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  • Question 1 - An elderly man with chronic heart and lung disease develops Legionnaires' Disease. By...

    Incorrect

    • An elderly man with chronic heart and lung disease develops Legionnaires' Disease. By what route was the infection most likely to have been acquired:

      Your Answer: Inhalation of spores from moldy hay

      Correct Answer: Inhalation of aerosolised contaminated water

      Explanation:

      Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.

      The clinical features of the pneumonic form of Legionnaires’ disease include:
      Mild flu-like prodrome for 1-3 days
      Cough (usually non-productive and occurs in approximately 90%)
      Pleuritic chest pain
      Haemoptysis
      Headache
      Nausea, vomiting and diarrhoea
      Anorexia
      Legionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
      The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
      Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
      Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      27
      Seconds

  • Question 2 - A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of...

    Incorrect

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

      Your Answer: Obturator nerve

      Correct Answer: Femoral nerve

      Explanation:

      Iliacus is innervated by the femoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      973.2
      Seconds

  • Question 3 - A 27-year-old man presents with a laceration of his forearm that severed the...

    Incorrect

    • A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.
      Which of the following nerves has been damaged in this case? Select ONE answer only.

      Your Answer: The anterior interosseous nerve

      Correct Answer: The median nerve

      Explanation:

      Flexor carpi radialis is innervated by the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      27.4
      Seconds

  • Question 4 - You examine a patient who is experiencing a worsening of his chronic heart...

    Correct

    • You examine a patient who is experiencing a worsening of his chronic heart failure. You discuss his care with the on-call cardiology registrar, who recommends switching him from furosemide to bumetanide at an equivalent dose. He's on 80 mg of furosemide once a day right now.

      What is the recommended dose of bumetanide?

      Your Answer: 2 mg

      Explanation:

      Bumetanide is 40 times more powerful than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide. This patient is currently taking 80 mg of furosemide and should be switched to a 2 mg bumetanide once daily.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      45.7
      Seconds

  • Question 5 - A 66-year-old male presents to his family physician with the complaint of increasing...

    Incorrect

    • A 66-year-old male presents to his family physician with the complaint of increasing fatigue and lethargy, along with itching, especially after a hot bath. He also complains of increased sweating and dizziness. On examination, he has a plethoric appearance. Abdominal examination shows the presence of splenomegaly. A basic panel of blood tests is ordered in which her Hb comes out to be 17 g/dL.

      Which one of the following treatment options will be most suitable in this case?

      Your Answer:

      Correct Answer: Venesection

      Explanation:

      The clinical and laboratory findings, in this case, support a diagnosis of polycythaemia vera. A plethoric appearance, lethargy, splenomegaly and itching are common in this disease. Patients may also have gouty arthritis, Budd-Chiari syndrome, erythromelalgia, stroke, myocardial infarction or DVT. The average age for diagnosis of Polycythaemia Vera is 65-74 years. It is a haematological malignancy in which there is overproduction of all three cell lines. Venesection is the treatment of choice as it would cause a decrease in the number of red blood cells within the body.

      Erythropoietin is given in patients with chronic renal failure as they lack this hormone. Administration of erythropoietin in such patients causes stimulation of the bone marrow to produce red blood cells.

      Desferrioxamine is a chelating agent for iron and is given to patients with iron overload due to repeated blood transfusions, e.g. in thalassemia patients.

      Penicillamine is a chelating agent for Copper, given as treatment in Wilson’s disease.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 6 - A 72-year-old woman presents to your clinic with worsening oedema. She has ischaemic...

    Incorrect

    • A 72-year-old woman presents to your clinic with worsening oedema. She has ischaemic heart disease and heart failure. You decide to add a loop diuretic to her current drug regime to control the oedema. Which of the following is a contraindication to using a loop diuretic?

      Your Answer:

      Correct Answer: Anuria

      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 inhibit the Na-K-Cl pump in the ascending loop of Henle, resulting in salt-water excretion. This relieves congestion and reduces oedema.

