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  • Question 1 - Regarding drug interactions with erythromycin, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding drug interactions with erythromycin, which of the following statements is INCORRECT:

      Your Answer: There is an increased risk of myopathy if erythromycin is taken with simvastatin.

      Correct Answer: Erythromycin decreases plasma levels of warfarin.

      Explanation:

      Erythromycin and clarithromycin inhibit cytochrome P450-mediated metabolism of warfarin, phenytoin and carbamazepine and may lead to accumulation of these drugs. There is an increased risk of myopathy (due to cytochrome P450 enzyme CYP3A4 inhibition) if erythromycin or clarithromycin is taken with atorvastatin or simvastatin. Erythromycin increases plasma concentrations of theophylline, and theophylline may also reduce absorption of oral erythromycin. All macrolides can prolong the QT-interval and concomitant use of drugs that prolong the QT interval is not recommended.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      49.1
      Seconds
  • Question 2 - Regarding gas exchange at the alveolar-capillary membrane, which of the following statements is...

    Incorrect

    • Regarding gas exchange at the alveolar-capillary membrane, which of the following statements is CORRECT:

      Your Answer: Movement of particles across the membrane ceases once equilibrium has been reached.

      Correct Answer: Transfer of oxygen is usually perfusion-limited.

      Explanation:

      Gas exchange between alveolar air and blood in the pulmonary capillaries takes place by diffusion across the alveolar-capillary membrane. Diffusion occurs from an area of high partial pressure to an area of low partial pressure, thus the driving force for diffusion is the alveolar-capillary partial pressure gradient. Diffusion occurs until equilibrium is reached, but random movement of particles continues to occur and this is known as dynamic equilibrium. The diffusing capacity for oxygen (DLO2) cannot be measured directly but the rate of diffusion in the lungs can be estimated by measuring the diffusing capacity of the lungs for carbon monoxide (DLCO), not by measuring total lung capacity. The rate of transfer of a gas may be diffusion or perfusion limited; carbon monoxide transfer is diffusion-limited, oxygen transfer is usually perfusion-limited.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      67.9
      Seconds
  • Question 3 - A 40-year-old male presents to your clinic complaining of a cough with bloody...

    Correct

    • A 40-year-old male presents to your clinic complaining of a cough with bloody sputum for the past three months. He has also had fever, night sweats, and has noticed some weight loss over the past three months.

      Which ONE of the following statements regarding this disease is correct?

      Your Answer: It can be diagnosed using the Ziehl-Neelson stain

      Explanation:

      Tuberculosis is an infection caused by the microorganism Mycobacterium tuberculosis. TB can affect any organ system in the body, but it most commonly affects the lungs, followed by the lymph nodes.

      Option Tuberculosis is spread by the faecal-oral route: It is spread by inhalation of droplet nuclei.

      There are different methods to diagnose a tuberculosis infection.
      1) Direct Microscopy: The organisms are visualised using Ziehl-Neelsen or Auramine staining. This is the quickest method to establish a diagnosis and start treatment.
      2) Culture: M. tuberculosis can be grown on Lowenstein-Jensen or Ogawa mediums, but it can take up to 8 weeks; therefore, ZN staining is also performed to start treatment immediately.

      Option There are several types of vaccine currently available: The BCG vaccine is the only vaccine approved to prevent TB and is administered at birth.

      Option Miliary tuberculosis refers to tuberculosis that affects the spine: Miliary tuberculosis refers to a tuberculosis infection disseminated throughout the body’s organ systems via the blood or lymphatics. Pott’s disease is extrapulmonary TB that affects the spine. It usually affects the lower thoracic and upper lumbar regions.

      Option A Ghon focus typically appears at the apex of a lung: The Ghon focus is a primary sign of TB that forms in the lung of previously unaffected patients. It typically occurs in the mid or lower zones of the lung.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      48.1
      Seconds
  • Question 4 - A study investigating the risk of suffering a stroke in patients with atrial...

    Incorrect

    • A study investigating the risk of suffering a stroke in patients with atrial fibrillation taking the new antiplatelet drug ticagrelor, compared with standard treatment with warfarin is done over a 2-year time period. 30 of the 300 patients taking ticagrelor and 20 of the 500 patients taking warfarin suffered a stroke over the 2-year period.

      One of these statements is true regarding the outcomes of this study.

