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  • Question 1 - A patient is currently taking is glyceryl trinitrate among other chronic medications. Which of...

    Correct

    • A patient is currently taking is glyceryl trinitrate among other chronic medications. Which of the following side effects is he LEAST likely to develop?

      Your Answer: Syncope

      Explanation:

      Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.

      The following are common or very common side effects of nitrates:

      • Arrhythmias
      • Asthenia
      • Cerebral ischaemia
      • Dizziness
      • Drowsiness
      • Flushing
      • Headache
      • Hypotension
      • Nausea and vomiting
      • Diarrhoea, syncope and cyanosis can occur, but these are rare side effects.

      Dry eyes, bradycardia and metabolic acidosis have not been reported.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      13.5
      Seconds
  • Question 2 - Regarding the refractory period, which of the following statements is INCORRECT: ...

    Correct

    • Regarding the refractory period, which of the following statements is INCORRECT:

      Your Answer: Action potentials can occur in the relative refractory period but the amplitude of the action potential is smaller.

      Explanation:

      Following the action potential, Na+channels remain inactive for a time in a period known as the absolute refractory period where they cannot be opened by any amount of depolarisation. Following this there is a relative refractory period where the temporary hyperpolarisation (due to delayed closure of rectifier K+channels) makes the cell more difficult to depolarise and an action potential can be generated only in response to a larger than normal stimulus. The refractory period limits the frequency at which action potentials can be generated, and ensures that, once initiated, an action potential can travel only in one direction. An action potential is an all or nothing response so the amplitude of the action potential cannot be smaller.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      43.2
      Seconds
  • Question 3 - You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      15.9
      Seconds
  • Question 4 - Which of these cell types in the stomach releases pepsinogen? ...

    Correct

    • Which of these cell types in the stomach releases pepsinogen?

      Your Answer: Chief cells

      Explanation:

      The gastric chief cells in the stomach wall releases pepsinogen. Pepsinogen is a proenzyme. It mixes with hydrochloric acid in the stomach and is converted to pepsin. Pepsin breaks down proteins into peptides aiding protein digestion.

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      8.8
      Seconds
  • Question 5 - Which of the following is most likely to cause a homonymous hemianopia: ...

    Incorrect

    • Which of the following is most likely to cause a homonymous hemianopia:

      Your Answer: Pituitary adenoma

      Correct Answer: Posterior cerebral artery stroke

      Explanation:

      A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      21.2
      Seconds
  • Question 6 - Which of the following statements is INCORRECT. Fick's law tells us that the...

    Correct

    • Which of the following statements is INCORRECT. Fick's law tells us that the rate of diffusion of a gas across a membrane increases as:

      Your Answer: the partial pressure gradient decreases.

      Explanation:

      Fick’s law tells us that the rate of diffusion of a gas increases:
      the larger the surface area involved in gas exchange
      the greater the partial pressure gradient across the membrane
      the thinner the membrane
      the more soluble the gas in the membrane
      the lower the molecular weight of the gas

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      54.4
      Seconds
  • Question 7 - A 20-year-old male has an anaphylactic reaction following a wasp sting.

    What type of...

    Incorrect

    • A 20-year-old male has an anaphylactic reaction following a wasp sting.

      What type of hypersensitivity reaction is this?

      Your Answer: Type II

      Correct Answer: Type I

      Explanation:

      Anaphylaxis is an example of a type I hypersensitivity reaction.

      It is IgE mediated.

      It requires a prior exposure to the antigen. The initial exposure sensitizes the body to the antigen and a second exposure to that antigen leads to an anaphylactic reaction.

      Massive calcium influx into the cells leads to mast cell degranulation.

      The Immunoglobulin antigen complex binds to Fc receptors on the surface of mast cells. The result is mast cell degranulation and release of histamine, proteoglycans and serum proteases from cytoplasmic granules.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      16.6
      Seconds
  • Question 8 - The following statements concerning lung compliance is true EXCEPT?
    ...

    Incorrect

    • The following statements concerning lung compliance is true EXCEPT?

      Your Answer: Lung compliance is inversely proportional to stiffness and elastance

      Correct Answer: Lung compliance is described by the equation: C = ∆ P/ ∆V, where C = compliance, P = pressure, and V = volume

      Explanation:

      Lung compliance is the change in volume per unit change in distending pressure.

      It is calculated using the equation:
      Lung compliance = ΔV / ΔP
      Where:
      ΔV is the change in volume
      ΔP is the change in pleural pressure.

      Lung compliance is inversely proportional to stiffness and elastance.

      It comprises static (no airflow) and dynamic (during continuous breathing) components.

