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Question 1
Correct
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Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:
Your Answer: NMDA receptor
Explanation:In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).
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This question is part of the following fields:
- Anaesthesia
- Pharmacology
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Question 2
Incorrect
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A 49-year-old woman has a history of hypertension and persistent hypokalaemia and is diagnosed with hyperaldosteronism.
Which of these is the commonest cause of hyperaldosteronism?
Your Answer: Diuretic usage
Correct Answer: Adrenal adenoma
Explanation:When there are excessive circulating levels of aldosterone, hyperaldosteronism occurs. There are two main types of hyperaldosteronism:
Primary hyperaldosteronism (,95% of cases)
Secondary hyperaldosteronism (,5% of cases)Primary causes of hyperaldosteronism include:
Adrenal adenoma (Conn’s syndrome)
Adrenal hyperplasia
Adrenal cancer
Familial aldosteronism
Secondary causes of hyperaldosteronism include:
Drugs
Obstructive renal artery disease
Renal vasoconstriction
Oedematous disorders syndromeAdrenal adenoma is the commonest cause of hyperaldosteronism (seen in ,80% of all cases).
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 3
Correct
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Regarding the management of gout, which of the following statements is CORRECT:
Your Answer: Allopurinol may cause an acute attack of gout when first started.
Explanation:Allopurinol is a treatment for the prevention of gout. The initiation of treatment may precipitate an acute attack, and should be covered with an NSAID or colchicine, continued for at least one month after the hyperuricaemia has been corrected. Colchicine is not indicated for long term prevention of gout. NSAIDs are first line for acute gout; colchicine is an alternative in whom NSAIDs are contraindicated, not tolerated or ineffective (including in people taking anticoagulants). Ibuprofen is not recommended for acute gout, given it has only weak anti-inflammatory properties; naproxen, diclofenac or indometacin are indicated instead.
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This question is part of the following fields:
- Musculoskeletal
- Pharmacology
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Question 4
Correct
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What is the mechanism of action of penicillin antibiotics:
Your Answer: Inhibition of bacterial 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.
The integrity of the ß-lactam ring is essential for antimicrobial activity. Many bacteria (including most Staphylococci) are resistant to benzylpenicillin and phenoxymethylpenicillin because they produce enzymes (penicillinases, ß-lactamases) that open the ß-lactam ring. -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 5
Incorrect
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Dysuria and urinary frequency are symptoms of a 29-year-old woman. A urine dipstick is used to detect the presence of blood, protein, leucocytes, and nitrites in the urine. You diagnose a urinary tract infection and give antibiotics to the patient.
In the United Kingdom, which of the following antibiotics has the highest percentage of E.coli resistance?Your Answer: Co-amoxiclav
Correct Answer: Trimethoprim
Explanation:In the United Kingdom, antibiotic resistance is becoming a significant factor in the treatment of urinary tract infections and pyelonephritis. E. coli (the main causative organism of both urinary tract infections and acute pyelonephritis) resistance to the following antibiotics in laboratory-processed urine specimens is:
30.3 percent trimethoprim (varies by area from 27.1 to 33.4 percent )
19.8 percent co-amoxiclav (varies by area from 10.8 to 30.7 percent )
Ciprofloxacin (Cipro): 10.6% (varies by area from 7.8 to 13.7 percent )
Cefalexin has a concentration of 9.9%. (varies by area from 8.1 to 11.4 percent ) -
This question is part of the following fields:
- Infections
- Pharmacology
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Question 6
Incorrect
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Which of the following statements is correct regarding the lymphatic system?
Your Answer: Normally absorption of fluid into the capillaries is greater than filtration out of the capillaries.
Correct Answer: Lymphatic vessels contain both smooth muscle and unidirectional valves.
Explanation:Fluid filtration out of the capillaries is usually slightly greater than fluid absorption into the capillaries. About 8 L of fluid per day is filtered by the microcirculation and returns to the circulation by the lymphatic system. Lymphatic capillaries drain into collecting lymphatics, then into larger lymphatic vessels. Both of these containing smooth muscle and unidirectional valves. From this point, lymph is propelled by smooth muscle constriction and vessel compression by body movements into afferent lymphatics. It then goes to the lymph nodes where phagocytes remove bacteria and foreign materials. It is here that most fluid is reabsorbed by capillaries, and the remainder returns to the subclavian veins via efferent lymphatics and the thoracic duct. The lymphatic system has a major role to play in the body’s immune defence and also has a very important role in the absorption and transportation of fats.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 7
Incorrect
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An elderly man with chronic heart and lung disease develops Legionnaires' disease. Which of the following clinical features is NOT typical of Legionnaires' disease:
Your Answer: Haemoptysis
Correct Answer: Confusion
Explanation:Legionella pneumophilais a Gram negative bacterium that is found in natural water supplies and in the soil, transmitted predominantly via inhalation of aerosols generated from contaminated water (direct person-to-person spread of infected patients does not occur). It is the cause of Legionnaires’ disease. Outbreaks of Legionnaires’ disease have been linked to poorly maintained air conditioning systems, whirlpool spas and hot tubs.
