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  • Question 1 - Which of the following is most likely to cause a bitemporal hemianopia: ...

    Correct

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

      Your Answer: Pituitary adenoma

      Explanation:

      A bitemporal hemianopia is most likely due to compression at the optic chiasm. This may be caused by pituitary tumour, craniopharyngioma, meningioma, optic glioma or aneurysm of the internal carotid artery. 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
      3.5
      Seconds

  • Question 2 - Regarding red blood cell group antigens and antibodies, which of the following statements...

    Correct

    • Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:

      Your Answer: Anti-D antibodies are usually IgG.

      Explanation:

      Approximately 400 red blood cell group antigens have been described. The ABO group antigens are unusual in that naturally occurring antibodies occur in the plasma of subjects who lack the corresponding antigen, even if they have not been exposed to that antigen previously. The most important of these natural antibodies are anti-A and anti-B, which are usually IgM. Anti-D antibodies don’t occur naturally, and are therefore immune antibodies that result from previous transfusions or pregnancy. Only IgG antibodies are capable of transplacental passage and the most important immune antibody is the Rh antibody, anti-D.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      2.3
      Seconds

  • Question 3 - Which of the following best describes digoxin: ...

    Correct

    • Which of the following best describes digoxin:

      Your Answer: A positive inotrope and negative chronotrope

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      1.7
      Seconds

  • Question 4 - All of the following statements are considered true regarding likelihood ratios, except: ...

    Incorrect

    • All of the following statements are considered true regarding likelihood ratios, except:

      Your Answer: The likelihood ratio for a positive test = sensitivity / (1-specificity)

      Correct Answer: If less than one, indicates that the information increases the likelihood of the suspected diagnosis

      Explanation:

      The Likelihood Ratio (LR) is the likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.

      The LR is used to assess how good a diagnostic test is and to help in selecting an appropriate diagnostic tests or sequence of tests. They have advantages over sensitivity and specificity because they are less likely to change with the prevalence of the disorder, they can be calculated for several levels of the symptom/sign or test, they can be used to combine the results of multiple diagnostic test and they can be used to calculate post-test probability for a target disorder.

      A LR greater than 1 produces a post-test probability which is higher than the pre-test probability. An LR less than 1 produces a post-test probability which is lower than the pre-test probability. When the pre-test probability lies between 30 and 70 per cent, test results with a very high LR (say, above 10) rule in disease. An LR below 1 produces a post-test probability les than the pre-test probability. A very low LR (say, below 0.1) virtually rules out the chance that the patient has the disease.

    • This question is part of the following fields:

      • Evidence Based Medicine
      3.9
      Seconds

  • Question 5 - A 65-year-old female presents to the Emergency Department with complaints of chest pain...

    Incorrect

    • A 65-year-old female presents to the Emergency Department with complaints of chest pain pointing to angina. A dose of glyceryl trinitrate (GTN) was administered, rapidly resolving her symptoms. Unfortunately, she develops a side-effect of the drug.

      Which one of the following is the side effect she is most likely to have developed?

      Your Answer: Bradycardia

      Correct Answer: Flushing

      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 dinitrate

      Side effects to nitrate therapy are common especially
      The most common side effects are:
      1. Headaches
      2. Feeling dizzy, weak, or tired
      3. Nausea
      4. Flushing

      The serious but less likely to occur side effects are:
      1. Methemoglobinemia (rare)
      2. Syncope
      3. Prolonged bleeding time
      4. Exfoliative dermatitis
      5. Unstable angina
      6. Rebound hypertension
      7. Thrombocytopenia

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

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      6.1
      Seconds

  • Question 6 - You have been asked to give a tutorial on common upper limb neurology...

    Incorrect

    • You have been asked to give a tutorial on common upper limb neurology to a group of medical students. You use the example of a man falling from a balcony onto spiked fencing, sustaining a puncture wound to the axilla. This results in an injury to the musculocutaneous nerve. Which of the following clinical features would you LEAST expect to see in this patient:

      Your Answer: Weakness of forearm supination

      Correct Answer: Weakness of forearm pronation

      Explanation:

      Flexion of the arm and flexion and supination of the forearm are weakened but not lost entirely due to the actions of the pectoralis major and deltoid, the brachioradialis and the supinator muscles respectively. There is loss of sensation over the lateral aspect of the forearm. Forearm pronation would not be affected as this is primarily produced by the pronator quadratus and pronator teres muscles, innervated by the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      23.2
      Seconds

  • Question 7 - Which of the following pathogens causes tetanus: ...

    Incorrect

    • Which of the following pathogens causes tetanus:

      Your Answer: Clostridium difficile

      Correct Answer: Clostridium tetani

      Explanation:

      Tetanus is caused by Clostridium tetani, a bacterium. Tetanus can cause mild spasms to severe whole-body contractions, suffocation, and heart attack.

      Gas gangrene and food poisoning are both caused by Clostridium perfringens.

      Pseudomembranous colitis is caused by Clostridium difficile.

      Urinary tract infections, respiratory infections, dermatitis, soft tissue infections, bacteraemia, bone and joint infections, gastrointestinal infections, and a variety of systemic infections are all caused by Pseudomonas aeruginosa.

      Pharyngitis, skin infections, acute rheumatic fever, scarlet fever, poststreptococcal glomerulonephritis, toxic shock–like syndrome, and necrotizing fasciitis can all be caused by Streptococcus pyogenes infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      35.1
      Seconds

  • Question 8 - A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how...

