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  • Question 1 - A 32-year-old woman with a history of bipolar disorder exhibits lithium toxicity symptoms.

    Which...

    Correct

    • A 32-year-old woman with a history of bipolar disorder exhibits lithium toxicity symptoms.

      Which of the following is the MOST LIKELY feature to be present?

      Your Answer: Clonus

      Explanation:

      Lithium toxicity manifests itself in the following ways:
      Ataxia
      Clonus
      Coma
      Confusion
      Convulsions
      Diarrhoea
      Increased muscle tone
      Nausea and vomiting
      Nephrogenic diabetes insipidus
      Renal failure
      Tremor

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      12.2
      Seconds

  • Question 2 - In a ward round, you come across a patient's treatment chart prescribed an...

    Incorrect

    • In a ward round, you come across a patient's treatment chart prescribed an antibiotic to fight his infection. This antibiotic is a protein synthesis inhibitor.

      Which of the following antimicrobial drugs is prescribed to this patient?

      Your Answer: Ciprofloxacin

      Correct 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 preventing initiation of protein synthesis.

      Vancomycin inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of cell wall precursors.

      Penicillins and cephalosporins are the major antibiotics that inhibit bacterial cell wall synthesis. They inactivate transpeptidases that help cross-link peptidoglycans in cell walls.

      Metronidazole and the other 5-nitroimidazole agents inhibit nucleic acid synthesis by forming toxic free radical metabolites in the bacterial cell that damage DNA.

      Ciprofloxacin inhibits prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      19.5
      Seconds

  • Question 3 - Regarding the management of gout, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the management of gout, which of the following statements is CORRECT:

      Your Answer: Ibuprofen is the NSAID of choice in treating acute gout.

      Correct Answer: Allopurinol may cause an acute attack of gout when first started.

      Explanation:

      Allopurinol is a treatment for the prevention of gout. The initiation of treatment may precipitate an acute attack, and should be covered with an NSAID or colchicine, continued for at least one month after the hyperuricaemia has been corrected. Colchicine is not indicated for long term prevention of gout. NSAIDs are first line for acute gout; colchicine is an alternative in whom NSAIDs are contraindicated, not tolerated or ineffective (including in people taking anticoagulants). Ibuprofen is not recommended for acute gout, given it has only weak anti-inflammatory properties; naproxen, diclofenac or indometacin are indicated instead.

    • This question is part of the following fields:

      • Musculoskeletal
      • Pharmacology
      42.2
      Seconds

  • Question 4 - In adults in the United Kingdom, which of the following pathogens is the...

    Incorrect

    • In adults in the United Kingdom, which of the following pathogens is the most likely cause of viral infectious gastroenteritis:

      Your Answer: Adenovirus

      Correct Answer: Norovirus

      Explanation:

      Norovirus is the most common viral cause of epidemic gastroenteritis worldwide; it is also a common cause of endemic diarrhoea in community settings. In the United Kingdom, norovirus has become the most common cause of gastroenteritis in adults and children since the introduction of rotavirus vaccination.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      6.7
      Seconds

  • Question 5 - A 44 year old woman is brought to ED having fallen down the...

    Correct

    • A 44 year old woman is brought to ED having fallen down the stairs and injured her right arm. On examination she is unable to abduct her arm normally, and has weakness of lateral rotation. She has sensory loss over the lateral aspect of her upper arm. Which of the following injuries is most likely to produce this pattern of injury:

      Your Answer: Surgical neck of humerus fracture

      Explanation:

      Damage to the axillary nerve will result in loss of abduction past about 15 degrees and weakness of lateral rotation due to paralysis of the deltoid and teres minor and loss of sensation over the regimental badge area on the upper lateral arm. The axillary nerve is most likely injured in fracture of the surgical neck of the humerus due to its course where it winds around this region together with the posterior humeral circumflex vessels.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      52.9
      Seconds

  • Question 6 - C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:...

