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  • Question 1 - The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A...

    Correct

    • The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A CT head scan is performed, and the diagnosis of an ischaemic stroke is confirmed. Her blood pressure is currently very high, with the most recent measurement being 196/124 mmHg, according to the nurse in charge. While you wait for the stroke team to review her, she asks you to prescribe something to help lower the patient's blood pressure.

      Which of the following is the best drug treatment for this patient's BP reduction?

      Your Answer: Labetalol

      Explanation:

      End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.

      In the setting of a stroke syndrome (i.e., in the presence of focal neurological deficits), hypertensive emergencies usually necessitate a slower and more controlled blood pressure reduction than in other situations. Rapid reduction of MAP in the presence of an ischaemic stroke can compromise blood flow, leading to further ischaemia and worsening of the neurological deficit. In this situation, intravenous labetalol is the drug of choice for lowering blood pressure.

      Significantly elevated blood pressure (>185/110 mmHg) is a contraindication to thrombolysis, but there is some evidence for controlling blood pressure before thrombolysis in exceptional circumstances, when it is only slightly above this threshold.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      36.3
      Seconds
  • Question 2 - Through which of the following anatomical structures does an indirect inguinal hernia pass?...

    Incorrect

    • Through which of the following anatomical structures does an indirect inguinal hernia pass?

      Your Answer: Pyramidalis

      Correct Answer: External oblique

      Explanation:

      Inguinal hernias are subdivided into direct and indirect.

      An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum.

      A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.

      The deep (internal) inguinal ring is located above and halfway between the pubic tubercle and the anterior superior iliac spine. This serves as the entrance to the inguinal canal. The superficial (external) inguinal ring lies immediately above and medial to the pubic tubercle. This triangular opening is a defect in the external oblique aponeurosis, and forms the exit of the inguinal canal.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      50
      Seconds
  • Question 3 - An 85-year-old woman is brought in from her nursing home. She arrives in...

    Incorrect

    • An 85-year-old woman is brought in from her nursing home. She arrives in the Emergency Department and appears confused. The staff member from the nursing home accompanying her informs you that she takes a water tablet.

      From her past medical history and records, you deduce that the water tablet is a loop diuretic.

      Which of the following parts of a nephron does a loop diuretic act on?

      Your Answer: Descending loop of Henlé

      Correct Answer: Ascending loop of Henlé

      Explanation:

      Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
      Furosemide
      Bumetanide
      Torsemide
      Ethacrynic Acid

      Loop diuretics act on the apical membrane of the thick ascending loop of Henle and inhibit the Na-K-Cl cotransporter. This blocks the reabsorption of sodium and chloride and results in salt-water excretion. This relieves congestion and reduces oedema.

      Other diuretics act on the following part of the nephron:
      1. Thiazide diuretics – Na/Cl co-transporter in the distal convoluted tubule
      2. Osmotic diuretics – PCT and the loop of Henle
      3. Aldosterone antagonists – distal convoluted tubule
      4. Carbonic anhydrase inhibitors – inhibit the carbonic anhydrase and act on proximal tubular cells

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      42
      Seconds
  • Question 4 - In which of the following would you NOT typically see a neutropaenia: ...

    Incorrect

    • In which of the following would you NOT typically see a neutropaenia:

      Your Answer: Fulminant bacterial infection

      Correct Answer: Asplenism

      Explanation:

      Causes of neutropaenia:
      Drug-induced (e.g. chemotherapy, chloramphenicol, co-trimoxazole, phenytoin, carbamazepine, carbimazole, furosemide, chloroquine, clozapine, some DMARDs)
      Benign (racial or familial)
      Cyclical
      Immune (e.g. SLE, Felty’s syndrome, hypersensitivity and anaphylaxis)
      Leukaemia
      Infections (e.g. HIV, hepatitis, fulminant bacterial infection)
      General Pancytopaenia
      Hypersplenism, aplastic anaemia, malignant infiltration of bone marrow, megaloblastic anaemia, chemotherapy, myelodysplasia

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      32.1
      Seconds
  • Question 5 - A possible diagnosis of Cushing's illness is being investigated in an overweight patient...