    Correct

    • A 55-year-old woman with mild dyspepsia seeks advice from her pharmacist on how to deal with her symptoms. In the first instance, the pharmacist advises her to take an over-the-counter antacid. She buys an antacid that contains aluminium hydroxide, which relieves her symptoms but has a negative side effect.

      She's most likely to have developed which of the following side effects?

      Your Answer: Constipation

      Explanation:

      Aluminium hydroxide is a common antacid that is used to treat ulcer dyspepsia and non-erosive gastro-oesophageal reflux disease.

      When antacids containing aluminium salts are given to patients with renal impairment, there is a risk of accumulation and aluminium toxicity. If renal function is normal, aluminium accumulation does not appear to be a risk.

      Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.

      Magnesium-based antacids are generally laxative, whereas aluminium-based antacids can be constipating. Renal impairment, angioedema, and anaphylaxis are not significantly increased.

    • This question is part of the following fields:

      • Gastrointestinal Pharmacology
      • Pharmacology
      21.2
      Seconds

  • Question 9 - A 30-year-old male farmer presents to the Emergency Department due to a wound...

    Incorrect

    • A 30-year-old male farmer presents to the Emergency Department due to a wound on his right forearm sustained two days ago while working on the farm. He cleaned the wound under a tap, but there was still some dirt and debris on examination.

      Past medical history reveals that he never received a tetanus vaccine.

      After cleaning the wound and prescribing antibiotics, which ONE of the following actions should be taken to manage his tetanus risk?

      Your Answer: Tetanus vaccination alone

      Correct Answer: Tetanus vaccination and 500 IU tetanus immunoglobulin

      Explanation:

      If a patient presents with one of the following types of wounds, they are at risk of contracting tetanus and should be vaccinated immediately:
      1) Contaminated puncture-type wounds from gardening and farming (as they may contain tetanus spores)
      2) Wounds containing foreign bodies
      3) Open (compound) fractures
      4) Wounds or burns with sepsis
      5) Animal bites and scratches (animal saliva does not contain tetanus spores unless the animal was routing in soil or lives in an agriculture setting)

      Extremely high-risk tetanus-prone wounds are any of the above wounds with one of the following:
      1) Any wound contaminated by materials containing tetanus spores, e.g., soil, manure
      2) Burns or wounds with extensive devitalised tissue
      3) Wounds or burns with surgical intervention delayed for more than six hours even if the initial injury was not heavily contaminated

      The CDC recommends that adults who have never been vaccinated for tetanus receive a quick shot of the tetanus vaccine along with a booster dose ten years later. A tetanus-prone wound in an unvaccinated individual should also receive a high dose of tetanus immunoglobulin. The injected antibodies will prevent tetanus infection as the patient does not have any pre-existing antibodies against the disease.

      In this case, the patient has a high risk, contaminated wound. He should receive a high dose of tetanus immunoglobulin along with the tetanus vaccine. (The preventative dose of tetanus immunoglobulin is 250 IU in most cases unless over 24 hours have passed since the injury or the wound is heavily contaminated, then 500 IU should be given.) His physician also needs to be contacted to arrange the remainder of the course as indicated in this case.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      158.3
      Seconds

  • Question 10 - 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: Phenoxymethylpenicillin

      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
      26.9
      Seconds

  • Question 11 - All of the following are indications for beta-blockers EXCEPT for: ...

    Incorrect

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer: Heart failure

      Correct Answer: Prinzmetal's angina

      Explanation:

      Beta-blockers are contraindicated in Prinzmetal’s angina.Beta-blockers may be indicated in:HypertensionPheochromocytoma (only with an alpha-blocker)AnginaSecondary prevention after ACSArrhythmias including atrial fibrillationHeart failureThyrotoxicosisAnxietyProphylaxis of migraineEssential tremorGlaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      11.7
      Seconds

  • Question 12 - All of the muscles of the tongue (other than the palatoglossus) are innervated...

    Incorrect

    • All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:

      Your Answer: Facial nerve

      Correct Answer: Hypoglossal nerve

      Explanation:

      All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      20.7
      Seconds

  • Question 13 - A patient with pronounced tremor, muscle contractions, muscle spasms, and slowness of movement...

    Incorrect

    • A patient with pronounced tremor, muscle contractions, muscle spasms, and slowness of movement is brought in by his family. He has a long history of mental health issues for which he is currently treated with a variety of medications.

      Which of the medications listed below is most likely to be the cause of these side effects?

      Your Answer:

      Correct Answer: Haloperidol

      Explanation:

      Acute dyskinesias and dystonic reactions, tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw), Parkinsonism (tremor, bradykinesia, and rigidity), akinesia, akathisia, and neuroleptic malignant syndrome are all examples of extrapyramidal side effects. They are caused by dopamine depletion or blockade in the basal ganglia; this lack of dopamine frequently mimics idiopathic extrapyramidal pathologies.

      The first-generation antipsychotics, which are strong dopamine D2 receptor antagonists, are the drugs most commonly associated with extrapyramidal side effects. Haloperidol and fluphenazine are the two drugs in this class that are most commonly associated with extrapyramidal side effects. Extrapyramidal adverse effects are less common in second-generation antipsychotics (e.g., olanzapine) than in first-generation antipsychotics.

