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  • Question 1 - You review a patient with a history of Addison’s disease. He takes 100...

    Correct

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

      Your Answer: 25 mg

      Explanation:

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

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      88.5
      Seconds
  • Question 2 - Which of the following globin chains makes up normal adult haemoglobin (HbA)? ...

    Incorrect

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

      Your Answer: Two alpha chains and two delta chains

      Correct Answer: Two alpha and two beta chains

      Explanation:

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

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      89.5
      Seconds
  • Question 3 - Which of the following medications may lessen warfarin's anticoagulant effect: ...

    Incorrect

    • Which of the following medications may lessen warfarin's anticoagulant effect:

      Your Answer: Metronidazole

      Correct Answer: Phenytoin

      Explanation:

      Phenytoin will decrease the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
      Metronidazole will increase the level or effect of warfarin by affecting hepatic enzyme CYP2C9/10 metabolism.
      NSAIDs, when given with Warfarin, increase anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      40.8
      Seconds
  • Question 4 - A new chemotherapy drug is being tested. The intervention reduces the risk of...

    Correct

    • A new chemotherapy drug is being tested. The intervention reduces the risk of death from 10 in 1000 to 5 in 1000. What is the number needed to treat to prevent one death:

      Your Answer: 200

      Explanation:

      Absolute risk reduction (ARR) of treatment
      = risk of death in control group – risk of death in treatment group
      ARR = (10/1000) – (5/1000)
      = 5/1000 = 0.005
      Number needed to treat (NNT)
      = 1/ARR
      = 1/0.005
      = 200
      Therefore 200 people would need to be treated to prevent one extra death.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      427.8
      Seconds
  • Question 5 - All of the following are indications for beta-blockers EXCEPT for: ...

    Correct

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer: Raynaud's disease

      Explanation:

      Beta-blockers are contraindicated in Raynaud’s syndrome.
      Beta-blockers may be indicated in:
      Hypertension
      Pheochromocytoma (only with an alpha-blocker)
      Angina
      Secondary prevention after ACS
      Arrhythmias including atrial fibrillation
      Heart failure
      Thyrotoxicosis
      Anxiety
      Prophylaxis of migraine
      Essential tremor
      Glaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      11.6
      Seconds
  • Question 6 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Incorrect

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer: 10 ml of 1 in 1000 adrenaline solution

      Correct Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.

      For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      12.6
      Seconds
  • Question 7 - A 25-year-old patient requires procedural sedation for reduction of an open fracture of...

    Correct

    • A 25-year-old patient requires procedural sedation for reduction of an open fracture of his tibia and fibula. You plan on using ketamine as the sedative agent.
      Ketamine works as a result of action on what type of receptor? Select ONE answer only.

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

      Explanation:

      Ketamine is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties. When used correctly it is a very useful and versatile drug.
      Ketamine acts by non-competitive antagonism of the NMDA receptor Ca2+ channel pore and also inhibits NMDA receptor activity by interaction with the phencyclidine binding site.
      Ketamine can be used intravenously and intramuscularly. The intramuscular dose is 10 mg/kg, and when used by this route, it acts within 2-8 minutes and has a duration of action of 10-20 minutes. The intravenous dose is 1.5-2 mg/kg administered over a period of 60 seconds. When used intravenously, it acts within 30 seconds and has a duration of action of 5-10 minutes. Ketamine is also effective when administered orally, rectally, and nasally.
      Ketamine causes tachycardia, an increase in blood pressure, central venous pressure, and cardiac output, secondary to an increase in sympathetic tone. Baroreceptor function is well maintained, and arrhythmias are uncommon.
      The main disadvantage to the use of ketamine is the high incidence of hallucinations, nightmares, and other transient psychotic effects. These can be reduced by the co-administration of a benzodiazepine, such as diazepam or midazolam.
      The main side effects of ketamine are:
      Nausea and vomiting
      Hypertension
      Nystagmus
      Diplopia
      Rash

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      15.5
      Seconds
  • Question 8 - Which extraocular muscle is entrapped in a patient with a blowout fracture? ...