      It is the slope of the pressure-volume curve.

      Lung compliance describes the distensibility of the lungs and the chest wall.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      51.6
      Seconds
  • Question 9 - Regarding Cryptococcus neoformans, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding Cryptococcus neoformans, which of the following statements is INCORRECT:

      Your Answer: Cryptococcus neoformans is commonly found in bird droppings.

      Correct Answer: Patients with complement deficiency are at particular risk of infection.

      Explanation:

      Cryptococcus neoformans typically causes infection in patients with lymphoma, those taking steroid or cytotoxic therapy, those with T-cell deficiency e.g. AIDS and those with intense exposure, such as pigeon fanciers.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      11
      Seconds
  • Question 10 - Which of the following statements is correct with regards to natural killer cells?...

    Correct

    • Which of the following statements is correct with regards to natural killer cells?

      Your Answer: They are part of the innate immune system.

      Explanation:

      Natural Killer (NK) Cells are lymphocytes in the same family as T and B cells, which come from a common progenitor. They are cytotoxic CD8 positive cells that do not have the T-cell receptor. They are very big cells with cytoplasmic granules and are designed to kill target cells with a low level of expression of HLA class I molecules.
      Examples include during a viral infection or on a malignant cell. NK cells display several receptors for HLA molecules on their surface, and when HLA is expressed on the target cell, these deliver an inhibitory signal into the NK cell. Absent HLA molecules on the target cell cause this inhibitory signal to get lost and as a result, the NK cell can then kill its target. Also, NK cells display antibody-dependent cell-mediated cytotoxicity, where antibody binds to antigen on the surface of the target cell. The NK cells then bind to the Fc portion of the bound antibody and kill the target cell.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      7
      Seconds
  • Question 11 - Which of the following is an example of continuous data: ...

    Incorrect

    • Which of the following is an example of continuous data:

      Your Answer: Disease staging system

      Correct Answer: Height

      Explanation:

      Continuous data is data where there is no limitation on the numerical value that the variable can take e.g. weight, height.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      47.6
      Seconds
  • Question 12 - One of these statements about significance tests is true. ...

    Correct

    • One of these statements about significance tests is true.

      Your Answer: A p value of less than 1 in 20 is considered ‘statistically significant’

      Explanation:

      The p value is statistically significant when it is less than 0.05 (5% or 1 in 20).

      Statistical significance is not the same as clinical significance.

      The null hypothesis states that there is no difference between the groups.

      The power of a study is the probability of correctly rejecting the null hypothesis when it is false.

      A type I error occurs when the null hypothesis has been rejected when it is true. A type II error occurs when the null hypothesis has been accepted when it is actually false.

    • This question is part of the following fields:

      • Evidence Based Medicine
      45.1
      Seconds
  • Question 13 - A 43 year old lady suffering with idiopathic thrombocytopenic purpura has a splenectomy....

    Incorrect

    • A 43 year old lady suffering with idiopathic thrombocytopenic purpura has a splenectomy. She is advised to get the Pneumococcal vaccine booster every 5 - 10 years as Streptococcus pneumoniae has which of the following properties that make her prone to infection to this organism?

      Your Answer: It causes pneumonia

      Correct Answer: It is encapsulated

      Explanation:

      There is a lifelong susceptibility to increased risk of infection from a variety of organisms in patients with hyposplenism, especially in children under 5 years and those with sickle cell anaemia. Patients are most susceptible is to the encapsulated bacteria Streptococcus pneumoniae, Haemophilus influenzae type B and Neisseria meningitidis. Streptococcus pneumoniae is particular concerning as it can cause rapid and fulminant disease, which can be fatal. Malaria and animal bites that become infected also tend to be more severe.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      11.3
      Seconds
  • Question 14 - A 28-year-old patient is intubated and has a central venous catheter inserted after...

    Correct

    • A 28-year-old patient is intubated and has a central venous catheter inserted after being diagnosed with septic shock. You keep track of her central venous pressure.

      The normal value for central venous pressure is which of the following?

      Your Answer: 0-8 cmH 2 O

      Explanation:

      The pressure measured in the right atrium or superior vena cava is known as central venous pressure (CVP). In a spontaneously breathing subject, the usual CVP value is 0-8 cmH2O (0-6 mmHg).

      At the conclusion of expiration, the CVP should be measured with the patient resting flat. The catheter’s tip should be at the intersection of the superior vena cava and the right atrium. An electronic transducer is installed and zeroed at the level of the right atrium to measure it (usually in the 4th intercostal space in the mid-axillary line).
      CVP is a good predictor of preload in the right ventricle. Hypovolaemia is indicated by a volume challenge of 250-500 mL crystalloid eliciting an increase in CVP that is not sustained for more than 10 minutes.

