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Question 1
Correct
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Regarding chemical control of respiration, which of the following statements is INCORRECT:
Your Answer: The blood-brain barrier is freely permeable to HCO3 - ions.
Explanation:CSF is separated from the blood by the blood-brain barrier. This barrier is impermeable to polar molecules such as H+and HCO3-but CO2can diffuse across it easily. The pH of CSF is therefore determined by the arterial PCO2and the CSF HCO3-and is not affected by blood pH.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 2
Correct
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Which of the following side effects is most likely caused by erythromycin:
Your Answer: QT - prolongation
Explanation:The side effects of erythromycin include abdominal pain, anaphylaxis,
cholestatic hepatitis, confusion,
diarrhoea, dyspepsia, fever, flatulence, hallucinations, hearing loss,
headache, hypertrophic pyloric stenosis, hypotension, Interstitial
nephritis, mild allergic reactions, nausea, nervous system effects,
including seizures, pain, pruritus, pseudomembranous colitis,
QT prolongation, rash, skin eruptions, tinnitus, urticaria,
ventricular arrhythmias, ventricular tachycardia, vertigo, vomiting -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 3
Correct
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A known epileptic is transported in status epilepticus by ambulance. On the way to the hospital, she took some diazepam.
Which of the following statements about diazepam is correct?Your Answer: It crosses into breast milk
Explanation:Diazepam boosts GABA’s effects, giving it sedative, hypnotic, anxiolytic, anticonvulsant, and muscle-relaxing properties. It can be administered orally, rectally, or intravenously.
With a half-life of 20-100 hours, it is a long-acting benzodiazepine. Midazolam, oxazepam, and alprazolam are examples of short-acting benzodiazepines with a half-life of less than 12 hours (Xanax).
If used in the presence of hepatic impairment, benzodiazepines can cause coma. If treatment is necessary, benzodiazepines with shorter half-lives should be used in lower doses. Diazepam is a sedative that crosses into breast milk and should be avoided by breastfeeding mothers.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 4
Correct
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 5
Incorrect
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You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
Which SINGLE statement regarding mannitol is true?Your Answer: It crosses the blood-brain-barrier
Correct Answer: It is irritant to veins and causes phlebitis
Explanation:Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
Decreasing the rate of CSF formation,and;
Withdrawing extracellular fluid from the brain across the BBB
Other uses of mannitol include:
Short-term management of glaucoma
Treatment of rhabdomyolysis
Preserve renal function in peri-operative jaundiced patients
To initiate diuresis in transplanted kidneys
Bowel preparation prior to colorectal procedures
The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
Anuria
Intracranial bleeding (except during craniotomy)
Severe cardiac failure
Severe dehydration
Severe pulmonary oedema -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Correct
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An 18-year-old student presents with a 1-week history of sore throat, low grade fever, and malaise. Upon history taking, she noted that she had a fine rash over her body a week ago that quickly fades. Further examination and observation was done and the presence of mild splenomegaly was noted. Her test shows positive for heterophile antibody test, suspecting a diagnosis of infectious mononucleosis.
Which of the following characteristics is mostly associated with the diagnosis of infectious mononucleosis?Your Answer: Atypical lymphocytes
Explanation:Epstein-Barr virus causes infectious mononucleosis which is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue and fever.
It is accompanied by atypical large peripheral blood lymphocytes. These atypical lymphocytes, also known as Downey cells, are actually activated CD8 T lymphocytes, most of which are responding to EBV-infected cells.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 7
Incorrect
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When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?
Your Answer:
Correct Answer: Fifth cervical and fourth thoracic nerves
Explanation:The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 8
Incorrect
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A patient is diagnosed as having a glucagonoma. Her blood serum glucagon concentration is 1246 pg/mL.
Glucagon is produced in which of the following cells? Select ONE answer only.Your Answer:
Correct Answer: Alpha-cells in the pancreas
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 9
Incorrect
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A 22-year-old woman is brought in by ambulance from her GP surgery with suspected meningitis. She has been given a dose of benzylpenicillin already.
What is the mechanism of action of benzylpenicillin? Select ONE answer only.Your Answer:
Correct Answer: Inhibition of cell wall synthesis
Explanation:Penicillins and the other ß-lactam antibiotics are bactericidal. They produce their antimicrobial action by preventing cross-linkage between the linear peptidoglycan polymer chains that make up the bacterial cell wall. They, therefore, inhibit cell wall synthesis.
