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  • Question 1 - A patient who is a known case of rheumatoid arthritis presents to the...

    Correct

    • A patient who is a known case of rheumatoid arthritis presents to the clinic as his grandson was recently diagnosed with chickenpox. His grandson spent the weekend with her, and he was in close contact with him. He takes 50 mg of prednisolone once daily and has been for the past six months. There is no history of chickenpox.

      Out of the following, which is TRUE regarding the next plan of action for her care?

      Your Answer: She should receive prophylactic varicella-zoster Immunoglobulin (VZIG)

      Explanation:

      Varicella-zoster immunoglobulin (VZIG) is indicated for post exposure prevention and treatment of varicella. It is recommended as prophylaxis for high-risk patients with no known immunity (i.e. no known previous chickenpox) who have had a significant exposure to varicella-zoster (considered >4 hours close contact).

      The high-risk groups are:
      1. Neonates
      2. Pregnant women
      3. The immunocompromised (e.g. cancer, immunosuppressive therapies)
      4. Those on high dose steroids (children on more than 2 mg/kg/day for more than 14 days, or adults on 40 mg/day for more than a week)

      This patient is at high risk of developing adrenal insufficiency and may need a temporary increase in her steroid dose during infection or stress. It would be inappropriate to stop or wean down her dose of prednisolone and can cause side effects.

      Since he is on steroids without immunity for chickenpox, he is at risk of developing severe varicella infection, with possible complications including pneumonia, hepatitis and DIC.

      If he develops a varicella infection, he will need to be admitted and require a specialist review and intravenous Acyclovir.

    • This question is part of the following fields:

      • Immunological Products & Vaccines
      • Pharmacology
      57.6
      Seconds
  • Question 2 - Which of the following best characterizes the correct administration of amiodarone for a...

    Incorrect

    • Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:

      Your Answer: Give 300 mg IV amiodarone after 3 shocks, and then every 3 - 5 minutes thereafter

      Correct Answer: Give 300 mg IV amiodarone after 3 shocks

      Explanation:

      After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      45.9
      Seconds
  • Question 3 - A 54-year-old man who is acutely unwell has his blood sent for test...

    Correct

    • A 54-year-old man who is acutely unwell has his blood sent for test and the results come back with a CRP of 115.

      Which of these statements about C-reactive protein is FALSE?

      Your Answer: It is produced in the bone marrow

      Explanation:

      C-reactive protein(CRP) is synthesized in the liver in response to increased interleukin-6 (IL-6) secretion by macrophages and T-cells.
      Some conditions that cause CRP levels to a rise include: bacterial infection, fungal infection, severe trauma, autoimmune disease, Organ tissue necrosis, malignancy and surgery.

      It is useful in the clinical setting as a marker of inflammatory activity and can be used to monitor infections.

      CRP levels start to rise 4-6 hours after an inflammatory trigger and reaches peak levels at 36-50 hours.

      In the absence of a disease process, the normal plasma concentration is less than 5 mg/l.

      CRP is useful for monitoring inflammatory conditions (e.g. rheumatoid arthritis and malignancy), can be used as a prognostic marker in acute pancreatitis, and serial measurement can be used to recognize the onset of nosocomial infections in the intensive care settling.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      66.4
      Seconds
  • Question 4 - A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain,...

    Correct

    • A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain, and breathlessness. A bedside echocardiogram was performed and revealed a large pericardial effusion. Due to this finding, a pericardiocentesis was to be performed.

      Which of the following statements is considered true regarding pericardiocentesis?

      Your Answer: The needle should be aimed at the midpoint of the left clavicle

      Explanation:

      Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.

      In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle.

      The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      44
      Seconds
  • Question 5 - Following a decrease in extracellular volume, which of the following is a reaction...