    Incorrect

    • Which extraocular muscle is entrapped in a patient with a blowout fracture?

      Your Answer: Medial rectus

      Correct Answer: Inferior rectus

      Explanation:

      A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. The common mechanisms are falls, high-velocity ball-related sports, traffic accidents, and interpersonal violence.

      The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bones. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles.

      The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. Finally, the orbital injury can lead to retinal oedema, hyphema, and significant loss of vision.

      While some cases may be managed with conservative care, others may require some type of surgical intervention.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      37.8
      Seconds
  • Question 9 - Regarding the penis, which of the following statements is CORRECT: ...

    Correct

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

      Your Answer: The corpus spongiosum is ventral in the erect penis.

      Explanation:

      Because the anatomical position of the penis is erect, the paired corpora cavernosa are defined as dorsal in the body of the penis and the single corpus spongiosum as ventral. The nerves and vessels lie superficial to the corpus cavernosum. The urethra lies within the corpus spongiosum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      15.4
      Seconds
  • Question 10 - Intrinsic factor is vital for gastrointestinal absorption of which of the following: ...

    Correct

    • Intrinsic factor is vital for gastrointestinal absorption of which of the following:

      Your Answer: Vitamin B12

      Explanation:

      Intrinsic factor is essential for the absorption of the small amounts of vitamin B12 normally present in the diet from the terminal ileum. The parietal cells of the stomach produce intrinsic factor, and following a gastrectomy, the absorption of vitamin B12 will be markedly reduced, and a deficiency state will exist.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      5.3
      Seconds
  • Question 11 - Regarding iron deficiency anaemia, which of the following statements is INCORRECT: ...

    Correct

    • Regarding iron deficiency anaemia, which of the following statements is INCORRECT:

      Your Answer: Dietary insufficiency is the most common cause of iron deficiency anaemia in adult men in the UK.

      Explanation:

      Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia in adult men and postmenopausal women.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      25.5
      Seconds
  • Question 12 - Needle thoracentesis in a patient with a tension pneumothorax is performed at which...

    Correct

    • Needle thoracentesis in a patient with a tension pneumothorax is performed at which anatomical landmark?

      Your Answer: 4th or 5th intercostal space mid-axillary line

      Explanation:

      Tension pneumothorax is a fatal disease causing acute and severe compromise of patients’ ventilation and circulation, in which case immediate decompression is necessary for better prognosis [6]. A previous study has shown that the incidence of tension pneumothorax varies from 0.2% to 1.7% in patients with prehospital trauma. Several trauma guidelines recommend needle thoracostomy as a life-saving intervention, with placement in the second intercostal space at the midclavicular line (second ICS-MCL), the fourth intercostal space at the anterior axillary line (fourth ICS-AAL), or the fifth intercostal space at the midaxillary line (fifth ICS-MAL) for tension pneumothorax in a prehospital environment.

      In 2018, according to newly issued the Advanced Trauma Life Support (ATLS) guidelines, the fifth ICS-MAL was suggested as the preferred place, and an 8 cm needle rather than the common 5 cm needle was proved to increase success rate of adults’ decompression.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      25.4
      Seconds
  • Question 13 - Regarding local anaesthetics, which of the following statements is INCORRECT: ...

    Correct

    • Regarding local anaesthetics, which of the following statements is INCORRECT:

      Your Answer: Adrenaline should be used in digital nerve blocks to create a bloodless field.

      Explanation:

      It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in digits or appendages because of the risk of ischaemic necrosis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      30.3
      Seconds
  • Question 14 - Which of these immunoglobulin molecules can cross the placenta? ...

    Correct

    • Which of these immunoglobulin molecules can cross the placenta?

      Your Answer: IgG

      Explanation:

      An important mechanism that provides protection to the foetus is placental transfer of maternal IgG antibodies while his/her humoral response is inefficient. The only antibody class that significantly crosses the human placenta is IgG.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      8.4
      Seconds
  • Question 15 - A 24-year-old patient is suspected to have a possible acute hepatitis B infection...