      Your Answer: The absolute risk in the warfarin group is 0.1

      Correct Answer: Ticagrelor increases the risk of stroke

      Explanation:

      Absolute risk and relative risk are used to assess the strength of a relationship between a disease and a factor that may affect it.

      Absolute risk (AR) is the risk of developing a disease over a time period:
      AR = the number of events that occur in a group / number of people in that group

      The absolute risk reduction (ARR) is the difference between the absolute risk in the control group (ARC) and the absolute risk in the treated group (ART).

      ARR = ARC – ART

      The control group is the warfarin group, therefore the ARC is 20/500 (0.04).
      Treatment group is the ticagrelor group and ART = 30/300 (0.1).

      ARR = 0.04 – 0.1 = -0.06. This shows that treatment with ticagrelor increases risk of developing stroke. This is also termed a relative risk increase.

      Relative risk, or risk ratio, (RR) is used to compare the risk in the two different groups. It is the ratio of the absolute risks of the disease in the treatment group (ART) to the absolute risk of the disease in the control group (ARC):
      RR=ART /ARC

      Therefore RR = 0.1 / 0.04 = 2.5
      RR < 1 means the intervention reduces the risk of the outcome being studied
      RR = 1 means the treatment has no effect on the outcome being studied
      RR > 1 means the intervention increased the risk of the outcome being studied
      Since RR is 2.5, ticagrelor increases the risk of stroke.

      SUMMARY
      Absolute risk reduction is -0.06
      Absolute risk in warfarin group = 0.04
      Relative risk = 2.5
      Ticagrelor has no effect on stroke is incorrect because RR is not =1

    • This question is part of the following fields:

      • Evidence Based Medicine
      129.1
      Seconds
  • Question 5 - A 50-year-old man, known hypertensive on amlodipine has been visiting his GP with...

    Incorrect

    • A 50-year-old man, known hypertensive on amlodipine has been visiting his GP with symptoms of headache, tiredness, and muscle weakness. His blood test today shows a low potassium level of 2.8 mmol/L, and a slightly raised sodium level at 147 mmol/L.

      What is the MOST LIKELY diagnosis?

      Your Answer: Cushing’s syndrome

      Correct Answer: Conn’s syndrome

      Explanation:

      When there are excessive levels of aldosterone independent of the renin-angiotensin aldosterone axis, primary hyperaldosteronism occurs. Secondary hyperaldosteronism occurs due to high renin levels.

      Causes of primary hyperaldosteronism include:
      Conn’s syndrome
      Adrenal hyperplasia
      Adrenal cancer
      Familial aldosteronism

      Causes of secondary hyperaldosteronism include:
      Renal vasoconstriction
      Oedematous disorders
      Drugs – diuretics
      Obstructive renal artery disease

      Although patients are usually asymptomatic, when clinical features are present, classically hyperaldosteronism presents with:
      Hypokalaemia
      Sodium levels can be normal or slightly raised
      Hypertension
      Metabolic alkalosis
      Less common, clinical features are:
      Lethargy
      Headaches
      Intermittent paraesthesia
      Polyuria and polydipsia
      Muscle weakness (from persistent hypokalaemia)
      Tetany and paralysis (rare)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      101.2
      Seconds
  • Question 6 - Which of the following is a contraindication to the use of opioid analgesics: ...

    Correct

    • Which of the following is a contraindication to the use of opioid analgesics:

      Your Answer: Raised intracranial pressure

      Explanation:

      Opioids should be avoided in people who have:
      A risk of paralytic ileus (opioids reduce gastric motility)
      Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)
      Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure)

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      78.7
      Seconds
  • Question 7 - All of the following typically occurs as part of normal passive expiration except:...

    Incorrect

    • All of the following typically occurs as part of normal passive expiration except:

      Your Answer: Depression of the sternal ends of the ribs

      Correct Answer: Contraction of the internal intercostal muscles

      Explanation:

      Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs.
      In expiration, several movements occur. There are:
      1. depression of the sternal ends of the ribs (‘pump handle’ movement),
      2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and
      3. elevation of the diaphragm.
      These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      74.2
      Seconds
  • Question 8 - A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and...

    Correct

    • A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis.

      Which of these blood vessels has most likely been occluded?

