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  • Question 1 - Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for: ...

    Incorrect

    • Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:

      Your Answer: Hypochloraemic alkalosis

      Correct Answer: Hypocalcaemia

      Explanation:

      Common side effects of thiazide diuretics include:
      Excessive diuresis, postural hypotension, dehydration, renal impairment
      Acid-base and electrolyte imbalance
      Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosis
      Metabolic imbalance
      Hyperuricaemia and gout
      Impaired glucose tolerance and hyperglycaemia
      Altered plasma-lipid concentrations
      Mild gastrointestinal disturbances

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      619.5
      Seconds

  • Question 2 - A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His...

    Correct

    • A 50-year-old man presents with signs and symptoms of an anaphylactic reaction. His GP had recently given him a new medication.

      Which one of these is the most likely medication responsible for the drug-induced anaphylactic reaction?

      Your Answer: Penicillin

      Explanation:

      The most common cause of drug-induced anaphylaxis is penicillin.

      The second commonest cause are NSAIDs. Other drugs associated with anaphylaxis are ACE inhibitors and aspirin.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      693.7
      Seconds

  • Question 3 - Which of the following pathogens is the common cause of diarrhoea in a...

    Correct

    • Which of the following pathogens is the common cause of diarrhoea in a patient who has had a prolonged course of a broad spectrum of antibiotics?

      Your Answer: Clostridium difficile

      Explanation:

      Clostridium difficile is the most likely cause of diarrhoea after a long course of broad-spectrum antibiotic treatment.

      Clostridium difficile-associated diarrhoea appeared to be linked to an increase in the usage of third-generation cephalosporins.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      9.7
      Seconds

  • Question 4 - Which of the following drugs used in the management of hyperkalaemia does not...

    Correct

    • Which of the following drugs used in the management of hyperkalaemia does not affect serum potassium levels:

      Your Answer: Calcium gluconate

      Explanation:

      Calcium gluconate is given to antagonise cardiac cell membrane excitability to reduce the risk of arrhythmias. It has no effect on serum potassium levels unlike the alternative drugs listed above.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      9
      Seconds

  • Question 5 - At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts...

    Correct

    • At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts for around 50% of body weight. This can increase to nearly 80% of cardiac output during exercise. Skeletal muscle circulation is highly controlled and has a number of specialized adaptations as a result of this high degree of disparity during exercise, in combination with the diversity in the size of skeletal muscle around the body.

      What is the primary mechanism for boosting skeletal muscle blood flow during exercise?

      Your Answer: Metabolic hyperaemia

      Explanation:

      In skeletal muscle, blood flow is closely related to metabolic rate. Due to the contraction of precapillary sphincters, most capillaries are blocked off from the rest of the circulation at rest and are not perfused. This causes an increase in vascular tone and vessel constriction. As metabolic activity rises, this develops redundancy in the system, allowing it to cope with greater demand. During exercise, metabolic hyperaemia, which is induced by the release of K+, CO2, and adenosine, recruits capillaries. Sympathetic vasoconstriction in the active muscles is overridden by this. Simultaneously, blood flow in non-working muscles is restricted, preserving cardiac output. During exercise, muscle contractions pump blood through the venous system, raising the pressure differential between arterioles and venules and boosting blood flow via capillaries.

      Capillary angiogenesis is evident when muscles are used repeatedly (e.g. endurance training). It is a long-term effect, not a quick fix for increased blood flow.

      The local partial pressure of alveolar oxygen is the primary intrinsic control of pulmonary blood flow (pAO2). Low pAO2 promotes arteriole vasoconstriction and vice versa. The hypoxic pulmonary vasoconstriction (HPV) reflex allows blood flow to be diverted away from poorly ventilated alveoli and towards well-ventilated alveoli in order to maximize gaseous exchange.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      40.2
      Seconds

  • Question 6 - Which of the following side effects is more common of etomidate than other...

    Correct

    • Which of the following side effects is more common of etomidate than other intravenous induction agents:

      Your Answer: Extraneous muscle movements

      Explanation:

      Etomidate is associated with a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given prior to induction. Etomidate causes less hypotension than thiopental sodium and propofol during induction. Etomidate is associated with rapid recovery without a hangover effect. The rate of respiratory depression and tachycardia is not higher in etomidate.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      13.3
      Seconds

  • Question 7 - What is the primary route of transmission of Neisseria Gonorrhoeae? ...

