-
Question 1
Correct
-
A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.
The gastric ECL cells secrete which of the following substances?
Your Answer: Histamine
Explanation:Enterochromaffin-like cells (ECL cells) are a type of neuroendocrine cell located beneath the epithelium in the stomach glands. They’re most typically located near the parietal cells of the stomach. The ECL cells’ primary role is to produce histamine, which stimulates the formation of stomach acid by the parietal cells.
The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:
Cell type/ Substance secreted/ Function of secretion
Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
Chief cells/ Pepsinogen/ Protein digestion
Chief cells/ Gastric lipase/ Fat digestion
G-cells/ Gastrin/ Stimulates gastric acid secretion
Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
D-cells/ Somatostatin/ Inhibits gastric acid secretion -
This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
-
-
Question 2
Incorrect
-
A 39-year-old man with a long history of depression presents after intentionally overdoing his heart medication. Verapamil immediate-release 240 mg is the tablet he takes for this condition, he says. He took the pills about 30 minutes ago, but his wife discovered him right away and rushed him to the emergency room.
At the moment, he is completely symptom-free. When it comes to this type of overdose, how long does it usually take for symptoms to appear?Your Answer: 3-6 hours
Correct Answer: 1-2 hours
Explanation:Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.
>10 tablets of verapamil (160 mg or 240 mg immediate or sustained-release capsules) or diltiazem can cause serious toxicity (180 mg, 240 mg or 360 mg immediate or sustained-release capsules)
In children, 1-2 tablets of verapamil or diltiazem (immediate or sustained-release)
Symptoms usually appear within 1-2 hours of ingestion with standard preparations. However, with slow-release preparations, significant toxicity may take 12-16 hours to manifest, with peak effects occurring after 24 hours.
The following are the main clinical features of calcium-channel blocker overdose:
Nausea and vomiting
Hypotension
Bradycardia and first-degree heart block
Myocardial ischaemia and stroke
Renal failure
Pulmonary oedema
HyperglycaemiaThe following are some of the most important bedside investigations to conduct:
Blood glucose
ECG
Arterial blood gas
Other investigations that can be helpful include
Urea & electrolytes
Chest X-ray (pulmonary oedema)
Echocardiography -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 3
Correct
-
Gastrin release from antral G-cells is stimulated by all but which one of the following:
Your Answer: Secretin
Explanation:Gastrin secretion is stimulated by:
The presence of small peptides and amino acids in chyme
Gastric distension
Vagal stimulation directly via acetylcholine and indirectly via gastrin-releasing peptide (GRP)
Raised gastric pH -
This question is part of the following fields:
- Gastrointestinal
- Physiology
-
-
Question 4
Correct
-
Which of the following is NOT a typical clinical feature of hypoglycaemia:
Your Answer: Polyuria
Explanation:Clinical features of hypoglycaemia:
Autonomic symptoms: Sweating, feeling hot, anxiety/agitation, palpitations, shaking, paraesthesia, dizziness
Neuroglycopaenic symptoms: Weakness, blurred vision, difficulty speaking, poor concentration, poor coordination, drowsiness, confusion, seizures, coma
Other symptoms: Nausea, fatigue, hunger -
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 5
Correct
-
Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:
Your Answer: Myasthenia gravis
Explanation:Aspirin (at analgesic doses) is contraindicated in:
People with a history of true hypersensitivity to aspirin or salicylates (symptoms of hypersensitivity to aspirin or salicylates include bronchospasm, urticaria, angioedema, and vasomotor rhinitis)
People with active or previous peptic ulceration
People with haemophilia or another bleeding disorder
Children younger than 16 years of age (risk of Reye’s syndrome)
People with severe cardiac failure
People with severe hepatic impairment
People with severe renal impairmentN.B. Owing to an association with Reye’s syndrome, aspirin-containing preparations should not be given to children under 16 years, unless specifically indicated, e.g. for Kawasaki disease.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 6
Correct
-
Antispasmodic drugs are primarily indicated in which of the following conditions:
Your Answer: Irritable bowel syndrome
Explanation:Antispasmodics, such as antimuscarinics, may be used in the management of irritable bowel syndrome. Other antispasmodics used include direct-acting smooth muscle relaxants such as mebeverine, alverine, and peppermint oil. Antispasmodics are contraindicated in bowel obstruction and severe inflammatory bowel disease. Antispasmodics are occasionally of value in treating abdominal cramp associated with diarrhoea but they should not be used for primary treatment. Antispasmodics should be avoided in young children with gastroenteritis because they are rarely effective and have troublesome side effects. Antimuscarinics are contraindicated in urinary retention.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 7
Incorrect
-
Gallstones are commonly found lodged in which of the following parts of the gallbladder?