An overview of the different mechanisms of action of the various types of antimicrobial agents is shown below:
Mechanism of action
Examples
Inhibition of cell wall synthesis
Penicillins
Cephalosporins
Vancomycin
Disruption of cell membrane function
Polymyxins
Nystatin
Amphotericin B
Inhibition of protein synthesis
Macrolides
Aminoglycosides
Tetracyclines
Chloramphenicol
Inhibition of nucleic acid synthesis
Quinolones
Trimethoprim
5-nitroimidazoles
Rifampicin
Anti-metabolic activity
Sulfonamides
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 10
Incorrect
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A patient allergic to penicillin and with marked cellulitis presents and you decide to start him on erythromycin.
Which statement about macrolide antibiotics is true?
Your Answer:
Correct Answer: They are actively concentrated within leukocytes
Explanation:Macrolide antibiotics are bacteriostatic.
They act by binding to the 50S subunit of the bacterial ribosome inhibit protein synthesis.
Macrolide antibiotics are actively concentrated within leukocytes, because of this, they are transported into the site of infection.
Macrolide antibiotics are not effective in meningitis as they do not penetrate the central nervous system well.
They are mainly against Gram-positive organisms and can be used as an alternative in patients with penicillin allergy.
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This question is part of the following fields:
- Infections
- Pharmacology
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Question 11
Incorrect
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A 30 year old man presents to ED after a road traffic accident. Free intraperitoneal fluid is found on FAST (Focussed assessment for sonography in trauma) done in the supine position.
Which of these is most likely to be affected?
Your Answer:
Correct Answer: Hepatorenal recess
Explanation:Fluid accumulates most often in the hepatorenal pouch (of Morrison) in a supine patient. The hepatorenal pouch is located behind the liver and anterior to the right kidney and is the lowest space in the peritoneal cavity in the supine position.
Although the vesicouterine and rectouterine spaces are also potential spaces for fluid accumulation, fluid accumulation in them occur in the erect position.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 12
Incorrect
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A 32 year old man is brought to ED having been thrown off his motorbike. Following initial resuscitation and ruling out life-threatening injuries, you establish the patient has weakness of hip flexion. Which of the following nerves has most likely been injured:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the hip is produced by the iliacus, the psoas major, the sartorius, rectus femoris and the pectineus muscles. The femoral nerve innervates the iliacus, pectineus, sartorius and quadriceps femoris muscles, and supplies skin on the anterior thigh, anteromedial knee and medial leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Incorrect
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Which of the following is the most likely causative organism of acute epiglottitis in a 6 year old?
Your Answer:
Correct Answer: Streptococcus pneumoniae
Explanation:Since the introduction of the HIB vaccine, most cases of acute epiglottitis are now caused by Streptococcus spp. The condition is now rare in children.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 14
Incorrect
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Regarding haemophilia A, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: In haemophilia both the APTT and PT are prolonged.
Explanation:Haemophilia A is the most common of the hereditary clotting factor deficiencies. The inheritance is sex-linked but up to one-third of patients have no family history and these cases result from recent mutation. The vast majority of cases are inherited in an X-linked recessive fashion, affecting males born to carrier mothers. Females born to affected fathers can also, rarely, be affected due to homozygosity for the gene, where there is marriage to close relatives.
The defect is an absence or low level of plasma factor VIII. The APTT is prolonged but the PT is normal. Recurrent painful haemarthroses and muscle haematomas dominate the clinical course of severely affected patients and if inadequately treated, lead to progressive joint deformity and disability. Local pressure can cause entrapment neuropathy or ischaemic necrosis. Prolonged bleeding occurs after dental extractions or post-trauma. Spontaneous haematuria and gastrointestinal haemorrhage may occur. The clinical severity of the disease correlates inversely with the factor VIII level. Operative and post-traumatic haemorrhage are life-threatening both in severely and mildly affected patients.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 15
Incorrect
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A 58-year-old man with a long history of depression presents with a deliberate overdose of verapamil tablets, which he is prescribed for a heart condition.
What is verapamil's mechanism of action?Your Answer:
Correct Answer: L-type calcium channel blockade
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.
