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  • Question 1 - By what mechanism does Vibrio cholerae causes diarrhoea? ...

    Incorrect

    • By what mechanism does Vibrio cholerae causes diarrhoea?

      Your Answer: Increases HCO3- secretory channels in intestinal epithelial cells

      Correct Answer: Increases Cl- secretory channels in crypt cells

      Explanation:

      Cholera is a severe diarrheal illness caused by the Vibrio cholerae bacteria infecting the bowel. Ingesting cholera-infected food or drink is the a way to contract the disease. In the intestinal crypt cells, the toxigenic bacterium Vibrio cholera activates adenylate cyclase and raises cyclic adenosine monophosphate (cAMP).

      cAMP stimulates the Cl-secretory channels in crypt cells, resulting in the secretion of chloride with sodium ions and water. The toxin it produces causes the body to secrete massive amounts of water, resulting in diarrhoea and significant fluid and electrolyte loss.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      17.5
      Seconds

  • Question 2 - The following structures all lie anteriorly to the oesophagus EXCEPT for the: ...

    Correct

    • The following structures all lie anteriorly to the oesophagus EXCEPT for the:

      Your Answer: Thoracic duct

      Explanation:

      Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      31.2
      Seconds

  • Question 3 - A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency...

    Correct

    • A 60-year-old male presents to the genitourinary clinic with dysuria and urinary frequency complaints. He has a past medical history of benign prostate enlargement, for which he has been taking tamsulosin. There is blood, protein, leucocytes, and nitrites on a urine dipstick. Fresh blood tests were sent, and his estimated GFR is calculated to be >60 ml/minute. A urinary tract infection (UTI) diagnosis is made, and he is prescribed antibiotics. Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer: Ciprofloxacin

      Explanation:

      URINARY TRACT INFECTIONS IN ADULT MEN
      Symptomatic urinary tract infections are much less common in men than in women, and all UTIs
      in men are considered complicated UTIs. Men with UTIs should be evaluated for predisposing or
      causative factors.

      Uncomplicated cystitis

      • Fosfomycin, oral, 3 g as a single dose.

      If fosfomycin is unavailable:

      • Nitrofurantoin, oral, 100 mg 6 hourly for 5 days.

      Do not use nitrofurantoin or fosfomycin if there is any suspicion of early pyelonephritis as they do
      not achieve adequate renal tissue levels.
      If there are any factors precluding the use of the above agents, then a beta-lactam should be used.
      Options include:
      Cefixime 200 mg PO 12 hourly for 7 days
      OR
      Cefpodoxime 100 mg PO 12 hourly for 7 days

      Complicated cystitis
      Adults

      • Ciprofloxacin 500 mg PO 12 hourly
        OR
      • Levofloxacin 750 mg PO once daily

      Empiric antibiotic therapy should be changed based upon the bacteria isolated and its
      antimicrobial susceptibility.
      Treat for a total of 7–14 days

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      21.9
      Seconds

  • Question 4 - Which of the following is NOT a typical effect of cortisol: ...

    Incorrect

    • Which of the following is NOT a typical effect of cortisol:

      Your Answer: Increased lipolysis

      Correct Answer: Decreased protein catabolism

      Explanation:

      Cortisol is a steroid hormone produced in the zona fasciculata of the adrenal cortex. It is released in response to stress and low blood glucose concentrations.
      Cortisol acts to: raise plasma glucose by stimulating glycolysis and gluconeogenesis in the liver and inhibiting peripheral glucose uptake into storage tissues, increase protein breakdown in skeletal muscle, skin and bone to release amino acids, increase lipolysis from adipose tissues to release fatty acidsand at higher levels and mimic the actions of aldosterone on the kidney to retain Na+ and water and lose K+ ionssuppress the action of immune cells

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      23.6
      Seconds

  • Question 5 - Which of the following is a well recognised adverse effect of prochlorperazine: ...

    Correct

    • Which of the following is a well recognised adverse effect of prochlorperazine:

      Your Answer: Acute dystonic reaction

      Explanation:

      Adverse actions include anticholinergic effects such as drowsiness, dry mouth, and blurred vision, extrapyramidal effects, and postural hypotension. Phenothiazines can all induce acute dystonic reactions such as facial and skeletal muscle spasms and oculogyric crises; children (especially girls, young women, and those under 10 kg) are particularly susceptible.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      11.8
      Seconds

  • Question 6 - You are going to prescribe a NSAID to a 50-year-old male patient for...

