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  • Question 1 - A paediatric patient comes to the emergency room with complaints of right lower...

    Correct

    • A paediatric patient comes to the emergency room with complaints of right lower quadrant pain. The attending physician is considering appendicitis. Inside the operating room, the surgeon asks the medical student to locate the McBurney's point prior to the first incision.

      Which of the following is the surface anatomy of the McBurney's point?

      Your Answer: One-third of the distance from the anterior superior iliac spine to the umbilicus

      Explanation:

      Inflammation of the appendix is a significant public health problem with a lifetime incidence of 8.6% in men and 6.7% in women, with the highest incidence occurring in the second and third decade of life. While the rate of appendectomy in developed countries has decreased over the last several decades, it remains one of the most frequent emergent abdominal operations. Appendicitis can often result in anorexia, nausea, vomiting, and fever.

      McBurney’s point, which is found one-third of the distance between the anterior superior iliac spine and the umbilicus, is often the point of maximal tenderness in a patient with an anatomically normal appendix. A McBurney’s incision is chiefly used for cecostomy and appendectomy. It gives a limited exposure only, and should any doubt arise about the diagnosis, an infraumbilical right paramedian incision should be used instead.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      22.9
      Seconds

  • Question 2 - A 28-year-old female arrives after taking an unknown chemical in excess. She is tired...

    Correct

    • A 28-year-old female arrives after taking an unknown chemical in excess. She is tired and her speech is slurred. The following are her observations and results:HR 118,BP 92/58,SaO2 96%
      HR 118,  11/15 The following are the results  of his arterial blood gas (ABG):
      pH: 7.24pO 2 : 9.4kPa PCO2 : 3.3kPa HCO 3 -: 22 mmol/lNa + : 143 mmol/lCl – : 99 mmol/lLactate: 5 IU/l

      Which of the following statements about this patient is TRUE?

      Your Answer: Her anion gap is elevated

      Explanation:

      The interpretation of arterial blood gas (ABG) aids in the measurement of a patient’s pulmonary gas exchange and acid-base balance.
      The normal values on an ABG vary a little depending on the analyser, but they are roughly as follows:
      Variable
      Range
      pH
      7.35 – 7.45
      PaO2
      10 – 14 kPa
      PaCO2
      4.5 – 6 kPa
      HCO3-
      22 – 26 mmol/l
      Base excess
      -2 – 2 mmol/l

      The patient’s history indicates that she has taken an overdose in this case. Because her GCS is 11/15 and she can communicate with slurred speech, she is clearly managing her own airway, there is no current justification for intubation.

      The following are the relevant ABG findings:

      Hypoxia (mild)
      pH has been lowered (acidaemia)
      PCO2 levels are low.
      bicarbonate in its natural state
      Lactate levels have increased

      The anion gap represents the concentration of all the unmeasured anions in the plasma. It is the difference between the primary measured cations and the primary measured anions in the serum. It can be calculated using the following formula:
      Anion gap = [Na+] – [Cl-] – [HCO3-]

      The reference range varies depending on the technique of measurement, but it is usually between 8 and 16 mmol/L.

      The following formula can be used to compute her anion gap:
      Anion gap = [143] – [99] – [22]
      Anion gap = 22

      As a result, it is clear that she has a metabolic acidosis with an increased anion gap.

      The following are some of the causes of type A and type B lactic acidosis:
      Type A lactic acidosis
      Type B lactic acidosis
      Shock (including septic shock)
      Left ventricular failure
      Severe anaemia
      Asphyxia
      Cardiac arrest
      CO poisoning
      Respiratory failure
      Severe asthma and COPD
      Regional hypoperfusion
      Renal failure
      Liver failure
      Sepsis (non-hypoxic sepsis)
      Thiamine deficiency
      Alcoholic ketoacidosis
      Diabetic ketoacidosis
      Cyanide poisoning
      Methanol poisoning
      Biguanide poisoning

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      109.1
      Seconds

  • Question 3 - Regarding benzodiazepines, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding benzodiazepines, which of the following statements is INCORRECT:

      Your Answer: Flumazenil is used to antagonise the effects of benzodiazepines.

      Correct Answer: Diazepam is a short-acting benzodiazepine.