    Incorrect

    • A possible diagnosis of Cushing's illness is being investigated in an overweight patient with resistant hypertension. A CRH (corticotropin-releasing hormone) test is scheduled.

      Which of the following statements about corticotropin-releasing hormone is correct?

      Your Answer: It is secreted from the anterior pituitary

      Correct Answer: It is produced by cells within the paraventricular nucleus of the hypothalamus

      Explanation:

      Corticotropin-releasing hormone (CRH) is a neurotransmitter and peptide hormone. It is generated by cells in the hypothalamic paraventricular nucleus (PVN) and released into the hypothalamo-hypophyseal portal system at the median eminence through neurosecretory terminals of these neurons. Stress causes the release of CRH.

      The CRH is carried to the anterior pituitary through the hypothalamo-hypophyseal portal system, where it activates corticotrophs to release adrenocorticotropic hormone (ACTH). Cortisol, glucocorticoids, mineralocorticoids, and DHEA are all produced in response to ACTH.

      Excessive CRH production causes the size and quantity of corticotrophs in the anterior pituitary to expand, which can lead to the creation of a corticotrope tumour that generates too much ACTH.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      84.5
      Seconds
  • Question 6 - A patient had a left Colles' fracture, which you were able to repair. It...

    Incorrect

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

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

      Your Answer: 85%

      Correct Answer: 99%

      Explanation:

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

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      26.3
      Seconds
  • Question 7 - Regarding the lung roots, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the lung roots, which of the following statements is CORRECT:

      Your Answer: Generally the bronchi lie anterior to the vessels in the lung root.

      Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.

      Explanation:

      Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      58.3
      Seconds
  • Question 8 - Which of the following terms describes the proportion of individuals with a negative...

    Incorrect

    • Which of the following terms describes the proportion of individuals with a negative test result who actually do not have a disease:

      Your Answer: Specificity

      Correct Answer: Negative predictive value

      Explanation:

      Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.
      NPV = d/(c+d)

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      17.9
      Seconds
  • Question 9 - Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed...

    Incorrect

    • Aldin is a 24-year-old male patient who arrives at the emergency department diagnosed with psittacosis based on his symptoms and history of being a pigeon enthusiast. Which of the following is the causative bacteria of psittacosis?

      Your Answer: Legionella pneumophila

      Correct Answer: Chlamydia psittaci

      Explanation:

      Chlamydia psittaci is a microorganism that is commonly found in birds.

      These bacteria can infect people and cause psittacosis. Psittacosis is an infectious disease that may cause high fever and pneumonia associated with headaches, altered mental state, and hepatosplenomegaly.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      44.8
      Seconds
  • Question 10 - Achlorhydria is diagnosed in a 37-year-old individual who has had recurring episodes of...

    Incorrect

    • Achlorhydria is diagnosed in a 37-year-old individual who has had recurring episodes of gastroenteritis. This is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production.

      Damage to stomach parietal cells will alter the secretion of which other substance?

      Your Answer: Gastrin

      Correct Answer: Intrinsic factor

      Explanation:

      Achlorhydria is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production. The parietal cells that have been injured are unable to create the necessary amount of stomach acid. As a result, the pH of the stomach rises, food digestion suffers, and the risk of gastroenteritis rises.

      The secretion of hydrochloric acid and intrinsic factor is controlled by the gastric parietal cells, which are epithelial cells in the stomach. These cells can be found in the gastric glands, the fundus lining, and the stomach body.

      In response to the following three stimuli, the stomach parietal cells release hydrochloric acid:

      H2 Histamine receptors are stimulated by histamine (most significant contribution)
      Acetylcholine stimulates M3 Receptors via parasympathetic action.
      CCK2 receptors are stimulated by Gastrin.