      CVP is influenced by a number of factors, including:
      Mechanical ventilation (and PEEP)
      Pulmonary hypertension
      Pulmonary embolism
      Heart failure
      Pleural effusion
      Decreased cardiac output
      Cardiac tamponade
      CVP is reduced by the following factors:
      Distributive shock
      Negative pressure ventilation
      Hypovolaemia
      Deep inhalation

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      28.9
      Seconds
  • Question 15 - A 55-year-old male diabetic patient presents to the Emergency Room complaining of severe...

    Correct

    • A 55-year-old male diabetic patient presents to the Emergency Room complaining of severe chest pain. His medical record shows that he had coronary angioplasty one week ago, during which he was administered abciximab.

      Which of the following haematological diseases has a similar mechanism of action to this drug?

      Your Answer: Glanzmann’s thrombasthenia

      Explanation:

      Abciximab is glycoprotein IIb/IIIa receptor antagonist that decreases aggregation of platelets by prevent their cross-linking. In Glanzmann’s thrombasthenia there are low levels of these same receptors leading to decreased bridging of platelets as fibrinogen cannot attach. There is increased bleeding time both in this disease and when there is use of abciximab.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      12.8
      Seconds
  • Question 16 - Herpes simplex encephalitis has a predilection for which of the following sites: ...

    Incorrect

    • Herpes simplex encephalitis has a predilection for which of the following sites:

      Your Answer: Parietal lobe

      Correct Answer: Temporal lobe

      Explanation:

      Herpes simplex virus is the most common cause of infective encephalitis and has a predilection for the temporal lobes. Herpes simplex is transmitted through direct contact. It invades skin locally producing skin vesicles by its cytolytic activity.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      18
      Seconds
  • Question 17 - A 70-year-old woman presents with exacerbation of her chronic obstructive pulmonary disease (COPD),...

    Incorrect

    • A 70-year-old woman presents with exacerbation of her chronic obstructive pulmonary disease (COPD), increased cough, wheeze and chest tightness. On examination, she is tachypnoeic and oxygen saturation is 86%. You plan to administer supplemental oxygen.

      Which oxygen delivery system is most appropriate to use initially?

      Your Answer: Nasal cannulae

      Correct Answer: Venturi mask

      Explanation:

      In life-threatening emergencies, oxygen should be started immediately otherwise, it should be prescribed like any other drug. The prescription should include a target saturation range.

      Until blood gases can be measured, initial oxygen should be administered using a controlled concentration of 24% or 28%.
      The ideal mask is a Venturi mask.

      The other mask are not ideal for initial use

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      33.3
      Seconds
  • Question 18 - An 11-year-old girl presents with a 5-day history of persistent fever despite regular...

    Incorrect

    • An 11-year-old girl presents with a 5-day history of persistent fever despite regular paracetamol, throbbing left ear pain, ear discharge and deafness. Her parents have observed that she is not her usual self, not eating well, and has been lethargic. On examination there is a tender swelling in the post auricular region on the left hand side.

      What is the most likely causative organism?

      Your Answer: Streptococcus anginosus

      Correct Answer: Streptococcus pneumonia

      Explanation:

      Acute mastoiditis is a complication (rare) of acute otitis media (AOM) and the commonest causative organism is Streptococcus pneumoniae.

      Generally, acute mastoiditis presents with:
      Pyrexia
      Recent history of AOM
      Mastoid swelling and erythema
      Otalgia
      Otorrhoea and perforation of tympanic membrane
      Post-auricular pain
      Protrusion of the ears

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      42.9
      Seconds
  • Question 19 - Which of the following statements is correct regarding hyponatraemia? ...

    Incorrect

    • Which of the following statements is correct regarding hyponatraemia?

      Your Answer: SIADH is associated with low urine osmolality.

      Correct Answer: Correction of serum sodium that is too rapid can precipitate central pontine myelinolysis.

      Explanation:

      Hyponatraemia refers to a serum sodium concentration < 135 mmol/L.
      It is safer to quickly correct acute hyponatremia than chronic hyponatremia but correction should not be too fast, especially in chronic hyponatraemia, because of the risk of central pontine myelinolysis. Hyponatraemia is usually associated with a low plasma osmolality.
      Under normal circumstances, if serum osmolality is low, then urine osmolality should also be low because the kidneys should be trying to retain solute.
      In SIADH, excess ADH causes water retention, but not the retention of solute. Therefore, urine that is concentrated and relatively high in sodium is produced, even though the serum sodium is low (urine osmolality > 100 mosmol/kg).

