect

    • A trauma victim who has been intubated is tachycardic, hypotensive, and has a poor urine output. You feel she is dehydrated and decide to use a central venous catheter to help you manage her. As part of this, you keep an eye on the waveform of central venous pressure (CVP).

      Which of the following cardiac cycle phases corresponds to the CVP waveform's 'a wave'?

      Your Answer: Early systole

      Correct Answer: End diastole

      Explanation:

      The pressure measured in the right atrium or superior vena cava is known as central venous pressure (CVP). In a spontaneously breathing subject, the usual CVP value is 0-8 cmH2O (0-6 mmHg).

      The structure of the CVP waveform is as follows:
      The CVP’s components are listed in the table below:
      Component of the waveform
      The cardiac cycle phase.
      mechanical event
      mechanical event Diastole 
      Atrial contraction
      a wave 
      C  wave 
      v wave
      Early systole
      The tricuspid valve closes and bulges 
      Late Systole 
      Filling of the atrium with systolic blood 
      x descent
      y descent
      Mid systole
      Relaxation of the atrium 
      Early diastole
      Filling of the ventricles at an early stage

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      3252.3
      Seconds
  • Question 7 - Which of the following ions is more abundant in extracellular fluid than in...

    Correct

    • Which of the following ions is more abundant in extracellular fluid than in intracellular fluid:

      Your Answer: Cl -

      Explanation:

      Protein and phosphate are the primary intracellular anions, while chloride (Cl-) and bicarbonate are the predominant extracellular anions (HCO3-).

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      30.9
      Seconds
  • Question 8 - Which of the following statements regarding the infectivity periods of these corresponding diseases...

    Correct

    • Which of the following statements regarding the infectivity periods of these corresponding diseases is correct?

      Your Answer: Rubella is infectious until 5 days after the rash appears

      Explanation:

      Rubella can be contagious from 7 days before to 7 days after the rash appears.

      Patients with measles are contagious from 1-2 days before the onset of symptoms.

      A person with chickenpox is considered contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted (scabbed).

      The infectious period of mumps is considered from 2 days before to 5 days after parotitis onset.

      Hepatitis A is highly transmissible and has an average incubation period of 28 to 30 days (range 15–50 days). The maximum infectivity is during the second half of the incubation period (i.e. while asymptomatic) and most cases are considered non-infectious after the first week of jaundice.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      34.7
      Seconds
  • Question 9 - You are reviewing a patient following a fall from a horse. You suspect...

    Correct

    • You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:

      Your Answer: Erb's palsy may result in loss of sensation of the regimental badge area.

      Explanation:

      Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      83.8
      Seconds
  • Question 10 - Regarding the flexor digitorum profundus muscle, which of the following is true? ...

    Incorrect

    • Regarding the flexor digitorum profundus muscle, which of the following is true?

      Your Answer: The entire muscle is innervated by the median nerve

      Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve

      Explanation:

      Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.

      Flexor digitorum profundus has a dual innervation:

      (1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);

      (2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      78
      Seconds
  • Question 11 - A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of...

    Correct

    • A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.
      Iliacus is innervated by which of the following nerves? Select ONE answer only.

      Your Answer: Femoral nerve

      Explanation:

      Iliacus is innervated by the femoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      33.5
      Seconds
  • Question 12 - Which statement about cross-sectional studies is true? ...

    Correct

    • Which statement about cross-sectional studies is true?

      Your 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
      41.9
      Seconds
  • Question 13 - A 35-year-old man presents with haemoptysis, night sweats, and weight loss. Further examinations...

    Correct

    • A 35-year-old man presents with haemoptysis, night sweats, and weight loss. Further examinations were done and a diagnosis of tuberculosis is suspected.

      Which of the following statements is considered correct regarding Mycobacterium tuberculosis?

      Your Answer: It is impervious to decolourisation with acid

      Explanation:

      Mycobacterium tuberculosis are part of the Mycobacteriaceae family. They are described to have the characteristics of a Gram-positive cell wall but they are not easily stained with Gram stain. This is because their cell wall contains a high lipid content, and this lipid allows the Mycobacteria to bind to alkaline stains with the application and help of heat. Once stained, they are able to resist decolorization even with the use of acid alcohol as the decolourizer, making them very difficult to decolorize, that is why they are known to be acid-fast.