      Intrinsic factor, which is essential for vitamin B12 absorption, is also produced by stomach parietal cells.
      Omeprazole is a proton pump inhibitor that is both selective and irreversible. It inhibits the H+/K+-ATPase system present on the secretory membrane of gastric parietal cells, which lowers stomach acid secretion.
      Ranitidine inhibits histamine H2-receptors in a competitive manner. The reversible inhibition of H2-receptors in gastric parietal cells reduces both the volume and concentration of gastric acid.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      55.4
      Seconds
  • Question 11 - 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: Superior 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
      67.6
      Seconds
  • Question 12 - A 65-year-old man presents with cough and shortness of breath. His sputum is...

    Incorrect

    • A 65-year-old man presents with cough and shortness of breath. His sputum is rusty in colour and is suffering from a fever. Upon examination, it was noted that he has crackles in the right upper lobe. A chest X-ray showed the presence of a right upper lobe cavitation.

      Among the following microorganisms, which is considered to be mostly associated with a cavitating upper lobe pneumonia?

      Your Answer: Streptococcus pneumoniae

      Correct Answer: Klebsiella pneumoniae

      Explanation:

      Klebsiella pneumoniae is among the most common Gram-negative bacteria encountered by physicians worldwide and accounts for 0.5-5.0% of all cases of pneumonia. This organism can cause extensive pulmonary necrosis and frequent cavitation.

      It is one of the causes that could be suspected when there is cavitatory pneumonia with or without a bulging fissure sign. Often, there can be extensive lobar opacification with air bronchograms.

      A helpful feature which may help to distinguish from pneumococcal pneumonia is that Klebsiella pneumoniae develops cavitation in 30-50% of cases (in comparison, cavitation is rare in pneumococcal pneumonia). This occurs early and progresses quickly.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      35.9
      Seconds
  • Question 13 - A 30-year-old man presents with diarrhoea, fever, vomiting, and abdominal cramps. A stool...

    Incorrect

    • A 30-year-old man presents with diarrhoea, fever, vomiting, and abdominal cramps. A stool culture was ordered and showed growth of Salmonella spp.

      Among the following serotypes of Salmonella spp., which is considered to be the most common cause of salmonella gastroenteritis?

      Your Answer: Serotype C

      Correct Answer: Serotype D

      Explanation:

      A common cause of gastroenteritis, Salmonella enteritidis, and Salmonella typhi, which causes enteric fever, are both group D. Therefore, serotype D Salmonella species are most commonly associated with gastroenteritis.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      40.7
      Seconds
  • Question 14 - The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the...

    Correct

    • The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the postsynaptic cell responds to the neurotransmitter.

      Which of the following enzymes catalyses the breakdown of noradrenaline?

      Your Answer: Catechol-O-methyltransferase (COMT)

      Explanation:

      The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the post-synaptic cell responds to the neurotransmitter.

      This can be accomplished in a variety of ways:
      Re-uptake
      Breakdown
      Diffusion

      Serotonin is an example of a neurotransmitter that is uptake. Serotonin is absorbed back into the presynaptic neuron via the serotonin transporter (SERT), which is found in the presynaptic membrane. Re-uptake neurotransmitters are either recycled by repackaging into vesicles or broken down by enzymes.
      Specific enzymes found in the synaptic cleft can also break down neurotransmitters. The following enzymes are examples of these enzymes:
      Acetylcholinesterase (AChE) catalyses the acetylcholine breakdown (ACh)
      The enzyme catechol-O-methyltransferase (COMT) catalyses the breakdown of catecholamines like adrenaline , dopamine and noradrenaline.

      The breakdown of catecholamines, as well as other monoamines like serotonin, tyramine, and tryptamine, is catalysed by monoamine oxidases (MOA).
      Diffusion of neurotransmitters into nearby locations can also be used to eliminate them.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      25.4
      Seconds
  • Question 15 - After a work-related accident, a 33-year old male is taken to the emergency...

    Incorrect

    • After a work-related accident, a 33-year old male is taken to the emergency room with difficulty in adduction and flexion of his left arm at the glenohumeral joint. The attending physician is suspects involvement of the coracobrachialis muscle.

      The nerve injured in the case above is?