    Correct

    • C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:

      Your Answer: IL-6

      Explanation:

      Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      2.9
      Seconds

  • Question 7 - A patient suffers an injury to the nerve that innervates gluteus medius.​
    The gluteus...

    Correct

    • A patient suffers an injury to the nerve that innervates gluteus medius.​
      The gluteus medius muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer: Superior gluteal nerve

      Explanation:

      Gluteus minimus is innervated by the superior gluteal nerve.
      Gluteus medius is innervated by the superior gluteal nerve.
      Gluteus maximus is innervated by the inferior gluteal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      14.1
      Seconds

  • Question 8 - A 70-year-old patient develops bacteraemia following peripheral cannulation.

    Which of these bacteria is the...

    Incorrect

    • A 70-year-old patient develops bacteraemia following peripheral cannulation.

      Which of these bacteria is the most likely cause of the infection?

      Your Answer: Pseudomonas aeruginosa

      Correct Answer: Staphylococcus epidermidis

      Explanation:

      The commonest implicated organisms in hospital-acquired bacteraemia following cannulation are Staphylococcus aureus and Staphylococcus epidermidis.
      The risk is directly proportional to the length of time in-situ. Peripheral cannula should be replaced after 48 hours.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      4.3
      Seconds

  • Question 9 - Which of the following organelles form lysosomes? ...

    Correct

    • Which of the following organelles form lysosomes?

      Your Answer: The Golgi apparatus

      Explanation:

      Lysosomes are formed by the Golgi apparatus or the endoplasmic reticulum. Lysosome releases its enzymes and digests the cell when the cell dies.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      11.6
      Seconds

  • Question 10 - Which of the following nerves is responsible for the symptoms of a patient...

    Correct

    • Which of the following nerves is responsible for the symptoms of a patient with history of recurrent herpes simplex outbreaks on his face and presents with ophthalmic herpes zoster and a painful vesicle on the tip of his nose?

      Your Answer: Nasociliary nerve

      Explanation:

      Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve.

      The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      15.1
      Seconds

  • Question 11 - A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
    Which...

    Incorrect

    • A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
      Which of the following is NOT an action of the gluteus maximus muscle? Select ONE answer only.

      Your Answer: Raising the trunk from a flexed position

      Correct Answer: Hip abduction

      Explanation:

      Gluteus maximus is the main extensor muscle of the hip and assists with lateral rotation of the thigh at the hip joint. It also acts as a hip adductor, steadies the thigh, and assists in raising the trunk from a flexed position.
      Gluteus maximus is innervated by the inferior gluteal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      29.5
      Seconds

  • Question 12 - Which of the following does not increase renal phosphate excretion? ...

    Incorrect

    • Which of the following does not increase renal phosphate excretion?

      Your Answer: Parathyroid hormone

      Correct Answer: Vitamin D

      Explanation:

      PO43-renal excretion is regulated several mechanisms. These include:
      -parathyroid hormone – increases excretion by inhibiting reabsorption in the proximal tubule
      -acidosis – increases excretion
      -glucocorticoids – increases excretion
      -calcitonin – increases excretion
      -activated vitamin D – decreases excretion by increasing reabsorption in the distal tubule

    • This question is part of the following fields:

      • Physiology
      • Renal
      6
      Seconds

  • Question 13 - The following all cause a right shift in the oxygen dissociation curve EXCEPT...

    Incorrect

    • The following all cause a right shift in the oxygen dissociation curve EXCEPT for:

      Your Answer: Increase in 2,3-DPG

      Correct Answer: Foetal haemoglobin

      Explanation:

      A decreased affinity of haemoglobin for oxygen (and hence increased ease of dissociation), shown by a right shift in the oxygen dissociation curve, is caused by a fall in pH, a rise in PCO2(the Bohr effect) and an increase in temperature. These changes occur in metabolically active tissues such as in exercise, and encourage oxygen release. The metabolic by-product 2,3-diphosphoglycerate (2,3 -DPG) also causes a right shift; 2, 3 -DPG may also be raised in chronic anaemia, chronic lung disease, or at high altitude. Foetal haemoglobin (HbF) binds 2, 3 -DPG less strongly than does adult haemoglobin (HbA), and so the HbF dissociation curve lies to the left of that for HbA, reflecting its higher oxygen affinity. This helps transfer oxygen from mother to foetus.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      6.9
      Seconds

  • Question 14 - Where is angiotensin I primarily converted to angiotensin II: ...