      The Ghon complex is a non-pathognomonic radiographic finding on a chest x-ray that is significant for pulmonary infection of tuberculosis. The location of the Ghon’s focus is usually subpleural and predominantly in the upper part of the lower lobe and lower part of the middle or upper lobe.

      Skeletal tuberculosis of the spine is referred to as Pott disease.

      The risk of reactivation TB is about 3.3% during the first year after a positive PPD skin test and a total of 5% to 15% thereafter in the person’s lifetime. Progression from infection to active disease varies with age and the intensity and duration of exposure. Reactivation TB occurs when there is an alteration or suppression of the cellular immune system in the infected host that favours
      replication of the bacilli and progression to disease.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      44.6
      Seconds
  • Question 14 - Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT: ...

    Correct

    • Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT:

      Your Answer: There is a much greater predilection to disseminate to extranodal sites than in Hodgkin lymphoma.

      Explanation:

      Non-Hodgkin’s lymphoma (NHL) refers to a group of lymphoproliferative malignancies (about 85% of B-cell and 15% of T or NK (natural killer) cell origin) with different behavioural patterns and treatment responses. This group of malignancies encompasses all types of lymphoma without Reed-Sternberg cells being present. The Reed-Sternberg cell is classically seen in Hodgkin’s lymphoma.
      NHL is five times as common as Hodgkin’s lymphoma. The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.
      The following are recognised risk factors for NHL:
      Chromosomal translocations and molecular rearrangements
      Epstein-Barr virus infection
      Human T-cell leukaemia virus type-1 (HTLV-1)
      Hepatitis C
      Congenital and acquired immunodeficiency states
      Autoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis
      The most common clinical features at presentation are:
      Lymphadenopathy (typically asymmetrical and painless)
      Weight loss
      Fatigue
      Night sweats
      Hepatosplenomegaly
      For clinical purposes, NHL is divided into three groups: indolent, high-grade, and lymphoblastic.
      Indolent (low-grade) NHL:
      The cells are relatively mature
      Disease follows an indolent course without treatment
      Often acceptable to follow a ‘watch and wait’ strategy
      Local radiotherapy often effective
      Relatively good prognosis with median survival of 10 years
      High-grade NHL:
      Cells are immature
      Disease progresses rapidly without treatment
      Significant number of patients can be cured with intensive combination chemotherapy regimens
      Approximately 40% cure rate
      Lymphoblastic NHL:
      Cells are very immature and have a propensity to involve the CNS
      Treatment and progression are similar to that of acute lymphoblastic leukaemia (ALL)

    • This question is part of the following fields:

      • Haematology
      • Pathology
      38.6
      Seconds
  • Question 15 - A 20-year-old male patient lives in a travelling community and has never...

    Correct

    • A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.

      Which of these statements concerning indications and contraindications for vaccination is TRUE?

      Your Answer: Inactivated vaccines are safe in pregnancy

      Explanation:

      All vaccines are contraindicated in individuals with: A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.
      A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycin

      There is no evidence that vaccinating pregnant women with inactivated vaccine or toxoids harms the woman or foetus.

      The current protocol is that a child with history of egg allergy can be safely vaccinated with Fluenz tetra. However, if they had a previous severe anaphylaxis to egg requiring intensive care, then Flenz tetra is contraindicated.

      BCG, yellow fever or oral typhoid vaccinations are not safe in HIV positive patients.

      The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should not be implemented.

      Concurrent antibiotic therapy is not a contraindication to vaccination.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      104.9
      Seconds
  • Question 16 - Action potentials are transmitted from myocyte to myocyte via which of the following:...

    Correct

    • Action potentials are transmitted from myocyte to myocyte via which of the following:

      Your Answer: Gap junctions

      Explanation:

      Action potentials are transmitted to adjacent myocytes via gap junctions.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      35.3
      Seconds
  • Question 17 - A 52-year old male comes to the out-patient department for a groin mass...

    Correct

    • A 52-year old male comes to the out-patient department for a groin mass that protrudes when standing. The patient notes that it is reducible when lying down. On physical examination, there is presence of a cough impulse. The initial assessment is hernia. Further investigation reveals that the mass lies lateral to the epigastric vessels.

      Among the types of hernia, which is the most likely diagnosis of the case above?

      Your Answer: Indirect inguinal hernia

      Explanation:

      Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.

      Groin hernias are categorized into 2 main categories: inguinal and femoral.

      Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.

      A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      35.5
      Seconds
  • Question 18 - Which of the following drugs is first line treatment for a stable regular...