      Your Answer: The axillary nerve

      Correct Answer: The musculocutaneous nerve

      Explanation:

      The coracobrachialis muscle is innervated by the musculocutaneous nerve (C5-C7) a branch of the lateral cord of the brachial plexus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      49.5
      Seconds
  • Question 16 - Which of the following pathogens is most likely to cause an infection in...

    Incorrect

    • Which of the following pathogens is most likely to cause an infection in a chemo patient with significant neutropenia?

      Your Answer: Pneumocystic jirovecii

      Correct Answer: Candida

      Explanation:

      Chemotherapy that is too aggressive weakens your immune system, putting you at risk for a fungal and many other infection.

      Neutropenia is a condition in which a person’s neutrophil count is abnormally low. Neutrophils are an infection-fighting type of white blood cell. Neutrophils fight infection by killing bacteria and fungi (yeast) that infiltrate the body.

      Fungal organisms are significant pathogens in the setting of neutropenia.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      15.5
      Seconds
  • Question 17 - A 6-year-old child presents with profuse watery diarrhoea and dehydration.

    Which of the...

    Incorrect

    • A 6-year-old child presents with profuse watery diarrhoea and dehydration.

      Which of the following statements is considered correct regarding infective diarrhoea?

      Your Answer: Giardia lamblia typically causes bloody diarrhoea

      Correct Answer: E.Coli can cause diarrhoea and renal failure

      Explanation:

      E. coli may cause several different gastrointestinal syndromes. Based on virulence factors, clinical manifestation, epidemiology, and different O and H serotypes, there are five major categories of diarrheagenic E. coli, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroadherent, which includes diffusely adherent E. coli (DAEC) and enteroaggregative E. coli (EAEC). These five categories are sometimes
      collectively referred to as enterovirulent E. coli or diarrheagenic E. coli.

      Norwalk virus is part of the Caliciviridae family of viruses which are single-stranded RNA viruses and are the most common cause of infectious gastroenteritis in the US.

      Rotaviruses are the most common cause of viral gastroenteritis
      in infants and children. With the introduction in 2006 of a human-bovine rotavirus vaccine (RV5; RotaTeq, Merck), a delay in the onset of rotavirus
      season was seen. RotaTeq is a series of three oral vaccines beginning at 6 to 12 weeks of age. A second vaccine, Rotarix (RV1; GlaxoSmithKline, Middlesex, England), was approved in June 2008.

      Cryptosporidium causes an illness characterized by abdominal cramping, watery diarrhoea, vomiting, fever, and anorexia. This organism is resistant to chlorine, so public swimming pools can be the source of an outbreak.

      G. lamblia has a worldwide distribution and has frequently been identified as the causative agent of outbreaks of gastroenteritis and traveller’s diarrhoea.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      34.2
      Seconds
  • Question 18 - Regarding the glomerular filtration barrier, which of the following statements is CORRECT: ...

    Correct

    • Regarding the glomerular filtration barrier, which of the following statements is CORRECT:

      Your Answer: The main factor determining whether a substance is filtered or not is molecular weight.

      Explanation:

      Molecular weight is the main factor in determining whether a substance is filtered or not – molecules < 7 kDa in molecular weight are filtered freely e.g. glucose, amino acids, urea, ions but larger molecules are increasingly restricted up to 70 kDa, above which filtration is insignificant. Negatively charged molecules are further restricted, as they are repelled by negative charges, particularly in the basement membrane. Albumin has a molecular weight of 69 kDa and is negatively charged, thus only very small amounts are filtered (and all of the filtered albumin is reabsorbed in the proximal tubule), whereas small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. This means that ultrafiltrate is virtually protein free, but otherwise has an identical composition of that of plasma. The epithelial lining of the Bowman's capsule consists of a single layer of cells called podocytes. The glomerular capillary endothelium is perforated by pores (fenestrations) which allow plasma components with a molecular weight of < 70 kDa to pass freely.

    • This question is part of the following fields:

      • Physiology
      • Renal
      68.3
      Seconds
  • Question 19 - Bordetella pertussis causes which of the following infectious diseases: ...

    Correct

    • Bordetella pertussis causes which of the following infectious diseases:

      Your 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
      9.2
      Seconds
  • Question 20 - On which of the following types of receptors does loperamide act? ...