    Incorrect

    • You are going to prescribe a NSAID to a 50-year-old male patient for his back pain. Which of the following NSAIDs is least likely to cause gastrointestinal side effects:

      Your Answer: Indometacin

      Correct Answer: Ibuprofen

      Explanation:

      NSAIDs are associated with serious gastrointestinal irritation and drug-induced ulcers.

      Among the NSAIDs included in the choices, ibuprofen has the lowest risk.

      Piroxicam, ketoprofen, and ketorolac trometamol are associated with the highest risk of serious upper gastrointestinal side effects.

      Indomethacin, diclofenac, and naproxen are associated with an intermediate risk of serious upper gastrointestinal side effects.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
      21.9
      Seconds

  • Question 7 - You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus....

    Correct

    • You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?

      Your Answer: Potentiates effect of GABA

      Explanation:

      Lorazepam is a type of benzodiazepine.

      Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      17.3
      Seconds

  • Question 8 - You review a patient with a history of Addison’s disease. He takes 100...

    Incorrect

    • You review a patient with a history of Addison’s disease. He takes 100 mg of hydrocortisone per day to control this.
      What dose of prednisolone is equivalent to this dose of hydrocortisone? Select ONE answer only.

      Your Answer: 10 mg

      Correct Answer: 25 mg

      Explanation:

      Prednisolone is four times more potent than hydrocortisone, and therefore, a dose of 25 mg would be equivalent to 100 mg of hydrocortisone.
      The following table summarises the relative potency of the main corticosteroids compared with hydrocortisone:
      Corticosteroid
      Potency relative to hydrocortisone
      Prednisolone
      4 times more potent
      Triamcinolone
      5 times more potent
      Methylprednisolone
      5 times more potent
      Dexamethasone
      25 times more potent

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      26
      Seconds

  • Question 9 - Vitamin D is a group of secosteroids that play a role in calcium...

    Incorrect

    • Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.

      Which of the following actions of 1,25-dihydroxycholecalciferol is a direct action?

      Your Answer: Increases osteoblastic activity

      Correct Answer: Increases renal phosphate reabsorption

      Explanation:

      The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.

      The following are the primary effects of 1,25-dihydroxycholecalciferol:

      Calcium and phosphate absorption in the small intestine is increased.
      Calcium reabsorption in the kidneys is increased.
      Increases phosphate reabsorption in the kidneys.
      Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)
      Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback)
      Thyroid hormone (parathyroid hormone) Calcium reabsorption in the tubules of the kidneys is increased, but renal phosphate reabsorption is decreased.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      54
      Seconds

  • Question 10 - A patient suffers an injury to his thigh that damages the nerve that...

    Correct

    • A patient suffers an injury to his thigh that damages the nerve that innervates pectineus.
      Which of the following nerves has been damaged in this case? Select ONE answer only.

      Your Answer: Femoral nerve

      Explanation:

      Pectineus is innervated by the femoral nerve. It may also receive a branch from the obturator nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      16.3
      Seconds

  • Question 11 - 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 stored in the posterior 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
      20.9
      Seconds

  • Question 12 - Regarding the lumbar plexus, which of the following is a direct muscular branch?...

    Incorrect

    • Regarding the lumbar plexus, which of the following is a direct muscular branch?

      Your Answer: Nerve to sartorius

      Correct Answer: Nerve to quadratus lumborum

      Explanation:

      The lumbar plexus gives rise to several branches which supply various muscles and regions of the posterior abdominal wall and lower limb. These branches include the Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral and obturator nerves.

      In addition, the lumbar plexus gives off muscular branches from its roots, a branch to the lumbosacral trunk and occasionally an accessory obturator nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      21.1
      Seconds

  • Question 13 - You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy...

    Correct

    • You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her�with Cushing's syndrome.
      When would her random cortisol level likely be abnormal?

      Your Answer: 2400 hrs

      Explanation:

      Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep.

      The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      11
      Seconds

  • Question 14 - Which of the following does NOT predispose to digoxin toxicity in a patient...

    Correct

    • Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:

      Your Answer: Hyponatraemia

      Explanation:

      Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      6.2
      Seconds

  • Question 15 - Nitric oxide release from endothelium is stimulated by all of the following EXCEPT...