      Explanation:

      Diazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration. Midazolam is a water-soluble benzodiazepine that is often used in preference to intravenous diazepam; recovery is faster than from diazepam, but may be significantly longer in the elderly, in patients with a low cardiac output, or after repeated dosing. Midazolam is associated with profound sedation when high doses are given intravenously or when it is used with certain other drugs.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      10.3
      Seconds

  • Question 4 - A 35-year-old man suffers an open fracture of his forearm. The nerve that...

    Incorrect

    • A 35-year-old man suffers an open fracture of his forearm. The nerve that innervates the pronator quadratus muscle is damaged as a consequence of this injury.
      Which of the following nerves has been damaged in this case? Select ONE answer only.

      Your Answer: The median nerve

      Correct Answer: The anterior interosseous nerve

      Explanation:

      Pronator quadratus is a small, square-shaped muscle that lies in the anterior compartment of the forearm. It arises from the distal fourth of the anterior surface of the ulna and inserts into the distal fourth of the anterior surface of the radius.
      Pronator quadratus is innervated by the anterior interosseous nerve. It receives its blood supply from the anterior interosseous artery, which is a branch of the common interosseous artery, which in turn is a branch of the ulnar artery.
      The main action of pronator quadratus is to assist pronator teres with pronation of the forearm. The deep fibres bind the radius and ulna together.
      The pronator quadratus muscle highlighted in blue (adapted from Gray’s Anatomy)

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      11.1
      Seconds

  • Question 5 - A 28-year-old medical student ate a reheated Chinese takeaway and developed severe vomiting...

    Correct

    • A 28-year-old medical student ate a reheated Chinese takeaway and developed severe vomiting a few hours after.

      What is the SINGLE MOST likely causative organism?

      Your Answer: Bacillus cereus

      Explanation:

      Bacillus cereusis is the correct answer. It is a Gram-positive, rod-shaped, beta-haemolytic bacterium that causes ‘fried rice syndrome’.

      Hardy spores in rice can survive boiling. When left at room temperature for long periods prior to frying these spores germinate. The emetic enterotoxin-producing strains cause nausea and vomiting between 1 and 6 hours after consumption while the diarrheagenic enterotoxin-producing strains (commonly associated with ingestion of meat, vegetables and dairy products) causes abdominal pain and vomiting, which starts 8-12 hours after ingestion.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      10.6
      Seconds

  • Question 6 - Which of the following terms describes the proportion of individuals with a negative...

    Incorrect

    • Which of the following terms describes the proportion of individuals with a negative test result who actually do not have a disease:

      Your Answer: Specificity

      Correct Answer: Negative predictive value

      Explanation:

      Negative predictive value (NPV) is the proportion of individuals with a negative test result who do not have the disease.
      NPV = d/(c+d)

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      10.4
      Seconds

  • Question 7 - Which of the following statements regarding hookworm is FALSE: ...

    Incorrect

    • Which of the following statements regarding hookworm is FALSE:

      Your Answer: Hookworm larvae mature into adult worms in the small intestine.

      Correct Answer: Transmission of hookworm is via ingestion of contaminated food and water.

      Explanation:

      The hookworm life cycle begins with the passage of eggs from an adult host into the stool. Hookworm eggs hatch in the soil to release larvae that mature into infective larvae. Infection is usually transmitted by larval penetration into human skin (duodenal infection may also be transmitted by the oral route). From the skin, larvae migrate into the blood vessels and are carried to the lungs, where they penetrate the pulmonary alveoli, ascend the bronchial tree to the pharynx, and are swallowed.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      19.8
      Seconds

  • Question 8 - A 22 year old professional athlete sustains an inversion injury to her left...

    Correct

    • A 22 year old professional athlete sustains an inversion injury to her left ankle during the 800m. Which of the following ligaments is most likely injured:

      Your Answer: Anterior talofibular ligament

      Explanation:

      Inversion injuries at the ankle in plantarflexion (such as when wearing high heels) are common, and typically result in damage to the lateral collateral ligament of the ankle, made up of the anterior talofibular, the calcaneofibular and the posterior talofibular ligaments. The anterior talofibular and the calcaneofibular ligaments are most commonly injured, and the posterior talofibular ligament rarely. The spring ligament supports the head of the talus, the deltoid ligament supports the medial aspect of the ankle joint, and the long and short plantar ligaments are involved in maintaining the lateral longitudinal arch of the foot.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      16.9
      Seconds

  • Question 9 - Which of the following local anaesthetics has the longest duration of action: ...