    Correct

    • Following a decrease in extracellular volume, which of the following is a reaction to enhanced sympathetic innervation of the kidney:

      Your Answer: Release of renin

      Explanation:

      The RAS pathway begins with renin cleaving its substrate, angiotensinogen (AGT), to produce the inactive peptide, angiotensin I, which is then converted to angiotensin II by endothelial angiotensin-converting enzyme (ACE). ACE activation of angiotensin II occurs most extensively in the lung. Angiotensin II mediates vasoconstriction as well as aldosterone release from the adrenal gland, resulting in sodium retention and increased blood pressure.

    • This question is part of the following fields:

      • Physiology
      • Renal
      77.2
      Seconds
  • Question 6 - An elderly man presents with bilateral lower facial swelling around the mandible and...

    Incorrect

    • An elderly man presents with bilateral lower facial swelling around the mandible and upper neck. A CT scan of his neck was performed and the results were conclusive with Ludwig's angina.

      Which of the following spaces is most likely affected based on the case presented?

      Your Answer:

      Correct Answer: Submandibular space

      Explanation:

      Ludwig’s angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. It involves three compartments of the floor of the mouth: the sublingual, submental, and submandibular.

      Ludwig’s angina usually originates as a dental infection of the second or third mandibular molars. The infection begins in the subgingival pocket and spreads to the musculature of the floor of the mouth. It progresses below the mylohyoid line, indicating that it has moved to the sublingual space. As the roots of the second and third mandibular molars lie below this line, infection of these teeth will predispose to Ludwig’s angina. The infection spreads lingually rather than buccally because the lingual aspect of the tooth socket is thinner. It initially spreads to the sublingual space and progresses to the submandibular space.

      The disease is usually polymicrobial, involving oral flora, both aerobes, and anaerobes. The most common organisms are Staphylococcus, Streptococcus, Peptostreptococcus, Fusobacterium, Bacteroides, and Actinomyces.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds
  • Question 7 - Which of the following does not increase renal phosphate excretion? ...

    Incorrect

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

      Your Answer:

      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
      0
      Seconds
  • Question 8 - A patient is complaining of painless jaundice. His bilirubin levels are abnormally high.

    Which...

    Incorrect

    • A patient is complaining of painless jaundice. His bilirubin levels are abnormally high.

      Which of the following statements about bile is correct?

      Your Answer:

      Correct Answer: Bile acids are amphipathic

      Explanation:

      The liver produces bile on a constant basis, which is then stored and concentrated in the gallbladder. In a 24-hour period, around 400 to 800 mL of bile is generated.

      Bile is involved in the following processes:
      Fats are broken down into fatty acids.
      Waste products are eliminated.
      Cholesterol homeostasis is the balance of cholesterol in the body.

      The enteric hormones cholecystokinin and secretin are primarily responsible for bile secretion. When chyme from an unprocessed meal enters the small intestine, they are released, and they play the following function in bile secretion and flow:

      Cholecystokinin promotes gallbladder and common bile duct contractions, allowing bile to reach the intestine.
      Secretin enhances the secretion of bicarbonate and water by biliary duct cells, increasing the amount of bile and its flow into the gut.

      Bile acids have a hydrophobic and hydrophilic area, making them amphipathic. Bile acids’ amphipathic nature allows them to perform the following crucial functions:

      Emulsification of lipid aggregates increases the surface area of fat and makes it easier for lipases to digest it.
      Lipid solubilization and transport: solubilizes lipids by creating micelles, which are lipid clumps that float in water.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      0
      Seconds
  • Question 9 - At the start of the cardiac cycle, towards the end of diastole, all...

    Incorrect

    • At the start of the cardiac cycle, towards the end of diastole, all of the following statements are true EXCEPT for:

      Your Answer:

      Correct Answer: The semilunar valves are open.

      Explanation:

      At the start of the cardiac cycle, towards the end of diastole, the whole of the heart is relaxed. The atrioventricular (AV) valves are open because the atrial pressure is still slightly greater than the ventricular pressure. The semilunar valves are closed, as the pressure in the pulmonary artery and aorta is greater than the ventricular pressures. The cycle starts when the sinoatrial node (SAN) initiates atrial systole.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds
  • Question 10 - The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A...