      Your Answer: Posterior inferior cerebellar artery

      Explanation:

      Posterior inferior cerebellar artery (PICA) occlusion is characterised by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. PICA occlusion causes infarction of the posterior inferior cerebellum, inferior cerebellar vermis and lateral medulla.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      77.3
      Seconds
  • Question 9 - An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her...

    Correct

    • An elderly female with a diagnosed psychiatric illness was prescribed prochlorperazine for her complaints of dizziness and nausea. Two days later, she returned to the clinic with no improvement in the symptoms.

      Which one of the following is the mechanism of action of prochlorperazine?

      Your Answer: Dopamine receptor antagonism

      Explanation:

      Prochlorperazine is a phenothiazine drug as it is categorized as a first-generation antipsychotic. It mainly blocks the D2 (dopamine 2) receptors in the brain. Along with dopamine, it also blocks histaminergic, cholinergic, and noradrenergic receptors.

      It exerts its antiemetic effect via dopamine (D2) receptor antagonist. It is used to treat nausea and vomiting of various causes, including labyrinthine disorders.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      25.3
      Seconds
  • Question 10 - How does abciximab mediate its antiplatelet effect: ...

    Correct

    • How does abciximab mediate its antiplatelet effect:

      Your 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
      22.6
      Seconds
  • Question 11 - Which of the following best describes pathogenicity: ...

    Correct

    • Which of the following best describes pathogenicity:

      Your Answer: The ability to cause disease

      Explanation:

      Pathogenicity is the ability to cause disease.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      14.6
      Seconds
  • Question 12 - A patient presents with a fever, headache and neck stiffness. A CSF sample...

    Correct

    • A patient presents with a fever, headache and neck stiffness. A CSF sample of someone with meningococcal meningitis typically shows:

      Your Answer: All of the above

      Explanation:

      CSF analysis typically shows:
      cloudy turbid appearance
      raised WCC – predominantly neutrophils
      high protein
      low glucose (typically < 40% of serum glucose)
      Gram-negative diplococci seen under microscopy

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      48.2
      Seconds
  • Question 13 - Regarding aspirin at analgesic doses, which of the following statements is CORRECT: ...

    Correct

    • Regarding aspirin at analgesic doses, which of the following statements is CORRECT:

      Your Answer: It is contraindicated in patients with severe heart failure.

      Explanation:

      Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      156.3
      Seconds
  • Question 14 - Aplastic crises in sickle cell anaemia is classically precipitated by which of the...

    Correct

    • Aplastic crises in sickle cell anaemia is classically precipitated by which of the following infections:

      Your Answer: Parvovirus B19

      Explanation:

      A serious complication in sickle cell disease (SCD) is the aplastic crisis. This may be caused by infection with Parvovirus B-19 (B19V). This virus causes fifth disease, a normally benign childhood disorder associated with fever, malaise, and a mild rash. This virus infects RBC progenitors in bone marrow, resulting in impaired cell division for a few days.
      Healthy people experience, at most, a slight drop in hematocrit, since the half-life of normal erythrocytes in the circulation is 40-60 days. In people with SCD, however, the RBC lifespan is greatly shortened (usually 10-20 days), and a very rapid drop in Hb occurs. The condition is self-limited, with bone marrow recovery occurring in 7-10 days, followed by brisk reticulocytosis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      18.4
      Seconds
  • Question 15 - Which of the following statements accurately describes the number needed to harm? ...

    Incorrect

    • Which of the following statements accurately describes the number needed to harm?

      Your Answer: A high NNH indicates a high rate of side effects experienced by those in the trial

      Correct Answer: The NNH is the number of patients that need to be treated for one to experience the side effect

      Explanation:

      Number needed to harm (NNH) corresponds to the number of individuals that must be treated, so that one of them presents an adverse reaction accountable to the treatment.

      Hence, a NNH of 100 means that 100 individuals need to be treated in order to produce an adverse effect of the treatment in one individual.

    • This question is part of the following fields:

      • Evidence Based Medicine
      61.7
      Seconds
  • Question 16 - Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT: ...

    Correct

    • Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:

      Your Answer: ALL is the most common malignancy of childhood.

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      36.9
      Seconds
  • Question 17 - The myocardium is responsible for creating the force with which the atrial and...

    Correct

    • The myocardium is responsible for creating the force with which the atrial and ventricular muscles contract. It is made up of myocytes, which are heart muscle cells.