    Correct

    • Which of the following local anaesthetics has the longest duration of action:

      Your Answer: Bupivacaine

      Explanation:

      Bupivacaine has a longer duration of action than the other local anaesthetics, up to 8 hours when used for nerve blocks. It has a slow onset, taking up to 30 minutes for full effect. It is often used in lumbar epidural blockade and is particularly suitable for continuous epidural analgesia in labour, or for postoperative pain relief. It is the principal drug used for spinal anaesthesia.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      7.4
      Seconds

  • Question 10 - Regarding pressures and airflow during the normal breathing cycle, which of the following...

    Incorrect

    • Regarding pressures and airflow during the normal breathing cycle, which of the following statements is INCORRECT:

      Your Answer: In forced expiration, intrapleural pressure becomes positive.

      Correct Answer: Negative intrapleural pressure causes dynamic compression of the airways.

      Explanation:

      Dynamic compression occurs during forced expiration, when as the expiratory muscles contract, all the structures within the lungs, including the airways, are compressed by the positive intrapleural pressure. Consequently the smaller airways collapse before the alveoli empty completely and some air remains within the lungs (the residual volume).

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      71.2
      Seconds

  • Question 11 - On her most recent blood tests, a 55 year-old female with a history of hypertension...

    Correct

    • On her most recent blood tests, a 55 year-old female with a history of hypertension was discovered to be hypokalaemic. She  is diagnosed with primary hyperaldosteronism.

      Which of the following is a direct action of aldosterone?

      Your Answer: Secretion of H + into the distal convoluted tubule

      Explanation:

      Aldosterone is a steroid hormone produced in the adrenal cortex’s zona glomerulosa. It is the most important mineralocorticoid hormone in the control of blood pressure. It does so primarily by promoting the synthesis of Na+/K+ATPases and the insertion of more Na+/K+ATPases into the basolateral membrane of the nephron’s distal tubules and collecting ducts, as well as stimulating apical sodium and potassium channel activity, resulting in increased sodium reabsorption and potassium secretion. This results in sodium conservation, potassium secretion, water retention, and a rise in blood volume and blood pressure.

      Aldosterone is produced in response to the following stimuli:

      Angiotensin II levels have risen.
      Potassium levels have increased.
      ACTH levels have risen.
      Aldosterone’s principal actions are as follows:
      Na+ reabsorption from the convoluted tubule’s distal end
      Water resorption from the distal convoluted tubule (followed by Na+)
      Cl is reabsorbed from the distal convoluted tubule.
      K+ secretion into the convoluted distal tubule’s 
      H+ secretion into the convoluted distal tubule’s 

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      44.2
      Seconds

  • Question 12 - A 30-year-old man suffers from an open femoral shaft fracture after being involved...

    Incorrect

    • A 30-year-old man suffers from an open femoral shaft fracture after being involved in a road traffic accident. As a consequence of his injury, the nerve that was damaged innervates the popliteus muscle.

      In which of the following nerves is the popliteus muscle innervated by?

      Your Answer: Deep peroneal nerve

      Correct Answer: Tibial nerve

      Explanation:

      The popliteus muscle is innervated by the tibial nerve (L4, 5 and S1).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      29
      Seconds

  • Question 13 - You've been summoned to your Emergency Department resuscitation area to see a patient....

    Correct

    • You've been summoned to your Emergency Department resuscitation area to see a patient. You consider giving him an atropine shot because he is severely bradycardic.

      Which of the following statements about the use of atropine is correct?

      Your Answer: It blocks the effects of the vagus nerve on both the SA and AV nodes

      Explanation:

      At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.

      At muscarinic receptors, atropine blocks the action of the parasympathetic neurotransmitter acetylcholine. As a result, it inhibits the vagus nerve’s effects on both the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction.

      The most common cause of asystole during cardiac arrest is primary myocardial pathology, not excessive vagal tone, and there is no evidence that atropine is helpful in the treatment of asystole or PEA. As a result, it is no longer included in the ALS algorithm’s non-shockable section. Atropine is most commonly used in the peri-arrest period. It is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.

      If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of 500 mcg IV:
      Shock
      Syncope
      Myocardial ischaemia
      Heart failure

      Atropine is also used for the following purposes:
      Topically as a cycloplegic and mydriatic to the eyes
      To cut down on secretions (e.g. in anaesthesia)
      Organophosphate poisoning is treated with
      Atropine’s side effects are dose-dependent and include:
      Mouth is parched
      Vomiting and nausea
      Vision is hazy
      Retention of urine
      Tachyarrhythmias
      It can also cause severe confusion and hallucinations in patients, especially the elderly.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      45.2
      Seconds

  • Question 14 - A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic...

