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  • Question 1 - Which of the following laboratory findings are indicative of von Willebrand disease (VWD):...

    Incorrect

    • Which of the following laboratory findings are indicative of von Willebrand disease (VWD):

      Your Answer: Low factor VII level

      Correct Answer: Prolonged APTT

      Explanation:

      Laboratory results often show that:
      PFA-100 test results are abnormal.
      Low levels of factor VIII (if a factor VIII/VWF binding assay is conducted)
      APTT is Prolonged (or normal)
      PT is normal
      VWF values are low.
      Defective Platelet aggregation
      The platelet count is normal.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      11
      Seconds

  • Question 2 - A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening...

    Correct

    • A 58-year-old woman presents with symptoms of increase in weight, proximal muscular weakening and withering, easy bruising, and acne. You notice that she has a full, plethoric aspect to her face, as well as significant supraclavicular fat pads, when you examine her. She has previously been diagnosed with Cushing's syndrome.

      Cushing's syndrome is most commonly caused by which of the following?

      Your Answer: Iatrogenic administration of corticosteroids

      Explanation:

      Cushing’s syndrome is a group of symptoms and signs brought on by long-term exposure to high amounts of endogenous or exogenous glucocorticoids. Cushing’s syndrome affects about 10-15 persons per million, and it is more common in those who have had a history of obesity, hypertension, or diabetes.

      Iatrogenic corticosteroid injection is the most prevalent cause of Cushing’s syndrome. Cushing’s illness is the second most prevalent cause of Cushing’s syndrome. Cushing’s disease is distinct from Cushing’s syndrome in that it refers to a single cause of the illness, a pituitary adenoma that secretes high quantities of ACTH, which raises cortisol levels.

      Cushing’s syndrome has several endogenous sources, including:
      Cushing’s disease is caused by a pituitary adenoma.
      Adrenal adenoma Ectopic corticotropin syndrome, e.g. small cell cancer of the lung
      Adrenal carcinoma is a cancer of the adrenal gland.
      Hyperplasia of the adrenal glands

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      38.2
      Seconds

  • Question 3 - Which of the following statements accurately describes the extensor indicis muscle? ...

    Correct

    • Which of the following statements accurately describes the extensor indicis muscle?

      Your Answer: It lacks the juncturae tendinum

      Explanation:

      Extensor indicis is a narrow, elongated muscle found in the posterior compartment of the forearm. It belongs to the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus, and extensor pollicis brevis muscles. It lacks the juncturae tendinum, which connects the extensor digitorum on the dorsal aspect of the hand.

      Extensor indicis can be palpated by applying deep pressure over the lower part of the ulna while the index finger is extended. The main function of extensor indicis involves the extension of the index finger at the metacarpophalangeal and interphalangeal joints. As the index finger is one of the few fingers that have their own separate extensor muscle, it is able to extend independently from other fingers. Additionally, extensor indicis muscle produces a weak extension of the wrist.

      Extensor indicis receives its nervous supply from posterior interosseous nerve, a branch of the radial nerve derived from spinal roots C7 and C8. The skin overlying the muscle is supplied by the same nerve, with fibres that stem from the spinal roots C6 and C7.

      The superficial surface of the extensor indicis receives arterial blood supply from posterior interosseous branch of the ulnar artery, whereas its deep surface receives blood from perforating branches of the anterior interosseous artery.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      64.1
      Seconds

  • Question 4 - A patient with a stab wound to the axilla arrives to the emergency...

    Correct

    • A patient with a stab wound to the axilla arrives to the emergency department. You notice weakness in elbow flexion and forearm supination during your assessment. Which of these nerves has been affected:

      Your Answer: Musculocutaneous nerve

      Explanation:

      The musculocutaneous nerve is relatively protected in the axilla, hence injury to it is uncommon. A stab wound in the axilla is the most prevalent source of damage. Because of the activities of the pectoralis major and deltoid, the brachioradialis, and the supinator muscles, arm flexion and forearm flexion and supination are diminished but not completely lost. Over the lateral part of the forearm, there is a lack of sensation.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      42.6
      Seconds

  • Question 5 - A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself...

    Incorrect

    • A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke.

      Branches of which of the following arteries are most likely implicated in the case?

      Your Answer: Posterior inferior cerebellar artery

      Correct Answer: Basilar artery

      Explanation:

      The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.

      It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      76.2
      Seconds

  • Question 6 - The most important Complement protein for antigen opsonization is: ...

    Incorrect

    • The most important Complement protein for antigen opsonization is:

      Your Answer: C3a

      Correct Answer: C3b

      Explanation:

      Phagocytosis is largely responsible for depletion of cells coated with antibodies. Cells opsonized by IgG antibodies are recognized by phagocyte Fc receptors, which are specific for the Fc portions of some IgG subclasses. In addition, when IgM or IgG antibodies are deposited on the surfaces of cells, they may activate the complement system by the classical pathway. Complement activation generates by-products, mainly C3b and C4b, which are deposited on the surfaces of the cells and recognized by phagocytes that express receptors for these proteins. The net result is phagocytosis of the opsonized cells and their destruction.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      15
      Seconds

  • Question 7 - An analytical cohort study aimed to determine a relationship between intake of dietary...

    Incorrect

    • An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:

      No. of post-menopausal women who took Calcium: 500
      No. of post-menopausal women who took Calcium and suffered a hip fracture: 10

      No. of post-menopausal women who took placebo: 500
      No. of post-menopausal women who took placebo and suffered a hip fracture: 25

      Compute for the risk ratio of a hip fracture.

      Your Answer: 0.02

      Correct Answer: 0.4

      Explanation:

      Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.

      RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).

      RR = ART/ARC
      RR = (10/500) / (25/500)
      RR = 0.4

      Recall that:

      If RR < 1, then the intervention reduces the risk of the outcome.
      If RR = 1, then the treatment has no effect on the outcome.
      If RR > 1, then the intervention increases the risk of the outcome.