      The contra-indications to the use of loop diuretics are:
      1. Anuria
      2. Comatose and precomatose states associated with liver cirrhosis
      3. Renal failure due to nephrotoxic or hepatotoxic drugs
      4. Severe hypokalaemia
      5. Severe hyponatremia
      6. History of hypersensitivity to furosemide, bumetanide, or torsemide (or sulphonamides)

      The following conditions or states are not contraindications, but loop diuretics needs to be used cautiously in these conditions:
      1. Diabetes (but hyperglycaemia less likely than with thiazides)
      2. Gout
      3. Hypotension (correct before initiation of treatment)
      4. Hypovolaemia (Correct before initiation of treatment)

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 7 - Regarding forest plots, which of the following is the purpose of this graph?...

    Incorrect

    • Regarding forest plots, which of the following is the purpose of this graph?

      Your Answer:

      Correct Answer: To graphically display the relative strength of multiple studies attempting to answer the same question

      Explanation:

      The results of meta-analysis are often displayed graphically in a forest plot. A properly constructed forest plot is the most effective way to graphically display the relative strength of multiple studies attempting to answer the same question. A typical meta-analysis consists of three main objectives that include estimation of effect sizes from individual studies and a pooled summary estimate with their confidence intervals (CIs), heterogeneity among the studies, and any publication bias. The forest plot illustrates the first two of these objectives. Forest plots visualize the effect measure and CI of individual studies, which provide the raw data for the meta-analysis, as well the pooled-effect measure and CI. The individual studies also can be grouped in the forest plot by some of their characteristics for ease of interpretation such as by study size or year of publication. When comparing the outcomes between an intervention and a control group, dichotomous outcome variables are expressed as ratios (i.e. odds ratios, ORs or risk ratios, RRs), while for continuous outcomes, a weighted mean difference is reported.

    • This question is part of the following fields:

      • Evidence Based Medicine
      0
      Seconds

  • Question 8 - Regarding probability distribution, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding probability distribution, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: In a negative skew, the mass of distribution is concentrated on the right.

      Explanation:

      Distribution of data is usually unimodal (one peak) but may be bimodal (two peaks) or uniform (no peaks, each value equally likely). The normal distribution is a symmetrical bell-shaped curve. The mean, median, and mode of a normal distribution are equal. In a positive skew, the right tail is longer and the mass of distribution is concentrated on the left; mean > median > mode. In a negative skew, the left tail is longer and the mass of distribution is concentrated on the right; mean < median < mode.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      0
      Seconds

  • Question 9 - Which of the following is NOT a typical side effect of opioid analgesics:...

    Incorrect

    • Which of the following is NOT a typical side effect of opioid analgesics:

      Your Answer:

      Correct Answer: Diarrhoea

      Explanation:

      All opioids have the potential to cause:
      Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
      Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
      Cardiovascular effects – Peripheral vasodilation, postural hypotension
      Dependence and tolerance

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 10 - In which of the following cases is intravenous phenytoin contraindicated? ...

    Incorrect

    • In which of the following cases is intravenous phenytoin contraindicated?

      Your Answer:

      Correct Answer: Second degree heart block

      Explanation:

      Phenytoin Contraindications include:

      Hypersensitivity
      Sinus bradycardia
      Sinoatrial block
      Second and third degree A-V block
      Adams-Stokes syndrome
      Concurrent use with delavirdine
      History of prior acute hepatotoxicity attributable to phenytoin

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 11 - A 6-year-old girl is brought to the nephrology clinic by her mother due...

    Incorrect

    • A 6-year-old girl is brought to the nephrology clinic by her mother due to facial oedema. Her lab workup shows proteinuria of 7 g/24 hours and serum albumin levels of 15 g/L. A diagnosis of Nephrotic Syndrome is made, and corticosteroid therapy is initiated.

      Which one of the following is the most likely cause of nephrotic syndrome in this patient?

      Your Answer:

      Correct Answer: Minimal change disease

      Explanation:

      Minimal Change Disease is the most common cause of Nephrotic Syndrome in the paediatric population. It may be caused by NSAID use. Electron microscopy shows the fusion of foot processes while light microscopy will appear normal.

      Focal segmental glomerulosclerosis causes Nephrotic Syndrome in adults. It is associated with Heroin use and HIV infection. There is a limited response to steroids, and the disease progresses to end-stage renal failure in 5-10 years.

      Diabetic nephropathy occurs after a long period of diabetes due to the deposition of amyloid protein leading to a decrease in glomerular filtration.