    Correct

    • Where is angiotensin I primarily converted to angiotensin II:

      Your Answer: Lungs

      Explanation:

      Angiotensin I is converted to angiotensin II by the removal of two C-terminal residues by the enzyme angiotensin-converting enzyme (ACE). This primarily occurs in the lungs, although it does also occur to a lesser degree in endothelial cells and renal epithelial cells.
      The main actions of angiotensin II are:
      Vasoconstriction of vascular smooth muscle (resulting in increased blood pressure)
      Vasoconstriction of the efferent arteriole of the glomerulus (resulting in an increased filtration fraction and preserved glomerular filtration rate)
      Stimulation of aldosterone release from the zona glomerulosa of the adrenal cortex
      Stimulation of anti-diuretic hormone (vasopressin) release from the posterior pituitary
      Stimulation of thirst via the hypothalamus
      Acts on the Na+/H+ exchanger in the proximal tubule of the kidney to stimulate Na+reabsorption and H+excretion

    • This question is part of the following fields:

      • Physiology
      • Renal
      3
      Seconds

  • Question 15 - A 21-year-old student presents to the minors area of your Emergency Department with...

    Incorrect

    • A 21-year-old student presents to the minors area of your Emergency Department with a laceration on his external nose that occurred during sparring in a kickboxing class. The area is bleeding profusely and will require suturing. Pressure is being applied. The laceration extends through some of the nasal muscles.
      Motor innervation of the nasal muscles of facial expression is provided by which of the following ? Select ONE answer only.

      Your Answer: Trigeminal nerve

      Correct Answer: Facial nerve

      Explanation:

      The facial nerve (the labyrinthine segment) is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.
      Motor innervation of the nasal muscles of facial expression is provided by the facial nerve (CN VII).

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      24.9
      Seconds

  • Question 16 - Regarding protein digestion, which of the following statements is CORRECT: ...

    Correct

    • Regarding protein digestion, which of the following statements is CORRECT:

      Your Answer: Oligopeptides are broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on the brush border.

      Explanation:

      Digestion of dietary protein begins in the stomach where pepsin hydrolyses protein to polypeptides, and continues in the duodenum where pancreatic proteases (trypsin and chymotrypsin) continue the process of hydrolysis forming oligopeptides. These are further broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on luminal membrane epithelial cells. Free amino acids are absorbed across the apical membrane by secondary active transport coupled with Na+transport into the cell. Amino acids cross the basal membrane into the capillaries by facilitated diffusion.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      35.1
      Seconds

  • Question 17 - A patient complains of headache and visual loss. CT scan demonstrates a lesion...

    Incorrect

    • A patient complains of headache and visual loss. CT scan demonstrates a lesion of the temporal lobe. What type of visual field defect would you most expect to see in this patient:

      Your Answer: Homonymous hemianopia with macular sparing

      Correct Answer: Contralateral homonymous superior quadrantanopia

      Explanation:

      Axons from the lateral geniculate nucleus (LGN) carry visual information, via the upper and lower optic radiations, to the visual cortex in the occipital lobe:
      The upper optic radiation carries fibres from the superior retinal quadrants (corresponding to the inferior visual field quadrants) and travels through the parietal lobe to reach the visual cortex.
      The lower optic radiation carries fibres from the inferior retinal quadrants (corresponding to the superior visual field quadrants) and travels through the temporal lobe to reach the visual cortex of the occipital lobe.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      10.6
      Seconds

  • Question 18 - The risk of renal impairment in a patient on ACE inhibitor therapy is...

