00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - Salivary glands produce saliva which is mostly water, but it also contains a...

    Incorrect

    • Salivary glands produce saliva which is mostly water, but it also contains a range of essential chemicals such as mucus, electrolytes, antibiotic agents, and enzymes.

      Which of the following is a carbohydrate-digesting enzyme found in saliva?

      Your Answer: Trypsin

      Correct Answer: Amylase

      Explanation:

      The acinar cells of the parotid and submandibular glands release amylase. Amylase begins starch digestion before food is even eaten, and it works best at a pH of 7.4.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      28.4
      Seconds
  • Question 2 - A 55-year-old male diabetic patient presents to the Emergency Room complaining of severe...

    Incorrect

    • A 55-year-old male diabetic patient presents to the Emergency Room complaining of severe chest pain. His medical record shows that he had coronary angioplasty one week ago, during which he was administered abciximab.

      Which of the following haematological diseases has a similar mechanism of action to this drug?

      Your Answer: Von Willebrand disease

      Correct Answer: Glanzmann’s thrombasthenia

      Explanation:

      Abciximab is glycoprotein IIb/IIIa receptor antagonist that decreases aggregation of platelets by prevent their cross-linking. In Glanzmann’s thrombasthenia there are low levels of these same receptors leading to decreased bridging of platelets as fibrinogen cannot attach. There is increased bleeding time both in this disease and when there is use of abciximab.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      29.3
      Seconds
  • Question 3 - Which of the following best describes a natural killer cell: ...

    Incorrect

    • Which of the following best describes a natural killer cell:

      Your Answer: A large phagocyte that is part of the innate immune system.

      Correct Answer: A large granular lymphocyte that kills by inducing target cell apoptosis.

      Explanation:

      Natural killer (NK) cells are cytotoxic CD8 positive cells that lack the T-cell receptor. They are large cells with cytoplasmic granules. NK cells are designed to kill target cells that have a low level of expression of HLA class I molecules, such as may occur during viral infection or on a malignant cell. NK cells do this by displaying several receptors for HLA molecules on their surface. When HLA is expressed on the target cell these deliver an inhibitory signal into the NK cell. When HLA molecules are absent on the target cell this inhibitory signal is lost and the NK cell can then kill its target. In addition, NK cells display antibody-dependent cell-mediated cytotoxicity. In this, antibody binds to antigen on the surface of the target cell and then NK cells bind to the Fc portion of the bound antibody and kill the target cell.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      317.1
      Seconds
  • Question 4 - Continuous capillaries are typically found where in the body: ...

    Incorrect

    • Continuous capillaries are typically found where in the body:

      Your Answer: Renal glomeruli

      Correct Answer: Blood-brain barrier

      Explanation:

      Continuous capillaries, found in the skin, lungs, muscles and CNS, are the most selective with low permeability, as junctions between the endothelial cells are very tight, restricting the flow of molecules with MW > 10,000.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      30.6
      Seconds
  • Question 5 - Cefotaxime (or ceftriaxone) is used first line for which of the following infections:...

    Correct

    • Cefotaxime (or ceftriaxone) is used first line for which of the following infections:

      Your Answer: Blind treatment of suspected bacterial meningitis

      Explanation:

      Cefotaxime (or ceftriaxone) are indicated first line in:
      – Blind treatment of meningitis in patients > 3 months (with amoxicillin if patient > 50 years)
      – Meningitis caused by meningococci
      – Meningitis caused by pneumococci
      – Meningitis caused by H. influenzae
      – Severe or invasive salmonellosis
      – Typhoid fever
      – Gonorrhoea
      – Gonococcal arthritis
      – Haemophilus influenzae epiglottitis

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      17.3
      Seconds
  • Question 6 - All of the following statements are incorrect about insulin except: ...

    Correct

    • All of the following statements are incorrect about insulin except:

      Your Answer: Proinsulin is cleaved into insulin and C peptide.

      Explanation:

      Proinsulin is synthesised as a single-chain peptide. A connecting peptide (C peptide) within storage granules is removed by proteases to yield insulin.

      Insulin:
      1. is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds.
      2. is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas.
      3. release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin. However, most output is driven by the rise in plasma glucose concentration that occurs after a meal.
      4. effects are mediated by the receptor tyrosine kinase.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      37.3
      Seconds
  • Question 7 - Antidiuretic hormone (ADH) has which of the following effects: ...