      There is no history of Hepatitis B in this patient and no symptoms of liver disease such as jaundice.

      Membranous glomerulonephritis would present with features of Nephritic Syndrome. These would be oedema, haematuria; red blood cell casts in the urine and hypertension.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 12 - A 64-year-old woman had a humerus midshaft fracture due to tripping on a...

    Incorrect

    • A 64-year-old woman had a humerus midshaft fracture due to tripping on a curb and falling on her left arm. She might also have damaged which of the following structures?

      Your Answer:

      Correct Answer: Radial nerve and deep brachial artery

      Explanation:

      The radial nerve and brachial artery are most likely to be damaged in humerus fractures. They are tethered together to the bone and cannot withstand the forces applied to it as a result of the displacement.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 13 - During bedside rounds, an 82-year old female in the Medicine Ward complains of...

    Incorrect

    • During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.

      Which of the following is expected to undergo atrophy in carpal tunnel syndrome?

      Your Answer:

      Correct Answer: The thenar eminence

      Explanation:

      Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.

      The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:
      L– lateral two lumbricals
      O– Opponens pollicis
      A– Abductor pollicis
      F– Flexor pollicis brevis

      In the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.

      Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 14 - A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 15 - Antidiuretic hormone (ADH) has which of the following effects: ...

    Incorrect

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

      Your Answer:

      Correct 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
      0
      Seconds

  • Question 16 - Regarding aspirin at analgesic doses, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding aspirin at analgesic doses, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: It is contraindicated in patients with severe heart failure.

      Explanation:

      Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 17 - A newborn baby is rushed to the neonatal ICU 4 hours after birth...

    Incorrect

    • A newborn baby is rushed to the neonatal ICU 4 hours after birth due to sudden onset severe jaundice and generalised oedema. Family history reveals that this is the second baby, while blood testing shows that the mother has an Rh-negative blood group while the baby is Rh-positive. A diagnosis of haemolytic disease of the newborn is established.

      Which one of the following hypersensitivity reactions have occurred in this case?

      Your Answer:

      Correct Answer: Type II hypersensitivity reaction

      Explanation:

      Hepatitis A usually doesn’t pose a special risk to a pregnant woman or her baby. Maternal infection doesn’t result in birth defects, and a mother typically doesn’t transmit the infection to her baby. HAV is almost always transmitted by the faecal-oral route and is usually acquired through close personal contact or via contaminated food.

      When a woman has chickenpox in the first 20 weeks of pregnancy, there is a 1 in 50 chance for the baby to develop a set of birth defects. This is called the congenital varicella syndrome. It includes scars, defects of muscle and bone, malformed and paralyzed limbs, small head size, blindness, seizures, and intellectual disability.

      TORCH Syndrome refers to infection of a developing foetus or newborn by any of a group of infectious agents. “TORCH” is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex.
      Infection with any of these agents may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and other symptoms and findings.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 18 - After collapsing in his nursing home, a 70-year-old man is brought into the...

    Incorrect

    • After collapsing in his nursing home, a 70-year-old man is brought into the ER. He is a known case of diabetes mellitus and is on medication for it. An RBS of 2.5 mmol/L (3.9-5.5 mmol/L) is recorded in the ER.

      Out of the following, which medication for diabetes mellitus is MOST likely responsible for his hypoglycaemic episode?

      Your Answer:

      Correct Answer: Pioglitazone

      Explanation:

      Pioglitazone is used to treat type 2 diabetes mellitus. It selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-γ) and to a lesser extent PPAR-α.

      Of the medications mentioned in this question, only pioglitazone is a recognized cause of hypoglycaemia.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 19 - A 29-year-old woman presents with night sweats, fever, and haemoptysis. A diagnosis of...

    Incorrect

    • A 29-year-old woman presents with night sweats, fever, and haemoptysis. A diagnosis of tuberculosis was suspected.

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

      Your Answer:

      Correct Answer: Mycobacteria tuberculosis can be typed using a RFLP method

      Explanation:

      Although a variety of clinical specimens may be submitted to the
      laboratory to recover MTB and NTM, respiratory secretions such
      as sputum and bronchial aspirates are the most common. An
      early-morning specimen should be collected on three consecutive
      days, although recent studies have suggested that the addition of
      a third specimen does not significantly increase the sensitivity
      of detecting Mycobacteria.