    Correct

    • The risk of renal impairment in a patient on ACE inhibitor therapy is increased by concomitant treatment with which of the following drug classes:

      Your Answer: NSAIDs

      Explanation:

      Concomitant treatment with NSAIDs increases the risk of renal damage, and with potassium-sparing diuretics (or potassium-containing salt substitutes) increases the risk of hyperkalaemia. Hyperkalaemia and other side effects of ACE inhibitors are more common in the elderly and in those with impaired renal function and the dose may need to be reduced.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      13.1
      Seconds

  • Question 19 - Epigastric pain and haematemesis present in a 67-year-old man. In the emergency room,...

    Correct

    • Epigastric pain and haematemesis present in a 67-year-old man. In the emergency room, he is stabilised and referred to the on-call medical team. He has been scheduled for an endoscopy in the morning due to a suspected peptic ulcer. Before transferring him to the ward, you consider giving him a proton pump inhibitor (PPI).

      Which of the following doses and routes are the best?

      Your Answer: A PPI should not be prescribed

      Explanation:

      PPIs should not be used prior to endoscopic therapy when an early endoscopic examination is performed within 24 hours of admission, according to current recommendations.
      High-dose PPI therapy reduces the risk of rebleeding and surgery after endoscopic treatment of severe peptic ulcer bleeding. Both oral and intravenous PPIs produce similar results, and there is no discernible benefit to using the intravenous formulation in patients who can tolerate oral medication.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      23.3
      Seconds

  • Question 20 - Which of the following statements is correct with regards to insulin receptors? ...

    Incorrect

    • Which of the following statements is correct with regards to insulin receptors?

      Your Answer: Insulin has its intracellular effects via the increased production of cAMP.

      Correct Answer: Insulin has its intracellular effects via activation of tyrosine kinase.

      Explanation:

      Most cells have insulin receptors present on them which can be sequestered into the cell to inactivate them. These receptors consist of two extracellular alpha subunits which contain the insulin-binding site and two transmembrane beta subunits. Because insulin is a polypeptide hormone, it must act via cell surface receptors as it is unable to readily cross the cell membrane. On binding to the receptor, the beta subunit of insulin autophosphorylation, which activates tyrosine kinase. As a result, there is an intracellular cascade of phosphorylation, causing a translocation of the glucose transporter GLUT4 and GLUT-1 to the plasma membrane of the affected cell. This facilitates glucose entry.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      20.1
      Seconds

  • Question 21 - A 75-year-old man with rheumatoid arthritis had gained weight, developed resistant hypertension, muscle...

    Incorrect

    • A 75-year-old man with rheumatoid arthritis had gained weight, developed resistant hypertension, muscle weakness, and ankle oedema. This patient is most likely suffering from what condition?

      Your Answer: Renal artery stenosis

      Correct Answer: Cushing's syndrome

      Explanation:

      Overuse of cortisol medication, as seen in the treatment of patients with chronic asthma or rheumatoid arthritis, can cause Cushing’s syndrome.

      Weight gain, thin arms and legs, a round face, increased fat around the base of the neck, a fatty hump between the shoulders, easy bruising, wide purple stretch marks primarily on the abdomen, breasts, hips, and under the arms, weak muscles, hirsutism, hypertension, erectile dysfunction, osteoporosis, frontal alopecia, acne, depression, poor wound healing, and polycythaemia are all clinical features of Cushing’s syndrome.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      15.9
      Seconds

  • Question 22 - A 22-year-old student presents with a painful, red and itchy right eye. On...

    Correct

    • A 22-year-old student presents with a painful, red and itchy right eye. On examination, there is mild erythema of palpebral conjunctiva, and follicles are visible on eversion of the eyelid. Lid oedema is evident, and you can also see a few petechial subconjunctival haemorrhages. The eye appears watery, and there is no purulent discharge. He has recently recovered from a mild upper respiratory tract infection.

      Which of these is the most likely causative organism?