    Correct

    • Antidiuretic hormone (ADH) has which of the following effects:

      Your Answer: Increases urine osmolality

      Explanation:

      ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, raising cAMP levels and causing intracellular vesicles to fuse with the apical membrane. In their membrane these vesicles have water channels called aquaporins, which increase the water permeability allowing greater water reabsorption and concentration of urine. ADH also binds to V1 receptor receptors on vascular smooth muscle, causing vasoconstriction and enhancing the effect of aldosterone on sodium reabsorption in the distal tubule. ADH release is stimulated primarily by raised plasma osmolality detected by osmoreceptors in the anterior hypothalamus. Other factors that increase ADH release include: extracellular fluid volume depletion, angiotensin II, nausea, pain, stress, exercise, emotion, hypoglycaemia. ADH release is inhibited by low plasma osmolality, alcohol, caffeine, glucocorticoids and atrial natriuretic peptide (ANP). ADH deficiency (or an inadequate response to ADH) results in diabetes insipidus. Excess levels of ADH results in syndrome of inappropriate ADH secretion (SIADH).

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      4099.4
      Seconds
  • Question 8 - Which of the following is a clinical effect of hyperkalaemia: ...

    Incorrect

    • Which of the following is a clinical effect of hyperkalaemia:

      Your Answer: Tetany

      Correct Answer: Muscle weakness

      Explanation:

      Clinical features of hyperkalaemia may include:
      paraesthesia, muscle weakness or paralysis, cardiac conduction abnormalities and dysrhythmias.

      Clinical features of hypokalaemia may include:
      muscle weakness, muscle cramps, rhabdomyolysis and myoglobinuria, ascending paralysis resulting in respiratory failure, constipation, gut ileus with distension, anorexia, nausea and vomiting, impaired ADH action with polyuria and polydipsia, ECG changes and cardiac arrhythmias.

    • This question is part of the following fields:

      • Physiology
      • Renal
      19.4
      Seconds
  • Question 9 - The most important Complement protein for antigen opsonization is: ...

    Correct

    • The most important Complement protein for antigen opsonization is:

      Your 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
      138.8
      Seconds
  • Question 10 - Which of the following is true regarding respiration? ...

    Correct

    • Which of the following is true regarding respiration?

      Your Answer: The diaphragm is responsible for abdominal breathing

      Explanation:

      The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.

      Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.

      In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.

      Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      45
      Seconds
  • Question 11 - A novel anti-tuberculosis medicine was compared to standard treatment and shown to cut...

    Incorrect

    • A novel anti-tuberculosis medicine was compared to standard treatment and shown to cut the risk of death from 30 to 10 per 1000 people. How many patients would need to be treated (number need to treat (NNT)) in order to prevent 10 additional tuberculosis deaths:

      Your Answer: 25

      Correct Answer: 500

      Explanation:

      The risk of mortality in the control group (usual therapy) minus the risk of death in the treatment group equals the absolute risk reduction (ARR) of treatment.
      30/1000 minus 10/1000 = 20/1000 = 0.02

      NNT = 1/ARR = 1/0.02 = 50
      As a result, 50 people would need to be treated in order to prevent one additional fatality, and 500 people would need to be treated in order to avoid 10 additional deaths.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      152
      Seconds
  • Question 12 - You suspect that your patient with polycystic kidney disease has developed a berry...

    Correct

    • You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?

      Your Answer: Anterior communicating artery

      Explanation:

      One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm.

      A berry aneurysm is the most common type of brain aneurysm.

      The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      39
      Seconds
  • Question 13 - Which of the following classes of drugs may predispose to lithium toxicity: ...

    Correct

    • Which of the following classes of drugs may predispose to lithium toxicity:

      Your Answer: Thiazide diuretics

      Explanation:

      Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      21.3
      Seconds
  • Question 14 - A 39-year-old man with a long history of depression presents after intentionally overdoing...

    Incorrect

    • A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.

      Which of the following is a verapamil toxicity?

      Your Answer: Hyperinsulinaemia

      Correct Answer: Negative inotropy

      Explanation:

      Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium-channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.

      The following summarises the toxicity of calcium-channel blockers:
      Cardiac effects
      Vascular smooth muscle tone affects
      Metabolic effects
      Excessive negative inotropy: myocardial depression
      Negative chronotropy: sinus bradycardia
      Negative dromotropy: atrioventricular node blockade
      Decreased afterload
      Systemic hypotension
      Coronary vasodilation
      Hypoinsulinaemia
      Calcium channel blocker-induced insulin resistance

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      41.2
      Seconds
  • Question 15 - Nifedipine commonly causes which of the following adverse effects? ...