      Other drugs are linked to extrapyramidal symptoms as well, but at a lower rate. Some antidepressants, lithium, various anticonvulsants, antiemetics, and, in rare cases, oral contraceptive agents are among them.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 14 - All of the following statements are considered true regarding L'Abbe plots, except: ...

    Incorrect

    • All of the following statements are considered true regarding L'Abbe plots, except:

      Your Answer:

      Correct Answer: Treatment group results are plotted on the horizontal axis

      Explanation:

      A L’Abbé plot is a scatter plot with the risk in the control group on the x-axis and the risk in the experimental group on the y-axis. It can be used to evaluate heterogeneity in meta-analysis. Furthermore, this plot can aid to choose a summary measure (odds ratio, risk ratio, risk difference) that will result in more consistent results.

    • This question is part of the following fields:

      • Evidence Based Medicine
      0
      Seconds

  • Question 15 - Which of the following is NOT a common clinical manifestation of sickle cell...

    Incorrect

    • Which of the following is NOT a common clinical manifestation of sickle cell disease?

      Your Answer:

      Correct Answer: Iron deficiency

      Explanation:

      Signs and symptoms of Sickle cell disease(SCD):
      Acute and chronic pain: The most common clinical manifestation of SCD is vaso-occlusive crisis; pain crises are the most distinguishing clinical feature of SCD
      Bone pain: Often seen in long bones of extremities, primarily due to bone marrow infarction
      Anaemia: Universally present, chronic, and haemolytic in nature
      Aplastic crisis: Serious complication due to infection with parvovirus B19 (B19V)
      Splenic sequestration: Characterized by the onset of life-threatening anaemia with rapid enlargement of the spleen and high reticulocyte count
      Infection: Organisms that pose the greatest danger include encapsulated respiratory bacteria, particularly Streptococcus pneumoniae; adult infections are predominantly with gram-negative organisms, especially Salmonella
      Growth retardation, delayed sexual maturation, being underweight
      Hand-foot syndrome: This is a dactylitis presenting as bilateral painful and swollen hands and/or feet in children
      Acute chest syndrome: Young children present with chest pain, fever, cough, tachypnoea, leucocytosis, and pulmonary infiltrates in the upper lobes; adults are usually afebrile, dyspnoeic with severe chest pain, with multilobar/lower lobe disease
      Pulmonary hypertension: Increasingly recognized as a serious complication of SCD
      Avascular necrosis of the femoral or humeral head: Due to vascular occlusion
      Central nervous system (CNS) involvement: Most severe manifestation is stroke
      Ophthalmologic involvement: Ptosis, retinal vascular changes, proliferative retinitis
      Cardiac involvement: Dilation of both ventricles and the left atrium
      Gastrointestinal involvement: Cholelithiasis is common in children; liver may become involved
      Genitourinary involvement: Kidneys lose concentrating capacity; priapism is a well-recognized complication of SCD
      Dermatologic involvement: Leg ulcers are a chronic painful problem

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 16 - Loop diuretics primarily act on which Na+ transporter? ...

    Incorrect

    • Loop diuretics primarily act on which Na+ transporter?

      Your Answer:

      Correct Answer: Na + /K + /2Cl - symporter

      Explanation:

      The most potent diuretics are loop diuretics e.g. furosemide. They work by inhibiting the Na+/K+/2Cl-symporter in the thick ascending limb of the loop of Henle, which inhibits sodium, potassium, and chloride reabsorption. As a result, there is diuresis with loss of these electrolytes. There is a reduction in transcellular voltage difference, paracellular calcium and magnesium reabsorption.
      The medullary interstitium becomes more concentrated by salt reabsorption in the ascending limb. Loop diuretics block this process and reduce the ability of the kidney to concentrate urine. In the collecting duct, there is increased sodium delivery to the principal cells, which increases potassium secretion in return for sodium reabsorption.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

  • Question 17 - Which of the following side effects has limited the use of etomidate as...

    Incorrect

    • Which of the following side effects has limited the use of etomidate as an intravenous induction agent:

      Your Answer:

      Correct Answer: Adrenocortical suppression

      Explanation:

      Etomidate causes the least cardiovascular depression of the intravenous induction agents, with only a small reduction in the cardiac output and blood pressure. In the past, etomidate was widely used to induce anaesthesia in the shocked, elderly or cardiovascularly unstable patient. However, more recently it has become less popular as a single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4 – 8 hours, and up to 24 hours in elderly and debilitated patients. Although no increase in mortality has been identified following a single dose during induction of anaesthesia, the use of etomidate has declined due to a perceived potential morbidity.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      0
      Seconds

  • Question 18 - A 22-year-old presents with acute severe asthma. He takes a drug prescribed by...

    Incorrect

    • A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.

      Which drug is least likely to have caused his hypokalaemia?

      Your Answer:

      Correct Answer: Spironolactone

      Explanation:

      Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.

      Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      0
      Seconds

  • Question 19 - Which of the following causes increased aldosterone secretion: ...

    Incorrect

    • Which of the following causes increased aldosterone secretion:

      Your Answer:

      Correct Answer: Decreased blood volume

      Explanation:

      Decreased blood volume stimulates the secretion of renin (because of decreased renal perfusion pressure) and initiates the renin-angiotensin-aldosterone cascade. Angiotensin-converting enzyme (ACE) inhibitors block the cascade by decreasing the production of angiotensin. Hyperosmolarity stimulates antidiuretic hormone (ADH) [not aldosterone] secretion. Hyperkalaemia, not hypokalaemia, directly stimulates aldosterone secretion by the adrenal cortex. ANP inhibits renin secretion, thereby inhibiting the production of angiotensin and aldosterone.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

  • Question 20 - A 35-year-old lady has suffered a serious brain injury. Her uvula has deviated...

