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  • Question 1 - For which of the following is micelle formation necessary to facilitate intestinal absorption?...

    Incorrect

    • For which of the following is micelle formation necessary to facilitate intestinal absorption?

      Your Answer: Bile acids

      Correct Answer: Vitamin D

      Explanation:

      The arrangement of micelles is such that hydrophobic lipid molecules lie in the centre, surrounded by hydrophilic bile acids that are arranged in the outer region. This arrangement allows the entry of micelles into the aqueous layers surrounding the microvilli. As a result, the products of fat digestion (fatty acids and monoglycerides), cholesterol and fat-soluble vitamins (such as vitamin D) can then diffuse passively into the enterocytes. The bile salts are left within the lumen of the gut where they are reabsorbed from the ileum or excreted in faeces.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      8.1
      Seconds
  • Question 2 - An analytical study is conducted to compare the risk of stroke between Ticagrelor...

    Incorrect

    • An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:

      No. of patients who took Ticagrelor: 300
      No. of patients who took Ticagrelor and suffered a stroke: 30

      No. of patients who took Warfarin: 500
      No. of patients who took Warfarin and suffered a stroke: 20

      Compute for the risk ratio of a stroke.

      Your Answer: 0.4

      Correct Answer: 2.5

      Explanation:

      Relative risk (RR) is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group.

      RR can be computed as the absolute risk of events in the treatment group (ART), divided by the absolute risk of events in the control group (ARC).

      RR = ART/ARC
      RR = (30/300) / (20/500)
      RR = 2.5

      Recall that:

      If RR < 1, then the intervention reduces the risk of the outcome.
      If RR = 1, then the treatment has no effect on the outcome.
      If RR > 1, then the intervention increases the risk of the outcome.

    • This question is part of the following fields:

      • Evidence Based Medicine
      8.5
      Seconds
  • Question 3 - Which of the following is NOT a side effect of phenytoin: ...

    Incorrect

    • Which of the following is NOT a side effect of phenytoin:

      Your Answer: Acne and hirsutism

      Correct Answer: Ototoxicity

      Explanation:

      Adverse effects of phenytoin include:
      Nausea and vomiting
      Drowsiness, lethargy, and loss of concentration
      Headache, dizziness, tremor, nystagmus and ataxia
      Gum enlargement or overgrowth
      Coarsening of facial features, acne and hirsutism
      Skin rashes
      Blood disorders

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      10.1
      Seconds
  • Question 4 - The following are all examples of type IV hypersensitivity EXCEPT for: ...

    Correct

    • The following are all examples of type IV hypersensitivity EXCEPT for:

      Your Answer: Extrinsic allergic alveolitis

      Explanation:

      Examples of type IV reactions includes:
      Contact dermatitis
      Hashimoto’s thyroiditis
      Primary biliary cholangitis
      Tuberculin skin test (Mantoux test)
      Chronic transplant rejection
      Granulomatous inflammation (e.g. sarcoidosis, Crohn’s disease)

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      10.8
      Seconds
  • Question 5 - A 20-year-old patient had sustained a supracondylar fracture due to falling from a...

    Incorrect

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

      Your Answer: Radial nerve

      Correct Answer: Median nerve

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      11.9
      Seconds
  • Question 6 - Which of the following anatomic structures will gallstones most likely lodge into, and...

    Correct

    • Which of the following anatomic structures will gallstones most likely lodge into, and cause cholestasis?

      Your Answer: Hartmann’s pouch

      Explanation:

      Hartmann’s pouch is a diverticulum that can occur at the neck of the gallbladder. It is one of the rarest congenital anomalies of the gallbladder. Hartmann’s gallbladder pouch is a frequent but inconsistent feature of normal and pathologic human gallbladders. It is caused by adhesions between the cystic duct and the neck of the gallbladder. As a result, it is classified as a morphologic rather than an anatomic entity.

      There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      5.7
      Seconds
  • Question 7 - A 6-year-old girl is brought into the paediatric emergency room by her mother...