      Which of the following statements about cardiac muscle anatomy is correct?

      Your Answer: Cardiac myocytes have intercalated discs

      Explanation:

      Typically, granuloma has Langerhan’s cells (large multinucleated cells ) surrounded by epithelioid cell aggregates, T lymphocytes and fibroblasts.

      Antigen presenting monocytic cells found in the skin are known as Langerhan’s cells.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      43.7
      Seconds
  • Question 18 - A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon...

    Correct

    • A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon observation and examination, it was noted that he is febrile and Kernig's sign is positive. A diagnosis of meningitis was suspected and a lumbar puncture was to be performed.

      Which of the following statements regarding meningitis is true?

      Your Answer: The dura mater is the outermost layer

      Explanation:

      Meningitis is defined as the inflammation of the meninges due to an infection caused by a bacteria or a virus. Symptoms usually include stiffness of the neck, headache, and fever.
      There are 3 meningeal layers that surround the spinal cord and they are the dura mater, arachnoid matter, and pia mater.

      The dura mater is the outermost and thickest layer out of all the 3 layers.
      The arachnoid atter is the middle layer, and is very thin.
      The third and deepest meningeal layer is the pia mater that is bound tightly to the surface of the spinal cord.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      49.8
      Seconds
  • Question 19 - Which of the following is NOT one of insulin's actions: ...

    Correct

    • Which of the following is NOT one of insulin's actions:

      Your Answer: Increased gluconeogenesis

      Explanation:

      Insulin has a number of effects on glucose metabolism, including:
      Inhibition of glycogenolysis and gluconeogenesis
      Increased glucose transport into fat and muscle
      Increased glycolysis in fat and muscle
      Stimulation of glycogen synthesis
      By inhibiting gluconeogenesis, insulin maintains the availability of amino acids as substrates for protein synthesis. Thus, insulin supports protein synthesis through direct and indirect mechanisms.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      30
      Seconds
  • Question 20 - Which cervical interspace is most likely injured if a patient presents with difficulty...

    Correct

    • Which cervical interspace is most likely injured if a patient presents with difficulty of shoulder abduction and elbow flexion, pain in the right shoulder and lateral arm, and decreased sensation over the deltoid and lateral arm?

      Your Answer: C4-C5

      Explanation:

      In the setting of cervical radiculopathy, because the nerve root of a spinal nerve is compressed or otherwise impaired, the pain and symptomatology can spread far from the neck and radiates to arm, neck, chest, upper back and/or shoulders. Often muscle weakness and impaired deep tendon reflexes are noted along the course of the spinal nerve.

      Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging especially in cases of trauma. If there is nerve impingement, the affected side will be reduced relative to the unaffected side. Reduction in strength of muscles innervated by the affected nerve is also significant physical finding.

      For a C4-C5 injury, the following symptoms may present:

      Weakness in the deltoid muscle (front and side of the shoulder) and upper arm
      Shoulder pain
      Numbness along the outside of the upper arm

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      41.8
      Seconds
  • Question 21 - You investigated a patient with a chest infection and want to start antibiotics right...

    Correct

    • You investigated a patient with a chest infection and want to start antibiotics right away. The patient says they she can't take cephalosporins when you ask about allergies.

      Choose the 'second-generation' cephalosporin from the following choices?

      Your Answer: Cefuroxime

      Explanation:

      Cephalosporins of the first generation  include cephalexin, cefradine, and cefadroxil. Urinary tract infections, respiratory tract infections, otitis media, and skin and soft-tissue infections are all treated with them.

      Second-generation cephalosporins include cefuroxime, cefaclor, and cefoxitin. These cephalosporins are less vulnerable to beta-lactamase inactivation than the ‘first-generation’ cephalosporins. As a result, they’re effective against germs that are resistant to other antibiotics, and they’re especially effective against Haemophilus influenzae.

      Cephalosporins of the third generation include cefotaxime, ceftazidime, and ceftriaxone. They are more effective against Gram-negative bacteria than second generation’ cephalosporins. They are, however, less effective against Gram-positive bacteria such Staphylococcus aureus than second-generation cephalosporins.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      27.6
      Seconds
  • Question 22 - Carbamazepine is indicated for all of the following EXCEPT for: ...