Your Answer: Fundus
Correct Answer: Neck
Explanation:There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
-
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
-
-
Question 8
Correct
-
Adenosine is primarily indicated for which of the following:
Your Answer: Paroxysmal supraventricular tachycardia
Explanation:Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia including those associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 9
Incorrect
-
Regarding hepatitis C, which of the following statements is INCORRECT:
Your Answer: There is no hepatitis C vaccine available.
Correct Answer: Anti-HCV IgG antibodies are diagnostic of acute infection.
Explanation:Anti-HCV IgG antibodies indicate exposure to hepatitis C but this could be acute, chronic or resolved infection. If the antibody test is positive, HCV RNA should be tested for, which if positive indicates that a person has current infection with active hepatitis C.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 10
Correct
-
A 20-year-old male has an anaphylactic reaction following a wasp sting.
What type of hypersensitivity reaction is this?
Your 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
-
-
Question 11
Incorrect
-
If a lesion is observed in Broca's area, which function is expected to become affected?
Your Answer:
Correct Answer: Formation of words
Explanation:The primary functions of the Broca area are both language production and comprehension. While the exact role in the production is still unclear, many believe that it directly impacts the motor movements to allow for speech. Although originally thought to only aid in speech production, lesions in the area can rarely be related to impairments in the comprehension of language. Different regions of the Broca area specialize in various aspects of comprehension. The anterior portion helps with semantics, or word meaning, while the posterior is associated with phonology, or how words sound. The Broca area is also necessary for language repetition, gesture production, sentence grammar and fluidity, and the interpretation of others’ actions.
Broca’s aphasia is a non-fluent aphasia in which the output of spontaneous speech is markedly diminished and there is a loss of normal grammatical structure. Specifically, small linking words, conjunctions, such as and, or, and but, and the use of prepositions are lost. Patients may exhibit interjectional speech where there is a long latency, and the words that are expressed are produced as if under pressure. The ability to repeat phrases is also impaired in patients with Broca’s aphasia. Despite these impairments, the words that are produced are often intelligible and contextually correct. In pure Broca’s aphasia, comprehension is intact.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 12
Incorrect
-
A 2nd-year medical student is solving an exam paper with questions about the immune system. She comes across a question regarding innate immunity. Innate immunity is the immunity naturally present within the body from birth.
Which ONE of the following is not a part of this type of immunity?Your Answer:
Correct Answer: Antibody production
Explanation:Innate immunity, also called non-specific immunity, refers to the components of the immune system naturally present in the body at birth.
The components of innate immunity include:
1) Natural Killer Cells
2) Neutrophils
3) Macrophages
4) Mast Cells
5) Dendritic Cells
6) Basophils.Acquired or adaptive immunity is acquired in response to infection or vaccination. Although the response takes longer to develop, it is also a more long-lasting form of immunity.
The components of this system include:
1) T lymphocytes
2) B lymphocytes
3) Antibodies -
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 13
Incorrect
-
Alpha cells of the endocrine pancreas produce which of the following hormones:
Your Answer:
Correct Answer: Glucagon
Explanation:Glucagon is a peptide hormone that is produced and secreted by alpha cells of the islets of Langerhans, which are located in the endocrine portion of the pancreas. The main physiological role of glucagon is to stimulate hepatic glucose output, thereby leading to increases in glycaemia. It provides the major counter-regulatory mechanism to insulin in maintaining glucose homeostasis.
Hypoglycaemia is the principal stimulus for the secretion of glucagon but may also be used as an antidote in beta-blocker overdose and in anaphylaxis in patients on beta-blockers that fail to respond to adrenaline.