    Incorrect

    • A 6-year-old girl is brought into the paediatric emergency room by her mother in a state of high-grade fever and extreme irritability. She is also reluctant to urinate as it is associated with lower abdominal pain and stinging. She has no history of any UTIs requiring antibiotics in the past 12 months.

      The urine sensitivity test report is still unavailable. A clean catch urine sample is taken for urine dipstick, which reveals the presence of blood, protein, leukocytes and nitrites. Fresh blood tests were sent, and her estimated GFR is calculated to be 40 ml/minute.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer: Co-amoxiclav

      Correct Answer: Trimethoprim

      Explanation:

      The NICE guidelines for children and young people under 16 years lower UTIs are:
      1. Get a urine sample before antibiotics are taken, and do a dipstick test OR send for culture and susceptibility
      2. Assess and manage children under 5 with lower UTI with fever as recommended in the NICE guideline on fever in under 5s.
      3. Prescribe an immediate antibiotic prescription and take into account the previous urine culture and susceptibility results, previous antibiotic use, which may have led to resistant bacteria
      4. If urine culture and susceptibility report is sent
      – Review the choice of antibiotic when the results are available AND
      – change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possible

      The choice of antibiotics for non-pregnant young people under 16 years with lower UTI is summarised below:
      1. Children under 3 months:
      – Refer to paediatric specialist and treat with intravenous antibiotic in line with NICE guideline on fever in under 5s
      2. Children over 3 months:
      – First-choice
      Nitrofurantoin – if eGFR >45 ml/minute
      Trimethoprim – (if low risk of resistance*)
      – Second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice not suitable)
      Nitrofurantoin – if eGFR >45 ml/minute and not used as first-choice
      Amoxicillin (only if culture results available and susceptible)
      Cefalexin

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      27.8
      Seconds
  • Question 8 - The least likely feature of anaemia is: ...

    Correct

    • The least likely feature of anaemia is:

      Your Answer: Narrow pulse pressure

      Explanation:

      Non-specific signs of anaemia include:
      1. pallor of mucous membranes or nail beds (if Hb < 90 g/L),
      2. tachycardia
      3. bounding pulse
      4. wide pulse pressure
      5. flow murmurs
      6. cardiomegaly
      7. signs of congestive cardiac failure (in severe cases)

    • This question is part of the following fields:

      • Haematology
      • Pathology
      4.2
      Seconds
  • Question 9 - 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: Culture on the Lowenstein-Jenson medium typically takes 48 hours

      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
      22.8
      Seconds
  • Question 10 - Which of the following is NOT a typical side effect of opioid analgesics:...

    Correct

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

      Your 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
      14.2
      Seconds
  • Question 11 - A 42-year-old man presented to the emergency room after an incident of slipping...

    Correct

    • 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: 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
      20.3
      Seconds
  • Question 12 - A patient presents to your clinic with fever of unknown origin. His...

    Correct

    • A patient presents to your clinic with fever of unknown origin. His blood results shows a markedly elevated C-Reactive Protein (CRP) level.

      Which of these is responsible for mediating the release of CRP?

      Your Answer: IL-6

      Explanation:

      C-reactive protein (CRP) is an acute phase protein produced by the liver hepatocytes. Its production is regulated by cytokines, particularly interleukin 6 (IL-6) and it can be measured in the serum as a nonspecific marker of inflammation.

      Although a high CRP suggest an acute infection or inflammation, it does not identify the cause or location of infection.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      6.1
      Seconds
  • Question 13 - What is the recommended dosing regime for amiodarone in the treatment of a...

    Correct

    • What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:

      Your Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours

      Explanation:

      A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      21.4
      Seconds
  • Question 14 - Following the administration of a medication for a heart condition, a 69-year-old man...

    Correct

    • Following the administration of a medication for a heart condition, a 69-year-old man develops hypothyroidism.