    Incorrect

    • The patient is a 78-year-old woman who has recently developed left-sided hemiplegia. A CT head scan is performed, and the diagnosis of an ischaemic stroke is confirmed. Her blood pressure is currently very high, with the most recent measurement being 196/124 mmHg, according to the nurse in charge. While you wait for the stroke team to review her, she asks you to prescribe something to help lower the patient's blood pressure.

      Which of the following is the best drug treatment for this patient's BP reduction?

      Your Answer:

      Correct Answer: Labetalol

      Explanation:

      End-organ damage (e.g. encephalopathy, intracranial haemorrhage, acute myocardial infarction or ischaemia, dissection, pulmonary oedema, nephropathy, eclampsia, papilledema, and/or angiopathic haemolytic anaemia) characterises a hypertensive emergency (also known as ‘accelerated hypertension’ or malignant hypertension’ It’s a life-threatening condition that necessitates rapid blood pressure reduction to avoid end-organ damage and a negative outcome.

      In the setting of a stroke syndrome (i.e., in the presence of focal neurological deficits), hypertensive emergencies usually necessitate a slower and more controlled blood pressure reduction than in other situations. Rapid reduction of MAP in the presence of an ischaemic stroke can compromise blood flow, leading to further ischaemia and worsening of the neurological deficit. In this situation, intravenous labetalol is the drug of choice for lowering blood pressure.

      Significantly elevated blood pressure (>185/110 mmHg) is a contraindication to thrombolysis, but there is some evidence for controlling blood pressure before thrombolysis in exceptional circumstances, when it is only slightly above this threshold.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 11 - A 36-year-old man presented to the emergency room after an incident of slipping...

    Incorrect

    • A 36-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip extension, but normal hip abduction.

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

      Your Answer:

      Correct Answer: Gluteus maximus

      Explanation:

      The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.

      The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.
      The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds
  • Question 12 - A blood test of a 7-year-old child with a 6-day history of bloody...

    Incorrect

    • A blood test of a 7-year-old child with a 6-day history of bloody diarrhoea reveals a low platelet count, anaemia, and impaired kidney function. What bacteria is suspected of causing such a condition?

      Your Answer:

      Correct Answer: Escherichia coli

      Explanation:

      Escherichia coli produces shiga toxin that causes diarrhoea, hemorrhagic colitis, and haemolytic uremic syndrome.

      Haemolytic uremic syndrome is characterized by anaemia, thrombocytopenia, and acute renal failure. Transmission of E. coli is possible after consuming contaminated, undercooked drinks and foods. E. coli enters the body via the faecal-oral pathway.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds
  • Question 13 - Which of the following muscles laterally rotates the hip? ...

    Incorrect

    • Which of the following muscles laterally rotates the hip?

      Your Answer:

      Correct Answer: Gluteus maximus

      Explanation:

      External (lateral) rotation at the hip joint is produced by the gluteus maximus together with a group of 6 small muscles (lateral rotators): piriformis, obturator internus, superior and inferior gemelli, quadratus femoris and obturator externus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds
  • Question 14 - The triage nurse asks if you will prescribe a dose of codeine phosphate...

    Incorrect

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

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

      Your Answer:

      Correct Answer: Age under 12 years

      Explanation:

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

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

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

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

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

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

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 15 - In the Paediatric Emergency Department, you saw a 6-year-old girl with severe bilateral conjunctivitis....

    Incorrect

    • In the Paediatric Emergency Department, you saw a 6-year-old girl with severe bilateral conjunctivitis. You give her mother some general eye hygiene advice and prescribe chloramphenicol eye drops.

      What is the chloramphenicol's mechanism of action?