    Incorrect

    • Carbamazepine is indicated for all of the following EXCEPT for:

      Your Answer: Simple focal seizures

      Correct Answer: Myoclonic seizures

      Explanation:

      Carbamazepine is a drug of choice for simple and complex focal seizures and is a first-line treatment option for generalised tonic-clonic seizures. It is also used in trigeminal neuralgia and diabetic neuropathy. Carbamazepine may exacerbate tonic, atonic, myoclonic and absence seizures and is therefore not recommended if these seizures are present.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      38.5
      Seconds
  • Question 23 - The following are all examples of type IV hypersensitivity EXCEPT for: ...

    Incorrect

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

      Your Answer: Sarcoidosis

      Correct 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
      33.7
      Seconds
  • Question 24 - A 62-year-old woman has reduced urine output, nausea, and confusion. Renal function tests...

    Incorrect

    • A 62-year-old woman has reduced urine output, nausea, and confusion. Renal function tests and other investigations done leads to a diagnosis of acute kidney injury (AKI). Which one of these is consistent with a diagnosis of AKI?

      Your Answer: A fall in urine output to less than 1.5 mL/kg/hour for more than 12 hours

      Correct Answer: A rise in serum creatinine of 26 μmol/L within 48 hours

      Explanation:

      AKI is diagnosed based on an acutely rising serum creatinine and/or reduction in urine output.

      • AKI can often be non-oliguric.

      AKI is present if any one or more of the following criteria is met:

      • A rise in serum creatinine of ≥26 micromol/L (≥0.3 mg/dL) within 48 hours

      • A rise in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the past 7 days (in practice you can use the lowest value from the past 3 months as the baseline for the patient)

      • Urine volume <0.5 ml/kg/hour for at least 6 hours.

       

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      64.6
      Seconds
  • Question 25 - An ambulance transports a 72-year-old woman to the Emergency Department. She is confused,...

    Incorrect

    • An ambulance transports a 72-year-old woman to the Emergency Department. She is confused, has been vomiting and having stomach pains. Digoxin is one of her medications.

      Which of the following claims about digoxin is correct?

      Your Answer: Hyperkalaemia can predispose to digoxin toxicity

      Correct Answer: Therapeutic plasma levels are between 1.0-1.5 nmol/l

      Explanation:

      Digoxin is a cardiac glycoside that is used to treat atrial fibrillation and flutter, as well as congestive heart failure. In cardiac myocytes, it works by inhibiting the membrane Na/K ATPase. Through Na/Ca exchange, this raises intracellular sodium concentration and indirectly increases intracellular calcium availability. Increased intracellular calcium levels have both a positive inotropic and negative chronotropic effect.

      Digoxin therapeutic plasma levels are typically between 1.0 and 1.5 nmol/l, though higher concentrations may be required, and the value varies between laboratories. At concentrations greater than 2 nmol/l, the risk of toxicity increases dramatically.

      In patients with normal renal function, digoxin has a long plasma half-life of 36 to 48 hours. This can take up to 5 days in patients with impaired renal function.

      Hypokalaemia, rather than hyperkalaemia, has been shown to increase the risk of digoxin toxicity.

      In the treatment of persistent and permanent atrial fibrillation, digoxin is no longer widely used. Beta-blockers, also known as rate-limiting calcium channel blockers, are now the first-line treatment for this condition.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      37.9
      Seconds
  • Question 26 - A 55-year-old woman with a known history of bronchiectasis has lung function testing...

    Incorrect

    • A 55-year-old woman with a known history of bronchiectasis has lung function testing carried out and is found to have significant airways obstruction.
      Which of the following lung volumes or capacities is LEAST likely to be decreased in this case? Select ONE answer only.