    Incorrect

    • A 24-year-old patient is suspected to have a possible acute hepatitis B infection and is currently under investigation.

      Which of the following markers is considered the earliest indicator of acute infection in acute Hepatitis B?

      Your Answer: IgM antibody to hepatitis B core antigen

      Correct Answer: Hepatitis B surface Ag

      Explanation:

      HBsAg is the serological hallmark of HBV infection. After an acute exposure to HBV, HBsAg appears in serum within 1 to 10 weeks. Persistence of this marker for more than 6 months implies chronic HBV infection.

      Anti-HBs is known as a neutralizing antibody, and confers long-term immunity. In patients with acquired immunity through vaccination, anti-HBs is the only serological marker detected in serum.

      HBcAg is an intracellular presence in infected hepatocyte, thus it is not identified in the serum. During acute infection, anti-HBc IgM and IgG emerges 1–2 weeks after the presence of HBsAg along with raised serum aminotransferase and symptoms. After 6 months of acute infection, anti-HBc IgM wears off. Anti-HBc IgG continues to detect in both patients with resolved HBV infection and chronic hepatitis B.

      Hepatitis D virus, also known as the delta hepatitis virus, is a defective ssRNA virus that requires HBV for replication. The infection can occur in one of two clinical forms, co-infection or superinfection. In a co-infection, the patient is simultaneously infected with HBV and HDV. In a superinfection, an HDV infection develops in a patient with a chronic HBV infection.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      43.4
      Seconds
  • Question 16 - The syndrome of inappropriate antidiuresis due to excessive antidiuretic hormone (ADH) secretion is...

    Correct

    • The syndrome of inappropriate antidiuresis due to excessive antidiuretic hormone (ADH) secretion is diagnosed in a male patient with a history of recurrent hyponatraemia.

      Which of the following produces ADH?

      Your Answer: Hypothalamus

      Explanation:

      Antidiuretic hormone (ADH), commonly known as vasopressin, is a peptide hormone that controls how much water the body retains.

      It is produced in the magnocellular and parvocellular neurosecretory cells of the paraventricular nucleus and supraoptic nucleus in the hypothalamus from a prohormone precursor. It is subsequently carried to the posterior pituitary via axons and stored in vesicles.

      The secretion of ADH from the posterior pituitary is regulated by numerous mechanisms:
      Increased plasma osmolality: Osmoreceptors in the hypothalamus detect an increase in osmolality and trigger ADH release.

      Stretch receptors in the atrial walls and big veins detect a decrease in atrial pressure as a result of this (cardiopulmonary baroreceptors). ADH release is generally inhibited by atrial receptor firing, but when the atrial receptors are stretched, the firing reduces and ADH release is promoted.
      Hypotension causes baroreceptor firing to diminish, resulting in increased sympathetic activity and ADH release.
      An increase in angiotensin II stimulates angiotensin II receptors in the hypothalamus, causing ADH production to increase.

      The main sites of action for ADH are:
      The kidney is made up of two parts. ADH’s main job is to keep the extracellular fluid volume under control. It increases permeability to water by acting on the renal collecting ducts via V2 Receptors (via a camp-dependent mechanism). This leads to a decrease in urine production, an increase in blood volume, and an increase in arterial pressure as a result.

      Vascular system: Vasoconstriction is a secondary function of ADH. ADH causes vasoconstriction via binding to V1 Receptors on vascular smooth muscle (via the IP3 signal transduction pathway). An increase in arterial pressure occurs as a result of this.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      25.7
      Seconds
  • Question 17 - Arterial baroreceptors are located primarily in which of the following: ...

    Incorrect

    • Arterial baroreceptors are located primarily in which of the following:

      Your Answer: Carotid sinus and right atrium

      Correct Answer: Carotid sinus and aortic arch

      Explanation:

      Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      11.3
      Seconds
  • Question 18 - A CT pulmonary angiography of a patient with a massive pulmonary embolus will...