    Correct

    • Which of the following drugs is first line treatment for a stable regular broad-complex tachycardia:

      Your Answer: Amiodarone

      Explanation:

      A regular broad-complex tachycardia is likely to be ventricular tachycardia or a regular supraventricular rhythm with bundle branch block. A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours. If previously confirmed as SVT with bundle branch block, the patient should be treated as for narrow-complex tachycardia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      13.1
      Seconds
  • Question 19 - The parasympathetic supply to the rectum is from which of the following: ...

    Correct

    • The parasympathetic supply to the rectum is from which of the following:

      Your Answer: Pelvic splanchnic nerves

      Explanation:

      Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      32.8
      Seconds
  • Question 20 - 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
      42.2
      Seconds
  • Question 21 - Regarding carbon dioxide transport in the blood, which of the following statements is...

    Incorrect

    • Regarding carbon dioxide transport in the blood, which of the following statements is CORRECT:

      Your Answer: The chloride shift refers to an efflux of Cl - ions from red blood cells to maintain electroneutrality.

      Correct Answer: Deoxygenated haemoglobin acts as a buffer for H+ ions.

      Explanation:

      CO2generated in the tissues and water combine to form carbonic acid which readily dissociates to form HCO3-and H+. The first part of this reaction is very slow in plasma, but is accelerated dramatically by the enzyme carbonic anhydrase present in red blood cells. Bicarbonate is therefore formed preferentially in red cells, from which it freely diffuses down its concentration gradient into plasma where it is transported to the lungs. The red cell membrane is impermeable to H+ions which remain in the cell. To maintain electroneutrality, Cl-ions diffuse into the cell to replace HCO3-, an effect known as the chloride shift. Deoxygenated haemoglobin acts as a buffer for H+, allowing the reaction to continue.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      72.1
      Seconds
  • Question 22 - By the third day of wound healing, which sort of inflammatory cell has...

    Incorrect

    • By the third day of wound healing, which sort of inflammatory cell has predominated:

      Your Answer: Neutrophils

      Correct Answer: Macrophages

      Explanation:

      The inflammatory phase of healing is sometimes called the lag phase because wound strength does not begin to return immediately. The inflammatory phase is completed within three days except in the presence of infection or other factors associated with impaired wound healing. Mononuclear leukocytes accumulate and are transformed into macrophages. The maturation of blood-derived monocytes into macrophages is heralded by several events, including secretion of vimentin, which is a structural filament protein involved in wound healing.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
      26.7
      Seconds
  • Question 23 - The proximal convoluted tubule (PCT) is the first part of the renal tubule...

    Incorrect

    • The proximal convoluted tubule (PCT) is the first part of the renal tubule and lies in the renal cortex. The bulk of reabsorption of solute occurs is the PCT and 100% of glucose is reabsorbed here.

      Which of the following is the mechanism of glucose reabsorption in the PCT?

      Your Answer: Simple diffusion

      Correct Answer: Secondary active transport

      Explanation:

      Glucose reabsorption occurs exclusively in the proximal convoluted tubule by secondary active transport through the Na.Glu co-transporters, driven by the electrochemical gradient for sodium.
      The co-transporters transport two sodium ions and one glucose molecule across the apical membrane, and the glucose subsequently crosses the basolateral membrane by facilitated diffusion.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      37.5
      Seconds
  • Question 24 - The pathophysiology of Addison's disease is as follows: ...

    Correct

    • The pathophysiology of Addison's disease is as follows:

      Your Answer: Adrenocortical insufficiency

      Explanation:

      Primary adrenal insufficiency, also known as Addison’s disease, occurs when the adrenal glands cannot produce an adequate amount of hormones despite a normal or increased corticotropin (ACTH) level.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      43.9
      Seconds
  • Question 25 - A 50-year-old man has recently been on antibiotics for a chest infection. He...

    Incorrect

    • A 50-year-old man has recently been on antibiotics for a chest infection. He suffers from COPD and is currently on Seretide inhalers, salbutamol, and Phyllocontin continus. Since commencing the antibiotics, he has developed nausea, vomiting and abdominal pain.

      Which of the following antibiotics has he MOST LIKELY been on for his chest infection?

      Your Answer: Amoxicillin

      Correct Answer: Erythromycin

      Explanation:

      Phyllocontin continues contains aminophylline, a bronchodilator used in the management of asthma and COPD.