Glucagon then causes:
Glycogenolysis
Gluconeogenesis
Lipolysis in adipose tissue
The secretion of glucagon is also stimulated by:
Adrenaline
Cholecystokinin
Arginine
Alanine
Acetylcholine
The secretion of glucagon is inhibited by:
Insulin
Somatostatin
Increased free fatty acids
Increased urea productionGlycolysis is the metabolic pathway that converts glucose into pyruvate. The free energy released by this process is used to form ATP and NADH. Glycolysis is inhibited by glucagon, and glycolysis and gluconeogenesis are reciprocally regulated so that when one cell pathway is activated, the other is inactive and vice versa.
Glucagon has a minor effect of enhancing lipolysis in adipose tissue. Lipolysis is the breakdown of lipids and involves the hydrolysis of triglycerides into glycerol and free fatty acids. It makes fatty acids available for oxidation.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 14
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
-
-
Question 15
Incorrect
-
A tumour compresses the jugular foramen of a 50-year-old patient. Compression of several nerves in the jugular foramen will result in which of the following complications?
Your Answer:
Correct Answer: Loss of gag reflex
Explanation:The glossopharyngeal nerve, which is responsible for the afferent pathway of the gag reflex, the vagus nerve, which is responsible for the efferent pathway of the gag reflex, and the spinal accessory nerve all exit the skull through the jugular foramen. These nerves are most frequently affected if the jugular foramen is compressed. As a result, the patient’s gag reflex is impaired.
The vestibulocochlear nerve is primarily responsible for hearing. The trigeminal nerve provides sensation in the face. The facial nerve innervates the muscles of face expression (including those responsible for closing the eye). Tongue motions are controlled mostly by the hypoglossal nerve.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 16
Incorrect
-
Regarding inflammatory bowel disease, acute mild to moderate disease of the rectum or rectosigmoid should be treated initially with:
Your Answer:
Correct Answer: Local aminosalicylate
Explanation:Acute mild to moderate disease affecting the rectum (proctitis) or the rectosigmoid is treated initially with local application of an aminosalicylate; alternatively, a local corticosteroid can be used but it is less effective. A combination of a local aminosalicylate and a local corticosteroid can be used for proctitis that does not respond to a local aminosalicylate alone.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 17
Incorrect
-
Since the fluid that enters the loop of Henle is isotonic, what is its estimated osmolality?
Your Answer:
Correct Answer: 300 mOsm
Explanation:The loop of Henle connects the proximal tubule to the distal convoluted tubule and lies parallel to the collecting ducts. It is consists of three major segments, the thin descending limb, the thin ascending limb, and the thick ascending limb.
The segments are differentiated based on structure, anatomic location, and function. The main action of the loop of Henle is to recover water and sodium chloride from urine. The liquid entering the loop of Henle is a solution of salt, urea, and other substances traversed along by the proximal convoluted tubule, from which most of the dissolved components are needed by the body, particularly glucose, amino acids, and sodium bicarbonate that have been reabsorbed into the blood.
This fluid is isotonic. Isotonic fluids generally have an osmolality ranging from 270 to 310 mOsm/L. With the fluid that enters the loop of Henle, it is estimated to be 300 mOsm/L. However, after passing the loop, fluid entering the distal tubule is hypotonic to plasma since it has been diluted during its passage.
-
This question is part of the following fields:
- Physiology
- Renal Physiology
-
-
Question 18
Incorrect
-
A patient with a high potassium level is at risk of going into cardiac arrest. What changes in the ECG may indicate the incident of cardiac arrest in this patient?
Your Answer:
Correct Answer: Peaked T waves and broad QRS complex
Explanation:Severe hyperkalaemia can result in a heart attack or a life-threatening arrhythmia.
T waves become narrow-based, pointed, and tall if hyperkalaemia is not treated.
The QRS complex widens and eventually merges with the T wave, resulting in a classic sine-wave electrocardiogram. Ventricular fibrillation and asystole are likely to follow.
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 19
Incorrect
-
You're taking a history of a 59-year-old banker who has had heartburn in the past.