    Incorrect

    • A 35-year-old lady has suffered a serious brain injury. Her uvula has deviated to the right, according to inspection. Which of the following nerves is likely to be affected?

      Your Answer:

      Correct Answer: Left vagus nerve

      Explanation:

      When the vagus nerve is damaged, the soft palate is paralyzed and the uvula is shifted away from the affected side. The vagus nerve innervates the uvulae muscle, which forms the uvula’s core. If only one side is innervated, contraction of the active muscle will draw the uvula towards it.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      0
      Seconds

  • Question 21 - Which coronary artery is mostly likely affected if an ECG shows a tombstone...

    Incorrect

    • Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?

      Your Answer:

      Correct Answer: Left anterior descending artery

      Explanation:

      Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.

      Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern.

      The following ECG leads determine the location and vessels involved in myocardial infarction:

      ECG Leads Location Vessel involved
      V1-V2 Septal wall Left anterior descending
      V3-V4 Anterior wall Left anterior descending
      V5-V6 Lateral wall Left circumflex artery
      II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)
      I, aVL High lateral wall Left circumflex artery
      V1, V4R Right ventricle Right coronary artery
      V7-V9 Posterior wall Right coronary artery

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 22 - Urine flow rate = 2 ml/min
    Urine concentration of creatinine = 18 mg/ml
    Plasma...

    Incorrect

    • Urine flow rate = 2 ml/min
      Urine concentration of creatinine = 18 mg/ml
      Plasma concentration of creatinine = 0.25 mg/ml

      What is the estimated glomerular filtration rate (eGFR)?

      Your Answer:

      Correct Answer: 144 ml/min

      Explanation:

      GFR can be estimated by:
      GFR = UCr x V / PCr
      Where:
      UCr = urine concentration of creatinine
      PCr = plasma concentration of creatinine
      V = rate of urine flow

      In this case GFR = (18 x 2) / 0.25 = 144 ml/min

      Note: Creatinine is used to estimate GFR because it is an organic base naturally produced by muscle breakdown, it is freely filtered at the glomerulus, it is not reabsorbed from the nephron, it is not produced by the kidney, it is not toxic, and it doesn’t alter GFR.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      0
      Seconds

  • Question 23 - C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:...

    Incorrect

    • C-reactive protein (CRP) synthesis is predominantly stimulated by which of the following cytokines:

      Your Answer:

      Correct Answer: IL-6

      Explanation:

      Activated leukocytes, adipocytes, and endothelial cells all release interleukin 6 (IL-6), a significant proinflammatory cytokine. The main downstream mediator of the acute phase response is C-reactive protein, which is predominantly produced by IL-6–dependent hepatic biosynthesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      0
      Seconds

  • Question 24 - The following statements are not true of the flexor digiti minimi brevis, except?...

    Incorrect

    • The following statements are not true of the flexor digiti minimi brevis, except?

      Your Answer:

      Correct Answer: It is situated on the radial border of abductor digiti minimi

      Explanation:

      Flexor digiti minimi brevis muscle is located on the ulnar side of the palm, lying on the radial border of the abductor digiti minimi. Together with the abductor digiti minimi and opponens digiti minimi muscles, it forms the hypothenar eminence. The muscle is situated inferior and lateral to adductor digiti minimi muscle and superior and medial to opponens digiti minimi muscle. The proximal parts of flexor digiti minimi brevis and abductor digiti minimi muscles form a gap through which deep branches of the ulnar artery and ulnar nerve pass.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 25 - Regarding loop diuretics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding loop diuretics, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: The risk of hypokalaemia is greater with loop diuretics than with an equipotent dose of a thiazide diuretic.

      Explanation:

      Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diuretic. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic failure, hypokalaemia caused by diuretics can precipitate encephalopathy, particularly in alcoholic cirrhosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 26 - What proportion of peripheral blood leukocytes are monocytes? ...

    Incorrect

    • What proportion of peripheral blood leukocytes are monocytes?

      Your Answer:

      Correct Answer: 5 - 10%

      Explanation:

      Monocytes account for around 5 to 10% of peripheral white cells. Monocytes in peripheral blood are generally bigger than other leukocytes and feature a large central oval or indented nucleus with clumped chromatin. The abundant cytoplasm staining blue and containing numerous fine vacuoles gives the appearance of ground glass. Cytoplasmic granules are another type of granule.

      Monocytes evolve from the granulocyte-macrophage progenitor to become monoblasts, promonocytes, monocytes, and tissue macrophages (in increasing order of maturity). Monocytes only stay in the bone marrow for a short time before exiting to circulate in the bloodstream for 20-40 hours before becoming macrophages.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      0
      Seconds

  • Question 27 - A newborn baby girl is delivered vaginally to a 19-year old female, however...

    Incorrect

    • A newborn baby girl is delivered vaginally to a 19-year old female, however with complications due to cephalopelvic disproportion. Upon examination by the attending paediatrician, there is a notable 'claw hand' deformity of the left, and sensory loss of the ulnar aspect of the left distal upper extremity.

      What is the most probable diagnosis of the case above?