      Which of the following drugs is most likely to be the cause?

      Your Answer: Amiodarone

      Explanation:

      Amiodarone has a chemical structure that is similar to that of thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, though hypothyroidism is far more common, with 5-10% of patients suffering from it.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      6.2
      Seconds
  • Question 15 - A 50-year-old man presents with headaches, lethargy, hypertension, and electrolyte disturbance. A...

    Correct

    • A 50-year-old man presents with headaches, lethargy, hypertension, and electrolyte disturbance. A diagnosis of primary hyperaldosteronism is made.

      Which biochemical pictures would best support this diagnosis?

      Your Answer: Hypokalaemic metabolic alkalosis

      Explanation:

      When there are excessive levels of aldosterone outside of the renin-angiotensin axis, primary hyperaldosteronism occurs. High renin levels will lead to secondary hyperaldosteronism.

      The classical presentation of hyperaldosteronism when symptoms are present include:
      Hypokalaemia
      Metabolic alkalosis
      Hypertension
      Normal or slightly raised sodium levels

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      15.3
      Seconds
  • Question 16 - A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a...

    Correct

    • A 61-year-old patient experiences a spontaneous rupture of his Achilles tendon following a course of antibiotics

      Which of the antibiotics listed below is MOST likely to be the cause? 

      Your Answer: Ciprofloxacin

      Explanation:

      Tendinopathy and spontaneous tendon rupture are caused by fluoroquinolones, which are an uncommon but well-known cause. Tendon problems caused by fluoroquinolones are expected to affect 15 to 20 people per 100,000. Patients over the age of 60 are most likely to develop them.

      It usually affects the Achilles tendon, but it has also been described in cases involving the quadriceps, peroneus brevis, extensor pollicis longus, long head of biceps brachii, and rotator cuff tendons. The exact aetiology is uncertain, although the fluoroquinolone medication is thought to obstruct collagen activity and/or cut off blood supply to the tendon.

      Other factors linked to tendon rupture spontaneously include:
      Gout
      Treatment with corticosteroids
      Hypercholesterolaemia
      Long-term dialysis
      Kidney transplant
      Rheumatoid arthritis 

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      6.3
      Seconds
  • Question 17 - You're a member of the cardiac arrest team, and you're helping to resuscitate...

    Incorrect

    • You're a member of the cardiac arrest team, and you're helping to resuscitate an elderly gentleman who had collapsed at home. The team leader requests that you administer an adrenaline shot.

      Which of the following statements about adrenaline is FALSE?

      Your Answer: It is a directly acting sympathomimetic amine

      Correct Answer: The IM dose in anaphylaxis is 1 ml of 1:1000

      Explanation:

      Adrenaline (epinephrine) is a sympathomimetic amine that binds to alpha- and beta-adrenergic receptors and acts as an agonist. It is active at both alpha and beta receptors in roughly equal amounts.

      When taken orally, it becomes inactive. Subcutaneous absorption is slower than intramuscular absorption. In cardiac arrest, it is well absorbed from the tracheal mucosa and can be given through an endotracheal tube.

      At the adrenergic synapse, catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) metabolise it primarily. The inactive products are then passed through the kidneys and excreted in the urine.

      In adult cardiac arrest, the IV dose is 1 mg, which is equal to 10 ml of 1:10000 or 1 ml of 1:1000. In anaphylaxis, the IM dose is 0.5 ml of 1:1000. (500 mcg).

      In open-angle glaucoma, adrenaline causes mydriasis and lowers pressure.

      Adrenaline is used in cardiopulmonary resuscitation, the treatment of severe croup, and the emergency management of acute allergic and anaphylactic reactions (as a nebuliser solution).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      16.9
      Seconds
  • Question 18 - A 27-year-old female is brought to the Emergency Department by ambulance with extensive...

    Correct

    • A 27-year-old female is brought to the Emergency Department by ambulance with extensive bleeding from her upper arm following a fall from a bicycle onto a fence. On inspection her biceps brachii muscle has been lacerated.
      How will the muscle heal from this injury? Select ONE answer only.