    Incorrect

    • Nitric oxide release from endothelium is stimulated by all of the following EXCEPT for:

      Your Answer: Substance P

      Correct Answer: Noradrenaline

      Explanation:

      Nitric oxide (NO) production by the endothelium is increased by factors that elevate intracellular Ca2+, including local mediators such as bradykinin, histamine and serotonin, and some neurotransmitters (e.g. substance P). Increased flow (shear stress) also stimulates NO production and additionally activates prostacyclin synthesis. The basal production of NO continuously modulates vascular resistance; increased production of nitric oxide acts to cause vasodilation. Nitric oxide also inhibits platelet activation and thrombosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      10.5
      Seconds

  • Question 16 - A 56-year-old female visits her cardiologist complaining of a condition that has started...

    Correct

    • A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone.

      Which one of the following conditions will this woman NOT have?

      Your Answer: Xanthopsia

      Explanation:

      Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias.

      Side effects include:
      1. pulmonary fibrosis
      2. blue discolouration of the skin
      3. phototoxicity
      4. corneal deposits
      5. hepatic necrosis
      6. thyroid dysfunction
      7. sleep disturbances
      8. peripheral neuropathy.

      Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      21.8
      Seconds

  • Question 17 - Regarding cross-sectional studies, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cross-sectional studies, which of the following statements is CORRECT:

      Your Answer: They are useful for considering trends over time.

      Correct Answer: They are particularly suitable for estimating point prevalence.

      Explanation:

      Cross-sectional studies aim to provide data about population health, normal ranges of biological parameters, and disease prevalence or severity by observing the entire population, or a representative subset, at a single point in time. Cross-sectional studies are relatively simple and quick to perform and can be used to study multiple outcomes, but are subject to confounding and recall bias and are not suitable for studying rare diseases. Cross-sectional studies cannot be used to assess causation or to consider trends over time.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      17.9
      Seconds

  • Question 18 - A 78-year-old male presents to the Orthopaedic clinic with lower back pain for...

    Correct

    • A 78-year-old male presents to the Orthopaedic clinic with lower back pain for the past month. His past medical history reveals a history of cancer. After examination, you diagnose Metastatic Spinal Cord Compression (MSCC).

      Which one of the following cancers is this patient most likely to have had?

      Your Answer: Prostate cancer

      Explanation:

      Compression of the thecal sac causes metastatic Spinal Cord Compression (MSCC) due to a Metastatic tumour and its components. It can cause symptoms of limb weakness, sensory disturbances and back pain depending on the extent and level of Compression.

      The most common source of a tumour causing MSCC is a prostate carcinoma that metastasized to the spinal cord via the vertebral venous plexus.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      13.7
      Seconds

  • Question 19 - The correct statement regarding the parasympathetic nervous system is which of the following?...

    Incorrect

    • The correct statement regarding the parasympathetic nervous system is which of the following?

      Your Answer: Parasympathetic preganglionic neurones release acetylcholine which acts on cholinergic muscarinic receptors.

      Correct Answer: Parasympathetic preganglionic neurones run in cranial nerves III, VII, IX and X.

      Explanation:

      The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2 molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      24.3
      Seconds

  • Question 20 - A 30-year-old female presented to the Emergency Department after a fall during a...

    Incorrect

    • A 30-year-old female presented to the Emergency Department after a fall during a hiking expedition caused severe pain in her left arm and wrist drop. An X-ray revealed a mid-shaft fracture of the humerus, which most likely damaged the radial nerve.

      Which one of the following statements best describes the healing process of peripheral nerves?

      Your Answer: Schwann cells are able to regenerate axons from their cell

      Correct Answer: Peripheral nerve fibres regenerate at around 1mm per day

      Explanation:

      Peripheral nerves are nerves that lie outside the brain and spinal cord. Peripheral nerves readily regenerate, while central nervous system axonal injury does not spontaneously regenerate.
      If there is damage to the axons of peripheral nerves, the nerves will regenerate at a slow rate of 1 mm per day. The slow regeneration process may lead to muscle atrophy before regeneration is complete.

      Each peripheral nerve has a single cell body that supplies nutrients to the growing nerve fibre. The cell body does not undergo mitosis; only the axon is regenerated.

      Schwann cells of the peripheral nervous system provide support for this process, while the analogous oligodendrocytes of the central nervous system do not. Schwann cells themselves do not cause regeneration. Schwann cells provide myelin for myelinated fibres and surround non-myelinated fibres with their cytoplasm.