      Your Answer:

      Correct Answer: Klumpke’s palsy

      Explanation:

      Klumpke palsy, named after Augusta Dejerine-Klumpke, is a neuropathy involving the lower brachial plexus. In contrast, the more common Erb–Duchenne palsy involves the more cephalic portion of the brachial plexus C5 to C6. The brachial plexus is a bundle of individual nerves that exit between the anterior and middle scalene muscles in the anterior lateral and basal portion of the neck. Although the most common anatomical presentation of the brachial plexus is between the anterior and middle scalene, there are variations, with the most common being penetration of the anterior scalene. The main mechanism of injury to the lower brachial plexus is hyper-abduction traction, and depending on the intensity, it will lead to signs and symptoms consistent with a neurological insult.

      The most common aetiology resulting in Klumpke palsy is a hyper-abduction trauma to the arm that has enough intensity to traction the lower brachial plexus. Trauma during birth can cause brachial plexus injuries, but again hyper-abduction and traction forces to the upper extremity are usually present.

      The history presented by the patient usually depicts a long axis hyper-abduction traction injury with high amplitude and velocity. The typical patient presentation is a decrease of sensation along the medial aspect of the distal upper extremity along the C8 and T1 dermatome. The patient might also present myotome findings that can range from decreasing muscular strength to muscular atrophy and positional deformity. For example, if the neurological damage has led to muscular atrophy and tightening, the patient may present with a claw hand. This deformity presents a finger and wrist flexion. The patient may also describe the severe pain that starts at the neck and travels down the medial portion of the arm. One other sign of a lower brachial plexus injury is Horner syndrome; because of its approximation to the T1 nerve root, it may damage the cephalic sympathetic chain. If this happens, the patient will develop ipsilateral ptosis, anhidrosis, and miosis.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 28 - A 25-year-old patient requires procedural sedation for reduction of an open fracture of...

    Incorrect

    • A 25-year-old patient requires procedural sedation for reduction of an open fracture of his tibia and fibula. You plan on using ketamine as the sedative agent.
      Ketamine works as a result of action on what type of receptor? Select ONE answer only.

      Your Answer:

      Correct Answer: N-methyl-D-aspartate (NMDA)

      Explanation:

      Ketamine is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties. When used correctly it is a very useful and versatile drug.
      Ketamine acts by non-competitive antagonism of the NMDA receptor Ca2+ channel pore and also inhibits NMDA receptor activity by interaction with the phencyclidine binding site.
      Ketamine can be used intravenously and intramuscularly. The intramuscular dose is 10 mg/kg, and when used by this route, it acts within 2-8 minutes and has a duration of action of 10-20 minutes. The intravenous dose is 1.5-2 mg/kg administered over a period of 60 seconds. When used intravenously, it acts within 30 seconds and has a duration of action of 5-10 minutes. Ketamine is also effective when administered orally, rectally, and nasally.
      Ketamine causes tachycardia, an increase in blood pressure, central venous pressure, and cardiac output, secondary to an increase in sympathetic tone. Baroreceptor function is well maintained, and arrhythmias are uncommon.
      The main disadvantage to the use of ketamine is the high incidence of hallucinations, nightmares, and other transient psychotic effects. These can be reduced by the co-administration of a benzodiazepine, such as diazepam or midazolam.
      The main side effects of ketamine are:
      Nausea and vomiting
      Hypertension
      Nystagmus
      Diplopia
      Rash

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
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  • Question 29 - A 26 year old horse rider has a bad fall and sustains a...

    Incorrect

    • A 26 year old horse rider has a bad fall and sustains a neck injury which displays the following signs:
      - ability to extend the wrist against gravity
      - paralysis of the hands, trunk, and legs
      - absent sensation in the fingers and medial upper arms
      - normal sensation over the thumbs
      - absent sensation in chest, abdomen, and legs

      What is the neurological level of the injury?

      Your Answer:

      Correct Answer: C6

      Explanation:

      C1 – C4 INJURY
      Most severe of the spinal cord injury levels; paralysis in arms, hands, trunk and legs; patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements; ability to speak is sometimes impaired or reduced

      C5 INJURY
      Person can raise his or her arms and bend elbows; likely to have some or total paralysis of wrists, hands, trunk and legs; can speak and use diaphragm, but breathing will be weakened

      C6 INJURY
      Nerves affect wrist extension; paralysis in hands, trunk and legs, typically; should be able to bend wrists back; can speak and use diaphragm, but breathing will be weakened

      C7 INJURY
      Nerves control elbow extension and some finger extension; most can straighten their arm and have normal movement of their shoulders

      C8 INJURY
      Nerves control some hand movement; should be able to grasp and release objects

      C5 – Elbow flexors (biceps, brachialis)
      C6 – Wrist extensors (extensor carpi radialis longus and brevis)
      C7 – Elbow extensors (triceps)
      C8 – Finger flexors (flexor digitorum profundus) to the middle finger

      C5 – Elbow flexed at 90 degrees, arm at the patient’s side and forearm supinated
      C6 – Wrist in full extension
      C7 – Shoulder is neutral rotation, adducted and in 90 degrees of flexion with elbow in 45 degrees of flexion
      C8 –Full flexed position of the distal phalanx with the proximal finger joints stabilized in a extended position

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 30 - A blood transfusion is given to a 52-year-old woman. She develops chills and...

    Incorrect

    • A blood transfusion is given to a 52-year-old woman. She develops chills and rigours shortly after the transfusion begins.

      The following are her observations: Temperature 40°C, HR 116 bpm, BP 80/48, SaO 2 97 percent on air.