    • This question is part of the following fields:

      • Evidence Based Medicine
      110
      Seconds

  • Question 8 - A 27-year-old man has been diagnosed with testicular cancer and has spread to...

    Incorrect

    • A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes.

      The lymph from the testes will drain to which of the following nodes?

      Your Answer: Deep inguinal lymph nodes

      Correct Answer: Para-aortic lymph nodes

      Explanation:

      Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.

      The scrotum is the one which drains into the nearby superficial inguinal nodes.

      The glans penis and clitoris drains into the deep inguinal lymph nodes.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      25.2
      Seconds

  • Question 9 - Which of the following best describes an intention to treat analysis: ...

    Correct

    • Which of the following best describes an intention to treat analysis:

      Your Answer: All patients are included in the analysis according to the group into which they were randomised even if they are withdrawn from the study.

      Explanation:

      An intention to treat (ITT) analysis is one in which all patients are included in the analysis, classified according to the group into which they were randomised, even if they were withdrawn from the study and did not actually receive the treatment, did not comply with treatment or drop-out. Intention to treat analysis is a more reliable estimate of true treatment effectiveness by replicating what happens in the ‘real world’ (e.g. noncompliance and protocol violations commonly affect therapies).

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      59.3
      Seconds

  • Question 10 - A 60-year-old female is referred to the Oncology clinic due to the presence...

    Correct

    • A 60-year-old female is referred to the Oncology clinic due to the presence of lumps in her neck. There is a non-tender enlargement of several groups of cervical lymph nodes on examination. She is sent for a lymph node biopsy. The results show the presence of lymphoma cells, but there are no Reed-Sternberg cells.

      Which one is most appropriate for this case out of the following diagnoses?

      Your Answer: Non-Hodgkin’s lymphoma

      Explanation:

      Non-Hodgkin’s Lymphoma (NHL) causes neoplastic transformation of both B cell (85%) and T cell (15%) lines.

      The most common presentation is with enlarged, rubbery, painless lymph nodes. The patient may also have B symptoms which consist of night sweats, weight loss and fevers. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs.

      The presence of Reed-Sternberg cells characterises Hodgkin’s lymphoma. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.

      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

    • This question is part of the following fields:

      • Haematology
      • Pathology
      47.7
      Seconds

  • Question 11 - A 40-year-old man who has a history of asthma arrives at the emergency...

    Incorrect

    • A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?

      Your Answer: Sotalol

      Correct Answer: Atenolol

      Explanation:

      Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels.

      This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific.

      They have a lower effect on airway resistance, although they are not without this adverse effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      32.9
      Seconds

  • Question 12 - What is the primary function of collagen in wound healing? ...

    Incorrect

    • What is the primary function of collagen in wound healing?

      Your Answer: Phagocytosis

      Correct Answer: Strength and support

      Explanation:

      Key elements of the maturation stage include collagen cross-linking, collagen remodelling, wound contraction, and repigmentation. The tensile strength of the wound is directly proportional to the amount of collagen present. Numerous types of collagen have been identified; types I and III predominate in the skin and aponeurotic layers. Initially, a triple helix (tropocollagen) is formed by three protein chains; two are identical alpha-1 protein chains, and the third is an alpha-2 protein.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
      29.9
      Seconds

  • Question 13 - The sensory innervation of the oropharynx is provided by which of the following...

    Incorrect

    • The sensory innervation of the oropharynx is provided by which of the following nerves:

      Your Answer: Maxillary nerve

      Correct Answer: Glossopharyngeal nerve

      Explanation:

      Each subdivision of the pharynx has a different sensory innervation:the nasopharynx is innervated by the maxillary nervethe oropharynx is innervated by the glossopharyngeal nervethe laryngopharynx is innervated by the vagus nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      52.9
      Seconds

  • Question 14 - The myocardium is responsible for creating the force with which the atrial and...

    Incorrect

    • The myocardium is responsible for creating the force with which the atrial and ventricular muscles contract. It is made up of myocytes, which are heart muscle cells.

      Which of the following statements about cardiac muscle anatomy is correct?

      Your Answer: The nucleus is peripherally located within the myocyte

      Correct Answer: Cardiac myocytes have intercalated discs

      Explanation:

      Typically, granuloma has Langerhan’s cells (large multinucleated cells ) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.

      Antigen presenting monocytic cells found in the skin are known as Langerhan’s cells.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      24.7
      Seconds

  • Question 15 - Streptococcus pyogenes is commonly implicated in all of the following infective diseases EXCEPT for:...

    Incorrect

    • Streptococcus pyogenes is commonly implicated in all of the following infective diseases EXCEPT for:

      Your Answer: Quinsy

      Correct Answer: Gas gangrene

      Explanation:

      Gas gangrene is a life-threatening infection caused by toxin-producing Clostridium species, primarily Clostridium perfringens, and characterised by rapidly progressive muscle necrosis, gas production and sepsis.
      Gas gangrene is not a notifiable disease.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      90.9
      Seconds

  • Question 16 - When the breast cancer of a 60-year old patient metastasizes and compresses the...

    Correct

    • When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?

      Your Answer: Fifth cervical and fourth thoracic nerves

      Explanation:

      The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      38
      Seconds

  • Question 17 - A 77 year old lady presents to ED with her left leg shortened...

    Incorrect

    • A 77 year old lady presents to ED with her left leg shortened and externally rotated following slipping and falling on a wet bathroom floor. There is an intracapsular fracture of the neck of femur seen on imaging studies. She is at risk of avascular necrosis of the head of femur.

      This is caused by lack of blood supply from which of these arteries?

      Your Answer: Superior gluteal artery

      Correct Answer: Medial circumflex artery

      Explanation:

      The primary blood supply to the head of the femur is from branches of the medial femoral circumflex artery.

      The superior and inferior gluteal arteries supply the hip joint but not the head of femur.

      The lateral circumflex artery anastomoses with the medial femoral circumflex artery and assists in supplying the head of femur.