      Your Answer: Satellite cells will produce a small number of regenerated myocytes

      Explanation:

      Muscle heals with fibrous tissue to form a scar. Once cut, it will never regain its previous bulk or power. Within the scar a small number of myocytes (muscle cells) may be seen, which are formed from satellite cells but they contribute little to the function of the muscle overall.
      In more widespread ischaemic injury, such as critical ischaemic limb due to arterial compromise, or in compartment syndrome, damaged myocytes are replaced diffusely with fibrous tissue. This fibrous tissue contracts and reduces movement, and in extreme cases can pull the limb into abnormal positions such as in Volkmann’s ischaemic contracture of the forearm.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      11.3
      Seconds
  • Question 19 - This anatomic part lies at the heart of the tooth. ...

    Incorrect

    • This anatomic part lies at the heart of the tooth.

      Your Answer: The root

      Correct Answer: The pulp cavity

      Explanation:

      Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      13.6
      Seconds
  • Question 20 - Which of the following is NOT a typical feature of a lesion to...

    Incorrect

    • Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:

      Your Answer: Nystagmus

      Correct Answer: Hyperacusis

      Explanation:

      Hyperacusis is increased acuity of hearing with hypersensitivity to low tones resulting from paralysis of the stapedius muscle, innervated by the facial nerve. General sensation to the face and to the anterior two-thirds of the tongue is carried by the divisions of the trigeminal nerve (although taste to the anterior two-thirds of the tongue is supplied by the facial nerve). Eye movements are mediated by the oculomotor, trochlear and abducens nerve. Ptosis results from paralysis of the levator palpebrae superioris, innervated by the oculomotor nerve, or the superior tarsal muscle, innervated by the sympathetic chain.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      10.5
      Seconds
  • Question 21 - Regarding antacids, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antacids, which of the following statements is CORRECT:

      Your Answer: Aluminium hydroxide tends to cause diarrhoea.

      Correct Answer: Antacids should not be taken at the same time as other drugs as they impair absorption.

      Explanation:

      Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids act by neutralising stomach acid. They are used for symptomatic relief in dyspepsia, but are not first line for proven peptic ulcer disease where antisecretory drugs have a better healing effect. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are contraindicated in hypophosphataemia.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      12.5
      Seconds
  • Question 22 - During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was...

    Incorrect

    • During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was prematurely born with cyanosis and ashen grey coloured skin as a result of this. Other symptoms were hypotonia, low blood pressure, and poor feeding.

      From the  following antibiotics, which one is most likely to cause this side effect?

      Your Answer: Gentamicin

      Correct Answer: Chloramphenicol

      Explanation:

      Grey baby syndrome is a rare but causes significant adverse effect caused by the build-up of chloramphenicol in neonates (particularly preterm babies).

      The following are the main characteristics of ‘grey baby syndrome’:

      Skin that is ashy grey in colour.
      Feeding problems
      Vomiting
      Cyanosis
      Hypotension
      Hypothermia
      Hypotonia
      Collapse of the cardiovascular system
      Distension of the abdomen
      trouble breathing

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      13.8
      Seconds
  • Question 23 - A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She...

    Incorrect

    • A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She states that she has also felt very itchy, particularly after a hot bath and that she is often dizzy and sweaty. On examination she appears plethoric and you note the presence of splenomegaly. Her blood tests today show that her haemoglobin level is 16.9 g/dl.
      What is the most likely diagnosis in this case? Select ONE answer only.