      Which of the following treatments is the most appropriate?

      Your Answer:

      Correct Answer: Stop the transfusion and administer antibiotics

      Explanation:

      Bacterial infections are common in the following situations:

      Platelet transfusions are associated with a higher risk of bacterial infection (as platelets are stored at room temperature)
      Immersion in a water bath thawed previously frozen components.
      Components of red blood cells that have been stored for several weeks
      Gram-positive and Gram-negative bacteria have both been linked to transfusion-transmitted bacterial infection, but Gram-negative bacteria are linked to a higher rate of morbidity and mortality.
      Yersinia enterocolitica is the most common bacterial organism linked to transfusion-transmitted bacterial infection. This organism can multiply at low temperatures while also utilising iron as a nutrient. As a result, it’s well-suited to proliferating in blood banks.

      The following are some of the most common clinical signs and symptoms of a bacterial infection transmitted through a blood transfusion. These symptoms usually appear shortly after the transfusion begins:
      Fever is very high.
      Rigours and chills
      Vomiting and nausea
      Tachycardia
      Hypotension
      Collapse of the circulatory system

      If a bacterial infection from a transfusion is suspected, the transfusion should be stopped right away. Blood cultures and a Gram stain should be requested, as well as broad-spectrum antibiotics. In addition, the blood pack should be returned to the blood bank for an urgent culture and Gram-stain.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 31 - Regarding pressures and airflow during the normal breathing cycle, which of the following...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 32 - A 54-year-old man with a long history of poorly controlled hypertension complains of...

    Incorrect

    • A 54-year-old man with a long history of poorly controlled hypertension complains of a headache and vision blurring today. In triage, his blood pressure is 210/192 mmHg. A CT head scan is scheduled to rule out the possibility of an intracranial haemorrhage. You make the diagnosis of hypertensive encephalopathy and rush the patient to reus to begin blood pressure-lowering treatment. He has a history of brittle asthma, for which he has been admitted to the hospital twice in the last year.

      Which of the following is the patient's preferred drug treatment?

      Your Answer:

      Correct Answer: 25% of the mean arterial pressure over the first hour

      Explanation:

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

      Hypertensive encephalopathy is a syndrome that includes headaches, seizures, visual changes, and other neurologic symptoms in people who have high blood pressure. It is reversible if treated quickly, but it can progress to coma and death if not treated properly.

      Any patient with suspected hypertensive encephalopathy should have an urgent CT scan to rule out an intracranial haemorrhage, as rapid blood pressure reduction could be dangerous in these circumstances.

      The drug of choice is labetalol, which reduces blood pressure steadily and consistently without compromising cerebral blood flow.
      An initial reduction of approximately 25% in mean arterial pressure (MAP) over an hour should be aimed for, followed by a further controlled MAP reduction over the next 24 hours. In patients who are unable to take beta-blockers, nicardipine can be used as a substitute.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 33 - Which of the following is NOT a typical electrolyte disturbance caused by furosemide:...

    Incorrect

    • Which of the following is NOT a typical electrolyte disturbance caused by furosemide:

      Your Answer:

      Correct Answer: Hypercalcaemia

      Explanation:

      Adverse effects of loop diuretics include:
      Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathy
      Hyperglycaemia
      Acute urinary retention
      Water and electrolyte imbalance
      Hyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolism
      Metabolic alkalosis
      Hyperuricaemia
      Blood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)
      Visual disturbance, tinnitus and deafness
      Hypersensitivity reactions

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
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      Seconds

  • Question 34 - Where on the body is the radial artery pulsation best palpated? ...

    Incorrect

    • Where on the body is the radial artery pulsation best palpated?

      Your Answer:

      Correct Answer: At the wrist just lateral to the flexor carpi radialis tendon

      Explanation:

      The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 35 - A 42-year-old woman presents with face swelling prominently affecting her upper lip and...

    Incorrect

    • A 42-year-old woman presents with face swelling prominently affecting her upper lip and hands. She has previously been diagnosed with hereditary angioedema.

      Which of these is the most appropriate management option for this acute attack?

      Your Answer:

      Correct Answer: Fresh frozen plasma

      Explanation:

      Hereditary angioedema is inherited as an autosomal dominant disorder and is caused by deficiency of C1 esterase inhibitor, a protein that forms part of the complement system.

      Attacks can be precipitated by stress and minor surgical procedures. Clinical features of hereditary angioedema include oedema of the skin and mucous membranes commonly affecting the face, tongue and extremities.

      Angioedema and anaphylaxis due to a deficiency of C1 esterase inhibitor are resistant to adrenaline, steroids and antihistamines. Treatment is with fresh frozen plasma or C1 esterase inhibitor concentrate, which contains C1 esterase inhibitor.

      Short-term prophylaxis for events that may precipitate angioedema attack is achieved with C1 esterase inhibitor or fresh frozen plasma infusions before the event while long-term prophylaxis can be achieved with antifibrinolytic drugs (tranexamic acid) or androgenic steroids.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
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  • Question 36 - A 59-year-old woman presents with a history of tiredness and weight gain and...

    Incorrect

    • A 59-year-old woman presents with a history of tiredness and weight gain and a diagnosis of hypothyroidism is suspected.

      Which of these changes is likely to appear first in primary hypothyroidism?