      The obturator artery is an important source of blood supply in children up to about 8 years. It gives rise to the artery of the head of femur which runs in the ligamentum teres and is insufficient to supply the head of femur in adults.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      10.8
      Seconds

  • Question 18 - After what time period should intravenous phenytoin be used as second-line treatment of...

    Incorrect

    • After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?

      Your Answer: 15 minutes

      Correct Answer: 25 minutes

      Explanation:

      If seizures recur or fail to respond after initial treatment with benzodiazepines within 25 minutes of onset, phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium should be used.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      8
      Seconds

  • Question 19 - Glucagon may be used as an antidote for overdose with which of the...

    Incorrect

    • Glucagon may be used as an antidote for overdose with which of the following:

      Your Answer: Calcium channel blockers

      Correct Answer: Beta blockers

      Explanation:

      Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
      Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
      Glucagon then causes:
      Glycogenolysis
      Gluconeogenesis
      Lipolysis in adipose tissue
      The secretion of glucagon is also stimulated by:
      Adrenaline
      Cholecystokinin
      Arginine
      Alanine
      Acetylcholine
      The secretion of glucagon is inhibited by:
      Insulin
      Somatostatin
      Increased free fatty acids
      Increased urea production

      Glycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.

      Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      73
      Seconds

  • Question 20 - A 25-year-old man suffers from a shoulder injury that damaged the nerve that...

    Incorrect

    • A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.

      Which of the following nerves may most likely be affected?

      Your Answer: The dorsal scapular nerve

      Correct Answer: The suprascapular nerve

      Explanation:

      The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      38.1
      Seconds

  • Question 21 - A 7-year-old girl is admitted to the hospital with a persistently high temperature....

    Incorrect

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

      What are the effects of paracetamol and ibuprofen on fever?

      Your Answer: Vascular smooth muscle relaxation

      Correct Answer: Reduction in prostaglandin synthesis

      Explanation:

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

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

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

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

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

    • This question is part of the following fields:

      • Pathology
      • Pathology Of Infections
      48
      Seconds

  • Question 22 - You see a 63-year-old man with a history of melaena and epigastric discomfort....

    Incorrect

    • You see a 63-year-old man with a history of melaena and epigastric discomfort. For a few months, he's been taking aspirin.

      Which of the following statements about aspirin's mechanism of action is correct?

      Your Answer: It reversibly blocks cyclo-oxygenase (COX)

      Correct Answer: It inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day)

      Explanation:

      Aspirin inhibits cyclo-oxygenase irreversibly by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2. The production of prostaglandin and thromboxane is reduced as a result. As a result, platelet activation and aggregation are reduced. A single dose of aspirin has a half-life of 7-10 days, which is the time it takes for the bone marrow to produce new platelets.

      Aspirin only inhibits COX-1, the enzyme that produces thromboxane A2, at low doses (75 mg per day), and thus has a primarily anti-thrombotic effect.

      Aspirin inhibits both COX-1 and COX-2 at medium to high doses (500-5000 mg per day). COX-2 is involved in the production of prostaglandins, so it has an anti-inflammatory effect at these concentrations.

      Aspirin, when used as an antipyretic for a viral illness in children, can cause Reye’s syndrome. Reye’s syndrome is a potentially fatal liver disease that causes encephalopathy and liver failure.

      The inability of aspirin to reduce platelet production of thromboxane A2, and thus platelet activation and aggregation, is known as aspirin resistance. Although the exact frequency and mechanism of aspirin resistance are unknown, it is thought to affect about 1% of users. Women are more likely than men to experience this phenomenon.

      According to new research, taking aspirin on a regular basis lowers the risk of colorectal cancer. It may also protect against cancers of the breast, bladder, prostate, and lungs.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      12.8
      Seconds

  • Question 23 - Water is reabsorbed in which portion of the Henle loop: ...

    Incorrect

    • Water is reabsorbed in which portion of the Henle loop:

      Your Answer: Thick ascending limb

      Correct Answer: Thin descending limb

      Explanation:

      The loop of Henle consists of three functionally distinct segments: the thin descending segment, the thin ascending segment, and the thick ascending segment. About 20 percent of the filtered water is reabsorbed in the loop of Henle and almost all of this occurs in the thin descending limb. Na+ and Cl-ions are actively reabsorbed from the tubular fluid in the thick ascending limb via the Na+/K+/2Cl-symporter on the apical membrane. Because the thick ascending limb is water-impermeable, ion reabsorption lowers tubular fluid osmolality while raising interstitial fluid osmolality, resulting in an osmotic difference. Water moves passively out of the thin descending limb as the interstitial fluid osmolality rises, concentrating the tubular fluid. This concentrated fluid descends in the opposite direction of fluid returning from the deep medulla still higher osmolality areas.

    • This question is part of the following fields:

      • Physiology
      • Renal
      63.7
      Seconds

  • Question 24 - A clinical audit cycle comprises of 5 steps. Each of these processes are...

    Incorrect

    • A clinical audit cycle comprises of 5 steps. Each of these processes are listed below:
      Which is the correct order that these should occur?

      1. Observation of practice and collection of data
      2. Identification of the problem
      3. Implementation of change
      4. Definition of criteria and setting of standards
      5. Analysis of data and comparison of performance with the criteria and standards

      Your Answer: 1,5,2,4,3

      Correct Answer: 2,4,1,5,3

      Explanation:

      An audit assesses if a certain aspect of health care is attaining a recognized standard. This lets care providers and patients know where their service is doing well, and where there could be improvements. The aim is to achieve quality improvement and improve outcomes for patients.

      Audits are a quality improvement measure and one of the 7 pillars of clinical governance. It allows organizations to continually work toward improving quality of care by showing them where they are falling short, allows them to implement improvements, and reaudit or close the audit cycle to see if beneficial change has taken place.