Which of the following information about antacids is correct?Your Answer:
Correct Answer: Magnesium carbonate can reduce the absorption of drugs taken at the same time
Explanation:Antacids such as aluminium hydroxide and magnesium carbonate are commonly used. They’re both water-insoluble and can reduce the absorption of drugs taken together. Allow at least 1-2 hours between taking these antacids and any other medications.
Because it reduces gastrointestinal phosphate absorption, aluminium hydroxide can also be used to treat hyperphosphatemia in patients with renal failure.
Magnesium carbonate has a laxative effect, whereas aluminium hydroxide has a constipating effect.
-
This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
-
-
Question 20
Incorrect
-
A 5 day old, full term neonate is with a unilateral purulent eye discharge noticed earlier that day is brought in. On gram stain of the exudate, no bacteria are seen.
What is the most likely causative pathogen?
Your Answer:
Correct Answer: Chlamydia trachomatis
Explanation:Conjunctivitis occurring in the first 28 days of life (Ophthalmia neonatorum) is most commonly caused by Chlamydia trachomatis in the UK.
-
This question is part of the following fields:
- Microbiology
- Pathogens
-
-
Question 21
Incorrect
-
Which of the following is NOT a side effect of phenytoin:
Your Answer:
Correct Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:
Nausea and vomiting
Drowsiness, lethargy, and loss of concentration
Headache, dizziness, tremor, nystagmus and ataxia
Gum enlargement or overgrowth
Coarsening of facial features, acne and hirsutism
Skin rashes
Blood disorders -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 22
Incorrect
-
Regarding the trachea, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: A cricothyrotomy involves making an opening in the neck inferior to the cricoid cartilage.
Explanation:A cricothyrotomy involves making an opening in the median cricothyroid ligament (the medial part of the cricothyroid membrane), between the cricoid cartilage below and the thyroid cartilage above.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 23
Incorrect
-
Elevation of the mandible is produced primarily by which of the following muscles:
Your Answer:
Correct Answer: Temporalis, masseter and medial pterygoid
Explanation:Elevation of the mandible is generated by the temporalis, masseter and medial pterygoid muscles.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 24
Incorrect
-
Which of the following statements regarding the pituitary gland is CORRECT:
Your Answer:
Correct Answer: Cortisol inhibits release of adrenocorticotropic hormone (ACTH) from the anterior pituitary.
Explanation:Anterior pituitary hormones are released under the control of hypothalamic releasing or inhibiting hormones originating from small neurons with their cell bodies in the hypothalamus and released into the blood at the median eminence. These hypothalamic hormones are transported directly to the anterior pituitary via hypophyseal portal vessels. The anterior pituitary hormones (and the hormones released by their target organs) inhibit further release of hypothalamic and anterior pituitary hormones by negative feedback mechanisms e.g. cortisol inhibits the release of ACTH. Prolactin release from the anterior pituitary is inhibited by dopamine.The posterior pituitary is really a direct extension of the hypothalamus. Oxytocin and ADH are manufactured in the cell bodies of large neurons in the hypothalamus and are transported down the axons of these cells to their terminals on capillaries originating from the inferior hypophyseal artery within the posterior pituitary gland. ADH release is controlled by negative feedback mechanisms based on plasma osmolality and blood volume, oxytocin however is involved in positive feedback mechanisms.
-
This question is part of the following fields:
- Endocrine
- Physiology
-
-
Question 25
Incorrect
-
A type II error occurs when:
Your Answer:
Correct Answer: The null hypothesis is accepted when it is false.
Explanation:A type II error occurs when the null hypothesis is wrongly accepted when it is actually false and we conclude that there is no evidence of a difference in effect when one really exists (a false negative result).
-
This question is part of the following fields:
- Evidence Based Medicine
- Statistics
-
-
Question 26
Incorrect
-
A patient has suffered a nerve injury that has caused weakness of the pectoralis minor muscle.
Pectoralis minor receives its innervation from which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Medial pectoral nerve
Explanation:Pectoralis minor is a thin, triangular muscle that is situated in the upper chest. It is thinner and smaller than pectoralis major. It is innervated by the medial pectoral nerve.