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      52.1
      Seconds
  • Question 20 - Regarding the flexor digitorum profundus muscle, which of the following is true? ...

    Incorrect

    • Regarding the flexor digitorum profundus muscle, which of the following is true?

      Your Answer: The lateral aspect of the muscle is innervated by the radial nerve

      Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve

      Explanation:

      Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.

      Flexor digitorum profundus has a dual innervation:

      (1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);

      (2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      14.2
      Seconds
  • Question 21 - Which nerve supplies the muscle flexor hallucis longus? ...

    Incorrect

    • Which nerve supplies the muscle flexor hallucis longus?

      Your Answer: Superficial peroneal nerve

      Correct Answer: Tibial nerve

      Explanation:

      Flexor hallucis longus is innervated by the tibial nerve, composed of spinal roots L4, L5, S1, S2, and S3.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      11.3
      Seconds
  • Question 22 - Ipratropium bromide should be used with caution in patients with which of the...

    Correct

    • Ipratropium bromide should be used with caution in patients with which of the following conditions:

      Your Answer: Prostatic hyperplasia

      Explanation:

      Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.

      The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.
      The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).

      Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.
      The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma)

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      16.3
      Seconds
  • Question 23 - Regarding protein digestion, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding protein digestion, which of the following statements is CORRECT:

      Your Answer: Pepsin released from gastric parietal cells hydrolyses protein to polypeptide.

      Correct Answer: Oligopeptides are broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on the brush border.

      Explanation:

      Digestion of dietary protein begins in the stomach where pepsin hydrolyses protein to polypeptides, and continues in the duodenum where pancreatic proteases (trypsin and chymotrypsin) continue the process of hydrolysis forming oligopeptides. These are further broken down into small peptides and amino acids by pancreatic carboxypeptidases and aminopeptidases located on luminal membrane epithelial cells. Free amino acids are absorbed across the apical membrane by secondary active transport coupled with Na+transport into the cell. Amino acids cross the basal membrane into the capillaries by facilitated diffusion.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      30.3
      Seconds
  • Question 24 - Which extraocular muscle is entrapped in a patient with a blowout fracture? ...

    Incorrect

    • Which extraocular muscle is entrapped in a patient with a blowout fracture?

      Your Answer: Superior oblique

      Correct Answer: Inferior rectus

      Explanation:

      A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. The common mechanisms are falls, high-velocity ball-related sports, traffic accidents, and interpersonal violence.

      The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bones. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles.

      The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. Finally, the orbital injury can lead to retinal oedema, hyphema, and significant loss of vision.

      While some cases may be managed with conservative care, others may require some type of surgical intervention.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      40.4
      Seconds
  • Question 25 - The interquartile range (IQ) is often displayed using which of the following: ...

    Correct

    • The interquartile range (IQ) is often displayed using which of the following:

      Your Answer: Box and whisker plot

      Explanation:

      A boxplot is a vertical or horizontal rectangle used to display the interquartile range, with the ends of the rectangle corresponding to the upper and lower quartiles of the data values. The box contains 50% of the data values. A line drawn through the rectangle corresponds to the median value. Whiskers, starting at the ends of the rectangle usually indicate the minimum and maximum values, therefore the entire box and whisker plot represents the range. Any outliers can be plotted independent of the box and whisker plot.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      12.4
      Seconds
  • Question 26 - Aplastic crises in sickle cell anaemia is classically precipitated by which of the...

    Incorrect

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

      Your Answer: Epstein-Barr virus

      Correct Answer: Parvovirus B19

      Explanation:

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

    • This question is part of the following fields:

      • Haematology
      • Pathology
      7.7
      Seconds
  • Question 27 - A 28-year-old female patient with a history of hypothyroidism arrives at the Emergency...

    Incorrect

    • A 28-year-old female patient with a history of hypothyroidism arrives at the Emergency Department after taking 30 of her 200 mcg levothyroxine tablets. She tells you she's 'tired of life' and 'can't take it any longer.' She is currently asymptomatic, and her findings are all within normal limits.

      What is the minimum amount of levothyroxine that must be taken before thyrotoxicosis symptoms appear?

      Your Answer: >2 mg

      Correct Answer: >10 mg

      Explanation:

      An overdose of levothyroxine can happen by accident or on purpose. Intentional overdosing is sometimes done to lose weight, but it can also happen in patients who are suicidal. The development of thyrotoxicosis, which can lead to excited sympathetic activity and high metabolism syndrome, is the main source of concern. The time between ingestion and the emergence of clinical features associated with an overdose is often quite long.