      Your Answer:

      Correct Answer: Increased thyroid-stimulating hormone (TSH)

      Explanation:

      The earliest biochemical change seen in hypothyroidism is an increase in thyroid-stimulating hormone (TSH) levels.

      Triiodothyronine (T3) and thyroxine (T4) levels are normal in the early stages.

      TBG levels are generally unchanged in primary hypothyroidism.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 37 - An analytical study is conducted to compare the risk of stroke between Ticagrelor...

    Incorrect

    • An analytical study is conducted to compare the risk of stroke between Ticagrelor therapy and Warfarin therapy among patients with atrial fibrillation. The following is obtained from the study:

      No. of patients who took Ticagrelor: 300
      No. of patients who took Ticagrelor and suffered a stroke: 30

      No. of patients who took Warfarin: 500
      No. of patients who took Warfarin and suffered a stroke: 20

      Compute for the absolute risk in the Ticagrelor group.

      Your Answer:

      Correct Answer: 0.1

      Explanation:

      The absolute risk (AR) is the probability or chance of an event. It is computed as the number of events in treated or control groups, divided by the number of people in that group.

      AR = 30/300 = 0.1

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 38 - A 29-year-old man presents with painful red eye with copious discharge and you...

    Incorrect

    • A 29-year-old man presents with painful red eye with copious discharge and you make a diagnosis of infective conjunctivitis following a history and an examination,.

      One of these is NOT an indication for an urgent ophthalmology referral in this patient.

      Your Answer:

      Correct Answer: Bilateral conjunctivitis

      Explanation:

      Urgent referral to ophthalmology is indicated if the patient with conjunctivitis has any of the following:

      Suspected gonococcal or chlamydial conjunctivitis
      Corneal involvement associated with soft contact lens use
      Severe disease indicated by presence of a pseudomembrane
      Conjunctivitis associated with rheumatoid arthritis or in immunocompromised patient. Ophthalmia neonatorum.
      Possible herpes infection.
      Had recent intraocular surgery. A red flag indicating a serious cause of red eye.
      Suspected periorbital or orbital cellulitis.

      Bilateral conjunctivitis is not an indication for urgent referral to ophthalmology.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 39 - Regarding the abductor pollicis longus, which of the following statements is true? ...

    Incorrect

    • Regarding the abductor pollicis longus, which of the following statements is true?

      Your Answer:

      Correct Answer: It extends the thumb at the carpometacarpal joint

      Explanation:

      Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.

      Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.

      Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.

      Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.

      Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 40 - An injury to the brachial plexus can cause Erb's palsy. The following is...

    Incorrect

    • An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:

      Your Answer:

      Correct Answer: Weakness of medial rotation of the arm

      Explanation:

      Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus.

      The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 41 - An infection causes an Addisonian crisis in a male patient with a known history...

    Incorrect

    • An infection causes an Addisonian crisis in a male patient with a known history of Addison's disease.

      Which of the following is NOT a well-known symptom of an Addisonian crisis?

      Your Answer:

      Correct Answer: Hyperglycaemia

      Explanation:

      Although Addisonian crisis is a rare illness, it can be fatal if it is misdiagnosed. Hypoglycaemia and shock are the most common symptoms of an Addisonian crisis (tachycardia, peripheral vasoconstriction, hypotension, altered conscious level, and coma).

      Other clinical characteristics that may be present are:
      Fever
      Psychosis
      Leg and abdominal pain
      Dehydration and vomiting
      Convulsions 

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
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  • Question 42 - Regarding basophils, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      Correct Answer: They are the second most common type of granulocyte.

      Explanation:

      Basophils are only occasionally seen in normal peripheral blood comprising < 1% of circulating white cells. However, they are the largest type of granulocyte. They have many dark cytoplasmic granules which overlie the nucleus and contain heparin and histamine. They have immunoglobulin E (IgE) attachment sites and their degranulation is associated with histamine release. Basophils are very similar in both appearance and function to mast cells.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
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  • Question 43 - Which of the following best describes the therapeutic effect of calcium gluconate when used...

    Incorrect

    • Which of the following best describes the therapeutic effect of calcium gluconate when used in treatment for hyperkalaemia:

      Your Answer:

      Correct Answer: Reduces cardiac cell membrane excitability

      Explanation:

      Calcium resonium is an ion-exchange resin that exchanges sodium for potassium as it passes through the intestine, leading to excretion of potassium from the body. Salbutamol and insulin act to increase intracellular uptake of K+ via Na-K ATP pump. Sodium bicarbonate acts to correct acidosis and thus promotes intracellular uptake of K+. Calcium gluconate acts to protect the cardiac membrane and has no effect on serum K+ levels.

    • This question is part of the following fields:

      • Fluids And Electrolytes
      • Pharmacology
      0
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  • Question 44 - Which among the following antibacterial regimens is considered the most appropriate to prescribe...

    Incorrect

    • Which among the following antibacterial regimens is considered the most appropriate to prescribe in a patient presenting with clinical signs and symptoms consistent with a diagnosis of pelvic inflammatory disease?

      Your Answer:

      Correct Answer: Ceftriaxone plus doxycycline plus metronidazole

      Explanation:

      The endocervix is the most common site of Neisseria gonorrhoeae infection in women. Symptoms of infection, when present, include dysuria, cervical discharge, and lower abdominal pain. However, 50% of cases in women may be asymptomatic leading to complications such as pelvic inflammatory disease (PID), which may cause sterility, ectopic pregnancy, or perihepatitis.