      Your Answer: Secondary polycythaemia

      Correct Answer: Polycythaemia vera

      Explanation:

      Polycythaemia vera (PCV), which is also referred to as polycythaemia rubra vera, is a clonal haematological malignancy in which the bone marrow produces too many red blood cells. It may also result in the overproduction of white blood cells and platelets. It is most commonly seen in the elderly and the mean age at diagnosis is 65-74 years.
      Patients can be completely asymptomatic and it is often discovered as an incidental finding on a routine blood count. Approximately 1/3 of patients present with symptoms due to thrombosis, of these 3/4 have arterial thrombosis and 1/4 venous thrombosis. Features include stroke, myocardial infarction, deep vein thrombosis and pulmonary embolism.
      The other clinical features of PCV include:
      Plethoric appearance
      Lethargy and tiredness
      Splenomegaly (common)
      Pruritis (in 40% – particularly after exposure to hot water)
      Headaches, dizziness and sweating (in 30%)
      Gouty arthritis (in 20%)
      Budd-Chiari syndrome (in 5-10%)
      Erythromyalgia (in <5% – burning pain and red/blue discolouration of hands and feet)
      Increased incidence of peptic ulcer disease (possibly related to increased histamine release from mast cells)
      The diagnosis of PCV requires two major criteria and one minor criterion, or the first major criterion and two minor criteria:
      Major criteria:
      HB > 18.5 g/dl in men, 16.5 g/dl in women
      Elevated red cell mass > 25% above mean normal predicted value
      Presence of JAK2 mutation

      Minor criteria:
      Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic and megakaryocytic proliferation
      Serum erythropoietin level below normal range
      Endogenous erythroid colony formation in vitro
      The main aim of treatment is to normalize the full blood count and prevent complications such as thrombosis. Venesection is the treatment of choice but hydroxyurea can also be used to help control thrombocytosis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      17.6
      Seconds
  • Question 24 - The triage nurse asks if you will prescribe a dose of codeine phosphate...

    Correct

    • The triage nurse asks if you will prescribe a dose of codeine phosphate for a patient who is in a lot of pain. You discover that you are unable to prescribe it due to a contra-indication after evaluating the patient.

      The use of codeine phosphate is contraindicated in which of the following situations?

      Your Answer: Age under 12 years

      Explanation:

      Codeine phosphate is a mild opiate that can be used to treat mild to moderate pain when other pain relievers like paracetamol or ibuprofen have failed. It can also be used to treat diarrhoea and coughs that are dry or painful.

      The use of all opioids is contraindicated for the following reasons:
      Respiratory depression (acute)
      Patients who are comatose
      Head injury (opioid analgesics impair pupillary responses, which are crucial for neurological evaluation)
      Intracranial pressure has risen (opioid analgesics interfere with pupillary responses vital for neurological assessment)
      There’s a chance you’ll get paralytic ileus.

      The use of codeine phosphate is contraindicated in the following situations:
      Because of the significant risk of respiratory side effects in children under the age of 12, it is not recommended for children under the age of 12.

      Patients of any age who have been identified as ultra-rapid codeine metabolizers (CYP2D6 ultra-rapid metabolizers)

      Because codeine can pass through breast milk to the baby and because mothers’ ability to metabolise codeine varies greatly, it is especially dangerous in breastfeeding mothers.

      If other painkillers, such as paracetamol or ibuprofen, fail to relieve acute moderate pain in children over the age of 12, codeine should be used. In children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy, a significant risk of serious and life-threatening adverse reactions has been identified.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      10.7
      Seconds
  • Question 25 - An analytical cohort study aimed to determine a relationship between intake of dietary...

    Incorrect

    • An analytical cohort study aimed to determine a relationship between intake of dietary calcium and incidence of hip fractures among post-menopausal women. The following are the data obtained from the study:

      No. of post-menopausal women who took Calcium: 500
      No. of post-menopausal women who took Calcium and suffered a hip fracture: 10

      No. of post-menopausal women who took placebo: 500
      No. of post-menopausal women who took placebo and suffered a hip fracture: 25

      Compute for the absolute risk reduction of a hip fracture.

      Your Answer: 0.3

      Correct Answer: 0.03

      Explanation:

      Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).