      Mycobacterium tuberculosis appear red on acid-fast staining because they take up the primary stain, which is carbolfuchsin, and is not decolorized by the acid alcohol anymore.

      Culture on Lowenstein-Jensen medium should be read within 5 to 7 days after inoculation and once a week thereafter for up to 8 weeks.

      Nucleic acid amplification assays designed to detect M. tuberculosis complex
      bacilli directly from patient specimens can be performed in as little as 6 to 8 hours on processed specimens.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 20 - A 22-year-old woman is brought in by ambulance from her GP surgery with...

    Incorrect

    • A 22-year-old woman is brought in by ambulance from her GP surgery with suspected meningitis. She has been given a dose of benzylpenicillin already.
      What is the mechanism of action of benzylpenicillin? Select ONE answer only.

      Your Answer:

      Correct Answer: Inhibition of cell wall synthesis

      Explanation:

      Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
      An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
      Mechanism of action
      Examples
      Inhibition of cell wall synthesis
      Penicillins
      Cephalosporins
      Vancomycin
      Disruption of cell membrane function
      Polymyxins
      Nystatin
      Amphotericin B
      Inhibition of protein synthesis
      Macrolides
      Aminoglycosides
      Tetracyclines
      Chloramphenicol
      Inhibition of nucleic acid synthesis
      Quinolones
      Trimethoprim
      5-nitroimidazoles
      Rifampicin
      Anti-metabolic activity
      Sulfonamides
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
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  • Question 21 - A 69-year-old man with a history of chronic anaemia is transfused. He takes...

    Incorrect

    • A 69-year-old man with a history of chronic anaemia is transfused. He takes bisoprolol and furosemide for his cardiac failure, and his most recent BNP was 123 pmol/l. He developed shortness of breath and his pre-existing peripheral oedema became worse 5 hours after transfusion was commenced. His BP rises to 170/105 mmHg and a repeat measurement of his BNP is 192 pmol/l.

      What is the most likely transfusion reaction to have occurred?

      Your Answer:

      Correct Answer: TACO

      Explanation:

      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. Typical 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.

      Febrile transfusion reaction presents with a 1 degree rise in temperature from baseline during transfusion. Patient may have chills and malaise. It is the most common transfusion reaction (1 in 8 transfusions) and is usually caused by cytokines released from leukocytes in transfused red cell or platelet components.

      TRALI (Transfusion Related Acute Lung Injury) is a clinical syndrome with abrupt onset of non-cardiogenic pulmonary oedema within 6 hours of transfusion not explained by another risk factor. Associated with the presence of antibodies in the donor blood to recipient leukocyte antigens. patients present with dyspnoea, hypertension, hypotension, acute leukopenia.

      Graft versus host disease(GVHD) is an immune mediated condition that arises from a complex interaction between donor and recipients adaptive immunity. It presents as dermatitis, hepatitis and enteritis developing within 100 days after stem cell or bone marrow transplant.

      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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 22 - Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism...

    Incorrect

    • Atracurium is used as a muscle relaxant during endotracheal intubation. This drug’s mechanism of action is best described by which of the following?

      Your Answer:

      Correct Answer: Nicotinic acetylcholine receptor antagonist

      Explanation:

      Atracurium is a non-depolarizing neuromuscular blocker that is used to help with intubation and controlled ventilation by causing muscle relaxation and paralysis.

      At the neuromuscular junction’s post-synaptic membrane, atracurium competes with acetylcholine for nicotinic (N2) receptor binding sites. This prevents the receptors from being stimulated by acetylcholine.

      Muscle paralysis occurs gradually due to the competitive blockade.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
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  • Question 23 - 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:

      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
      0
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  • Question 24 - Which of the following data types does a pain-scoring system represent? ...

    Incorrect

    • Which of the following data types does a pain-scoring system represent?

      Your Answer:

      Correct Answer: Ordinal

      Explanation:

      Pain scoring systems are processes for assessing pain and the severity of illnesses that have been scientifically designed and tested. An example of ordinal categorical data is a pain scoring system.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      0
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  • Question 25 - In the United Kingdom, which of the following is the most often used...