      Clinical audits are a cycle with several steps:

      1. Identification of the problem
      2. Definition of criteria and setting of standards
      3. Observation of practice and collection of data
      4. Analysis of data and comparison of performance with the criteria and standards
      5. Implementation of change

    • This question is part of the following fields:

      • Evidence Based Medicine
      29.7
      Seconds

  • Question 25 - Regarding Clostridium tetani, which of the following statements is CORRECT: ...

    Correct

    • Regarding Clostridium tetani, which of the following statements is CORRECT:

      Your Answer: Infection is predominantly derived from animal faeces and soil.

      Explanation:

      Clostridium tetaniis a Gram positive, rod shaped, obligate anaerobic bacterium.
      The incubation period is quoted as anywhere between 4-21 days and can occur after several months but symptoms usually occur within the first 7 days after exposure.
      Approximately 80% of patients develop generalised tetanus. The commonest presenting feature of generalised tetanus is trismus (lockjaw), occurring in approximately 75% of affected individuals. Other clinical features include:
      Facial spasms (risus sardonicus)
      Opisthotonus (characteristic body shape during spasms)
      Neck stiffness
      Dysphagia
      Calf and pectoral muscle rigidity
      Fever
      Hypertension
      Tachycardia
      Spasms can occur frequently and last for several minutes, they can continue to occur for up to 4 weeks. Current mortality rates are between 10 and 15%.
      Tetanic spasms are caused by the exotoxin tetanospasmin. The effects of tetanolysin are not fully understood but it is not believed to have clinical significance.
      Localised tetanus is a rare form of the disease, occurring in around 1% of affected individuals. Patients have persistent contraction of muscles in the same anatomic area as the injury. It may precede generalised tetanus.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      45.4
      Seconds

  • Question 26 - Regarding apoptosis, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: Apoptosis leads to the formation of membrane-bound apoptotic bodies.

      Correct Answer: Apoptosis leads to cell swelling and eventual cell lysis.

      Explanation:

      Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      17.3
      Seconds

  • Question 27 - Which of the following ions is more abundant in extracellular fluid than in...

    Incorrect

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

      Your Answer: Mg 2+

      Correct 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
      22.8
      Seconds

  • Question 28 - A 57-year old man presented himself to the emergency room with persistent cough....

    Incorrect

    • A 57-year old man presented himself to the emergency room with persistent cough. During history taking, a record of his previous sputum sample was seen and the report stated that it tested positive for AFB (acid-fast bacilli).

      What is the most likely pathogen?

      Your Answer: Bordetella pertussis

      Correct Answer: Mycobacterium tuberculosis

      Explanation:

      M. tuberculosis is the causative agent of pulmonary tuberculosis (TB). The most commonly used diagnostic test for the diagnosis of pulmonary TB is the direct sputum smear microscopy (DSSM) wherein the presence of acid-fast bacilli (AFB) is tested.

      The most common method is the hot method or also known as Ziehl-Neelsen method. This is a staining method special for Mycobacteria species because they are known to be acid-fast which means that they are not easily decolorized by acid alcohol. Once the DSSM tests positive for acid-fast bacilli, this indicates possible infection with tuberculosis. The gold standard for diagnosis is still culture but Mycobacteria species are slow-growers that is why DSSM is considered the best diagnostic method. A positive AFB smear and correlation with symptoms is usually used by physicians to create a final diagnosis of pulmonary tuberculosis.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      26
      Seconds

  • Question 29 - In adults in the United Kingdom, which of the following pathogens is the...

    Correct

    • In adults in the United Kingdom, which of the following pathogens is the most likely cause of viral infectious gastroenteritis:

      Your Answer: Norovirus

      Explanation:

      Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhoea in community settings. In the United Kingdom, norovirus has become the most common cause of gastroenteritis in adults and children since the introduction of rotavirus vaccination.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      14.3
      Seconds

  • Question 30 - Detection of urinary Bence-Jones protein would be most suggestive of which of the...

    Incorrect

    • Detection of urinary Bence-Jones protein would be most suggestive of which of the following malignancies:

      Your Answer: Acute myeloid leukaemia

      Correct Answer: Multiple myeloma

      Explanation:

      Bence Jones proteins are monoclonal immunoglobulin light chains found in urine (and plasma) of some patients with myeloma. Because of their relatively small size, light chains are readily excreted into the urine. The presence of significant amounts of Bence Jones proteins in urine is indicative of malignant B cell proliferation.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      78.5
      Seconds

  • Question 31 - Which of the following statements is correct regarding flow through the cardiovascular system?...

    Incorrect

    • Which of the following statements is correct regarding flow through the cardiovascular system?

      Your Answer: Laminar blood flow may be heard as a carotid bruit or heart murmur.

      Correct Answer: Turbulent blood flow may be caused by increased cardiac output.

      Explanation:

      Frictional forces at the sides of a vessel cause a drag force on the fluid touching them in laminar blood flow, which creates a velocity gradient where the flow is greatest at the centre. Laminar blood flow may become disrupted and flow may become turbulent at high velocities, especially in large arteries or where the velocity increases sharply at points of sudden narrowing in the vessels, or across valves. There is increased tendency for thrombi formation when there is turbulent blood flow. Clinically, turbulence may be heard as a murmur or a bruit. As a result of elevated cardiac output, there may be turbulent blood flow, even when the cardiac valves are anatomically normal, and as a result, a physiological murmur can be heard. One such example is pregnancy.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      33.9
      Seconds

  • Question 32 - A 40-year-old male visits his family physician with the complaint of a high-grade...

    Incorrect

    • A 40-year-old male visits his family physician with the complaint of a high-grade fever for the past five days. A complete blood count report shows the presence of neutrophilia.

      Which one of the following facts regarding neutrophilia is accurate?

      Your Answer: It is only caused by generalized and not localized bacterial infections

      Correct Answer: It can be caused by eclampsia

      Explanation:

      A total neutrophil count of greater than 7.5 x 109/L is called neutrophilia. Typhoid fever usually causes leukopenia or neutropenia. Both localised and generalised bacterial infections can cause neutrophilia.