    Incorrect

    • A 40-year-old woman was rushed to the Emergency Department due to an anaphylactic reaction after being stung by a bee. She responded well to initial treatment but developed anaphylactic symptoms after 6 hours. Her symptoms were resolved after a further dose of adrenaline. Her family threatened legal action as they thought she had not received adequate treatment but withdrew their accusation after the attending physician explained that the woman had suffered a biphasic reaction.

      What is the approximate percentage of people who suffer this type of reaction?

      Your Answer: 1%

      Correct Answer: 20%

      Explanation:

      Anaphylactic reactions are Type 1 hypersensitivity reactions IgE-mediated and can be potentially life-threatening if not treated promptly. There are four well-recognized patterns of anaphylaxis:
      1) Uniphasic
      2) Biphasic
      3) Protracted
      4) Refractory

      Biphasic reactions occur in 20% of the population, although their mechanism is poorly understood. The symptoms of anaphylaxis recur within 4-6 hours, although they may also recur up to 72 hours later. All patients discharged from the hospital after an anaphylactic shock must:
      1) Be warned to return to the hospital immediately if symptoms recur
      2) Have a treatment plan in place
      3) Have a follow-up appointment
      4) Be considered for an adrenaline auto-injector
      5) Referred to an allergy clinic

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      12.1
      Seconds

  • Question 15 - A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment....

    Correct

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

      Which one is a nucleic acid synthesis inhibitor?

      Your Answer: Ciprofloxacin

      Explanation:

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

      Action Mechanisms- Examples:

      Cell wall production is inhibited
      Vancomycin
      Vancomycin
      Cephalosporins

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

      Inhibition of protein synthesis
      Chloramphenicol
      Macrolides
      Aminoglycosides
      Tetracyclines

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

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      9.4
      Seconds

  • Question 16 - What is the recommended dosing regime for amiodarone in the treatment of a...

    Incorrect

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

      Your Answer: 300 mg IV over 20 - 60 minutes, followed by further 300 mg IV infusion over 20 - 60 minutes if no response

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

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      27.8
      Seconds

  • Question 17 - A 45-year-old obese patient goes to the emergency department with a fever and...

    Correct

    • A 45-year-old obese patient goes to the emergency department with a fever and significant right upper quadrant pain. The pain radiates to her right shoulder tip.  Murphy's sign is positive and acute cholecystitis is diagnosed. The pain referred to the shoulder tip is caused by one of the following nerves:

      Your Answer: Phrenic nerve

      Explanation:

      Gallbladder inflammation can cause pain in the right upper quadrant and right shoulder, which is caused by irritation of the diaphragmatic peritoneum. Pain from areas supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3-C5.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      28
      Seconds

  • Question 18 - All of the following are physiological effects of thyroid hormones except: ...

    Correct

    • All of the following are physiological effects of thyroid hormones except:

      Your Answer: Increased glycogenesis

      Explanation:

      Thyroid hormones have multiple physiological effects on the body. These include:
      1. Heat production (thermogenesis)
      2. Increased basal metabolic rate
      3. Metabolic effects:
      (a) Increase in protein turnover (both synthesis and degradation are increased, although overall effect is catabolic)
      (b) Increase in lipolysis
      (c)Increase in glycogenolysis and gluconeogenesis
      4. Enhanced catecholamine effect – Increase in heart rate, stroke volume and thus cardiac output
      5. Important role in growth and development

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      19.9
      Seconds

  • Question 19 - Achlorhydria is diagnosed in a 37-year-old individual who has had recurring episodes of...

    Correct

    • Achlorhydria is diagnosed in a 37-year-old individual who has had recurring episodes of gastroenteritis. This is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production.

      Damage to stomach parietal cells will alter the secretion of which other substance?

      Your Answer: Intrinsic factor

      Explanation:

      Achlorhydria is an autoimmune illness of the gastric parietal cells that causes insufficient stomach acid production. The parietal cells that have been injured are unable to create the necessary amount of stomach acid. As a result, the pH of the stomach rises, food digestion suffers, and the risk of gastroenteritis rises.

      The secretion of hydrochloric acid and intrinsic factor is controlled by the gastric parietal cells, which are epithelial cells in the stomach. These cells can be found in the gastric glands, the fundus lining, and the stomach body.