      The index patient is exhibiting symptoms of theophylline toxicity. This may have been triggered by the antibiotic he took. Macrolide antibiotics, like erythromycin and quinolone antibiotics, like ciprofloxacin and levofloxacin, increases the plasma concentration of theophyllines and can lead to toxicity.

      Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin.
      Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      23.3
      Seconds
  • Question 26 - The percentage of patients with hepatitis B that develop chronic infection is about:...

    Correct

    • The percentage of patients with hepatitis B that develop chronic infection is about:

      Your Answer: 10%

      Explanation:

      With hepatitis B, about 90% of people will develop lifelong immunity after clearing the infection. Chronic hepatitis develops in about 10% of patients and this may be complicated by cirrhosis or hepatocellular carcinoma. There is a very high risk of chronic infection and hepatocellular carcinoma when there is congenital infection. The risk of this in healthy adults is only about 5%.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      9.2
      Seconds
  • Question 27 - Which of the following drug classes may cause bronchoconstriction: ...

    Correct

    • Which of the following drug classes may cause bronchoconstriction:

      Your Answer: Beta-blockers

      Explanation:

      Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      7.6
      Seconds
  • Question 28 - Urine flow rate = 2 ml/min
    Urine concentration of creatinine = 18 mg/ml
    Plasma...

    Correct

    • Urine flow rate = 2 ml/min
      Urine concentration of creatinine = 18 mg/ml
      Plasma concentration of creatinine = 0.25 mg/ml

      What is the estimated glomerular filtration rate (eGFR)?

      Your Answer: 144 ml/min

      Explanation:

      GFR can be estimated by:
      GFR = UCr x V / PCr
      Where:
      UCr = urine concentration of creatinine
      PCr = plasma concentration of creatinine
      V = rate of urine flow

      In this case GFR = (18 x 2) / 0.25 = 144 ml/min

      Note: Creatinine is used to estimate GFR because it is an organic base naturally produced by muscle breakdown, it is freely filtered at the glomerulus, it is not reabsorbed from the nephron, it is not produced by the kidney, it is not toxic, and it doesn’t alter GFR.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      10.2
      Seconds
  • Question 29 - On her most recent blood tests, a 55 year-old female with a history of hypertension...

    Incorrect

    • On her most recent blood tests, a 55 year-old female with a history of hypertension was discovered to be hypokalaemic. She  is diagnosed with primary hyperaldosteronism.

      Which of the following is a direct action of aldosterone?

      Your Answer: Secretion of Cl - into the distal convoluted tubule

      Correct Answer: Secretion of H + into the distal convoluted tubule

      Explanation:

      Aldosterone is a steroid hormone produced in the adrenal cortex’s zona glomerulosa. It is the most important mineralocorticoid hormone in the control of blood pressure. It does so primarily by promoting the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane of the nephron’s distal tubules and collecting ducts, as well as stimulating apical sodium and potassium channel activity, resulting in increased sodium reabsorption and potassium secretion. This results in sodium conservation, potassium secretion, water retention, and a rise in blood volume and blood pressure.

      Aldosterone is produced in response to the following stimuli:

      Angiotensin II levels have risen.
      Potassium levels have increased.
      ACTH levels have risen.
      Aldosterone’s principal actions are as follows:
      Na+ reabsorption from the convoluted tubule’s distal end
      Water resorption from the distal convoluted tubule (followed by Na+)
      Cl is reabsorbed from the distal convoluted tubule.
      K+ secretion into the convoluted distal tubule’s 
      H+ secretion into the convoluted distal tubule’s 

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      42.9
      Seconds
  • Question 30 - A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is...

    Correct

    • A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is diagnosed with hyperaldosteronism.

      Which of these is the commonest cause of hyperaldosteronism?

      Your Answer: Adrenal adenoma

      Explanation:

      When there are excessive circulating levels of aldosterone, hyperaldosteronism occurs. There are two main types of hyperaldosteronism:

      Primary hyperaldosteronism (,95% of cases)
      Secondary hyperaldosteronism (,5% of cases)

      Primary causes of hyperaldosteronism include:
      Adrenal adenoma (Conn’s syndrome)
      Adrenal hyperplasia
      Adrenal cancer
      Familial aldosteronism
      Secondary causes of hyperaldosteronism include:
      Drugs
      Obstructive renal artery disease
      Renal vasoconstriction
      Oedematous disorders syndrome

      Adrenal adenoma is the commonest cause of hyperaldosteronism (seen in ,80% of all cases).

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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