    Correct

    • What is the primary route of transmission of Neisseria Gonorrhoeae?

      Your Answer: Sexually transmitted

      Explanation:

      Neisseria gonorrhoeae is primarily spread by sexual contact or through transmission during childbirth. It causes gonorrhoea which is a purulent infection of the mucous membrane surfaces.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      5.7
      Seconds

  • Question 8 - Herpes simplex virus is transmitted most commonly through which of the following routes:...

    Correct

    • Herpes simplex virus is transmitted most commonly through which of the following routes:

      Your Answer: Direct contact spread

      Explanation:

      Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      9.1
      Seconds

  • Question 9 - A 29-year-old female with chronic anaemia secondary to sickle cell disease is being...

    Correct

    • A 29-year-old female with chronic anaemia secondary to sickle cell disease is being transfused. A few minutes after starting the blood transfusion, she develops widespread itching with urticarial rash, wheezing, nausea and chest pain. Her BP reduces to 60/40 mmHg.

      What is the most appropriate treatment?

      Your Answer: Stop the transfusion and administer adrenaline

      Explanation:

      Anaphylaxis transfusion reaction occurs when an individual has previously been sensitized to an allergen present in the blood and, on re-exposure, releases IgE or IgG antibodies. Patients with anaphylaxis usually develop laryngospasm, bronchospasm, abdominal pain, nausea, vomiting, hypotension, shock, and loss of consciousness. The transfusion should be stopped immediately and the patient should be treated with adrenaline, oxygen, corticosteroids, and antihistamines.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      26.3
      Seconds

  • Question 10 - You assess a patient that has suffered a nerve injury that has paralysed...

    Incorrect

    • You assess a patient that has suffered a nerve injury that has paralysed her left latissimus dorsi muscle.
      Latissimus dorsi receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer: Long thoracic nerve

      Correct Answer: Thoracodorsal nerve

      Explanation:

      Latissimus dorsi originates from the lower part of the back, where it covers a wide area. It lies underneath the inferior fibres of trapezius superiorly, and trapezius is the most superficial back muscle.
      Superficial muscles of the back showing latissimus dorsi (from Gray’s Anatomy)
      Latissimus dorsi has a broad origin, arising from the spinous processes of T6-T12, the thoracolumbar fascia, the iliac crest and the inferior 3 or 4 ribs. The fibres converge into a tendon that inserts into the intertubercular groove of the humerus.
      Latissimus dorsi is innervated by the thoracodorsal nerve.
      Latissimus dorsi acts to extend, adduct and medially rotate the humerus. It, therefore, raises the body towards the arm during climbing.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      22.9
      Seconds

  • Question 11 - Which of these statements about the monospot test is true? ...

    Correct

    • Which of these statements about the monospot test is true?

      Your Answer: It can be positive in rubella

      Explanation:

      Infectious mononucleosis can be diagnosed using specific EBV antibodies and a variety of unrelated non-EBV heterophile antibodies.

      Heterophile antibodies:
      About 70-90% of patients with EBV infectious mononucleosis produce antibodies against an antigen produced in one species that react against antigens from other species called heterophile antibodies. False positives can be seen with rubella, hepatitis, SLE, malaria, toxoplasmosis, lymphoma and leukaemia.

      These antibodies can be detected by two main screening tests:
      The monospot test uses horse red blood cells. It agglutinates in the presence of heterophile antibodies.
      Paul-Bunnell test uses sheep red blood cells. The blood agglutinates in the presence of heterophile antibodies.

      EBV-specific antibodies:
      Patients can remain heterophile-negative after six weeks and are then considered to be heterophile-negative and should be tested for EBV-specific antibodies. EBV-specific antibodies test are helpful if a false positive heterophile antibody test is suspected.
      The indirect Coombs test is used to detect in-vitro antibody-antigen reactions. It is typically used in antenatal antibody screening and in preparation for blood transfusion.
      Heterophile antibody tests are generally not positive in the incubation period of infectious mononucleosis (4-6 weeks) before the onset of symptoms.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      10.2
      Seconds

  • Question 12 - A 22 year old male has been stabbed and is brought to the...