The origin of pectoralis minor is the 3rdto the 5thribs, near the costal cartilages. It inserts into the medial border and superior surface of the coracoid process of the scapula.
The main action of pectoralis minor is to draw the scapula inferiorly and anteriorly against the thoracic wall. This serves to stabilise the scapula. -
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 27
Incorrect
-
A 39-year-old man who is suffering from a bacterial infection require antibiotic treatment. You need to figure out which antibiotic is most suitable. Listed below are antimicrobial drugs.
Which one is a nucleic acid synthesis inhibitor?
Your Answer:
Correct Answer: Ciprofloxacin
Explanation:Ciprofloxacin and other quinolone antibiotics work by blocking DNA gyrase, an enzyme that compresses bacterial DNA into supercoils, as well as a type II topoisomerase, which is required for bacterial DNA separation. As a result, they prevent nucleic acid synthesis.
The following is a summary of the many modes of action of various types of antimicrobial agents:Action Mechanisms-Â Examples:
Cell wall production is inhibited
Vancomycin
Vancomycin
CephalosporinsThe function of the cell membrane is disrupted
Nystatin
Polymyxins
Amphotericin BÂInhibition of protein synthesis
Chloramphenicol
Macrolides
Aminoglycosides
TetracyclinesNucleic acid synthesis inhibition
Quinolones
Trimethoprim
Rifampicin
5-nitroimidazoles
Sulphonamides
Anti-metabolic activity
Isoniazid -
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 28
Incorrect
-
A 45-old woman is on several medications and being treated for epilepsy and bipolar disorder. In the ward rounds, you are asked to examine her in detail and discover she has a noticeable tremor. You believe that one of her medications may be responsible for this new onset tremor.
Which of the following medications is least likely to be responsible for this tremor?Your Answer:
Correct Answer: Carbamazepine
Explanation:The only medication that does not commonly cause tremors is carbamazepine.
The other drugs present with the following types of tremors as a side effect to their usage:
1. Sodium valproate – Postural tremor is most common, but a resting tremor can also occur. Approximately 25% of patients taking sodium valproate are found to develop a tremor within 12 months of starting therapy.
2. Lithium – fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer.
3. Atypical antipsychotics, such as olanzapine and quetiapine – tremor and limb shakiness. -
This question is part of the following fields:
- CNS Pharmacology
- Pharmacology
-
-
Question 29
Incorrect
-
What is the effect of a positive inotrope on the Starling curve:
Your Answer:
Correct Answer: Shifts the curve upwards
Explanation:Contractility (inotropy) is the intrinsic ability of cardiac muscle to develop force at a given muscle length. It is determined by the intracellular [Ca2+] and can be estimated by the ejection fraction. Increases in contractility cause an increase in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume, and hence shift the Starling curve upwards. Decreases in contractility cause a decrease in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume and hence shift the Starling curve downwards.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 30
Incorrect
-
Which of the following is NOT a typical side effect of digoxin:
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Digoxin does not cause hypokalaemia, but hypokalaemia does potentiate digoxin toxicity. The adverse effects of digoxin are frequently due to its narrow therapeutic window and include:
Cardiac adverse effects – Sinoatrial and atrioventricular block, Premature ventricular contractions, PR prolongation and ST-segment depression
Nausea, vomiting and diarrhoea
Blurred or yellow vision
CNS effects – weakness, dizziness, confusion, apathy, malaise, headache, depression, psychosis
Thrombocytopenia and agranulocytosis (rare)
Gynaecomastia in men in prolonged administration -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 31
Incorrect
-
Which of the following is NOT a mineralocorticoid effect of corticosteroids:
Your Answer:
Correct Answer: Hyperglycaemia
Explanation:Mineralocorticoid side effects include:hypertensionsodium retentionwater retention and oedemapotassium losscalcium loss
Glucocorticoid side effects include:weight gainhyperglycaemia and diabetesosteoporosis and osteoporotic fracturesmuscle wasting (proximal myopathy)peptic ulceration and perforationpsychiatric reactions -
This question is part of the following fields:
- Endocrine
- Pharmacology
-
-
Question 32
Incorrect
-
Which of the following is NOT a characteristic of megaloblastic anaemia?