The clinical features of the pneumonic form of Legionnaires’ disease include:
Mild flu-like prodrome for 1-3 days
Cough (usually non-productive and occurs in approximately 90%)
Pleuritic chest pain
Haemoptysis
Headache
Nausea, vomiting and diarrhoea
AnorexiaLegionella pneumophilainfections can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur with Legionnaires’ disease and will result in hyponatraemia as is seen in this case.
Legionella pneumophilainfections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used. The majority of cases of Legionnaires’ disease are caused by Legionella pneumophila, however many other species of Legionella have been identified.
Legionella longbeachae is another less commonly encountered species that has also been implicated in outbreaks. It is predominantly found in soil and potting compost, and has caused outbreaks of Pontiac fever, the non-respiratory and less severe variant of Legionnaires’ disease. -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 8
Correct
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Regarding hepatitis A, which of the following statements is CORRECT:
Your Answer: Anti-HAV IgM antibodies are diagnostic.
Explanation:Anti-HAV IgM antibodies are diagnostic. Disease in children is more commonly asymptomatic, risk of symptomatic disease increases with age. Transmission is by the faecal-oral route. Faecal shedding has been demonstrated for 2 – 3 weeks before and about a week after, the onset of jaundice. Infection confers lifelong immunity.
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 9
Correct
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A 23-year-old man is discovered to have an infection from Helicobacter pylori.
Which of the following types of cancer is mostly associated with Helicobacter pylori infection?Your Answer: Gastric cancer
Explanation:H. pylori is recognized as a major cause of type B gastritis, a chronic condition formerly associated primarily with stress and chemical irritants. In addition, the strong association between long-term H. pylori infection and gastric cancer has raised more questions regarding the clinical significance of this organism. There is speculation that long-term H. pylori infection resulting in chronic gastritis is an important risk factor for gastric carcinoma resulting in H. pylori being classified as a carcinogen.
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This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 10
Incorrect
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Which of the following is a primary action of aldosterone:
Your Answer: Renal potassium reabsorption
Correct Answer: Renal sodium reabsorption
Explanation:Aldosterone acts mainly at the renal distal convoluted tubule (DCT) to cause sodium retention and potassium loss. It increases the synthesis of transport mechanisms in the distal nephron including the Na+pump, Na+/H+symporter, and Na+and K+channels in principal cells, and H+ATPase in intercalated cells. Na+(and thus water) reabsorption and K+and H+secretion are thereby enhanced.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 11
Correct
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Regarding gas gangrene, which of the following statements is CORRECT:
Your Answer: Infection is characterised by rapidly spreading tissue myonecrosis with crepitus.
Explanation:Gas gangrene usually occurs within 3 days of injury, and is characterised by pain, rapidly spreading oedema, myositis, necrosis, palpable crepitus and systemic toxicity. Diagnosis is clinical and laboratory confirmation should not delay urgent surgical intervention. Hyperbaric oxygen therapy can be considered in addition to surgery and antibiotic therapy, to stop toxin production and inhibit bacteria from replicating and spreading (as Clostridium spp. are obligate anaerobes).
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 12
Correct
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How is measles primarily transmitted:
Your Answer: Respiratory droplet route
Explanation:Measles belongs to the paramyxoviridae group of viruses. The incubation period is 7-18 days (average 10) and it is spread by airborne or droplet transmission. The classical presentation is of a high fever with coryzal symptoms and photophobia with conjunctivitis often being present. The rash that is associated is a widespread erythematous maculopapular rash. Koplik spots are pathognomonic for measles, and are the presence of white lesions on the buccal mucosa.
Differential diagnoses would include:
Rubella
Roseola infantum (exanthem subitom)
Scarlet fever
Kawasaki disease
Erythema infectiosum (5thdisease)
Enterovirus
Infectious mononucleosis
Diagnosis can be confirmed by the following means:
Salivary swab for measles specific IgM
Serum sample for measles specific IgM
Salivary swab for RNA detection
Possible complications include:
Otitis media
Febrile convulsions
Pneumonia
Bronchiectasis
Diarrhoea
Meningitis
Encephalitis
Immunosuppression
Subacute sclerosing panencephalitis
Death -
This question is part of the following fields:
- Microbiology
- Pathogens
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Question 13
Incorrect
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You've been summoned to the resuscitation area to assist a patient who is having a seizure. As part of the treatment protocol, a benzodiazepine dose is given.
Which of the following statements about the use of benzodiazepines in seizures is correct?Your Answer: IV diazepam is the first-line drug
Correct Answer: Lorazepam can be given by the rectal route
Explanation:A single dose of IV benzodiazepine will terminate the seizure in 60 to 80 percent of patients who present with seizures.
Because benzodiazepines are lipid-soluble, they cross the blood-brain barrier quickly. This explains their quick onset of action.
As a first-line treatment, IV lorazepam should be given. If IV lorazepam is not available, IV diazepam can be used instead, and buccal midazolam can be used if intravenous access cannot be established quickly. Lorazepam can be administered via the rectal route, but it is less reliable and has a lower absorption rate and bioavailability.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 14
Incorrect
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You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her�with Cushing's syndrome.