    Correct

    • A CT pulmonary angiography of a patient with a massive pulmonary embolus will most likely show which of the following signs?

      Your Answer: Increased alveolar dead space

      Explanation:

      A CT pulmonary angiogram is an angiogram of the blood vessels of the lungs. It is a diagnostic imaging test used to check for pulmonary embolism.

      A pulmonary embolism is caused by a blood clot or thrombus that has become lodged in an artery in the lung and blocks blood flow to the lung. A patient with pulmonary embolism may feel an abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia. Also, pulmonary embolism can result in alveolar dead space.

      Dead space represents the volume of ventilated air that does not participate in gas exchange. The alveolar dead space is caused by ventilation/perfusion imbalances in the alveoli. It is defined as the sum of the volumes of alveoli that are ventilated but not perfused.

      Aside from pulmonary embolism, smoking, bronchitis, emphysema, and asthma are among the other causes of alveolar dead space.

      The other types of dead space are the following: Anatomical dead space is the portion of the airways that conducts gas to the alveoli. This is usually around 150 mL, and there is no possibility of gas exchange in these areas. Physiological dead space is the sum of anatomical and alveolar dead spaces.

      Physiological dead space can account for up to 30% of the tidal volume.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      16.2
      Seconds
  • Question 19 - An analytical cohort study aimed to determine a relationship between intake of dietary...

    Correct

    • 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: 0.03

      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
      98.3
      Seconds
  • Question 20 - The extensor digitorum longus is supplied by which nerve? ...

    Correct

    • The extensor digitorum longus is supplied by which nerve?

      Your Answer: Deep peroneal nerve

      Explanation:

      The extensor digitorum longus is innervated by the deep fibular nerve (L5, S1), a branch of the common fibular nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      27.3
      Seconds
  • Question 21 - A 13-year-old male presents to the Emergency Department with a heavy nosebleed. His...

    Correct

    • A 13-year-old male presents to the Emergency Department with a heavy nosebleed. His medical record shows that he was diagnosed with Haemophilia B as a child.

      What is the mode of inheritance of this disease?

      Your Answer: X-linked recessive

      Explanation:

      Deficiency of Factor IX causes Haemophilia B, and like the other Haemophilia’s, it has an X-linked recessive pattern of inheritance, affecting males born to carrier mothers.

      Haemophilia B is the second commonest form of haemophilia and is rarer than haemophilia A. Haemophilia B is similar to haemophilia A but is less severe. You can distinguish the two disorders by specific coagulation factor assays.

      The incidence of Haemophilia B is one-fifth of that of haemophilia A.

      In laboratory findings, you get prolonged APTT, normal PT and low factor IX for Haemophilia B.

      There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      9.7
      Seconds
  • Question 22 - The proximal convoluted tubule (PCT) is the first part of the renal tubule...

    Correct

    • The proximal convoluted tubule (PCT) is the first part of the renal tubule and lies in the renal cortex. The bulk of reabsorption of solute occurs is the PCT and 100% of glucose is reabsorbed here.

      Which of the following is the mechanism of glucose reabsorption in the PCT?

      Your Answer: Secondary active transport

      Explanation:

      Glucose reabsorption occurs exclusively in the proximal convoluted tubule by secondary active transport through the Na.Glu co-transporters, driven by the electrochemical gradient for sodium.
      The co-transporters transport two sodium ions and one glucose molecule across the apical membrane, and the glucose subsequently crosses the basolateral membrane by facilitated diffusion.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      30.9
      Seconds
  • Question 23 - Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior...

    Correct

    • Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?

      Your Answer: Auriculotemporal nerve

      Explanation:

      Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      24.2
      Seconds
  • Question 24 - An 11-year-old girl presents with a 5-day history of persistent fever despite regular...