    Incorrect

    • A 22 year old male has been stabbed and is brought to the ED with a stab wound to his upper limb. On examination, the patient is unable to flex the distal interphalangeal joints of the ring and little finger. However, the proximal interphalangeal joint is intact. The most likely affected nerve is which of the following, and at which level is this occurring?

      Your Answer: Ulnar nerve at wrist

      Correct Answer: Ulnar nerve at elbow

      Explanation:

      The medial half of the flexor digitorum profundus is innervated by the ulnar nerve. Paralysis of this muscle results in loss of flexion at the distal interphalangeal joint of the ring and little finger.
      Flexion at the proximal interphalangeal joint is preserved as this is a function of the flexor digitorum superficialis which is innervated by the median nerve.
      The ulnar nerve is not correct as ulnar nerve injury at the wrist would not affect the long flexors, and the injury must have been more proximal.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      77.7
      Seconds

  • Question 13 - Which nerve supplies the muscle flexor hallucis longus? ...

    Correct

    • Which nerve supplies the muscle flexor hallucis longus?

      Your Answer: Tibial nerve

      Explanation:

      Flexor hallucis longus is innervated by the tibial nerve, composed of spinal roots L4, L5, S1, S2, and S3.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      114.8
      Seconds

  • Question 14 - A 44 year old woman sustains an injury to the median nerve at...

    Correct

    • A 44 year old woman sustains an injury to the median nerve at the elbow after falling awkwardly. Which of the following clinical features are you LEAST likely to see on examination:

      Your Answer: Loss of flexion of the medial two digits

      Explanation:

      Flexion of the index and middle fingers at the IPJs is lost due to paralysis of the flexor digitorum superficialis and the lateral half of the flexor digitorum profundus. Flexion of the MCPJs of the index and middle fingers are lost due to paralysis of the lateral two lumbrical muscles. Flexion of the ring and little fingers are preserved as these are supported by the medial half of the flexor digitorum profundus and the medial two lumbrical muscles, innervated by the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      38.7
      Seconds

  • Question 15 - A 30-year old male is taken to the emergency room after suffering a...

    Correct

    • A 30-year old male is taken to the emergency room after suffering a blunt trauma to the abdomen. He is complaining of severe abdominal pain, however all his other vital signs remain stable. A FAST scan is performed to assess for hemoperitoneum.

      If hemoperitoneum is present, it is most likely to be observed in which of the following areas?

      Your Answer: Liver

      Explanation:

      The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%.

      The FAST exam evaluates four regions for pathologic fluid: (1) the right upper quadrant, (2) the subxiphoid (or subcostal) view, (3) the left upper quadrant, and (4) the suprapubic region.

      The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The probe is positioned in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The hand is placed against the bed to ensure visualization of the retroperitoneal kidney. The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Recent retrospective evidence suggests the area along the caudal edge of the left lobe of the liver has the highest sensitivity, exceeding 93%.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      28.5
      Seconds

  • Question 16 - The medial and lateral pterygoid muscles are innervated by which of the following...

    Correct

    • The medial and lateral pterygoid muscles are innervated by which of the following nerves:

      Your Answer: Mandibular division of the trigeminal nerve

      Explanation:

      Both the medial and lateral pterygoids are innervated by the mandibular division of the trigeminal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      15.1
      Seconds

  • Question 17 - Co-amoxiclav is used first line for which of the following indications: ...

    Correct

    • Co-amoxiclav is used first line for which of the following indications:

      Your Answer: Animal bite

      Explanation:

      Co-amoxiclav is used first line for infected and prophylaxis of infection in animal and human bites.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      4.8
      Seconds

  • Question 18 - The last two segments of the nephrons are the distal convoluted tubule (DCT)...

    Incorrect

    • The last two segments of the nephrons are the distal convoluted tubule (DCT) and collecting duct (CD).

      Which cell reabsorbs sodium more in the late DCT and CD?

      Your Answer: Intercalated cells

      Correct Answer: Principal cells

      Explanation:

      The main Na+ reabsorbing cells in the late distal convoluted tubule and collecting duct are the principal cells. These make up the majority of the tubular cells.

      The exchange is driven by the Na.K.ATPase pumps on the basolateral membrane.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      34.2
      Seconds

  • Question 19 - A 65-year-old female presents to the Emergency Department with complaints of chest pain...

    Correct

    • A 65-year-old female presents to the Emergency Department with complaints of chest pain pointing to angina. A dose of glyceryl trinitrate (GTN) was administered, rapidly resolving her symptoms. Unfortunately, she develops a side-effect of the drug.