    Incorrect

    • Nifedipine commonly causes which of the following adverse effects?

      Your Answer: Bradycardia

      Correct Answer: Ankle oedema

      Explanation:

      Most common adverse effects of Nifedipine include:
      Peripheral oedema (10-30%)
      Dizziness (23-27%)
      Flushing (23-27%)
      Headache (10-23%)
      Heartburn (11%)
      Nausea (11%)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      940.1
      Seconds
  • Question 16 - Fusidic acid is primarily indicated for infections caused by which of the following...

    Incorrect

    • Fusidic acid is primarily indicated for infections caused by which of the following microorganisms:

      Your Answer: Streptococcal infections

      Correct Answer: Staphylococcal infections

      Explanation:

      Fusidic acid is a narrow spectrum antibiotic used for staphylococcal infections, primarily topically for minor staphylococcal skin (impetigo) or eye infection. It is sometimes used orally for penicillin-resistant staphylococcal infection, including osteomyelitis or endocarditis, in combination with other antibacterials.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      14.8
      Seconds
  • Question 17 - 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
      29
      Seconds
  • Question 18 - You contact the intensive care outreach team to inquire about a severely hypotensive...

    Correct

    • You contact the intensive care outreach team to inquire about a severely hypotensive resuscitated patient. They make the decision to start a dopamine infusion.

      Dopamine primarily has which of the following effects at high doses (>15 g/kg/min)?

      Your Answer: Alpha-adrenergic stimulation

      Explanation:

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

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

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

      Because clearance varies greatly in critically ill patients, plasma concentrations cannot be predicted reliably from infusion rates.
      Dopamine is given as an intravenous infusion, and because extravasation can cause tissue necrosis and sloughing, a central line is usually used (especially at higher doses >240 g/min). In an emergency, however, dopamine can be administered through a large vein (cephalic or basilic) while a central line is being prepared. Alkaline intravenous solutions inactivate it, so sodium bicarbonate should not be infused with it.

      The following are the most common dopamine side effects:
      Nausea and vomiting
      Tachycardia
      Dysrhythmias
      Angina
      Hypertension

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      943.7
      Seconds
  • Question 19 - Which of the following is NOT a notifiable disease: ...

    Correct

    • Which of the following is NOT a notifiable disease:

      Your Answer: Chickenpox

      Explanation:

      Chickenpox is not a notifiable disease.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      7.1
      Seconds
  • Question 20 - Regarding renal clearance, which of the following statements is CORRECT: ...

    Correct

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

      Your 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
      266.3
      Seconds
  • Question 21 - A 20-year-old patient had sustained a supracondylar fracture due to falling from a...

    Correct

    • A 20-year-old patient had sustained a supracondylar fracture due to falling from a skateboard. The frequency of acute nerve injuries accompanying supracondylar humeral fractures ranges from 10 to 20%. The most common complication is injury to which nerve?

      Your Answer: Median nerve

      Explanation:

      According to various studies, the frequency of acute nerve damage associated with supracondylar humeral fractures in children ranges from 10% to 20%.

      Median nerve injury and anterior interosseous nerve injury are the most common consequences.

      Damage to this nerve indicated weakening or abnormal extension of the index finger’s distal interphalangeal joint and the thumb’s interphalangeal joint. The absence of sensibility is a distinguishing attribute.

      A surgical neck humerus fracture may cause injury to the axillary nerve. A midshaft humerus fracture might cause injury to the radial nerve. A medial epicondylar fracture might cause injury to the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      910.5
      Seconds
  • Question 22 - A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy...

    Correct

    • A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy vaginal bleeding. She complains of feeling hot and cold during transfusion of the second unit and her temperature is 38.5ºC. Prior to the transfusion, her temperature was 37ºC. She has no other symptoms.

      Which of these transfusions reactions most likely occurred?

      Your Answer: Febrile transfusion reaction

      Explanation:

      Febrile transfusion reactions presents with an unexpected temperature rise (≥ 38ºC or ≥ 1ºC above baseline, if baseline ≥ 37ºC) during or shortly after transfusion. It is usually an isolated finding and the fever is accompanied by chills and malaise occasionally.

      Allergic reaction is commonly caused by foreign plasma proteins but may be due to anti-IgA. Allergic type reactions usually present with urticaria, pruritus, hives. Associations include laryngeal oedema or bronchospasm.

      Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.

      Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.