      Metabolic disorders such as
      – gout
      – eclampsia
      – uraemia
      can also cause neutrophilia.

      Acute neutrophilia, in which immature neutrophils can be seen, is referred to as a left shift and can be seen in conditions such as appendicitis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      40.7
      Seconds

  • Question 33 - Regarding the lacrimal apparatus, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the lacrimal apparatus, which of the following statements is CORRECT:

      Your Answer: The nasolacrimal duct empties into the middle nasal meatus.

      Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.

      Explanation:

      Lacrimal fluid is drained from the eyeball through the lacrimal punctum.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      20.4
      Seconds

  • Question 34 - Which of the following intravenous induction drugs results in the highest drop in...

    Incorrect

    • Which of the following intravenous induction drugs results in the highest drop in blood pressure:

      Your Answer: Midazolam

      Correct Answer: Propofol

      Explanation:

      Propofol’s most frequent side effect is hypotension, which affects 17% of paediatric patients and 26% of adults. This is attributable to systemic vasodilation as well as a decrease in preload and afterload. Propofol has a little negative inotropic impact as well. The drop in blood pressure is dosage-dependent and is more noticeable in the elderly, thus this should be expected.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      36.6
      Seconds

  • Question 35 - A 46-year-old male who is suffering from a chest infection. You decide to start giving...

    Incorrect

    • A 46-year-old male who is suffering from a chest infection. You decide to start giving the patient antibiotics, however he is allergic to penicillin. You consult with one of your co-workers about the best choice of antibiotic to give.

      From the following choices, which is considered an example of bacteriostatic antibiotic?

      Your Answer: Ciprofloxacin

      Correct Answer: Trimethoprim

      Explanation:

      Antibiotics that are bactericidal kill bacteria, while antibiotics that are bacteriostatic limit their growth or reproduction. The antibiotics grouped into these two classes are summarized in the table below:

      Bactericidal antibiotics
      Bacteriostatic antibiotics

      Vancomycin
      Metronidazole
      Fluoroquinolone, such as ciprofloxacin
      Penicillins, such as benzylpenicillin
      Cephalosporin, such as ceftriaxone
      Co-trimoxazole
      Tetracyclines, such as doxycycline
      Macrolides, such as erythromycin
      Sulphonamides, such as sulfamethoxazole
      Clindamycin
      Trimethoprim
      Chloramphenicol

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      30.6
      Seconds

  • Question 36 - Which of the following side effects is most likely caused by erythromycin: ...

    Incorrect

    • Which of the following side effects is most likely caused by erythromycin:

      Your Answer: Tendon rupture

      Correct Answer: QT - prolongation

      Explanation:

      The side effects of erythromycin include abdominal pain, anaphylaxis,
      cholestatic hepatitis, confusion,
      diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss,
      headache, hypertrophic pyloric stenosis, hypotension, Interstitial
      nephritis, mild allergic reactions, nausea, nervous system effects,
      including seizures, pain, pruritus, pseudomembranous colitis,
      QT prolongation, rash, skin eruptions, tinnitus, urticaria,
      ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      81
      Seconds

  • Question 37 - An X-ray of a 24-year-old female hockey player who arrives at the hospital...

    Incorrect

    • An X-ray of a 24-year-old female hockey player who arrives at the hospital with a left foot injury reveals an avulsion fracture of the fifth metatarsal tuberosity. Which of the following muscles is most likely responsible for the movement of the fractured fragment?

      Your Answer: Fibularis tertius

      Correct Answer: Fibularis brevis

      Explanation:

      An avulsion fracture of the base of the fifth metatarsal happens when the ankle is twisted inwards.

      When the ankle is twisted inwards a muscle called the fibularis brevis contracts to stop the movement and protect the ligaments of the ankle.

      The base of the fifth metatarsal is where this muscle is attached. The group of lateral leg muscles that function to plantarflex the foot includes the fibularis brevis and the fibularis longus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      30.6
      Seconds

  • Question 38 - The hypothalamus produces antidiuretic hormone (ADH), also known as vasopressin, which is a...

    Incorrect

    • The hypothalamus produces antidiuretic hormone (ADH), also known as vasopressin, which is a peptide hormone. It is important for maintaining water and electrolyte balance, as well helping control arterial pressure.

      To have an effect on blood arteries, ADH binds to which of the following receptors?

      Your Answer: AT 1 receptor

      Correct Answer: V 1 receptor

      Explanation:

      ADH, or antidiuretic hormone, is a hormone that regulates water and electrolyte balance. It is released in response to a variety of events, the most important of which are higher plasma osmolality or lower blood pressure. ADH increases plasma volume and blood pressure via acting on the kidneys and peripheral vasculature.

      It causes vasoconstriction by binding to peripheral V1 Receptors on vascular smooth muscle via the IP3 signal transduction and Rho-kinase pathways. The systemic vascular resistance and arterial pressure rise as a result. High levels of ADH appear to be required for this to have a major impact on arterial pressure, such as in hypovolaemic shock.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      17.4
      Seconds

  • Question 39 - Which of the following is an example of a non-parametric test: ...

    Incorrect

    • Which of the following is an example of a non-parametric test:

      Your Answer: Kruskal-Wallis test

      Correct Answer: All of the above

      Explanation:

      All of the above answers are non-parametric tests.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      12
      Seconds

  • Question 40 - Which of the following is NOT a notifiable disease: ...

    Incorrect

    • Which of the following is NOT a notifiable disease:

      Your Answer: Scarlet fever

      Correct Answer: HIV

      Explanation:

      HIV mainly infects CD4+ T helper cells. Viral replication results in progressive T-cell depletion and impaired cell-mediated immunity with subsequent secondary opportunistic infections and increased risk of malignancy. B-cell function is also reduced as a result of lack of T-cell stimulation.
      HIV is not a notifiable disease.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      56.8
      Seconds

  • Question 41 - A patient sustains an injury to the proximal median nerve after falling through...