      Which one of the following is the side effect she is most likely to have developed?

      Your Answer: Flushing

      Explanation:

      Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.

      Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
      1. Glyceryl trinitrate
      2. Isosorbide dinitrate

      Side effects to nitrate therapy are common especially
      The most common side effects are:
      1. Headaches
      2. Feeling dizzy, weak, or tired
      3. Nausea
      4. Flushing

      The serious but less likely to occur side effects are:
      1. Methemoglobinemia (rare)
      2. Syncope
      3. Prolonged bleeding time
      4. Exfoliative dermatitis
      5. Unstable angina
      6. Rebound hypertension
      7. Thrombocytopenia

      Dry eyes, bradycardia, and metabolic acidosis have not been reported.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      21.8
      Seconds

  • Question 20 - A 40-year-old male visits his family physician with the complaint of a high-grade...

    Correct

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

      Which one of the following facts regarding neutrophilia is accurate?

      Your Answer: It can be caused by eclampsia

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Haematology
      • Pathology
      373.3
      Seconds

  • Question 21 - A 42-year-old man presented to the emergency room after an incident of slipping...

    Incorrect

    • A 42-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip adduction, but normal hip flexion.

      Which of the following muscles was most likely injured in this case?

      Your Answer: Sartorius

      Correct Answer: Pectineus

      Explanation:

      The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.

      The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      35.2
      Seconds

  • Question 22 - A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is...

    Correct

    • A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is diagnosed with hyperaldosteronism.

      Which of these is the commonest cause of hyperaldosteronism?

      Your Answer: Adrenal adenoma

      Explanation:

      When there are excessive circulating levels of aldosterone, hyperaldosteronism occurs. There are two main types of hyperaldosteronism:

      Primary hyperaldosteronism (,95% of cases)
      Secondary hyperaldosteronism (,5% of cases)

      Primary causes of hyperaldosteronism include:
      Adrenal adenoma (Conn’s syndrome)
      Adrenal hyperplasia
      Adrenal cancer
      Familial aldosteronism
      Secondary causes of hyperaldosteronism include:
      Drugs
      Obstructive renal artery disease
      Renal vasoconstriction
      Oedematous disorders syndrome

      Adrenal adenoma is the commonest cause of hyperaldosteronism (seen in ,80% of all cases).

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      21.6
      Seconds

  • Question 23 - A 23-year-old male presents to his family physician with the complaint of repeated...

    Correct

    • A 23-year-old male presents to his family physician with the complaint of repeated episodes of abdominal pain and the passage of dark coloured urine every morning. He also reports increasing fatigue over the past several months. On examination, there are raised, painful red nodules over the skin of the back. Laboratory workup shows haemolytic anaemia, leukopenia and thrombocytopenia.

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

      Your Answer: Paroxysmal nocturnal haemoglobinuria

      Explanation:

      Paroxysmal nocturnal haemoglobinuria is an acquired genetic disorder that causes a decrease in red blood cells due to a membrane defect that allows increased complement binding to RBCs, causing haemolysis. Patients complain of dark-coloured urine first in the morning due to haemoglobinuria secondary to lysis of red blood cells overnight.

      Thrombosis occurs, which affects hepatic, abdominal, cerebral and subdermal veins. Thrombosis of hepatic veins can lead to Budd-Chiari syndrome, thrombosis of subdermal veins can lead to painful nodules on the skin, and thrombosis of cerebral vessels can lead to stroke. The presence of dark urine in the morning only and at no other time differentiates this condition from other conditions.

      Multiple myeloma would present with bone pain, signs of radiculopathy if there were nerve root compression and a history of repeated infections.

      Patients with Non-Hodgkin Lymphoma would complain of enlarged lymph nodes, fatigue, fever, weight loss and a history of repeated infections.

      Acute lymphoblastic leukaemia presents more commonly in children than in adults. The patient would complain of bone pain, and on examination, there would be hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      54.6
      Seconds

  • Question 24 - All of the following statements are incorrect about insulin except: ...

    Incorrect

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

      Your Answer: The effects of insulin are mediated by a G-protein coupled receptor.

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

      Explanation:

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

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

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      875.2
      Seconds

  • Question 25 - In patients who are not at risk of hypercapnic respiratory failure but are...