      Transfusion-related lung injury (TRALI) is a form of acute respiratory distress caused by the donor plasma containing antibodies against the patient’s leukocytes. It is defined as hypoxia and bilateral pulmonary oedema that occurs within 6 hours of a transfusion in the absence of other causes of acute lung injury. Clinical features include Breathlessness, cough, frothy sputum, hypertension or hypotension, hypoxia and fever. Chest X-ray shows multiple perihilar nodules with infiltration of the lower lung fields.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      58.8
      Seconds
  • Question 23 - A 44 year old woman is brought to ED having fallen down the...

    Correct

    • A 44 year old woman is brought to ED having fallen down the stairs and injured her right arm. On examination she is unable to abduct her arm normally, and has weakness of lateral rotation. She has sensory loss over the lateral aspect of her upper arm. Which of the following injuries is most likely to produce this pattern of injury:

      Your Answer: Surgical neck of humerus fracture

      Explanation:

      Damage to the axillary nerve will result in loss of abduction past about 15 degrees and weakness of lateral rotation due to paralysis of the deltoid and teres minor and loss of sensation over the regimental badge area on the upper lateral arm. The axillary nerve is most likely injured in fracture of the surgical neck of the humerus due to its course where it winds around this region together with the posterior humeral circumflex vessels.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      48.7
      Seconds
  • Question 24 - Which anatomical structure is divided following an emergency department anterolateral thoracotomy? ...

    Correct

    • Which anatomical structure is divided following an emergency department anterolateral thoracotomy?

      Your Answer: Latissimus dorsi

      Explanation:

      Thoracotomy describes an incision made in the chest wall to access the contents of the thoracic cavity. Thoracotomies typically can be divided into two categories; anterolateral thoracotomies and posterolateral thoracotomies. These can be further subdivided into supra-mammary and infra-mammary and, of course, further divided into the right or left chest. Each type of incision has its utility given certain circumstances.

      A scalpel is used to sharply divide the skin along the inframammary crease overlying the fifth rib. Electrocautery is then used to divide the pectoralis major muscle and serratus anterior muscle. Visualization of the proper operative field can be achieved with the division and retraction of the latissimus dorsi. Either the fourth or fifth intercostal space is then entered after the division of intercostal muscles above the rib to ensure the preservation of the neurovascular bundle. Once the patient is properly secured to the operating table, the ipsilateral arm is raised and positioned anteriorly and cephalad to rest above the head. The incision is started along the inframammary crease and extended posterolaterally below the tip of the scapula. It is then extended superiorly between the spine and the edge of the scapula, a short distance. The trapezius muscle and the subcutaneous tissues are divided with electrocautery. The serratus anterior and latissimus dorsi muscles are identified and can be retracted. The intercostal muscles are then divided along the superior border of the ribs, and the thoracic cavity is accessed.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      60.7
      Seconds
  • Question 25 - Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the...

    Incorrect

    • Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the other hand, calcium-induced calcium release (CICR) is a mechanism that is unique to Cardiac myocytes. The influx of calcium ions (Ca 2+) into the cell causes a 'calcium spark,' which causes more ions to be released into the cytoplasm.

      In CICR, which membrane protein in the sarcoplasmic reticulum is involved?

      Your Answer: Voltage-gated potassium channel

      Correct Answer: Ryanodine receptor

      Explanation:

      Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.

      An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.

      The release of Ca2+ from the sarcoplasmic reticulum is required for calcium-induced calcium release (CICR). This is mostly accomplished by ryanodine receptors (RyR) on the sarcoplasmic reticulum membrane; Ca2+ binds to RyR, causing additional Ca2+ to be released.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      48.7
      Seconds
  • Question 26 - What is the pathophysiology of Cushing's syndrome: ...

    Incorrect

    • What is the pathophysiology of Cushing's syndrome:

      Your Answer: Hyperaldosteronism

      Correct Answer: Glucocorticoid excess

      Explanation:

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

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      19.8
      Seconds
  • Question 27 - When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle'...

    Incorrect

    • When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle' should be identified. Which of the following forms the inferior border of the 'safe triangle'?

      Your Answer: 4 th intercostal space

      Correct Answer: 5 th intercostal space

      Explanation:

      Care and management of the thoracostomy tubes (chest tubes) are subject to the direction and practice pattern of the responsible physician. Therefore, it is difficult to make a “one size fits all” set of instructions about the specific management recommendations for all chest tubes. It is recommended to discuss specific expectations for management with the patient’s attending physician. Facility specific Clinical Practice Guidelines (CPGs) may provide further guidance for one’s practice.