Your Answer:
Correct Answer: Raised reticulocyte count
Explanation:The LDH level is usually markedly increased in severe megaloblastic anaemia. Reticulocyte counts are inappropriately low, representing a lack of production of RBCs due to massive intramedullary haemolysis. These findings are characteristics of ineffective haematopoiesis that occurs in megaloblastic anaemia as well as in other disorders such as thalassemia major.
The common feature in megaloblastosis is a defect in DNA synthesis in rapidly dividing cells. To a lesser extent, RNA and protein synthesis are impaired. Unbalanced cell growth and impaired cell division occur since nuclear maturation is arrested. More mature RBC precursors are destroyed in the bone marrow prior to entering the bloodstream (intramedullary haemolysis). -
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 33
Incorrect
-
A patient presents with an acute severe asthma attack. Following a poor response to his initial salbutamol nebuliser, you administer a further nebuliser that this time also contains ipratropium bromide.
After what time period would you expect the maximum effect of the ipratropium bromide to occur? Select ONE answer only.Your Answer:
Correct Answer: 30 -60 minutes
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 Pharmacology
-
-
Question 34
Incorrect
-
You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?
Your Answer:
Correct Answer: Potentiates effect of GABA
Explanation:Lorazepam is a type of benzodiazepine.
Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 35
Incorrect
-
A 70-year-old patient presents with a chronic digoxin overdose. She has vomited several times, is extremely tired, and her vision 'appears yellow,' according to her.
Which of the following is a reason for this patient's use of Digifab?Your Answer:
Correct Answer: Coexistent renal failure
Explanation:An antidote for digoxin overdose is digoxin-specific antibody (Digifab). It’s a lyophilized preparation of digoxin-immune ovine Fab immunoglobulin fragments that’s sterile, purified, and lyophilized. These fragments were extracted from the blood of healthy sheep that had been immunised with a digoxin derivative called digoxin-dicarboxymethoxylamine (DDMA), a digoxin analogue that contains the functionally important cyclopentaperhydrophenanthrene:lactone ring moiety coupled to keyhole limpet hemocyanin (KLH).
Digifab has a higher affinity for digoxin than digoxin does for its sodium pump receptor, which is thought to be the site of its therapeutic and toxic effects. When given to a patient who is intoxicated, Digifab binds to digoxin molecules, lowering free digoxin levels and shifting the equilibrium away from binding to receptors, reducing cardio-toxic effects. The kidney and reticuloendothelial system then clear the Fab-digoxin complexes.
The following summarises the indications for Digifab in acute and chronic digoxin toxicity:
Acute digoxin toxicity
Chronic digoxin toxicity
Cardiac arrest
Life-threatening arrhythmia
Potassium level > 5 mmol/l
>10 mg digoxin ingested (adult)
>4 mg digoxin ingested (child)
Digoxin level > 12 ng/ml
Cardiac arrest
Life-threatening arrhythmia
Significant gastrointestinal symptoms
Symptoms of digoxin toxicity -
This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
-
-
Question 36
Incorrect
-
A 35-year-old man, who was feeling unwell after his return from a business trip, was diagnosed with a disease that is known to be transmitted by a vector.
Among the following microorganisms, which of the following has a mode of transmission of being vector-borne?Your Answer:
Correct Answer: Plasmodium falciparum
Explanation:Plasmodium falciparum is a parasite that is vector-borne which is transmitted by the female Anopheles mosquito.
Bordetella pertussis is transmitted through the respiratory tract, via respiratory droplets or direct contact with infectious secretions.
Mycobacterium tuberculosis is transmitted via inhalation of infected respiratory droplets.
HIV may be transmitted via sexual contact, vertical transmission from mothers to infants, and among injection drug users sharing infected needles, as well as through transfusion of infected blood products.
Treponema pallidum transmission normally occurs during direct sexual contact with an individual who has an active primary or secondary syphilitic lesion.