When would her random cortisol level likely be abnormal?Your Answer: 0900 hrs
Correct Answer: 2400 hrs
Explanation:Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep.
The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.
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This question is part of the following fields:
- Endocrine Physiology
- Physiology
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Question 15
Incorrect
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Among the following infectious diseases, which is typically considered to have an incubation period of 3 weeks and longer?
Your Answer: Gonorrhoea
Correct Answer: Infectious mononucleosis
Explanation:Infectious mononucleosis is caused by Epstein-Barr virus (EBV). The incubation period for EBV varies from 2 weeks to 2 months.
The usual incubation period for rubella is 14 days; with a range of 12 to 23 days.
Gonorrhoea has a short incubation period of approximately 2 to 7 days.
The mumps virus can be isolated from infected saliva and swabs rubbed over the Stensen’s duct from 9 days before onset of symptoms until 8 days after parotitis appears.
Scarlet fever, which appears within 1 to 2 days after bacterial infection, is characterized by a diffuse red rash that appears on the upper chest and spreads to the trunk and extremities. The rash disappears over the next 5 to
7 days and is followed by desquamation. -
This question is part of the following fields:
- Microbiology
- Specific Pathogen Groups
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Question 16
Correct
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Parasympathetic preganglionic neurons originate in which of the following locations:
Your Answer: Brainstem and pelvic splanchnic nerves
Explanation:Parasympathetic preganglionic neurones originate in the brainstem from which they run in cranial nerves III, VII, IX and X and also from the second and third sacral segments of the spinal cord. Parasympathetic preganglionic neurones release acetylcholine into the synapse, which acts on cholinergic nicotinic receptors on the postganglionic fibre. Parasympathetic peripheral ganglia are generally found close to or within their target, whereas sympathetic peripheral ganglia are located largely in two sympathetic chains on either side of the vertebral column (paravertebral ganglia), or in diffuse prevertebral ganglia of the visceral plexuses of the abdomen and pelvis. Parasympathetic postganglionic neurones release acetylcholine, which acts on cholinergic muscarinic receptors.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 17
Incorrect
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What is the direct mechanism of action of digoxin as a positive inotrope:
Your Answer: Stimulation of Ca2+ ATPase
Correct Answer: Inhibition of Na+/K+ ATPase pump
Explanation:Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 18
Incorrect
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Regarding Hodgkin lymphoma, which of the following statements is CORRECT:
Your Answer: The inguinal lymph nodes are most commonly affected.
Correct Answer: Some patients may complain alcohol-induced nodal pain and pruritus
Explanation:Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy. The major subdivision of lymphomas is into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and this is based on the histological presence of Reed-Sternberg cells present in HL. Hodgkin lymphoma can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. Most patients present with painless, asymmetrical, firm and discrete enlargement of superficial lymph nodes. Cervical nodes are involved in 60-70% of cases, axillary nodes in 10-15% and inguinal nodes in 6-12%. Modest splenomegaly occurs during the course of the disease in 50% of patients; the liver may also be enlarged. Bone marrow failure involvement is unusual in early disease. The prognosis depends on age, stage and histology, but overall approximately 85% of patients are cured. Alcohol‐induced pain and pruritus are two well‐known but rare symptoms in HL.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 19
Incorrect
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An ambulance transports a 37-year-old woman who is having a seizure. She is moved to resuscitation and given a benzodiazepine dose, which quickly ends the seizure. You later learn that she has epilepsy and is usually treated with carbamazepine to control her seizures.
What is carbamazepine's main mechanism of action?Your Answer: GABA receptor agonist
Correct Answer: Sodium channel blocker
Explanation:Carbamazepine is primarily used to treat epilepsy, and it is effective for both focal and generalised seizures. It is not, however, effective in the treatment of absence or myoclonic seizures. It’s also commonly used to treat neuropathic pain, as well as a second-line treatment for bipolar disorder and as a supplement for acute alcohol withdrawal.
Carbamazepine works as a sodium channel blocker that preferentially binds to voltage-gated sodium channels in their inactive state. This prevents an action potential from firing repeatedly and continuously.
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This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
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Question 20
Incorrect
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Regarding chronic idiopathic thrombocytopaenic purpura (ITP), which of the following statements is INCORRECT:
Your Answer: ITP is the most common cause of isolated thrombocytopaenia without anaemia or neutropaenia.
Correct Answer: ITP is classically associated with massive splenomegaly.
Explanation:Chronic ITP is a relatively common disorder. The highest incidence is in women aged 15 – 50 years. It is the most common cause of thrombocytopaenia without anaemia or neutropaenia. It is usually idiopathic but it may been seen in association with other conditions. Platelet autoantibodies (usually IgG) result in the premature removal of platelets from the circulation by macrophages of the reticuloendothelial system. In many causes the antibody is directed against the glycoprotein IIb/IIIa or Ib complex. The normal platelet lifespan of 10 days is reduced to a few hours. Total megakaryocyte mass and platelet turnover are increased to approximately five times normal. Despite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged. In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