      Your Answer: Adenovirus

      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

      Features of viral conjunctivitis include: watery and non-purulent eye discharge, lid oedema, follicles present on eyelid eversion, petechial subconjunctival haemorrhages and pseudomembranes may be seen on the tarsal conjunctival surfaces.

      This patients features are consistent with a viral aetiology, and the most likely causative organism is adenovirus,

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      17.8
      Seconds

  • Question 23 - A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You...

    Incorrect

    • A 52-year-old patient requires procedural sedation for DC cardioversion of atrial fibrillation. You plan on using propofol as the sedative agent.
      Propofol works as a result of action on what type of receptor? Select ONE answer only.

      Your Answer: N-methyl-D-aspartate (NMDA)

      Correct Answer: Gamma-aminobutyric acid (GABA)

      Explanation:

      Propofol (2,6-diisopropylphenol) is a short-acting phenol derivative that is primarily used for the induction of anaesthesia.
      Its mechanism of action is unclear but is thought to act by potentiating the inhibitory neurotransmitters GABA and glycine, which enhances spinal inhibition during anaesthesia.
      The dose for induction of anaesthesia is 1.5-2.5mg/kg. The dose for maintenance of anaesthesia is 4-12 mg/kg/hour. Following intravenous injection, propofol acts within 30 seconds and its duration of action is 5-10 minutes.
      Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.
      The main side effects of propofol are:
      Pain on injection (in up to 30%)
      Hypotension
      Transient apnoea
      Hyperventilation
      Coughing and hiccough
      Headache
      Thrombosis and phlebitis

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      10.8
      Seconds

  • Question 24 - A 39-year-old woman is feeling unwell one week after a parathyroid surgery.

    Which of...

    Incorrect

    • A 39-year-old woman is feeling unwell one week after a parathyroid surgery.

      Which of the following stimulates release of parathyroid hormone (PTH)?

      Your Answer: Increased 25-hydroxycholecalciferol levels

      Correct Answer: Increased plasma phosphate concentration

      Explanation:

      PTH is synthesised and released from the chief cells of the four parathyroid glands located behind the thyroid gland.
      It is a polypeptide containing 84 amino acids and it controls free calcium in the body.

      The following stimuli causes release of PTH:
      Increased plasma phosphate concentration
      Decreased plasma calcium concentration

      PTH release is inhibited by:
      Normal or increased plasma calcium concentration
      Hypomagnesaemia

      The main actions of PTH are:
      Increases plasma calcium concentration
      Decreases plasma phosphate concentration
      Increases osteoclastic activity (increasing calcium and phosphate resorption from bone)
      Increases renal tubular reabsorption of calcium
      Decreases renal phosphate reabsorption
      Increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)
      Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      17.3
      Seconds

  • Question 25 - Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is...

    Incorrect

    • Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is an increase in metabolic rate, the production of vasoactive metabolites increases. These metabolites act locally on the surrounding arterioles, causes vasodilation and an increase blood supply.

      Which of these metabolites is the most potent vasodilator in skeletal muscle?

      Your Answer: CO 2

      Correct Answer: K +

      Explanation:

      Hyperaemia is the process where the body adjusts blood flow to meet the metabolic needs of different tissues in health and disease. Vasoactive mediators that take part in this process include K+, adenosine, CO2, H+, phosphates and H2O2. Although the mechanism is not clear, all these mediators likely contribute to some extent at different points.

      Specific organs are more sensitive to specific metabolites:
      K+ and adenosine are the most potent vasodilators in skeletal muscles

      CO2 and K+ are the most potent vasodilators in cerebral circulation.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      17.6
      Seconds

  • Question 26 - Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or...

    Incorrect

    • Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:

      Your Answer: Oral steroid

      Correct Answer: Local aminosalicylate

      Explanation:

      Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      17.9
      Seconds

  • Question 27 - A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment....

    Incorrect

    • A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs.

      Which one is a nucleic acid synthesis inhibitor?