      If an axon is completely severed, as in the case of amputation, the axonal fibres regenerating from the cell body may never find their original route back to the muscle. Instead, they may form a traumatic neuroma, a painful collection of nerve fibres and myelin.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      38
      Seconds

  • Question 21 - A 68-year-old man with BPH presents to the emergency department in significant pain...

    Correct

    • A 68-year-old man with BPH presents to the emergency department in significant pain secondary to urinary retention. What is the location of the neuronal cell bodies that are responsible for urinary bladder discomfort sensation?

      Your Answer: Dorsal root ganglia of spinal cord levels S2, S3 and S4

      Explanation:

      The activation of stretch receptors with visceral afferents relayed through the pelvic nerve plexus and into the pelvic splanchnic nerves causes bladder pain. The sensory fibres of spinal nerves S2 – S4 enter the dorsal root ganglia.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      19.8
      Seconds

  • Question 22 - A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic...

    Incorrect

    • A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic reaction after being stung by a bee. She responded well to initial treatment but developed anaphylactic symptoms after 6 hours. Her symptoms were resolved after a further dose of adrenaline. Her family threatened legal action as they thought she had not received adequate treatment but withdrew their accusation after the attending physician explained that the woman had suffered a biphasic reaction.

      What is the approximate percentage of people who suffer this type of reaction?

      Your Answer: 5%

      Correct Answer: 20%

      Explanation:

      Anaphylactic reactions are Type 1 hypersensitivity reactions IgE-mediated and can be potentially life-threatening if not treated promptly. There are four well-recognized patterns of anaphylaxis:
      1) Uniphasic
      2) Biphasic
      3) Protracted
      4) Refractory

      Biphasic reactions occur in 20% of the population, although their mechanism is poorly understood. The symptoms of anaphylaxis recur within 4-6 hours, although they may also recur up to 72 hours later. All patients discharged from the hospital after an anaphylactic shock must:
      1) Be warned to return to the hospital immediately if symptoms recur
      2) Have a treatment plan in place
      3) Have a follow-up appointment
      4) Be considered for an adrenaline auto-injector
      5) Referred to an allergy clinic

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      36.6
      Seconds

  • Question 23 - Which of the following globin chains makes up normal adult haemoglobin (HbA)? ...

    Correct

    • Which of the following globin chains makes up normal adult haemoglobin (HbA)?

      Your Answer: Two alpha and two beta chains

      Explanation:

      Total adult haemoglobin comprises about 96 – 98 % of normal adult haemoglobin (HbA). It consists of two alpha (α) and two beta (β) globin chains.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      24.4
      Seconds

  • Question 24 - A young farmer who is caught under farm machinery and suffering from a...

    Correct

    • A young farmer who is caught under farm machinery and suffering from a major crush injury is taken to the emergency department and requires a quick induction sequence. In this type of injury, which of the following anaesthetic medicines should be avoided?

      Your Answer: Suxamethonium

      Explanation:

      Suxamethonium is a neuromuscular blocker. It is contraindicated in patients who have experienced massive trauma, hyperkalemic, or burn injuries.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      30.7
      Seconds

  • Question 25 - When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle'...

    Correct

    • 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: 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
      13.6
      Seconds

  • Question 26 - A 24-year-old student with red and painful right eye presents. Conjunctival erythema, mucopurulent...

    Incorrect

    • A 24-year-old student with red and painful right eye presents. Conjunctival erythema, mucopurulent discharge and lid crusting are seen on examination, and patient denies presence of itching of the eye. All his observations are normal, he has no fever and is otherwise well.

      Which of these is the most likely causative organism?

      Your Answer: Picornavirus

      Correct Answer: Haemophilus influenzae

      Explanation:

      The most frequent cause of red eye is conjunctivitis. It is caused by inflammation of the conjunctiva which can be infective or allergic and accounts for about 35% of all eye problems presenting to general practice.

      Viral conjunctivitis is commonly caused by adenoviruses and it is the most common infectious conjunctivitis.

      The common bacterial causes of conjunctivitis are Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.

      The clinical features of infective conjunctivitis include:
      Acute onset of conjunctival erythema
      Feeling ‘grittiness’, ‘foreign body’ or ‘burning’ sensation in the eye.
      Watering and discharge which may cause transient blurring of vision

      The discharge for viral conjunctivitis is less than that of bacterial conjunctivitis and usually watery.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      26
      Seconds

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

    Correct

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

      Your Answer: Cl -

      Explanation:

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

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      15.2
      Seconds

  • Question 28 - When the pulmonary artery is completely blocked, what is the ventilation over perfusion...