-
This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
-
-
Question 37
Incorrect
-
Dexamethasone would be most useful for which of the following conditions:
Your Answer:
Correct Answer: Raised intracranial pressure secondary to malignancy
Explanation:Dexamethasone has a very high glucocorticoid activity in conjunction with insignificant mineralocorticoid activity. This makes it particularly suitable for high-dose therapy in conditions where fluid retention would be a disadvantage such as in the management of raised intracranial pressure or cerebral oedema secondary to malignancy. Dexamethasone also has a long duration of action and this, coupled with its lack of mineralocorticoid action makes it particularly suitable for suppression of corticotropin secretion in congenital adrenal hyperplasia. In most individuals a single dose of dexamethasone at night, is sufficient to inhibit corticotropin secretion for 24 hours. This is the basis of the ‘overnight dexamethasone suppression test’ for diagnosing Cushing’s syndrome.
-
This question is part of the following fields:
- Endocrine
- Pharmacology
-
-
Question 38
Incorrect
-
Question 39
Incorrect
-
For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:
Your Answer:
Correct Answer: Synchronised DC shock
Explanation:If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 40
Incorrect
-
A 36 year old man who is overweight with a history of gout, presents to emergency room with an acutely painful big toe which is red, hot and swollen. However, he is apyrexic and otherwise systemically well. He has been diagnosed with acute gout. The most appropriate first line treatment for him is which of the following?
Your Answer:
Correct Answer: NSAIDs
Explanation:The first line treatment for acute gout includes NSAIDs like diclofenac, indomethacin or naproxen. In patients in whom NSAIDs are contraindicated, not tolerated or ineffective, colchicine is an alternative. In those who cannot tolerate or who are resistant to NSAIDs and colchicine, oral or parenteral corticosteroids are an effective alternative. In acute monoarticular gout, intra-articular injection of a corticosteroid can be used occasionally. In acute gout. allopurinol is not used in the actual treatment, but its use should be continued during an acute attack if the patient is already established on long term therapy.
-
This question is part of the following fields:
- Musculoskeletal
- Pharmacology
-
-
Question 41
Incorrect
-
Regarding red blood cell group antigens and antibodies, which of the following statements is CORRECT:
Your Answer:
Correct 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
-
-
Question 42
Incorrect
-
Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.
Which enzyme hydroxylates 25-hydroxycholecalciferol to form 1,25-dihydroxycholecalciferol?Your Answer:
Correct Answer: 1-alpha-hydroxylase
Explanation:The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.
In the presence of UVB light, 7-dehydrocholesterol is converted to cholecalciferol in the epidermal layer of the skin, resulting in 1,25-dihydroxycholecalciferol.
Cholecalciferol is then converted to 25-hydroxycholecalciferol in the endoplasmic reticulum of liver hepatocytes by 25-hydroxylase (calcifediol).
Finally, 1-alpha-hydroxylase converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol in the kidney. The key regulatory point in the formation of 1,25-dihydroxycholecalciferol is 1-alpha-hydroxylase, which is induced by parathyroid hormone or hypophosphatemia.
The following are the primary effects of 1,25-dihydroxycholecalciferol:
Calcium and phosphate absorption in the small intestine is increased.
Calcium reabsorption in the kidneys is increased.
Increases phosphate reabsorption in the kidneys.
Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)
Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback) -
This question is part of the following fields:
- Endocrine Physiology
- Physiology
-
-
Question 43
Incorrect
-
Which of the following microbes adheres to the genital mucosa using fimbriae:
Your Answer:
Correct Answer: Neisseria gonorrhoeae
Explanation:Infection of the genital mucosa by Neisseria gonorrhoeae involves attachment to and invasion of epithelial cells. Initial adherence of gonococci to columnar epithelial cells is mediated by type IV pili assembled from pilin subunit PilE proteins and pilus tip-associated PilC proteins, it then invades the epithelial layer, triggering a local acute inflammatory response.