      Your Answer: Isoniazid

      Correct Answer: Ciprofloxacin

      Explanation:

      Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.
      The following is a summary of the many modes of action of various types of antimicrobial agents:

      Action Mechanisms- Examples:

      Cell wall production is inhibited
      Vancomycin
      Vancomycin
      Cephalosporins

      The function of the cell membrane is disrupted
      Nystatin
      Polymyxins
      Amphotericin B 

      Inhibition of protein synthesis
      Chloramphenicol
      Macrolides
      Aminoglycosides
      Tetracyclines

      Nucleic acid synthesis inhibition
      Quinolones
      Trimethoprim
      Rifampicin
      5-nitroimidazoles
      Sulphonamides
      Anti-metabolic activity
      Isoniazid

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      9.6
      Seconds

  • Question 28 - A 60-year-old female with a past history of rheumatic fever and a prosthetic...

    Correct

    • A 60-year-old female with a past history of rheumatic fever and a prosthetic mitral valve presents to you with fever and an episode of expressive dysphasia that lasted around 30 minutes. There is no history of known drug allergies On examination you note a systolic murmur and you suspect it is infective endocarditis.

      Which antibacterial agents would be the most appropriate to prescribe in this case?

      Your Answer: Vancomycin, rifampicin and gentamicin

      Explanation:

      Endocarditis is infective or non infective inflammation (marantic endocarditis) of the inner layer of the heart and it often involves the heart valves.

      Risk factors include:
      Prosthetic heart valves
      Congenital heart defects
      Prior history of endocarditis
      Rheumatic fever
      Illicit intravenous drug use

      In the presentation of endocarditis, the following triad is often quoted:
      Persistent fever
      Embolic phenomena
      New or changing murmur

      A combination of vancomycin, rifampicin and gentamicin is advised if the patient has a cardiac prostheses, is penicillin allergic, or if methicillin-resistant Staphylococcus aureus (MRSA) is suspected. In this case the patient has a prosthetic valve making this the most appropriate initial treatment regimen.

      Flucloxacillin and gentamicin are current recommended by NICE and the BNF for the initial ‘blind’ therapy in endocarditis. This patient has prostheses and this is not the most appropriate initial treatment regimen.

      Other features that may be present include heart failure, splenomegaly, finger clubbing, renal features (haematuria, proteinuria, nephritis), and vasculitic features (splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth’s spots).

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      18.4
      Seconds

  • Question 29 - Which of the following states that the total pressure exerted by a mixture...

    Incorrect

    • Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:

      Your Answer: Boyle's law

      Correct Answer: Dalton's law

      Explanation:

      Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      7.2
      Seconds

  • Question 30 - A 35 year old man presents with a deep laceration to the proximal...

    Incorrect

    • A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb.

      The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.

      There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers.

      Which of these nerve(s) has most likely been affected?

      Your Answer: Ulnar nerve

      Correct Answer: Median nerve

      Explanation:

      A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:

      Loss of sensation to the lateral palm and the lateral three and a half fingers.

      Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals.

      Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialis

      Weakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.
      Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      1.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

CNS Pharmacology (1/1) 100%
Pharmacology (3/8) 38%
Infections (0/2) 0%
Musculoskeletal (0/1) 0%
Microbiology (3/5) 60%
Pathogens (0/1) 0%
Anatomy (2/6) 33%
Upper Limb (1/2) 50%
Inflammatory Responses (1/1) 100%
Pathology (1/1) 100%
Lower Limb (1/2) 50%
Principles Of Microbiology (0/1) 0%
Basic Cellular Physiology (1/1) 100%
Physiology (3/10) 30%
Specific Pathogen Groups (3/3) 100%
Renal (1/2) 50%
Respiratory (0/2) 0%
Head And Neck (0/1) 0%
Gastrointestinal (1/2) 50%
Central Nervous System (0/1) 0%
Cardiovascular (1/1) 100%
Gastrointestinal Pharmacology (1/1) 100%
Endocrine (0/2) 0%
Anaesthesia (0/1) 0%
Endocrine Physiology (0/1) 0%
Cardiovascular Physiology (0/1) 0%
Passmed
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