    Incorrect

    • On which of the following types of receptors does loperamide act?

      Your Answer: Muscarinic receptors

      Correct Answer: Opioid receptors

      Explanation:

      Loperamide inhibits acetylcholine release from the myenteric plexus acts by action on opioid mu-receptors, and this then reduces bowel motility. The intestinal transit time is increased, thereby facilitating water reabsorption.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      21.8
      Seconds
  • Question 21 - A 60 -year-old man is tested to have low calcium levels . After...

    Correct

    • A 60 -year-old man is tested to have low calcium levels . After additional questioning, it becomes clear that he has a calcium-deficient diet.

      What is the daily calcium intake recommendation for a healthy adult?

      Your Answer: 1300 mg

      Explanation:

      A daily calcium intake of 1,000 to 1,300 mg is advised for adults. Women have a slightly higher calcium need than men and are at a higher risk of developing osteoporosis as they age.

      Calcium-rich foods include the following:
      Milk, cheese, and butter as dairy products.
      Broccoli, spinach, and green beans as green veggies.
      Bread, rice, and cereals as whole grain foods.
      Sardines, salmon, and other bony fish
      Eggs
      Nuts
      The following foods have the least calcium:
      Carrot
      Fruits such as kiwis, raspberries, oranges, and papaya
      Chicken and pork in meats.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      30.7
      Seconds
  • Question 22 - For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the...

    Correct

    • For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:

      Your Answer: Synchronised DC shock

      Explanation:

      If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      34.2
      Seconds
  • Question 23 - A 5-year-old girl is brought into the Paediatric ER for acute seizures. She...

    Incorrect

    • A 5-year-old girl is brought into the Paediatric ER for acute seizures. She has been convulsing for the past 18 minutes now and was already two doses of lorazepam in the ambulance. Now, you prepare a phenytoin infusion to abolish the seizures.

      According to the APLS algorithm, what dose of phenytoin is advised for a convulsing child at this stage?

      Your Answer: 10 mg/kg over 20 minutes

      Correct Answer: 20 mg/kg over 20 minutes

      Explanation:

      Advanced paediatric life support (APLS) recommends phenytoin as the first choice for second-line anticonvulsant in a patient that continues to seize ten minutes after the second dose of the first-line anticonvulsant (benzodiazepine). (step 3 of the APLS algorithm)

      The recommended dose of phenytoin infusion is up at 20 mg/kg over 20 minutes. If the patient has already taken phenytoin as maintenance therapy or is allergic to phenytoin, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      42.6
      Seconds
  • Question 24 - All of the following typically occurs as part of normal passive expiration except:...

    Incorrect

    • All of the following typically occurs as part of normal passive expiration except:

      Your Answer: Elevation of the diaphragm

      Correct Answer: Contraction of the internal intercostal muscles

      Explanation:

      Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs.
      In expiration, several movements occur. There are:
      1. depression of the sternal ends of the ribs (‘pump handle’ movement),
      2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and
      3. elevation of the diaphragm.
      These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      64
      Seconds
  • Question 25 - Which of the following statements is correct with regards to Horner's syndrome? ...

    Incorrect

    • Which of the following statements is correct with regards to Horner's syndrome?

      Your Answer: Horner's syndrome results from damage to the oculomotor nerve.

      Correct Answer: Miosis occurs due to paralysis of the dilator pupillae muscle.

      Explanation:

      The characteristics of Horner’s syndrome are pupil constriction, partial ptosis and anhidrosis.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      74.1
      Seconds
  • Question 26 - Antispasmodic drugs are primarily indicated in which of the following conditions: ...

    Incorrect

    • Antispasmodic drugs are primarily indicated in which of the following conditions:

      Your Answer: Gastroenteritis

      Correct Answer: Irritable bowel syndrome

      Explanation:

      Antispasmodics, such as antimuscarinics, may be used in the management of irritable bowel syndrome. Other antispasmodics used include direct-acting smooth muscle relaxants such as mebeverine, alverine, and peppermint oil. Antispasmodics are contraindicated in bowel obstruction and severe inflammatory bowel disease. Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects. Antimuscarinics are contraindicated in urinary retention.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      43.4
      Seconds
  • Question 27 - A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus...