-
This question is part of the following fields:
- Microbiology
- Principles
-
-
Question 44
Incorrect
-
A 22 year old professional athlete sustains an inversion injury to her left ankle during the 800m. Which of the following ligaments is most likely injured:
Your Answer:
Correct Answer: Anterior talofibular ligament
Explanation:Inversion injuries at the ankle in plantarflexion (such as when wearing high heels) are common, and typically result in damage to the lateral collateral ligament of the ankle, made up of the anterior talofibular, the calcaneofibular and the posterior talofibular ligaments. The anterior talofibular and the calcaneofibular ligaments are most commonly injured, and the posterior talofibular ligament rarely. The spring ligament supports the head of the talus, the deltoid ligament supports the medial aspect of the ankle joint, and the long and short plantar ligaments are involved in maintaining the lateral longitudinal arch of the foot.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 45
Incorrect
-
A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.
Which of the following statements regarding the pectoralis minor muscle is considered correct?Your Answer:
Correct Answer: It stabilises the scapula
Explanation:The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.
Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 46
Incorrect
-
You investigated a patient with a chest infection and want to start antibiotics right away. The patient says they she can't take cephalosporins when you ask about allergies.
Choose the 'second-generation' cephalosporin from the following choices?Your Answer:
Correct Answer: Cefuroxime
Explanation:Cephalosporins of the first generation include cephalexin, cefradine, and cefadroxil. Urinary tract infections, respiratory tract infections, otitis media, and skin and soft-tissue infections are all treated with them.
Second-generation cephalosporins include cefuroxime, cefaclor, and cefoxitin. These cephalosporins are less vulnerable to beta-lactamase inactivation than the ‘first-generation’ cephalosporins. As a result, they’re effective against germs that are resistant to other antibiotics, and they’re especially effective against Haemophilus influenzae.
Cephalosporins of the third generation include cefotaxime, ceftazidime, and ceftriaxone. They are more effective against Gram-negative bacteria than second generation’ cephalosporins. They are, however, less effective against Gram-positive bacteria such Staphylococcus aureus than second-generation cephalosporins.
-
This question is part of the following fields:
- Infections
- Pharmacology
-
-
Question 47
Incorrect
-
The QRS duration of a broad-complex tachyarrhythmia is:
Your Answer:
Correct Answer: Greater than or equal to 0.12 s
Explanation:It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.
-
This question is part of the following fields:
- Cardiovascular
- Pharmacology
-
-
Question 48
Incorrect
-
Regarding antacids, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Antacids should not be taken at the same time as other drugs as they impair absorption.
Explanation:Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids act by neutralising stomach acid. They are used for symptomatic relief in dyspepsia, but are not first line for proven peptic ulcer disease where antisecretory drugs have a better healing effect. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are contraindicated in hypophosphataemia.
-
This question is part of the following fields:
- Gastrointestinal
- Pharmacology
-
-
Question 49
Incorrect
-
The following statements about leukotrienes as chemical mediators of the acute inflammatory response are all true EXCEPT?
Your Answer:
Correct Answer: They decrease vascular permeability
Explanation:Leukotrienes increases (not decrease) vascular permeability during acute inflammation.
All the other statements are correct
-
This question is part of the following fields:
- General Pathology
- Pathology
-
-
Question 50
Incorrect
-
Regarding the glomerular filtration barrier, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The main factor determining whether a substance is filtered or not is molecular weight.
Explanation:Molecular weight is the main factor in determining whether a substance is filtered or not – molecules < 7 kDa in molecular weight are filtered freely e.g. glucose, amino acids, urea, ions but larger molecules are increasingly restricted up to 70 kDa, above which filtration is insignificant. Negatively charged molecules are further restricted, as they are repelled by negative charges, particularly in the basement membrane. Albumin has a molecular weight of 69 kDa and is negatively charged, thus only very small amounts are filtered (and all of the filtered albumin is reabsorbed in the proximal tubule), whereas small molecules such as ions, glucose, amino acids and urea pass the filter without hindrance. This means that ultrafiltrate is virtually protein free, but otherwise has an identical composition of that of plasma. The epithelial lining of the Bowman's capsule consists of a single layer of cells called podocytes. The glomerular capillary endothelium is perforated by pores (fenestrations) which allow plasma components with a molecular weight of < 70 kDa to pass freely.
-
This question is part of the following fields:
- Physiology
- Renal
-
SESSION STATS - PERFORMANCE PER SPECIALTY