      Your Answer:

      Correct Answer: Inhibition of protein synthesis

      Explanation:

      Chloramphenicol is a broad-spectrum antibiotic that inhibits bacterial protein synthesis by blocking the 50S subunit of the bacterial ribosome’s peptidyl transferase activity. When administered systemically, it has limited usage due to the potential of significant side effects such as aplastic anaemia, peripheral neuropathy, and optic neuritis. It’s only used to treat typhoid fever and Haemophilus influenzae meningitis, but it’s usually better to use a broad-spectrum cephalosporin.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds
  • Question 16 - A 50-year-old man from Russia presents with a history of cough with blood-stained...

    Incorrect

    • A 50-year-old man from Russia presents with a history of cough with blood-stained sputum, fever, night sweats, and weight loss. Suspecting tuberculosis, you begin investigations.

      All the following statements regarding tuberculosis (TB) are true EXCEPT?

      Your Answer:

      Correct Answer: Corticosteroid use is not a risk factor for developing TB

      Explanation:

      Immunosuppressants like corticosteroids may be an important risk factor for developing tuberculosis.

      All of the other statements are true.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      0
      Seconds
  • Question 17 - The myocardium is responsible for creating the force with which the atrial and...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 18 - Which of the following ions is more abundant in extracellular fluid than in...

    Incorrect

    • Which of the following ions is more abundant in extracellular fluid than in intracellular fluid:

      Your Answer:

      Correct Answer: Cl -

      Explanation:

      Protein and phosphate are the primary intracellular anions, while chloride (Cl-) and bicarbonate are the predominant extracellular anions (HCO3-).

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds
  • Question 19 - A 65-year-old man comes for a visit at the clinic with complaints of...

    Incorrect

    • A 65-year-old man comes for a visit at the clinic with complaints of abdominal pain. On inquiring about drug history, you find out that he has been taking around 8-10 paracetamol to help relieve the pain.

      Out of the following, which one is believed to be the main mechanism of action for paracetamol?

      Your Answer:

      Correct Answer: Selective inhibition of COX-3 receptors

      Explanation:

      The FDA categorizes Paracetamol as an NSAID (nonsteroidal anti-inflammatory drug) as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord.

      COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.
      Acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, therefore, has no peripheral anti-inflammatory effects.
      The antipyretic actions of acetaminophen are likely attributed to direct action on heat-regulating centres in the brain, resulting in peripheral vasodilation, sweating, and loss of body heat.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 20 - About what percentage of filtered Na+is reabsorbed in the loop of Henle: ...

    Incorrect

    • About what percentage of filtered Na+is reabsorbed in the loop of Henle:

      Your Answer:

      Correct Answer: 25%

      Explanation:

      About 25% of filtered sodium is reabsorbed in the the loop of Henle.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 21 - A 33 year old female patient presents to emergency room with some symptoms...

    Incorrect

    • A 33 year old female patient presents to emergency room with some symptoms that she thinks might be due to a drug that she has recently started. She was started on hyoscine butyl bromide for symptomatic relief of irritable bowel syndrome. The least likely expected side effect of this drug in this patient is:

      Your Answer:

      Correct Answer: Diarrhoea

      Explanation:

      One of the commonest antispasmodic medications that is used is hyoscine butylbromide. It is an antimuscarinic and typical side effects of this class of drugs include:
      – dilation of pupils with loss of accommodation (cycloplegia)
      -photophobia resulting in blurred vision (Blind as a bat)
      -dry mouth, eyes and skin (Dry as a bone),
      -elevated temperature (Hot as a hare)
      -skin flushing (Red as a beet)
      -confusion or agitation particularly in the elderly (Mad as a hatter)
      -reduced bronchial secretions
      -transient bradycardia followed by tachycardia, palpitation and arrhythmias
      -urinary retention and/or constipation

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      0
      Seconds
  • Question 22 - Which of the following laboratory findings is NOT typical of Hodgkin lymphoma: ...