    Correct

    • In patients who are not at risk of hypercapnic respiratory failure but are requiring oxygen, the oxygen saturations should be maintained at which of the following?

      Your Answer: 94 - 98%

      Explanation:

      Oxygen saturation should be 94 – 98% in most acutely ill patients with a normal or low arterial carbon dioxide (PaCO2). In some clinical situations, however, like cardiac arrest and carbon monoxide poisoning, it is more appropriate to aim for the highest possible oxygen saturation until the patient is stable.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      17.3
      Seconds

  • Question 26 - Approximately what proportion of lymphocytes are B-cells: ...

    Incorrect

    • Approximately what proportion of lymphocytes are B-cells:

      Your Answer: 0.65

      Correct Answer: 0.2

      Explanation:

      B-cells (20% of lymphocytes) mature in the bone marrow and circulate in the peripheral blood until they undergo recognition of antigen. B-cell immunoglobulin molecules synthesised in the cell are exported and bound to the surface membrane to become the B-cell receptor (BCR) which can recognise and bind to a specific antigen (either free or presented by APCs). The BCR is also important for antigen internalisation, processing and presentation to T helper cells. Most antibody responses require help from antigen-specific T helper cells (although some antigens such as polysaccharide can lead to T-cell independent B-cell antibody production). When the B-cell is activated, the receptor itself is secreted as free soluble immunoglobulin and the B-cell matures into a memory B-cell or a plasma cell (a B-cell in its high-rate immunoglobulin secreting state). Plasma cells are non-motile and are found predominantly in the bone marrow or spleen. Most plasma cells are short-lived (1 – 2 weeks) but some may survive much longer. A proportion of B-cells persist as memory cells, whose increased number and rapid response underlies the augmented secondary response of the adaptive immune system.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      7.6
      Seconds

  • Question 27 - In the emergency department, a 50-year-old female appears with a lack of sensation...

    Correct

    • In the emergency department, a 50-year-old female appears with a lack of sensation over the front two-thirds of her tongue. Taste and salivation are both present. The patient might have damage which of her nerves?

      Your Answer: Lingual nerve

      Explanation:

      The lingual nerve, a branch of the mandibular nerve, transmits sensation to the anterior two-thirds of the tongue.

      The chorda tympani, a branch of the facial nerve, transmits taste to the front two-thirds of the tongue as well as secretomotor innervation to the submandibular and sublingual glands.

      As a result, any damage to the lingual nerve can cause changes in salivary secretion on the affected side, as well as a loss of taste in the anterior two-thirds of the tongue and temporary or permanent sensory changes in the anterior two-thirds of the tongue and the floor of the mouth.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      20.9
      Seconds

  • Question 28 - 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: Type IV hypersensitivity reaction

      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
      49.2
      Seconds

  • Question 29 - A 27-year-old man was sent to the emergency department by ambulance with suspected...

    Correct

    • A 27-year-old man was sent to the emergency department by ambulance with suspected anaphylaxis. What is the best first-line treatment for this patient?

      Your Answer: 500 micrograms of adrenaline intramuscularly

      Explanation:

      Anaphylaxis is the sudden onset of systemic hypersensitivity due to IgE-mediated chemical release from mast cells and basophils.

      If anaphylaxis is suspected, 500 micrograms of adrenaline should be administered promptly (0.5 ml of 1:1000 solution).

      In anaphylaxis, the intramuscular route is the most immediate approach; the optimal site is the anterolateral aspect of the middle part of the thigh.

      Intravenous adrenaline should only be given by people who are well-versed in the use and titration of vasopressors in their routine clinical practice.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      24.7
      Seconds

  • Question 30 - What type of visual field defect are you likely to see in a...

    Correct

    • What type of visual field defect are you likely to see in a lesion of the visual cortex:

      Your Answer: Contralateral homonymous hemianopia with macular sparing

      Explanation:

      A lesion of the visual cortex will result in a contralateral homonymous hemianopia with macular sparing.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      55.3
      Seconds

  • Question 31 - Which of the following leukaemias is most common in children in the UK:...

    Correct

    • Which of the following leukaemias is most common in children in the UK:

      Your Answer: Acute lymphoblastic leukaemia

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. There is a secondary rise after the age of 40 years. 85% of cases are of B-cell lineage and have an equal sex incidence; there is a male predominance for the 15% of T-cell lineage.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      14.7
      Seconds

  • Question 32 - What is the direct mechanism of action of digoxin as a positive inotrope:...