      Placement of the appropriately sized chest tube is performed on the affected side. The typical landmark for placement is the 4th or 5th intercostal space (nipple line for males, inframammary fold for females) at the anterior axillary line. The space above the 5th intercostal space and below the base of the axilla that is bordered posteriorly by the trapezius and anteriorly by the pectoralis muscle has recently been described as the safe triangle. Tubes are positioned anteriorly for pneumothoraces and posteriorly for fluid processes.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      14.8
      Seconds
  • Question 28 - A 60-year-old female with a past history of rheumatic fever and a prosthetic...

    Correct

    • A 60-year-old female with a past history of rheumatic fever and a prosthetic mitral valve presents to you with fever and an episode of expressive dysphasia that lasted around 30 minutes. There is no history of known drug allergies On examination you note a systolic murmur and you suspect it is infective endocarditis.

      Which antibacterial agents would be the most appropriate to prescribe in this case?

      Your Answer: Vancomycin, rifampicin and gentamicin

      Explanation:

      Endocarditis is infective or non infective inflammation (marantic endocarditis) of the inner layer of the heart and it often involves the heart valves.

      Risk factors include:
      Prosthetic heart valves
      Congenital heart defects
      Prior history of endocarditis
      Rheumatic fever
      Illicit intravenous drug use

      In the presentation of endocarditis, the following triad is often quoted:
      Persistent fever
      Embolic phenomena
      New or changing murmur

      A combination of vancomycin, rifampicin and gentamicin is advised if the patient has a cardiac prostheses, is penicillin allergic, or if methicillin-resistant Staphylococcus aureus (MRSA) is suspected. In this case the patient has a prosthetic valve making this the most appropriate initial treatment regimen.

      Flucloxacillin and gentamicin are current recommended by NICE and the BNF for the initial ‘blind’ therapy in endocarditis. This patient has prostheses and this is not the most appropriate initial treatment regimen.

      Other features that may be present include heart failure, splenomegaly, finger clubbing, renal features (haematuria, proteinuria, nephritis), and vasculitic features (splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth’s spots).

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      33
      Seconds
  • Question 29 - You are examining the lower limbs of a 54 year old man who...

    Correct

    • You are examining the lower limbs of a 54 year old man who presented after falling from a ladder at home. During your neurological assessment you note a weakness of hip flexion. Which of the following nerves is the most important for flexion of the thigh at the hip joint:

      Your Answer: Femoral nerve

      Explanation:

      Flexion of the thigh at the hip joint is produced by the sartorius, psoas major, iliacus and pectineus muscles, assisted by the rectus femoris muscle, all innervated by the femoral nerve (except for the psoas major, innervated by the anterior rami of L1 – 3).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      21.8
      Seconds
  • Question 30 - What proportion of peripheral blood leukocytes are monocytes? ...

    Incorrect

    • What proportion of peripheral blood leukocytes are monocytes?

      Your Answer: 25 - 30%

      Correct Answer: 5 - 10%

      Explanation:

      Monocytes account for around 5 to 10% of peripheral white cells. Monocytes in peripheral blood are generally bigger than other leukocytes and feature a large central oval or indented nucleus with clumped chromatin. The abundant cytoplasm staining blue and containing numerous fine vacuoles gives the appearance of ground glass. Cytoplasmic granules are another type of granule.

      Monocytes evolve from the granulocyte-macrophage progenitor to become monoblasts, promonocytes, monocytes, and tissue macrophages (in increasing order of maturity). Monocytes only stay in the bone marrow for a short time before exiting to circulate in the bloodstream for 20-40 hours before becoming macrophages.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      7.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastrointestinal Physiology (0/1) 0%
Physiology (3/8) 38%
Cardiovascular Pharmacology (1/3) 33%
Pharmacology (4/8) 50%
Immune Responses (1/3) 33%
Pathology (2/4) 50%
Cardiovascular (0/2) 0%
Infections (2/3) 67%
Endocrine (2/3) 67%
Renal (1/2) 50%
Anatomy (6/7) 86%
Thorax (2/3) 67%
Evidence Based Medicine (1/2) 50%
Statistics (0/1) 0%
Central Nervous System (2/2) 100%
Study Methodology (1/1) 100%
Upper Limb (2/2) 100%
Haematology (1/1) 100%
Basic Cellular Physiology (0/1) 0%
Microbiology (1/1) 100%
Specific Pathogen Groups (1/1) 100%
Lower Limb (1/1) 100%
Passmed