      ARR = ARC-ART
      ARR = (25/500) – (10/500)
      ARR = 0.03

    • This question is part of the following fields:

      • Evidence Based Medicine
      2.8
      Seconds
  • Question 26 - Which of the following neurotransmitter and receptor combinations is present at the neuromuscular...

    Incorrect

    • Which of the following neurotransmitter and receptor combinations is present at the neuromuscular junction:

      Your Answer: Acetylcholine acting at muscarinic receptors

      Correct Answer: Acetylcholine acting at nicotinic receptors

      Explanation:

      At the neuromuscular junction, acetylcholine is released from the prejunctional membrane which acts on cholinergic nicotinic receptors on the postjunctional membrane.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      15.3
      Seconds
  • Question 27 - If the afferent arteriole's diameter is smaller than the efferent arteriole's diameter in...

    Incorrect

    • If the afferent arteriole's diameter is smaller than the efferent arteriole's diameter in the glomerulus:

      Your Answer: The glomerular filtration rate will increase

      Correct Answer: The net filtration pressure will decrease

      Explanation:

      The relative resistance of the afferent and efferent arterioles substantially influences glomerular capillary hydrostatic pressure and consequently GFR. Filtration is forced through the filtration barrier due to high pressure in the glomerular capillaries. Afferent arteriolar constriction lowers this pressure while efferent arteriolar constriction raises it.

    • This question is part of the following fields:

      • Physiology
      • Renal
      10.6
      Seconds
  • Question 28 - Which of these is NOT a naturally occurring anticoagulant: ...

    Correct

    • Which of these is NOT a naturally occurring anticoagulant:

      Your Answer: Factor V Leiden

      Explanation:

      It’s crucial that thrombin’s impact is restricted to the injured site. Tissue factor pathway inhibitor (TFPI), which is produced by endothelial cells and found in plasma and platelets, is the first inhibitor to function. It accumulates near the site of harm induced by local platelet activation. Xa and VIIa, as well as tissue factor, are inhibited by TFPI. Other circulating inhibitors, the most potent of which is antithrombin, can also inactivate thrombin and other protease factors directly. Coagulation cofactors V and VIII are inhibited by protein C and protein S. Tissue plasminogen activator (TPA) from endothelial cells facilitates fibrinolysis by promoting the conversion of plasminogen to plasmin.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      13.8
      Seconds
  • Question 29 - A 78-year-old woman visits the emergency room with dizziness and nausea. She claims...

    Correct

    • A 78-year-old woman visits the emergency room with dizziness and nausea. She claims that her doctor gave her cinnarizine two days prior, but that it didn't seem to help.

      Cinnarizine's mechanism of action is which of the following?

      Your Answer: Antihistamine action

      Explanation:

      Cinnarizine is a piperazine derivative with an antihistamine effect that makes it anti-emetic. Motion sickness and vestibular disorders, such as Méniéres disease, are the most common conditions for which it is prescribed.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      8.2
      Seconds
  • Question 30 - Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and...

    Correct

    • Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.

      What is cyclizine's main mechanism of action?

      Your Answer: Antihistamine action

      Explanation:

      Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      7.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastrointestinal (0/2) 0%
Physiology (2/5) 40%
Evidence Based Medicine (0/2) 0%
Central Nervous System (1/2) 50%
Pharmacology (7/12) 58%
Immune Responses (1/1) 100%
Pathology (4/5) 80%
Anatomy (2/5) 40%
Upper Limb (0/1) 0%
Abdomen And Pelvis (1/1) 100%
Infections (1/3) 33%
Haematology (1/2) 50%
Microbiology (0/1) 0%
Specific Pathogen Groups (0/1) 0%
Lower Limb (1/1) 100%
General Pathology (2/2) 100%
Cardiovascular (1/1) 100%
Cardiovascular Pharmacology (1/2) 50%
Endocrine Physiology (1/1) 100%
Head And Neck (0/1) 0%
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CNS Pharmacology (3/3) 100%
Basic Cellular (1/2) 50%
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