    Incorrect

    • A patient sustains an injury to the proximal median nerve after falling through a glass door. Which of the following muscles would you not expect to be affected:

      Your Answer: Flexor pollicis longus

      Correct Answer: Flexor carpi ulnaris

      Explanation:

      All of the muscles in the anterior forearm are innervated by the median nerve, except for the flexor carpi ulnaris and the medial half of the flexor digitorum profundus which are innervated by the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      49.1
      Seconds

  • Question 42 - Regarding haemoglobin, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: The rate limiting step of haem synthesis is the condensation of glycine and succinyl coenzyme A.

      Correct Answer: Haemoglobin synthesis occurs in mature erythrocytes.

      Explanation:

      Haemoglobin is composed of four polypeptide globin chains each with its own iron containing haem molecule. Haem synthesis occurs largely in the mitochondria by a series of biochemical reactions commencing with the condensation of glycine and succinyl coenzyme A under the action of the key rate-limiting enzyme delta-aminolevulinic acid (ALA) synthase. The globin chains are synthesised by ribosomes in the cytosol. Haemoglobin synthesis only occurs in immature red blood cells.
      There are three types of haemoglobin in normal adult blood: haemoglobin A, A2 and F:
      – Normal adult haemoglobin (HbA) makes up about 96 – 98 % of total adult haemoglobin, and consists of two alpha (α) and two beta (β) globin chains. 
      – Haemoglobin A2 (HbA2), a normal variant of adult haemoglobin, makes up about 1.5 – 3.5 % of total adult haemoglobin and consists of two α and two delta (δ) globin chains.
      – Foetal haemoglobin is the main Hb in the later two-thirds of foetal life and in the newborn until approximately 12 weeks of age. Foetal haemoglobin has a higher affinity for oxygen than adult haemoglobin. 
      Red cells are destroyed by macrophages in the liver and spleen after , 120 days. The haem group is split from the haemoglobin and converted to biliverdin and then bilirubin. The iron is conserved and recycled to plasma via transferrin or stored in macrophages as ferritin and haemosiderin. An increased rate of haemoglobin breakdown results in excess bilirubin and jaundice.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      38.6
      Seconds

  • Question 43 - A 71-year-old patient has been diagnosed with a dopamine-secreting neuroendocrine tumour.

    Which of the...

    Incorrect

    • A 71-year-old patient has been diagnosed with a dopamine-secreting neuroendocrine tumour.

      Which of the following statements about dopamine is correct?

      Your Answer: It is a derivative of the amino acid alanine

      Correct Answer: It inhibits prolactin release from the anterior pituitary

      Explanation:

      Dopamine is a neurotransmitter and amine hormone that is derived from the amino acid tyrosine. It is made in a number of places throughout the human body, both inside and outside the central nervous system. The adrenal medulla, dopamine neurons in the arcuate nucleus of the hypothalamus, the substantia nigra, and other areas of the brain produce dopamine.

      The tuberoinfundibular pathway refers to the dopamine neurons in the arcuate nucleus of the hypothalamus’ tubeal region. Dopamine is discharged into the hypothalamo-hypophyseal portal system from these neurons’ neurosecretory terminals at the median eminence.

      The major function of dopamine produced from the hypothalamus is to suppress prolactin production from the anterior pituitary, and it is released in reaction to excessive levels of prolactin secretion. Modulation of motor-control centres and activation of reward centres are two more crucial activities of the brain.
      Dopamine-secreting cells can also be found in other areas of the body, where they perform mostly paracrine functions (acting on nearby cells).

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      68.9
      Seconds

  • Question 44 - A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms...

    Incorrect

    • A 34-year-old woman was diagnosed with multiple sclerosis two years ago. Her symptoms have been steadily deteriorating, with no intervals of remission in sight.

      Which of the following aspects of nerve conduction is disrupted by multiple sclerosis?

      Your Answer: Potassium channel function

      Correct Answer: Saltatory conduction

      Explanation:

      Local currents propagate action potentials down the axons of neurons. This local current flow following depolarisation results in the depolarisation of the neighbouring axonal membrane, and when this region approaches the threshold, more action potentials are generated and so forth. Due to the refractory period, portions of the membrane that have recently depolarized will not depolarize again, resulting in the action potential only being able to go in one direction.

      The square root of axonal diameter determines the velocity of the action potential; the axons with the biggest diameter have the quickest conduction velocities. When a neuron is myelinated, the speed of the action potential rises as well.
      The myelin sheath is an insulating coating that surrounds certain neural axons. By increasing membrane resistance and decreasing membrane capacitance, the myelin sheath improves conduction. This enables faster electrical signal transmission via a neuron, making them more energy-efficient than non-myelinated neuronal axons.
      Electrical impulses are quickly transmitted from one node to the next, causing depolarization of the membrane above the threshold and triggering another action potential, which is then transmitted to the next node. An action potential is rapidly conducted down a neuron in this manner. Saltatory conduction is the term for this.
      Multiple sclerosis is an example of a clinical disorder in which the myelin sheath is affected. It is an immune-mediated disorder in which certain nerve cells in the brain and spinal cord become demyelinated. The ability of some areas of the nervous system to properly transmit action potentials is disrupted by demyelination, resulting in a variety of neurological symptoms and indications.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      14.4
      Seconds

  • Question 45 - Bordetella pertussis causes which of the following infectious diseases: ...

    Incorrect

    • Bordetella pertussis causes which of the following infectious diseases:

      Your Answer: Acute bronchiolitis

      Correct Answer: Whooping cough

      Explanation:

      Bordetella pertussis causes whooping cough. Acute bronchiolitis is typically caused by respiratory syncytial virus. Parainfluenza virus is the most common cause of croup. Acute epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. The common cold may be caused by a number of viruses including rhinovirus and coronavirus.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      53.7
      Seconds

  • Question 46 - When treating diabetic ketoacidosis (DKA), which of the following should be given if...