    Incorrect

    • In the United Kingdom, which of the following is the most often used intravenous aesthetic:

      Your Answer:

      Correct Answer: Propofol

      Explanation:

      In the United Kingdom, propofol is the most widely used intravenous anaesthetic. In adults and children, it can be used to induce or maintain anaesthesia, although it is not commonly used in newborns. It can also be used to sedate individuals in intensive care and for sedation during operations.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
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  • Question 26 - A 2-day-old male is referred to a tertiary care hospital by the community...

    Incorrect

    • A 2-day-old male is referred to a tertiary care hospital by the community midwife after a home visit due to jaundice and dyspnoea. After history and examination, the relevant blood work is performed, and the baby is found to have conjugated hyperbilirubinemia. The paediatric team suspects a hepatic origin for jaundice based on the findings.

      Which one of the following aetiologies is the most likely cause of jaundice in this case?

      Your Answer:

      Correct Answer: Alpha 1-antitrypsin deficiency

      Explanation:

      The presence of dyspnoea makes alpha-1 antitrypsin deficiency the more likely diagnosis as biliary atresia does not cause respiratory symptoms. Deficiency of the enzyme alpha-1 antitrypsin causes uninhibited elastase activity and a decrease in elastic tissue. This causes liver cirrhosis leading to an elevation of conjugated bilirubin and emphysema in the lungs.

      Rhesus disease, hereditary spherocytosis and breast milk jaundice cause an elevation of unconjugated bilirubin thus ruling it out in this case. Breast milk jaundice occurs due to an inability of the newborn to metabolize the proteins in breast milk.

      Rhesus disease occurs when an Rh negative mother gives birth to an Rh positive baby. The jaundice would have been accompanied by anaemia and oedema.

      Hereditary spherocytosis occurs due to extravascular haemolysis as defective RBCs are removed by the spleen. The patient would present with jaundice, splenomegaly and possibly an aplastic crisis (if Parvovirus B19 infection).

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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  • Question 27 - Which of the following is considered an example of an observational study? ...

    Incorrect

    • Which of the following is considered an example of an observational study?

      Your Answer:

      Correct Answer: Cohort study

      Explanation:

      The two most common types of observational studies are cohort studies and case-control studies; a third type is cross-sectional studies.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 28 - Regarding the resting membrane potential, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the resting membrane potential, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: The resting cell membrane is more permeable to K + ions than to Na + ions.

      Explanation:

      A membrane potential is a property of all cell membranes, but the ability to generate an action potential is only a property of excitable tissues. The resting membrane is more permeable to K+and Cl-than to other ions (and relatively impermeable to Na+); therefore the resting membrane potential is primarily determined by the K+equilibrium potential. At rest the inside of the cell is negative relative to the outside. In most neurones the resting potential has a value of approximately -70 mV.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 29 - A six-year-old boy presents with coryzal symptoms that have persisted for more than...

    Incorrect

    • A six-year-old boy presents with coryzal symptoms that have persisted for more than two weeks. He was born and raised in the Middle East. His mother claims he has been tired and has complained of various 'aches and pains.' On examination, you find splenomegaly and enlarged cervical lymph nodes. His legs and arms are covered in petechiae.

      In this case, what is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute lymphoblastic leukaemia (ALL)

      Explanation:

      ALL is the most common leukaemia in children, with a peak incidence between the ages of 2 and 5.
      ALL has a wide range of clinical symptoms, but many children present with an acute illness that resembles coryza or a viral infection. ALL also has the following features:
      Weakness and sluggishness all over
      Muscle, joint, and bone pain that isn’t specific
      Anaemia
      Petechiae and unexplained bruising
      Oedema
      Lymphadenopathy
      Hepatosplenomegaly

      The following are typical features of a full blood count in patients with ALL:
      Anaemia (normocytic or macrocytic)
      Leukopenia affects about half of the patients (WCC 4 x 109/l).
      Around 25% of patients have leucocytosis (WCC > 10 x 109/l).
      Around 25% of patients have hyperleukocytosis (WCC > 50 x 109/l).
      Thrombocytopaenia

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 30 - Which of these drugs may reduce the efficacy of contraception? ...

    Incorrect

    • Which of these drugs may reduce the efficacy of contraception?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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