      Your Answer: Expiratory reserve volume

      Correct Answer: Functional residual capacity

      Explanation:

      Obstructive lung disorders are characterised by airway obstruction. Many obstructive diseases of the lung result from narrowing of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself.
      In obstructive lung disease, FEV1is reduced to <80% of normal and FVC is usually reduced but to a lesser extent than FEV1. The FEV1/FVC ratio is reduced to <0.7.
      Types of obstructive lung disorders include:
      Chronic obstructive pulmonary disease (COPD)
      Asthma
      Bronchiectasis
      The following table outlines the effects of obstructive lung disease on the various lung volumes and capacities:
      Increased by obstructive lung disease
      Decreased in obstructive lung disease
      Total lung capacity (TLC)
      Residual volume (RV)
      Functional residual capacity (FRC) Residual volume/total lung capacity (RV/TLC) ratio
      Vital capacity (VC)
      Inspiratory capacity (IC)
      Inspiratory reserve volume (IRV) Expiratory reserve volume (ERV)
      According to the latestNICE guidelines(link is external), airflow obstruction is defined as follows:
      Mild airflow obstruction = an FEV1of >80% in the presence of symptoms
      Moderate airflow obstruction = FEV1of 50-79%
      Severe airflow obstruction = FEV1of 30-49%
      Very severe airflow obstruction = FEV1<30%.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      76.3
      Seconds
  • Question 27 - What is the main mechanism of action of dopamine as an inotropic sympathomimetic: ...

    Incorrect

    • What is the main mechanism of action of dopamine as an inotropic sympathomimetic:

      Your Answer: Beta2-receptor agonist

      Correct Answer: Beta1-receptor agonist

      Explanation:

      Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      33.5
      Seconds
  • Question 28 - A 29 year old patient with known inflammatory bowel disease presents to ED...

    Correct

    • A 29 year old patient with known inflammatory bowel disease presents to ED with surgical complications following his recent ileocaecal resection. Removal of the terminal ileum may result in the malabsorption of which of the following:

      Your Answer: Vitamin B12

      Explanation:

      On ingestion, vitamin B12 is bound to R protein found in saliva and gastric secretions, which protects it from digestion in the stomach. Intrinsic factor is secreted by gastric parietal cells. Receptors for the IF-B12 complex are present in the membrane of epithelial cells of the terminal ileum, which bind the complex and allow uptake of vitamin B12 across the apical membrane by endocytosis. Vitamin B12 is then transported across the basal membrane into the portal blood where it is bound to transcobalamin II and processed by the liver. In pernicious anaemia, there are autoantibodies against gastric parietal cells and intrinsic factor, resulting in vitamin B12 deficiency anaemia.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      26.8
      Seconds
  • Question 29 - A 30-year-old female presented to the Emergency Department after a fall during a...

    Incorrect

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

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

      Your Answer: Schwann cells are associated only with myelinated nerve fibres

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

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      58.4
      Seconds
  • Question 30 - Identify the type of graph described below:

    A graph wherein the frequency distribution is...

    Incorrect

    • Identify the type of graph described below:

      A graph wherein the frequency distribution is represented by adjoining vertical bars and cases are stacked in adjoining columns. It can be used for continuous quantitative data, such as to analyse outbreak data to show an epidemic curve.

      Your Answer: Pareto chart

      Correct Answer: Histogram

      Explanation:

      A histogram is used to demonstrate the distribution of continuous quantitative data. It is a very familiar graphical display device for representing the distribution of a single batch of data. The range of the data is divided into class intervals or bins, and the number of values falling into each interval is counted. The histogram then consists of a series of rectangles whose widths are defined by the class limits implied by the binwidths, and whose heights depend on the number of values in each bin. Histograms quickly reveal such attributes of the data distribution as location, spread, and symmetry. If the data are multimodal (i.e., more than one “hump” in the distribution of the data), this is quickly evident as well.

    • This question is part of the following fields:

      • Evidence Based Medicine
      24.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Infections (1/2) 50%
Pharmacology (5/9) 56%
Physiology (2/5) 40%
Respiratory (0/1) 0%
Microbiology (3/3) 100%
Specific Pathogen Groups (1/1) 100%
Evidence Based Medicine (0/3) 0%
Endocrine Physiology (0/1) 0%
Central Nervous System (4/5) 80%
Anatomy (3/4) 75%
Thorax (0/1) 0%
CNS Pharmacology (1/1) 100%
Haematology (3/3) 100%
Pathology (3/6) 50%
Principles (1/1) 100%
Pathogens (1/1) 100%
Basic Cellular Physiology (1/1) 100%
Endocrine (1/1) 100%
Head And Neck (1/1) 100%
Immune Responses (0/1) 0%
General Pathology (0/2) 0%
Cardiovascular Pharmacology (0/1) 0%
Respiratory Physiology (0/1) 0%
Cardiovascular (0/1) 0%
Gastrointestinal (1/1) 100%
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