    Incorrect

    • When treating diabetic ketoacidosis (DKA), which of the following should be given if the systolic blood pressure is initially less than 90 mmHg:

      Your Answer: 1 L sodium chloride 0.9% intravenous infusion over 10 - 15 minutes

      Correct Answer: 500 mL sodium chloride 0.9% intravenous infusion over 10 - 15 minutes

      Explanation:

      If SBP is less than 90 mmHg , 500 mL sodium chloride 0.9 percent should be administered intravenously over 10–15 minutes, and repeated if SBP remains less than 90 mmHg. When SBP is greater than 90 mmHg, sodium chloride infusion must be maintained at a rate that replaces the deficit.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      31.9
      Seconds

  • Question 47 - An ambulance transports a 23-year-old woman who has taken a witnessed overdose of...

    Incorrect

    • An ambulance transports a 23-year-old woman who has taken a witnessed overdose of her mother's diazepam tablets. She has no significant medical history and does not take any medications on a regular basis.

      In this case, what is the SINGLE MOST APPROPRIATE FIRST DRUG TREATMENT?

      Your Answer: Flumazenil IV 200 mg

      Correct Answer: Flumazenil IV 200 μg

      Explanation:

      Flumazenil is a benzodiazepine antagonist that can be helpful in some overdose situations. It works quickly (in less than a minute), but the effects are fleeting, lasting less than an hour. The dose is 200 micrograms every 1-2 minutes with a maximum dose of 3 milligrams per hour.

      Flumazenil should be avoided by patients who are addicted to benzodiazepines or who take tricyclic antidepressants because it can cause withdrawal symptoms. It can cause seizures or cardiac arrest in these situations.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      47.6
      Seconds

  • Question 48 - A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate,...

    Correct

    • 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: 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
      36
      Seconds

  • Question 49 - A 18 year old student presents to ED with a headache, fever and...

    Incorrect

    • A 18 year old student presents to ED with a headache, fever and photophobia. You suspect meningitis and agree to observe your junior performing a lumbar puncture. What is the highest safest vertebral level to perform lumbar puncture in adults:

      Your Answer: L1/L2

      Correct Answer: L3/L4

      Explanation:

      In adults, the spinal cord typically ends between L1/L2 whereas the subarachnoid space extends to approximately the lower border of vertebra S2. Lumbar puncture is performed in the intervertebral space L4/L5 or L3/L4.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      68.7
      Seconds

  • Question 50 - Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given: ...

    Incorrect

    • Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given:

      Your Answer: At a concentration of 1 unit/mL at a fixed rate of 0.2 units/kg/hour

      Correct Answer: At a concentration of 1 unit/mL at a fixed rate of 0.1 units/kg/hour

      Explanation:

      An intravenous insulin infusion should be started at a concentration of 1 unit/mL, at a fixed rate of 0.1 units/kg/hour. Established subcutaneous long-acting insulin therapy should be continued concomitantly. Blood ketone and blood glucose concentrations should be checked hourly and the insulin infusion rate adjusted accordingly. Blood ketone concentration should fall by at least 0.5 mmol/litre/hour and blood glucose concentration should fall by at least 3 mmol/litre/hour.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      36.2
      Seconds

  • Question 51 - Which of the following is most likely affected in De Quervain's tenosynovitis? ...

    Incorrect

    • Which of the following is most likely affected in De Quervain's tenosynovitis?

      Your Answer: Adductor pollicis

      Correct Answer: Extensor pollicis brevis

      Explanation:

      De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. It is a condition which involves tendon entrapment affecting the first dorsal compartment of the wrist. With this condition thickening of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis develops where the tendons pass in through the fibro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial and ulnar deviation of the wrist.

      The estimated prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties. It may be seen more commonly in individuals with a history of medial or lateral epicondylitis. Bilateral involvement is often reported in new mothers or child care providers in whom spontaneous resolution typically occurs once lifting of the child is less frequent.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      67.9
      Seconds

  • Question 52 - An analytical cohort study is done to compare the relationship between omega 3...

    Incorrect

    • An analytical cohort study is done to compare the relationship between omega 3 intake and occurrence of myocardial infarction (MI) among males aged over 65 years. The following are the data from the study:

      No. of subjects taking placebo: 100 men
      No. of subjects taking placebo who suffered an MI: 15 men

      No. of subjects taking omega 3: 100 men
      No. of subjects taking omega 3 who suffered an MI: 5 men

      Compute for the absolute risk in the treatment (omega 3) group.

      Your Answer: 0.2

      Correct Answer: 0.05

      Explanation:

      The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.

      AR = 5/100 = 0.05

    • This question is part of the following fields:

      • Evidence Based Medicine
      7
      Seconds

  • Question 53 - Insulin is produced by which of the following pancreatic cells: ...

    Incorrect

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

      Your Answer: F cells

      Correct Answer: β cells

      Explanation:

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

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      50.9
      Seconds

  • Question 54 - You review the arterial blood gas (ABG) of a patient with lactic acidosis.
    Which...

    Incorrect

    • You review the arterial blood gas (ABG) of a patient with lactic acidosis.
      Which SINGLE statement regarding lactic acidosis is true?

      Your Answer: The mortality associated with lactic acidosis is approximately 10%

      Correct Answer: Type A lactic acidosis is typically due to tissue hypoxia

      Explanation:

      Lactic acidosis is defined as a pH <7.35 and a lactate >5 mmol/L. It is a common finding in critically ill patients and is often associated with other serious underlying pathologies. The anion gap is raised in lactic acidosis.
      There are major adverse consequences of severe acidaemia, which affect all body systems, and there is an associated increase in mortality of critically ill patients with a raised lactate. The mortality associated with lactic acidosis despite full supportive treatment remains at 60-90%.
      Acquired lactic acidosis is classified into two subtypes:
      Type A is due to tissue hypoxia
      Type B is due to non-hypoxic processes affecting the production and elimination of lactate
      Lactic acidosis can be extreme after a seizure but usually resolves spontaneously within a few hours.
      Left ventricular failure typically results in tissue hypoperfusion and a type A lactic acidosis.
      Some causes of type A and type B lactic acidosis are shown below:
      Type A lactic acidosis
      Type B lactic acidosis
      Shock (including septic shock)
      Left ventricular failure
      Severe anaemia
      Asphyxia
      Cardiac arrest
      CO poisoning
      Respiratory failure
      Severe asthma and COPD
      Regional hypoperfusion
      Renal failure
      Liver failure
      Sepsis (non-hypoxic sepsis)
      Thiamine deficiency
      Alcoholic ketoacidosis
      Diabetic ketoacidosis
      Cyanide poisoning
      Methanol poisoning
      Biguanide poisoning

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      45.4
      Seconds

  • Question 55 - The monospot test for infectious mononucleosis uses which of the following types...