    Correct

    • When the pulmonary artery is completely blocked, what is the ventilation over perfusion ratio for the area that it supplies?

      Your Answer: Infinity

      Explanation:

      The ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching ventilation and perfusion.

      A pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. When a large pulmonary embolus completed blocked a pulmonary artery the alveoli were ventilated but not perfused at all, then the V/Q ratio would be infinity.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      29.1
      Seconds

  • Question 29 - A 78-year-old man develops renal impairment and hearing loss after inpatient management...

    Correct

    • A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.

      Which of these antibiotics is most likely to have been used?

      Your Answer: Gentamicin

      Explanation:

      Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.

      Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear).

      Both side effects are dose-related and occur commonly in the elderly.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      26.5
      Seconds

  • Question 30 - A 47-year-old woman comes in with palpitations that have been bothering her for...

    Correct

    • A 47-year-old woman comes in with palpitations that have been bothering her for the past four days. Her haemodynamics are normal, but her heart rate is currently 150 beats per minute. An ECG is performed, which reveals that she is experiencing atrial flutter. The patient is examined by a cardiology registrar, who recommends starting her on verapamil to control her ventricular rate while she waits for cardioversion.

      In these circumstances, which of the following is a contraindication to the use of verapamil?

      Your Answer: Acute porphyria

      Explanation:

      In most cases of atrial flutter, ventricular rate control is used as a stopgap measure until sinus rhythm is restored. A beta-blocker (e.g. bisoprolol), diltiazem, or verapamil can be used to reduce the rate of contractions in the heart.
      Electrical cardioversion, pharmacological cardioversion, and catheter ablation can all be used to return the heart to a normal rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or it has lasted longer than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is a sudden onset of symptoms and haemodynamic compromise. For recurrent atrial flutter, catheter ablation is preferred.

      Verapamil is a calcium-channel blocker that is non-dihydropyridine phenylalkylamine and can be used to treat supraventricular arrhythmias. It’s a calcium channel blocker with a high negative inotropic effect that lowers cardiac output, slows the heart rate, and may impair atrioventricular conduction. At high doses, it can cause heart failure, exacerbate conduction disorders, and cause hypotension.

      Adults should take 240-480 mg of verapamil in 2-3 divided doses. 5-10 mg IV over 30 seconds is the corresponding intravenous (IV) dose. After an IV injection, the peak effect lasts 3-5 minutes, and the action lasts 10-20 minutes.

      Verapamil should not be taken with beta-blockers like atenolol or quinidine because the combination of their negatively inotropic and negatively chronotropic effects can result in severe hypotension, bradycardia, impaired atrioventricular conduction, heart failure (due to impaired cardiac contractility), and sinus arrest.
      The use of verapamil is contraindicated in the following situations:
      Acute porphyrias are a type of porphyria that occurs suddenly.
      Accessory conducting pathways are linked to atrial flutter or fibrillation (e.g. Wolff-Parkinson-White-syndrome)
      Bradycardia
      Shock caused by the heart
      Insufficiency of the heart (with reduced ejection fraction)
      Left ventricular function has been significantly harmed in the past (even if controlled by therapy)
      Hypotension (blood pressure less than 90 mmHg)
      AV block in the second and third degrees
      Sinusitis is a condition in which the sinuses become
      Sino-atrial occlusion

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      23.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastrointestinal (0/1) 0%
Physiology (4/10) 40%
Anatomy (4/5) 80%
Thorax (2/2) 100%
Infections (2/2) 100%
Pharmacology (8/10) 80%
Endocrine (0/1) 0%
Central Nervous System (2/2) 100%
Musculoskeletal (0/1) 0%
Endocrine Pharmacology (0/1) 0%
Endocrine Physiology (1/3) 33%
Lower Limb (1/2) 50%
Cardiovascular (1/2) 50%
Cardiovascular Pharmacology (2/2) 100%
Evidence Based Medicine (0/1) 0%
Study Methodology (0/1) 0%
General Pathology (1/3) 33%
Pathology (1/3) 33%
Basic Cellular (2/3) 67%
Abdomen (1/1) 100%
Anaesthesia (1/1) 100%
Microbiology (0/1) 0%
Specific Pathogen Groups (0/1) 0%
Respiratory Physiology (1/1) 100%
Passmed
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