    Incorrect

    • An 11-year-old girl presents with a 5-day history of persistent fever despite regular paracetamol, throbbing left ear pain, ear discharge and deafness. Her parents have observed that she is not her usual self, not eating well, and has been lethargic. On examination there is a tender swelling in the post auricular region on the left hand side.

      What is the most likely causative organism?

      Your Answer: Staphylococcus aureus

      Correct Answer: Streptococcus pneumonia

      Explanation:

      Acute mastoiditis is a complication (rare) of acute otitis media (AOM) and the commonest causative organism is Streptococcus pneumoniae.

      Generally, acute mastoiditis presents with:
      Pyrexia
      Recent history of AOM
      Mastoid swelling and erythema
      Otalgia
      Otorrhoea and perforation of tympanic membrane
      Post-auricular pain
      Protrusion of the ears

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      51.3
      Seconds
  • Question 25 - You are calculating the anion gap on a patient with an acid-base disturbance...

    Incorrect

    • You are calculating the anion gap on a patient with an acid-base disturbance and you find the anion gap to be low. Which of the following is the most likely cause for the low anion gap:

      Your Answer: Renal tubular acidosis

      Correct Answer: Hypoalbuminaemia

      Explanation:

      A low anion gap is frequently caused by hypoalbuminemia. Albumin is a negatively charged protein and its loss from the serum results in the retention of other negatively charged ions such as chloride and bicarbonate. As bicarbonate and chloride anions are used to calculate the anion gap, there is a subsequent decrease in the gap. The anion gap is sometimes reduced in multiple myeloma, where there is an increase in plasma IgG (paraproteinaemia).

    • This question is part of the following fields:

      • Physiology
      • Renal
      23.9
      Seconds
  • Question 26 - 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
      22.1
      Seconds
  • Question 27 - A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness....

    Correct

    • A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre

      Out of the following, which drug is most likely responsible for the baby's condition?

      Your Answer: Lithium

      Explanation:

      In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.

      Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.

      If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.

      If given in the 2nd and 3rd-trimesters, there is a risk of the following:
      1. hypotonia
      2. lethargy
      3. feeding problems
      4. hypothyroidism
      5. goitre
      6. nephrogenic diabetes insipidus in the neonate

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      20.5
      Seconds
  • Question 28 - A 68-year-old man is being treated with digoxin for atrial fibrillation. When serum...

    Correct

    • A 68-year-old man is being treated with digoxin for atrial fibrillation. When serum digoxin levels are above the therapeutic range, he is at highest risk for developing digoxin toxicity if he also develops which of the following?

      Your Answer: Hypokalaemia

      Explanation:

      Predisposing factors for digoxin toxicity include hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia There should also be care taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Hyponatremia can result in the development of other pathological disturbances, but it does not make digoxin toxicity worse.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      151
      Seconds
  • Question 29 - You review a sick patient in resus who has been prescribed mannitol as...

    Incorrect

    • You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
      Which SINGLE statement regarding mannitol is true?

      Your Answer: It crosses the blood-brain-barrier

      Correct Answer: It is irritant to veins and causes phlebitis

      Explanation:

      Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
      Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
      Decreasing the rate of CSF formation,and;
      Withdrawing extracellular fluid from the brain across the BBB
      Other uses of mannitol include:
      Short-term management of glaucoma
      Treatment of rhabdomyolysis
      Preserve renal function in peri-operative jaundiced patients
      To initiate diuresis in transplanted kidneys
      Bowel preparation prior to colorectal procedures
      The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
      Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
      Anuria
      Intracranial bleeding (except during craniotomy)
      Severe cardiac failure
      Severe dehydration
      Severe pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      51.3
      Seconds
  • Question 30 - How does abciximab mediate its antiplatelet effect: ...

    Incorrect

    • How does abciximab mediate its antiplatelet effect:

      Your Answer:

      Correct Answer: It is a GPIIb/IIIa inhibitor.

      Explanation:

      Abciximab, eptifibatide and tirofiban are GPIIb/IIIa inhibitors, inhibiting platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor and other adhesive molecules.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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