    Incorrect

    • The monospot test for infectious mononucleosis uses which of the following types of red blood cell?

      Your Answer: Rat red blood cells

      Correct Answer: Horse red blood cells

      Explanation:

      Infectious mononucleosis can be diagnosed using specific EBV antibodies and a variety if unrelated non-EBV heterophile antibodies. These antibodies can be detected by two main screening tests:

      The monospot test uses horse red blood cells. It agglutinates in the presence of heterophile antibodies.

      Sheep red blood cells is used in Paul-Bunnell test. The blood agglutinates in the presence of heterophile antibodies.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      11.5
      Seconds

  • Question 56 - Naloxone is a reversal agent for which of the following groups of drugs:...

    Incorrect

    • Naloxone is a reversal agent for which of the following groups of drugs:

      Your Answer: Barbiturates

      Correct Answer: Opioids

      Explanation:

      Naloxone is a specific antagonist of mu(μ)-opioid receptors, the specific antidote for opioid overdose and will reverse respiratory depression and coma if given at sufficient dosage. The initial dose is usually 0.8 mg (2 mL) intravenously (the dose range suggested by BNF is 0.4-2 mg). It can also be given by intramuscular injection if the intravenous route is not feasible.
      As naloxone has a shorter duration of action than most opioids, close monitoring and repeated injections are necessary according to the respiratory rate and depth of coma. The dose is generally repeated every 2-3 minutes to a maximum of 10 mg. When repeated doses are needed, naloxone may be given by a continuous infusion adjusted according to the vital signs. Initially, the infusion rate can be set at 60% of the initial resuscitative IV dose per hour.
      In opioid addicts, naloxone administration may precipitate a withdrawal syndrome with abdominal cramps, nausea and diarrhoea, but these usually settle within 2 hours.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      13.1
      Seconds

  • Question 57 - The pelvic bone is formed by which of the following: ...

    Incorrect

    • The pelvic bone is formed by which of the following:

      Your Answer: Ilium, ischium and sacrum

      Correct Answer: Ilium, ischium and pubis

      Explanation:

      Each pelvic bone is formed by three elements: the ilium (superiorly), the pubis (anteroinferiorly) and the ischium (posteroinferiorly).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      86.5
      Seconds

  • Question 58 - Regarding renal clearance, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding renal clearance, which of the following statements is CORRECT:

      Your Answer: Creatinine is freely filtered and neither reabsorbed or secreted.

      Correct Answer: The MDRD equation uses plasma creatinine to estimate the GFR making an adjustment for age, sex and race.

      Explanation:

      Clearance is defined as the volume of plasma that is cleared of a substance per unit time. Inulin clearance is the gold standard for measurement of GFR but creatinine clearance is typically used instead. Creatinine is freely filtered and not reabsorbed, but there is a little creatinine tubular secretion. In practice, GFR is usually estimated from the plasma creatinine using a formula e.g. the MDRD equation making an adjustment for age, sex and race.

    • This question is part of the following fields:

      • Physiology
      • Renal
      48.3
      Seconds

  • Question 59 - A 63-year-old man complains of chest pain and syncope on occasion. His heart...

    Incorrect

    • A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.

      Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?

      Your Answer: Set up an adrenaline infusion at 2-10 mcg/min

      Correct Answer: Give atropine 500 mcg

      Explanation:

      Atropine is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.

      If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of atropine 500 mcg IV:
      Shock
      Syncope
      Myocardial ischemia
      Insufficiency of the heart

      If this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.

      The ALS bradycardia algorithm also suggests the following interim measures:
      Transcutaneous pacing
      Isoprenaline infusion 5 mcg/min
      Adrenaline infusion 2-10 mcg/minutes
      Alternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate)

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      12.7
      Seconds

  • Question 60 - Approximately how long is the duration of a lidocaine block (when given with...

    Incorrect

    • Approximately how long is the duration of a lidocaine block (when given with adrenaline):

      Your Answer:

      Correct Answer: 90 minutes

      Explanation:

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

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology (3/4) 75%
Pathology (5/7) 71%
Endocrine Physiology (1/2) 50%
Physiology (5/12) 42%
Anatomy (7/15) 47%
Upper Limb (2/5) 40%
Central Nervous System (1/3) 33%
Immune Responses (0/1) 0%
Evidence Based Medicine (4/5) 80%
Abdomen And Pelvis (0/1) 0%
Study Methodology (1/1) 100%
Cardiovascular (0/1) 0%
Pharmacology (9/14) 64%
Head And Neck (2/4) 50%
Basic Cellular Physiology (0/2) 0%
Microbiology (4/6) 67%
Pathogens (4/5) 80%
Lower Limb (2/2) 100%
Endocrine (3/4) 75%
Pathology Of Infections (1/1) 100%
CNS Pharmacology (1/2) 50%
Renal (1/2) 50%
Inflammatory Responses (1/1) 100%
Basic Cellular (1/3) 33%
Anaesthesia (3/3) 100%
Infections (1/3) 33%
Renal Physiology (1/2) 50%
Statistics (1/1) 100%
Specific Pathogen Groups (0/1) 0%
Abdomen (1/1) 100%
Cardiovascular Pharmacology (1/1) 100%
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