    Incorrect

    • Which of the following laboratory findings is NOT typical of Hodgkin lymphoma:

      Your Answer:

      Correct Answer: Basophilia

      Explanation:

      Features may include:Normochromic normocytic anaemia is most common; bone marrow failure involvement is unusual in early disease, but if it occurs bone marrow failure may develop with leucoerythroblastic anaemiaOne-third of patients have a neutrophilia; eosinophilia is frequentAdvanced disease is associated with lymphopenia and loss of cell-mediated immunityPlatelet count is normal or increased in early disease and reduced in later stagesESR and CRP are usually raised (ESR is useful in monitoring disease progress)Serum LDH is raised initially in 30-40% of casesDiagnosis is made by histological examination of an excised lymph nodeThe distinctive multinucleate polypoid RS cell is central to the diagnosis of the four classic types of HL (95% of cases)

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds
  • Question 23 - What is nimodipine used predominantly in the treatment of? ...

    Incorrect

    • What is nimodipine used predominantly in the treatment of?

      Your Answer:

      Correct Answer: Prevention and treatment of vascular spasm following subarachnoid haemorrhage

      Explanation:

      Nimodipine is a smooth muscle relaxant that is related to nifedipine, but the effects preferentially act on cerebral arteries. It is exclusively used for the prevention and treatment of vascular spasm after an aneurysmal subarachnoid haemorrhage.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds
  • Question 24 - Insulin is produced by which of the following pancreatic cells: ...

    Incorrect

    • Insulin is produced by which of the following pancreatic cells:

      Your Answer:

      Correct Answer: β cells

      Explanation:

      Insulin is produced by beta cells, located centrally within the islets of Langerhans, in the endocrine tissues of the pancreas. Insulin is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds. Proinsulin is synthesised as a single-chain peptide. Within storage granules, a connecting peptide (C peptide) is removed by proteases to yield insulin. Insulin release is stimulated initially during eating by the parasympathetic nervous system and gut hormones such as secretin, but most output is driven by the rise in plasma glucose concentration that occurs after a meal. The effects of insulin are mediated by the receptor tyrosine kinase.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      0
      Seconds
  • Question 25 - Regarding Clostridium difficile, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding Clostridium difficile, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: It is normally found in gut flora.

      Explanation:

      C. difficile is normally found in the gut flora but its growth is normally suppressed by more dominant anaerobes. It has exotoxin-mediated effects causing profuse diarrhoea. Oral clindamycin (a broad spectrum antibiotic) is commonly implicated in precipitating C. difficile colitis; first line treatment is with oral metronidazole. Tetanolysin is a toxin produced by Clostridium tetani bacteria.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds
  • Question 26 - After a work-related accident, a 33-year old male is taken to the emergency...

    Incorrect

    • After a work-related accident, a 33-year old male is taken to the emergency room with difficulty in adduction and flexion of his left arm at the glenohumeral joint. The attending physician is suspects involvement of the coracobrachialis muscle.

      The nerve injured in the case above is?

      Your Answer:

      Correct Answer: The musculocutaneous nerve

      Explanation:

      The coracobrachialis muscle is innervated by the musculocutaneous nerve (C5-C7) a branch of the lateral cord of the brachial plexus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 27 - Which of the following corticosteroids has the most potent mineralocorticoid effect: ...

    Incorrect

    • Which of the following corticosteroids has the most potent mineralocorticoid effect:

      Your Answer:

      Correct Answer: Fludrocortisone

      Explanation:

      Fludrocortisone has the most potent mineralocorticosteroid activity, making it ideal for mineralocorticoid replacement in adrenal insufficiency.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      0
      Seconds
  • Question 28 - A 36-year-old man who works in a farm presents with a deep laceration...

    Incorrect

    • A 36-year-old man who works in a farm presents with a deep laceration over the palm of his hand. A median nerve block was performed at his wrist to facilitate wound exploration and closure.

      Which of the following statements regarding median nerve blocks at the wrist is considered correct?