      After a levothyroxine overdose, the majority of patients are asymptomatic. Symptoms and signs are usually only seen in patients who have taken more than 10 mg of levothyroxine in total.

      The following are the most commonly seen clinical features in patients developing clinical features:
      Tremor
      Agitation
      Sweating
      Insomnia
      Headache
      Increased body temperature
      Increased blood pressure
      Diarrhoea and vomiting
      Less common clinical features associated with levothyroxine overdose include:
      Seizures
      Acute psychosis
      Thyroid storm
      Tachycardia
      Arrhythmias
      Coma

      The continued absorption of the ingested levothyroxine causes a progressive rise in both total serum T4 and total serum T3 levels in the first 24 hours after an overdose. However, in some cases, the biochemical picture is completely normal. Thyroid function tests are not always recommended after a thyroxine overdose. Although elevated thyroxine levels are common, they have little clinical significance and have no impact on treatment. Following a levothyroxine overdose, the following biochemical features are common:
      T4 and T3 levels in the blood are elevated.
      Free T4 and Free T3 levels are higher.
      TSH levels in the blood are low.
      If the patient is cooperative and more than 10 mg of levothyroxine has been consumed, activated charcoal can be given (i.e., likely to become symptomatic)
      Within an hour of ingestion, the patient presents.

      The treatment is mostly supportive and aimed at managing the sympathomimetic symptoms that come with levothyroxine overdose. If beta blockers aren’t an option, try propranolol 10-40 mg PO 6 hours or diltiazem 60-180 mg 8 hours.

    • This question is part of the following fields:

      • Endocrine Pharmacology
      • Pharmacology
      38.7
      Seconds
  • Question 28 - Regarding fluid balance, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding fluid balance, which of the following statements is CORRECT:

      Your Answer: One-third of total body fluid is intracellular.

      Correct Answer: About three-quarters of extracellular fluid is interstitial.

      Explanation:

      An ‘average’ person (70 kg male) contains about 40 litres of water in total, separated into different fluid compartments by biological semipermeable membranes; plasma cell membranes between extracellular and intracellular fluid, and capillary walls between interstitial and intravascular fluid. Around two-thirds of the total fluid (27 L) is intracellular fluid (ICF) and one-third of this (13 L) is extracellular fluid (ECF). The ECF can be further divided into intravascular fluid (3.5 L) and interstitial fluid (9.5 L).
      Transcellular fluid refers to any fluid that does not contribute to any of the main compartments but which are derived from them e.g. gastrointestinal secretions and cerebrospinal fluid, and has a collective volume of approximately 2 L.
      Osmosis is the passive movement of water across a semipermeable membrane from regions of low solute concentration to those of higher solute concentration.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      32.6
      Seconds
  • Question 29 - You review a sick patient in resus who has been prescribed mannitol as...

    Incorrect

    • 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 can be used in the ICU treatment of pulmonary oedema

      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
      20.6
      Seconds
  • Question 30 - A 23 year old student presents to ED with a widespread maculopapular rash....

    Incorrect

    • A 23 year old student presents to ED with a widespread maculopapular rash. She recently had a sore throat and was started on a course of antibiotics. The most likely antibiotic that she was prescribed is:

      Your Answer:

      Correct Answer: Amoxicillin

      Explanation:

      Maculopapular rashes are commonly seen with ampicillin and amoxicillin. However they are not usually related to true penicillin allergy. Very often, they occur in patients with glandular fever and so, broad-spectrum penicillins should not be used blindly, for management and treatment of a sore throat. There is also an increased risk of rash in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Pharmacology (2/3) 67%
Pharmacology (5/7) 71%
Basic Cellular (2/2) 100%
Physiology (7/9) 78%
Endocrine Physiology (1/1) 100%
Gastrointestinal Physiology (1/1) 100%
Anatomy (2/4) 50%
Central Nervous System (0/1) 0%
Respiratory (2/2) 100%
General Pathology (0/1) 0%
Pathology (2/4) 50%
Respiratory Physiology (0/1) 0%
Immune Responses (2/2) 100%
Evidence Based Medicine (2/3) 67%
Statistics (1/2) 50%
Cardiovascular Physiology (0/1) 0%
Infections (2/2) 100%
Microbiology (1/2) 50%
Respiratory Pharmacology (0/1) 0%
Specific Pathogen Groups (0/1) 0%
Endocrine (1/1) 100%
Upper Limb (0/1) 0%
Lower Limb (1/1) 100%
Gastrointestinal (1/1) 100%
Head And Neck (1/1) 100%
Haematology (0/1) 0%
Endocrine Pharmacology (1/1) 100%
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