    Incorrect

    • What is the direct mechanism of action of digoxin as a positive inotrope:

      Your Answer: Inhibition of Na+/Ca2+ exchanger

      Correct Answer: Inhibition of Na+/K+ ATPase pump

      Explanation:

      Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      14.2
      Seconds

  • Question 33 - Calcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic...

    Correct

    • Calcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels. The phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.

      A phenylalkylamine calcium-channel blocker is, for example, which of the following?

      Your Answer: Verapamil

      Explanation:

      Calcium-channel blockers, also known as calcium antagonists, stop calcium from entering cells through the L-type calcium channel. This causes vascular smooth muscle in vessel walls to relax, resulting in a decrease in peripheral vascular resistance.
      They can be used for a variety of things, including:
      Hypertension
      Angina
      Atrial fibrillation
      Migraine

      Calcium-channel blockers can be divided into two categories: dihydropyridines and non-dihydropyridines. The basic chemical structure of these two classes differs, as does their relative selectivity for cardiac versus vascular L-type calcium channels.

      Dihydropyridines have a high vascular selectivity and lower systemic vascular resistance and blood pressure. As a result, they’re frequently used to treat hypertension. Modified release formulations are also used to treat angina, but their powerful systemic vasodilator and pressure-lowering effects can cause reflex cardiac stimulation, resulting in increased inotropy and tachycardia, which can counteract the beneficial effects of reduced afterload on myocardial oxygen demand.

      The suffix -dpine distinguishes dihydropyridines from other pyridines. Examples of dihydropyridines that are commonly prescribed include:
      Amlodipine
      Felodipine
      Nifedipine
      Nimodipine

      The phenylalkylamine class and the benzothiazepine class are two subgroups of non-dihydropyridines.

      Phenylalkylamines are less effective as systemic vasodilators because they are relatively selective for the myocardium. This group of drugs lowers myocardial oxygen demand and reverses coronary vasospasm, making them useful in the treatment of angina. They are also occasionally used to treat arrhythmias. A phenylalkylamine calcium-channel blocker like verapamil is an example.

      In terms of selectivity for vascular calcium channels, benzothiazepines fall somewhere between dihydropyridines and phenylalkylamines. They can lower arterial pressure without producing the same level of reflex cardiac stimulation as dihydropyridines because they have both cardiac depressant and vasodilator effects. Diltiazem is the only benzothiazepine currently in clinical use.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      50
      Seconds

  • Question 34 - A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was...

    Incorrect

    • A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was rushed to the Emergency Department due to sudden onset crushing chest pain. ECG showed an ST-elevation myocardial infarct in the left anterior descending artery territory. The patient's condition was stabilised and managed with angioplasty, but he sustained significant myocardial damage.

      Which one of the following statements best agrees with the myocardial healing process?

      Your Answer: The anterior wall will hypertrophy to maintain cardiac output

      Correct Answer: The left ventricle will likely hypertrophy first to maintain cardiac output

      Explanation:

      Following a myocardial infarction scar tissue formation will take place at the site of the damaged muscle. This places increased load on the rest of the myocardium causing it to hypertrophy. The left ventricle will hypertrophy first as it is pumping blood against a greater afterload as compared to the right ventricle.

      There are three types of cells in the body with regards to the cell cycle: 1. permanent
      2. labile
      3. stable cells

      Permanent cells do not re-enter the cell cycle and remain in G0. If there is a pool of stem cells the stem cells will enter the cell cycle to form more cells. Myocardial cells are a type of permanent cell and there is no pool of stem cells in the heart muscle. The anterior wall will not hypertrophy as it is formed by the right atrium and ventricle and both of these hypertrophy after the left ventricle.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      18.6
      Seconds

  • Question 35 - Fracture of the medial epicondyle would result to the following, except ...

    Incorrect

    • Fracture of the medial epicondyle would result to the following, except

      Your Answer: Weakness of wrist flexion

      Correct Answer: Weakness of abduction of the thumb

      Explanation:

      Thumb abduction is mediated by the abductor pollicis longus and brevis, which are innervated by the radial and median nerves, respectively.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      59.9
      Seconds

  • Question 36 - Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the...