      PID is also known as Fitz-Hugh-Curtis syndrome is defined as an inflammation of the upper genital tract due to an infection in women. The disease affects the uterus, fallopian tubes, and ovaries. It is typically an ascending infection, spreading from the lower genital tract.

      The recommended intramuscular or oral regimens for PID are as follows:

      Ceftriaxone at 500 mg IM in a single dose (for persons weighing ≥150 kg, administer 1 g of ceftriaxone); plus doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
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  • Question 45 - What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient...

    Incorrect

    • What is the appropriate dose of 1:1000 adrenaline solution for a 15-year-old patient with suspected anaphylactic shock?

      Your Answer:

      Correct Answer: 500 micrograms intramuscularly

      Explanation:

      1: 1000 Adrenaline solution dosage for children above the age of 12 and adults, including pregnant women (over 50 kg) is 0.50 mL, which is equivalent to 500 mcg of adrenaline.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
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  • Question 46 - An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before...

    Incorrect

    • An 80-year-old male has presented with chest pain characteristic of angina pectoris. Before initiating treatment with Glyceryl nitrate, you examine the patient and find a murmur. The patient reveals that he has a heart valve disorder, and you immediately put a hold on the GTN order.

      Which of the following valve disorders is an absolute contraindication to the use of GTN?

      Your Answer:

      Correct Answer: Mitral stenosis

      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. Nitro-glycerine (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension
      2. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment)
      3. Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)

      The nitrate drugs cause vasodilation via the action of nitric oxide.

      The contraindications to the use of nitrate are the following:
      1. Allergy to nitrates
      2. Concomitant use of phosphodiesterases (PDE) inhibitors such as tadalafil and sildenafil
      3. Right ventricular infarction
      4. Hypertrophic cardiomyopathy
      5. Cardiac tamponade
      6. Constrictive pericarditis
      7. Hypotensive conditions
      8. Hypovolaemia
      9. Marked anaemia
      10. Mitral stenosis
      11. Raised intracranial pressure due to cerebral haemorrhage or head trauma
      12. Toxic pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 47 - What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:...

    Incorrect

    • What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:

      Your Answer:

      Correct Answer: Beta1-receptor agonist

      Explanation:

      Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 48 - Regarding hepatitis B, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hepatitis B, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months.

      Explanation:

      Chronic hepatitis B infection is indicated by the persistence of HBsAg for more than 6 months. Hepatitis B has a long incubation period of about 2 – 6 months. Hepatitis B vaccine has recently been introduced to the routine childhood immunisation schedule – given at 2, 3 and 4 months. It is also given to babies born to hepatitis B infected mothers at birth, four weeks and 12 months old. Treatment of acute hepatitis is supportive. Treatment with antivirals should be considered in chronic infection as responders have a reduced risk of liver damage and liver cancer in the long term.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 49 - Streptococcus pneumoniae is commonly implicated in all of the following infectious diseases EXCEPT...

    Incorrect

    • Streptococcus pneumoniae is commonly implicated in all of the following infectious diseases EXCEPT for:

      Your Answer:

      Correct Answer: Impetigo

      Explanation:

      Impetigo is a highly contagious infection of the superficial epidermis that most commonly affects young children but can occur in any age group. In children it is the most common bacterial skin infection and it is the third most common skin disease overall, behind dermatitis and viral warts.
      The commonest causative organism is Staphylococcus aureus. Streptococcus pyogenesis the second commonest and causes fewer cases, either alone or in combination withS. aureus.The streptococcal form tends to be commoner in warmer, more humid climates. (Hirschmann JV. Impetigo: etiology and therapy. Curr Clin Top Infect Dis. 2002;22:42–51.)
      Impetigo is most commonly spread by direct person-to-person contact, and can spread rapidly through families and school classes. It can also, less commonly, be spread by indirect contact.
      There are two main forms of impetigo:
      Non-bullous impetigo – lesions usually start as tiny pustules or vesicles that evolve rapidly into honey-crusted plaques that tend to be under 2 cm in diameter. These can be itchy but are rarely painful.
      Bullous impetigo – lesions have a thin roof and tend to rupture spontaneously. This type is more likely to be painful and may be associated with systemic upset.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
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  • Question 50 - Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS)...

    Incorrect

    • Which of the following could denote a diagnosis of acquired immunodeficiency syndrome (AIDS) in a patient infected with HIV:

      Your Answer:

      Correct Answer: CD4 count < 200 cells/uL

      Explanation:

      A diagnosis of AIDS can be made in a patient infected with HIV if the patient has a CD4 count < 200 cells/uL, or an AIDS-defining illness. Antiretroviral treatment should be considered in patients with CD4 counts < 350 cells/uL.

      Oral candidiasis is not an AIDS defining illness – candidiasis of the bronchi, trachea, lungs or of the oesophagus is an AIDS defining illness.

      A positive p24 antigen test seen in early HIV infection and does not indicate the development of AIDS.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
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SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (1/1) 100%
Central Nervous System (1/1) 100%
Immune Responses (1/1) 100%
Pathology (1/1) 100%
Cardiovascular (1/2) 50%
Pharmacology (2/5) 40%
Evidence Based Medicine (0/1) 0%
Fluids And Electrolytes (1/1) 100%
Microbiology (1/4) 25%
Specific Pathogen Groups (0/1) 0%
Respiratory (0/1) 0%
Cardiovascular Pharmacology (0/1) 0%
Pathogens (1/3) 33%
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