      In response to the following three stimuli, the stomach parietal cells release hydrochloric acid:

      H2 Histamine receptors are stimulated by histamine (most significant contribution)
      Acetylcholine stimulates M3 Receptors via parasympathetic action.
      CCK2 receptors are stimulated by Gastrin.

      Intrinsic factor, which is essential for vitamin B12 absorption, is also produced by stomach parietal cells.
      Omeprazole is a proton pump inhibitor that is both selective and irreversible. It inhibits the H+/K+-ATPase system present on the secretory membrane of gastric parietal cells, which lowers stomach acid secretion.
      Ranitidine inhibits histamine H2-receptors in a competitive manner. The reversible inhibition of H2-receptors in gastric parietal cells reduces both the volume and concentration of gastric acid.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      16.2
      Seconds

  • Question 20 - A 15-year-old boy was brought to the emergency room with complaints of a...

    Incorrect

    • A 15-year-old boy was brought to the emergency room with complaints of a headache, stiffness of the neck, and photophobia. Upon observation, the following were noted: HR 124, BP 86/43, RR 30, SaO 95%, temperature 39.5 deg C. A recently developed non-blanching rash on his legs was also observed.

      What is most likely the causative agent of the case presented above?

      Your Answer: Neisseria meningitidis group C

      Correct Answer: Neisseria meningitidis group B

      Explanation:

      The meningococcus is solely a human pathogen, and up to 50% of the population may carry meningococci in the nasopharynx. Factors that lead to invasion and production of disease include complex inter-relationships of genetic predisposition, host status, environmental conditions, and virulence of the organism.

      Meningococcal disease is the most common infectious cause of death in childhood in developed countries. It presents as septicaemia, meningitis, or a combination. Septicaemia is the more dangerous presentation, especially with septic shock; meningitis is more likely to lead to neurodevelopmental sequelae. Classic features of septicaemia are a non-blanching rash in a feverish, ill child.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      17.7
      Seconds

  • Question 21 - Adrenocorticotropic hormone release from the anterior pituitary is stimulated by which of the...

    Correct

    • Adrenocorticotropic hormone release from the anterior pituitary is stimulated by which of the following:

      Your Answer: Corticotropin-releasing hormone

      Explanation:

      ACTH secretion is stimulated by corticotropin-releasing hormone (CRH) from the hypothalamus.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      11.5
      Seconds

  • Question 22 - Which of the following leukaemias is most common in children in the UK:...

    Incorrect

    • Which of the following leukaemias is most common in children in the UK:

      Your Answer: Acute myeloid leukaemia

      Correct Answer: Acute lymphoblastic leukaemia

      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. There is a secondary rise after the age of 40 years. 85% of cases are of B-cell lineage and have an equal sex incidence; there is a male predominance for the 15% of T-cell lineage.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      6.6
      Seconds

  • Question 23 - Which of the following statements is false regarding the biceps brachii muscle? ...

    Correct

    • Which of the following statements is false regarding the biceps brachii muscle?

      Your Answer: It pronates the radioulnar joint in the forearm

      Explanation:

      The biceps brachii muscle is one of the chief muscles of the arm. The origin at the scapula and the insertion into the radius of the biceps brachii means it can act on both the shoulder joint and the elbow joint, which is why this muscle participates in a few movements of the arm. It derives its name from its two heads which merge in one unique distal body, defining the unusual structure of the muscle.

      The biceps brachii muscle is supplied by the musculocutaneous nerve (C5-C6), a branch of the brachial plexus.

      Arterial supply to the biceps brachii muscle varies considerably, coming from up to eight vessels originating from the brachial artery in the middle third of the arm.

      In the shoulder joint both muscle heads partially enforce opposite movements. The long head pulls the arm away from the trunk (abduction) and turns it inwards (inward rotation) whereas the short head pulls the arm back towards the trunk (adduction). When both heads contract simultaneously it leads to an arm bend (flexion). In the elbow joint the muscle bends the forearm (flexion) and rotates it outwards (supination). The supination is most powerful in a flexed elbow. In addition to the movement functions, the biceps has the important task to support the humeral head within the shoulder joint. Its antagonist is the triceps brachii in the posterior compartment of the arm.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      34.2
      Seconds

  • Question 24 - Which of the following best describes digoxin: ...

    Correct

    • Which of the following best describes digoxin:

      Your Answer: A positive inotrope and negative chronotrope

      Explanation:

      Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      7.3
      Seconds

  • Question 25 - A 6 year old boy is brought into the ED by his mom...