The standard ABC approach should be used to resuscitate all patients as needed. If life-threatening toxicity is expected, intubation and ventilation should be considered early on. If hypotension and shock are developing, early invasive blood pressure monitoring is recommended.
The primary goal of specific treatments is to support the cardiovascular system. These are some of them:
1. Fluid resuscitation: Give up to 20 mL of crystalloid per kilogramme of body weight.
2. Calcium supplementation
This can be a good way to raise blood pressure and heart rate temporarily.
via central venous access: 10% calcium gluconate 60 mL IV (0.6-1.0 mL/kg in children) or 10% calcium chloride 20 mL IV (0.2 mL/kg in children)
Boluses can be given up to three times in a row.
To keep serum calcium >2.0 mEq/L, consider a calcium infusion.3. Atropine: 0.6 mg every 2 minutes up to 1.8 mg is an option, but it is often ineffective.
4. HIET (high-dose insulin-euglycemic therapy):
The role of HIET in the step-by-step management of cardiovascular toxicity has changed.5. Vasoactive infusions:
This was once thought to be a last-ditch measure, but it is now widely recommended that it be used sooner rather than later.
Insulin with a short half-life 50 mL of 50 percent glucose IV bolus plus 1 U/kg bolus (unless marked hyperglycaemia present)
Short-acting insulin/dextrose infusions should be continued.
Glucose should be checked every 20 minutes for the first hour, then hourly after that.
Regularly check potassium levels and replace if they fall below 2.5 mmol/L.
Titrate catecholamines to effect (inotropy and chronotropy); options include dopamine, adrenaline, and/or noradrenaline infusions.6. Sodium bicarbonate: Use 50-100 mEq sodium bicarbonate (0.5-1.0 mEq/kg in children) in cases where a severe metabolic acidosis develops.
7. Cardiac pacing: It can be difficult to achieve electrical capture, and it may not improve overall perfusion.
Bypass AV blockade with ventricular pacing, which is usually done at a rate of less than 60 beats per minute.8. Intralipid transport
Calcium channel blockers are lipid-soluble agents, so they should be used in refractory cases. -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 16
Incorrect
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Regarding the brachioradialis muscle, which of the following statements is true?
Your Answer:
Correct Answer: It assists with supination of the forearm at the radioulnar joints
Explanation:Brachioradialis is a fusiform muscle located in the lateral part of the posterior forearm. Along with extensor carpi radialis brevis and extensor carpi radialis longus, it comprises the radial group of forearm muscles, which belong to the superficial layer of posterior forearm muscles. Although anatomically part of the posterior forearm muscles, which are known to be forearm extensors, brachioradialis’ fibre orientation enables it to rather flex the forearm, and aids in supination of the forearm at the radioulnar joint.
The brachioradialis muscle originates from the upper two-thirds of the lateral supracondylar ridge of humerus and the anterior surface of the lateral intermuscular septum of the arm. It slides over the lateral surface of the elbow joint, entering the anterolateral cubital area. The muscle fibres course inferiorly down the radial part of the anterior forearm, forming a thick tendon in approximately the middle of the forearm. This tendon then traverses the remainder of the forearm, inserting near the wrist, just proximal to the styloid process of radius.
Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus. Blood supply to the brachioradialis muscle comes from branches of the radial artery, radial recurrent artery and the radial collateral branch of the deep brachial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Incorrect
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A 62 year old man has sustained a penetrating injury to the submandibular triangle. On examination, his tongue is weak and when protruded deviates to the left. Which of the following nerves has most likely been injured:
Your Answer:
Correct Answer: Left hypoglossal nerve
Explanation:Damage to the hypoglossal nerve results in weakness of the tongue, with deviation of the tongue towards the weak side on protrusion.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 18
Incorrect
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A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre
Out of the following, which drug is most likely responsible for the baby's condition?Your Answer:
Correct Answer: Lithium
Explanation:In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.
Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.
If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.
If given in the 2nd and 3rd-trimesters, there is a risk of the following:
1. hypotonia
2. lethargy
3. feeding problems
4. hypothyroidism
5. goitre
6. nephrogenic diabetes insipidus in the neonate -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 19
Incorrect
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Question 20
Incorrect
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Which of the following best describes a natural killer cell:
Your Answer:
Correct Answer: A large granular lymphocyte that kills by inducing target cell apoptosis.