      Your Answer:

      Correct Answer: The needle should be inserted approximately 2.5 cm proximal to flexor retinaculum

      Explanation:

      A median nerve block is a simple, safe, and effective method of obtaining anaesthesia to the palmar aspect of the thumb, index finger, middle finger, radial portion of the palm and ring finger. The median nerve lies deep to the flexor retinaculum and about one centimetre under the skin of the volar wrist.
      The palmaris longus tendon lies superficial to the retinaculum and is absent in up to 20% of patients.
      The median nerve is located slightly lateral (radial) to the palmaris longus tendon and medial (ulnar) to the flexor carpi radialis tendon.

      The procedure is as follows:
      – Check sensation and motor function of the median nerve. Wear gloves and use appropriate barrier precautions.
      – Locate the flexor carpi radialis and palmaris longus tendons, which become prominent when the patient flexes the wrist against resistance. The palmaris longus tendon is usually the more prominent of the two tendons.
      – Needle-entry site: The needle will be inserted adjacent to the radial (lateral) border of the palmaris longus tendon just proximal to the proximal wrist crease. If the palmaris longus tendon is absent, the needle-entry site is about 1 cm ulnar to the flexor carpi radialis tendon.
      – Cleanse the site with antiseptic solution. Place a skin wheal of anaesthetic, if one is being used, at the needle-entry site.
      – Insert the needle perpendicularly through the skin and advance it slowly until a slight pop is felt as the needle penetrates the flexor retinaculum. When paraesthesia in the distribution of the median nerve confirms proper needle placement, withdraw the needle 1 to 2 mm.
      – Aspirate to exclude intravascular placement and then slowly (i.e., over 30 to 60 seconds) inject about 3 mL of anaesthetic. If the patient does not feel paraesthesia, redirect the needle in an ulnar direction, under the palmaris longus tendon. If paraesthesia is still not felt, slowly inject 3 to 5 mL of anaesthetic in the proximity of the nerve 1 cm deep to the tendon.
      – Allow about 5 to 10 minutes for the anaesthetic to take effect.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds
  • Question 29 - A 23-year-old female has been prescribed a medication in the first trimester of...

    Incorrect

    • A 23-year-old female has been prescribed a medication in the first trimester of pregnancy due to a life-threatening medical problem. After delivery, the foetus is found to have nasal hypoplasia, stippling of his bones and atrophy of bilateral optic discs along with growth retardation.

      Which ONE of the following drugs has this woman most likely received?

      Your Answer:

      Correct Answer: Warfarin

      Explanation:

      Warfarin is teratogenic and can cause a host of abnormalities in the growing foetus. These include hypoplasia of the nasal bridge, stippling of the epiphyses, multiple ophthalmic complications, growth retardation, pectus carinatum, atrial septal defect, ventriculomegaly and a patent ductus arteriosus.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds
  • Question 30 - You received a patient with a 2-day history of diarrhoea and vomiting. Later,...

    Incorrect

    • You received a patient with a 2-day history of diarrhoea and vomiting. Later, after examination, the patient was found to have progressive symmetric descending flaccid paralysis, initial development of blurred vision, dysphagia, and weakness of the upper limbs. The patient is apyrexial and his observations are all normal. Which of the following pathogens is responsible for the said symptoms?

      Your Answer:

      Correct Answer: Clostridium botulinum

      Explanation:

      A botulism infection results in neuroparalysis caused by the neurotoxin generated by Clostridium botulinum.

      Food-borne botulism symptoms often appear 12-36 hours after ingestion of the toxin-containing food and may include nausea, vomiting, stomach discomfort, and diarrhoea at first. The most common neurological pattern is an acute onset of bilateral cranial neuropathies with symmetric declining weakening.

      Other distinguishing characteristics include the absence of fever, the absence of cognitive abnormalities, the presence of a normal heart rate and blood pressure, and the absence of sensory defects.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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