    Correct

    • A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus minimus muscle.

      Which of the following nerves innervates the gluteus minimus muscle?

      Your Answer: Superior gluteal nerve

      Explanation:

      Gluteus minimus is the smallest muscle of the glutei. It is located just beneath the gluteus medius muscle. Gluteus minimus predominantly acts as a hip stabilizer and abductor of the hip.
      The superior gluteal nerve innervates the gluteus minimus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      23.1
      Seconds
  • Question 28 - A 64-year-old man presents with an acute episode of gout. He has a...

    Incorrect

    • A 64-year-old man presents with an acute episode of gout. He has a history of chronic heart failure and hypertension. His current medications include ramipril and furosemide.
      Which of the following statements regarding the treatment of gout is true? Select ONE answer only.

      Your Answer: Allopurinol is an effective treatment for acute gout

      Correct Answer: Colchicine has a role in prophylactic treatment

      Explanation:

      In the absence of any contra-indications, high-dose NSAIDs are the first-line treatment for acute gout. Naproxen 750 mg as a stat dose followed by 250 mg TDS is a commonly used and effective regime.
      Aspirin should not be used in gout as it reduces the urinary clearance of urate and interferes with the action of uricosuric agents. Naproxen, Diclofenac or Indomethacin are more appropriate choices.
      Allopurinol is used prophylactically, preventing future attacks by reducing serum uric acid levels. It should not be started in the acute phase as it increases the severity and duration of symptoms.
      Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. It is as effective as NSAIDs in relieving acute attacks. It also has a role in prophylactic treatment if Allopurinol is not tolerated.
      NSAIDs are contra-indicated in heart failure as they can cause fluid retention and congestive cardiac failure. Colchicine is the preferred treatment in patients with heart failure or those who are intolerant of NSAIDs.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
      32.2
      Seconds
  • Question 29 - Which of the following is NOT an adverse effect of amitriptyline: ...

    Incorrect

    • Which of the following is NOT an adverse effect of amitriptyline:

      Your Answer: Hepatic impairment

      Correct Answer: Hypokalaemia

      Explanation:

      Adverse effects include:
      Antimuscarinic effects: Dry mouth, Blurred vision, Constipation, Urinary retention, Sedation, Confusion
      Cardiovascular effects: Heart block, Arrhythmias, Tachycardia, Postural hypotension, QT-interval prolongation, Hepatic impairment, Narrow-angle glaucoma

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      24.3
      Seconds
  • Question 30 - How does aspirin mediate its antiplatelet effect: ...

    Correct

    • How does aspirin mediate its antiplatelet effect:

      Your Answer: It irreversibly inhibits cyclo-oxygenase

      Explanation:

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

    • This question is part of the following fields:

      • Haematology
      • Pathology
      13.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Pharmacology (1/2) 50%
Pharmacology (2/8) 25%
Abdomen And Pelvis (0/1) 0%
Anatomy (1/7) 14%
Immune Responses (0/2) 0%
Pathology (1/3) 33%
Endocrine Physiology (1/3) 33%
Physiology (3/6) 50%
Thorax (0/2) 0%
Evidence Based Medicine (0/1) 0%
Statistics (0/1) 0%
Infections (0/1) 0%
Microbiology (1/5) 20%
Gastrointestinal Physiology (0/1) 0%
Central Nervous System (0/2) 0%
Specific Pathogen Groups (0/3) 0%
Basic Cellular Physiology (1/1) 100%
Upper Limb (0/1) 0%
Renal (1/1) 100%
Pathogens (1/1) 100%
Gastrointestinal (0/2) 0%
Cardiovascular (1/1) 100%
CNS Pharmacology (0/1) 0%
Head And Neck (0/1) 0%
Lower Limb (1/1) 100%
Musculoskeletal Pharmacology (0/1) 0%
Haematology (1/1) 100%
Passmed