Explanation:Natural killer (NK) cells are cytotoxic CD8 positive cells that lack the T-cell receptor. They are large cells with cytoplasmic granules. NK cells are designed to kill target cells that have a low level of expression of HLA class I molecules, such as may occur during viral infection or on a malignant cell. NK cells do this by displaying several receptors for HLA molecules on their surface. When HLA is expressed on the target cell these deliver an inhibitory signal into the NK cell. When HLA molecules are absent on the target cell this inhibitory signal is lost and the NK cell can then kill its target. In addition, NK cells display antibody-dependent cell-mediated cytotoxicity. In this, antibody binds to antigen on the surface of the target cell and then NK cells bind to the Fc portion of the bound antibody and kill the target cell.
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 21
Incorrect
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Regarding gastric motility and emptying, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Gastric emptying is inhibited by the presence of the products of fat digestion in the duodenum.
Explanation:Gastric emptying is decreased by the presence of fats in the duodenum (by stimulating release of cholecystokinin). Mixing of the food with gastric secretions takes place in the distal body and antrum of the stomach where the muscularis externa layer is thicker. The stomach has an additional inner oblique smooth muscle layer (in addition to the inner circular layer and outer longitudinal layer). Gastric emptying is increased by a low gastric pH and decreased by a low duodenal pH.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 22
Incorrect
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Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?
Your Answer:
Correct Answer: The lateral spinothalamic tract
Explanation:The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 23
Incorrect
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Which of the following is NOT a side effect of phenytoin:
Your Answer:
Correct Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:
Nausea and vomiting
Drowsiness, lethargy, and loss of concentration
Headache, dizziness, tremor, nystagmus and ataxia
Gum enlargement or overgrowth
Coarsening of facial features, acne and hirsutism
Skin rashes
Blood disorders -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 24
Incorrect
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The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the postsynaptic cell responds to the neurotransmitter.
Which of the following enzymes catalyses the breakdown of noradrenaline?Your Answer:
Correct Answer: Catechol-O-methyltransferase (COMT)
Explanation:The neurotransmitter in the synaptic cleft is either eliminated or deactivated after the post-synaptic cell responds to the neurotransmitter.
This can be accomplished in a variety of ways:
Re-uptake
Breakdown
DiffusionSerotonin is an example of a neurotransmitter that is uptake. Serotonin is absorbed back into the presynaptic neuron via the serotonin transporter (SERT), which is found in the presynaptic membrane. Re-uptake neurotransmitters are either recycled by repackaging into vesicles or broken down by enzymes.
Specific enzymes found in the synaptic cleft can also break down neurotransmitters. The following enzymes are examples of these enzymes:
Acetylcholinesterase (AChE) catalyses the acetylcholine breakdown (ACh)
The enzyme catechol-O-methyltransferase (COMT) catalyses the breakdown of catecholamines like adrenaline , dopamine and noradrenaline.The breakdown of catecholamines, as well as other monoamines like serotonin, tyramine, and tryptamine, is catalysed by monoamine oxidases (MOA).
Diffusion of neurotransmitters into nearby locations can also be used to eliminate them. -
This question is part of the following fields:
- Basic Cellular Physiology
- Physiology
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Question 25
Incorrect
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An 80-year-old female complains of chest pain characteristic of angina. A dose of glyceryl trinitrate (GTN) is administered that resolves the chest pain rapidly.
Which ONE of the following is released on the initial metabolism of GTN?Your Answer:
Correct Answer: Nitrite ions
Explanation:Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.
Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
1. Glyceryl trinitrate
2. Isosorbide dinitrateThe nitrate drugs are metabolized in the following steps:
1. Release Nitrite ions (NO2-), which are then converted to nitric oxide (NO) within cells.
2. NO activates guanylyl cyclase, which causes an increase in the intracellular concentration of cyclic guanosine-monophosphate (cGMP) in vascular smooth muscle cells.
3. Relaxation of vascular smooth muscle.Although nitrates are potent coronary vasodilators, their principal benefit in the management of angina results from a predominant mechanism of venous dilation:
– Bigger veins hold more blood
– Takes blood away from the left ventricle
– Lowers LVEDV (preload), LA pressure
– Less pulmonary oedema → improved dyspnoea -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 26
Incorrect
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You suspected typhoid disease in a patient who had recently returned from South America and presented to the emergency department with fever, constipation, and a rose spot rash. Which of the following antibiotics will be administered to this patient?