    Incorrect

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

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

      Your Answer: Voltage-gated potassium channel

      Correct Answer: Ryanodine receptor

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      23.6
      Seconds

  • Question 37 - A patient has a cardiac output of 4.8 L/min and a heart rate...

    Incorrect

    • A patient has a cardiac output of 4.8 L/min and a heart rate of 80 bpm, therefore their stroke volume is:

      Your Answer: 56 mL

      Correct Answer: 60 mL

      Explanation:

      Cardiac output (CO) = Stroke volume (SV) x Heart rate (HR).
      Therefore SV = CO/HR
      = 4.8/80
      = 0.06 L = 60 mL.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      6.9
      Seconds

  • Question 38 - A 44-year-old man with an acute episode of gout presents to you and...

    Incorrect

    • A 44-year-old man with an acute episode of gout presents to you and you discuss treatment plan with him.

      Which one of these statements concerning the treatment of acute gout is true?

      Your Answer: Colchicine acts by reducing uric acid synthesis

      Correct Answer: A common first-line treatment is Naproxen as a stat dose of 750 mg followed by 250 mg TDS

      Explanation:

      High-dose NSAIDs are the first-line treatment for acute gout. In the absence of any contraindications, Naproxen 750 mg as a stat dose followed by 250 mg TDS is commonly used.

      Aspirin is contraindicated in gout. It reduces the urinary clearance of urate and also interferes with the action of uricosuric agents.

      Colchicine is preferred in patients with heart failure or in those who are intolerant of NSAIDs. It is as effective as NSAIDs in relieving acute attacks.

      Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. Where Allopurinol is not tolerated, it has a role in prophylactic treatment of gout.

      Allopurinol should not be started in the acute phase of gout as it increases the severity and duration of symptoms. It is used as a prophylaxis in preventing future attacks and acts by reducing serum uric acid levels.

    • This question is part of the following fields:

      • Musculoskeletal Pharmacology
      • Pharmacology
      6.4
      Seconds

  • Question 39 - A 23-year-old has a known diagnosis of HIV. Blood is sent to the...

    Incorrect

    • A 23-year-old has a known diagnosis of HIV. Blood is sent to the laboratory for tests.

      AIDS be diagnosed at a CD4 counts below?

      Your Answer:

      Correct Answer: 200 cells/mm 3

      Explanation:

      A normal CD4 count ranges from 500-1000 cells/mm3.

      At CD4 count of less than 350 cells/mm3 treatment with anti-retroviral therapy should be considered.

      At a CD4 count of >200 cells/mm3 AIDS is diagnosed.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds

  • Question 40 - Carbamazepine is contraindicated in which of the following: ...

    Incorrect

    • Carbamazepine is contraindicated in which of the following:

      Your Answer:

      Correct Answer: Atrioventricular block

      Explanation:

      Carbamazepine is contraindicated in:
      – People with known hypersensitivity to carbamazepine or structurally related drugs
      – People with atrioventricular block (may suppress AV conduction and ventricular automaticity)
      – People with a history of bone marrow depression (risk of agranulocytosis and aplastic anaemia)
      – People with a history of acute porphyrias
      – People taking a monoamine oxidase inhibitor (risk of serotonin syndrome)

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (0/2) 0%
Pharmacology (8/11) 73%
Infections (2/2) 100%
Microbiology (5/5) 100%
Pathogens (3/3) 100%
Fluids And Electrolytes (1/1) 100%
Cardiovascular Physiology (1/1) 100%
Physiology (3/5) 60%
Anaesthesia (1/1) 100%
Haematology (4/4) 100%
Pathology (5/7) 71%
Anatomy (6/10) 60%
Upper Limb (1/4) 25%
Specific Pathogen Groups (2/2) 100%
Lower Limb (1/2) 50%
Abdomen And Pelvis (1/1) 100%
Head And Neck (1/1) 100%
Renal Physiology (0/1) 0%
Cardiovascular Pharmacology (1/1) 100%
Endocrine Physiology (1/1) 100%
Endocrine (0/1) 0%
Respiratory (2/2) 100%
Immune Responses (0/1) 0%
Cranial Nerve Lesions (1/1) 100%
General Pathology (1/2) 50%
Central Nervous System (1/2) 50%
Basic Cellular Physiology (1/1) 100%
Musculoskeletal Pharmacology (1/1) 100%
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