    Correct

    • A 6 year old boy is brought into the ED by his mom with a rash that is associated with Koplik's spots and a diagnosis of measles is made. What advice should be given about returning to school?

      Your Answer: 4 days from the onset of the rash

      Explanation:

      Prevention of spread of measles is extremely important and infected patients should be isolated. The infectious stage is from 3 days before the rash emerges and patients are advised to stay away from school/nursery/work for 4 days from onset of the rash.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      15.6
      Seconds

  • Question 26 - Regarding acute idiopathic thrombocytopaenic purpura (ITP), which of the following statements is CORRECT:...

    Incorrect

    • Regarding acute idiopathic thrombocytopaenic purpura (ITP), which of the following statements is CORRECT:

      Your Answer: Patients usually require treatment with immunosuppression.

      Correct Answer: Over 80% of children recover without treatment.

      Explanation:

      Acute ITP is most common in children. In approximately 75% of cases, the episode follows vaccination or infection such as chicken pox or glandular fever. Most cases are caused by non-specific immune complex attachment to platelets. Acute ITP usually has a very sudden onset and the symptoms usually disappear in less than 6 months (often within a few weeks). It is usually a self-limiting condition and over 80% of children recover without treatment; in 5 – 10% of cases a chronic form of the disease develops.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      40.9
      Seconds

  • Question 27 - A 72 year old man is brought to ED by ambulance with sudden...

    Correct

    • A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:

      Your Answer: Synchronised DC cardioversion

      Explanation:

      All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      21.9
      Seconds

  • Question 28 - Regarding diuretics, which of the following statements is CORRECT: ...

    Correct

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

      Your Answer: Carbonic anhydrase inhibitors have their effect by inhibiting bicarbonate reabsorption.

      Explanation:

      Carbonic anhydrase inhibitors e.g. acetazolamide block the reaction of carbon dioxide and water and so prevent Na+/H+exchange and bicarbonate reabsorption. The increased bicarbonate levels in the filtrate oppose water reabsorption. Proximal tubule sodium reabsorption is also reduced because it is partly dependent on bicarbonate reabsorption.

    • This question is part of the following fields:

      • Physiology
      • Renal
      40.2
      Seconds

  • Question 29 - If the ejection fraction increases, there will be a decrease in: ...

    Correct

    • If the ejection fraction increases, there will be a decrease in:

      Your Answer: End-systolic volume

      Explanation:

      An increase in ejection fraction means that a higher fraction of the end-diastolic volume is ejected in the stroke volume (e.g. because of the administration of a positive inotropic agent). When this situation occurs, the volume remaining in the ventricle after systole, the end-systolic volume, will be reduced. Cardiac output, stroke volume, and mean arterial pressure will be increased.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      10.5
      Seconds

  • Question 30 - Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given: ...

    Correct

    • Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given:

      Your Answer: At a concentration of 1 unit/mL at a fixed rate of 0.1 units/kg/hour

      Explanation:

      An intravenous insulin infusion should be started at a concentration of 1 unit/mL, at a fixed rate of 0.1 units/kg/hour. Established subcutaneous long-acting insulin therapy should be continued concomitantly. Blood ketone and blood glucose concentrations should be checked hourly and the insulin infusion rate adjusted accordingly. Blood ketone concentration should fall by at least 0.5 mmol/litre/hour and blood glucose concentration should fall by at least 3 mmol/litre/hour.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      25.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen And Pelvis (1/1) 100%
Anatomy (4/6) 67%
Physiology (7/8) 88%
Renal Physiology (2/2) 100%
Anaesthesia (1/2) 50%
Pharmacology (6/8) 75%
Upper Limb (1/2) 50%
Microbiology (2/4) 50%
Specific Pathogen Groups (1/2) 50%
Evidence Based Medicine (0/1) 0%
Statistics (0/1) 0%
Pathogens (1/2) 50%
Lower Limb (1/2) 50%
Respiratory (0/1) 0%
Cardiovascular Pharmacology (1/1) 100%
General Pathology (0/1) 0%
Pathology (0/3) 0%
Infections (1/1) 100%
Cardiovascular (3/4) 75%
Abdomen (1/1) 100%
Endocrine (3/3) 100%
Gastrointestinal Physiology (1/1) 100%
Haematology (0/2) 0%
Renal (1/1) 100%
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