Your Answer:
Correct Answer: Cefotaxime
Explanation:Typhoid fever, often known as enteric fever, is a potentially fatal multi-systemic sickness caused predominantly by Salmonella enterica serotype typhi and, to a lesser extent, paratyphi A, B, and C.
Cefotaxime is the first-line treatment for typhoid fever (or ceftriaxone). In cases of mild or moderate sickness caused by multiresistant pathogens, azithromycin is an option. If the bacterium is sensitive, ciprofloxacin is an option.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 27
Incorrect
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Regarding the management of diabetic ketoacidosis (DKA), insulin should initially be given:
Your Answer:
Correct 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.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 28
Incorrect
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When treating diabetic ketoacidosis (DKA), glucose should be given together with insulin as soon as the blood glucose concentration falls below 14 mmol/L in the form of:
Your Answer:
Correct Answer: 10% glucose intravenous infusion at a rate of 125 mL/hour
Explanation:In addition to the sodium chloride 0.9 percent infusion, glucose 10% should be given intravenously (into a large vein with a large-gauge needle) at a rate of 125 mL/hour once blood glucose concentration falls below 14 mmol/litre.
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 29
Incorrect
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A 30-year-old woman is transfused following a diagnosis of anaemia secondary to heavy vaginal bleeding. She complains of feeling hot and cold during transfusion of the second unit and her temperature is 38.5ºC. Prior to the transfusion, her temperature was 37ºC. She has no other symptoms.
Which of these transfusions reactions most likely occurred?Your Answer:
Correct Answer: Febrile transfusion reaction
Explanation:Febrile transfusion reactions presents with an unexpected temperature rise (≥ 38ºC or ≥ 1ºC above baseline, if baseline ≥ 37ºC) during or shortly after transfusion. It is usually an isolated finding and the fever is accompanied by chills and malaise occasionally.
Allergic reaction is commonly caused by foreign plasma proteins but may be due to anti-IgA. Allergic type reactions usually present with urticaria, pruritus, hives. Associations include laryngeal oedema or bronchospasm.
Acute haemolytic reaction aka immediate haemolytic transfusion reaction presents with fever, chills, pain at transfusion site, nausea, vomiting, dark urine and feeling of ‘impending doom’. Often, it occurs due to ABO incompatibility.
Transfusion-associated circulatory overload (TACO) presents as acute or worsening respiratory distress within 6 hours of transfusion of a large volume of blood. It is common in patients with diminished cardiac reserve or chronic anaemia. Elderly patients, infants and severely anaemic patients are particularly susceptible. Clinical features of TACO include: Acute respiratory distress, Tachycardia, Hypertension, Acute/worsening pulmonary oedema on chest X-ray. The BNP is usually raised to at least 1.5 times the pre-transfusion baseline.
Transfusion-related lung injury (TRALI) is a form of acute respiratory distress caused by the donor plasma containing antibodies against the patient’s leukocytes. It is defined as hypoxia and bilateral pulmonary oedema that occurs within 6 hours of a transfusion in the absence of other causes of acute lung injury. Clinical features include Breathlessness, cough, frothy sputum, hypertension or hypotension, hypoxia and fever. Chest X-ray shows multiple perihilar nodules with infiltration of the lower lung fields.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 30
Incorrect
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A 33 year old lady with a known nut allergy was having dinner at a Thai restaurant. She suddenly complained of lip and tongue swelling and difficulty breathing and is brought to ED by ambulance with suspected anaphylaxis. She received intramuscular adrenaline in the ambulance.
The most appropriate doses of the second line treatments for anaphylaxis are which of the following?Your Answer:
Correct Answer: 10 mg chlorphenamine and 200 mg hydrocortisone
Explanation:Second line drugs to reduce the severity and duration of anaphylactic symptoms are intravenous or intramuscular chlorpheniramine and hydrocortisone. The recommended dose is 10 mg chlorpheniramine and 200 mg hydrocortisone in adults.
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This question is part of the following fields:
- Pharmacology
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
