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  • Question 1 - Funnel plots are typically used to display: ...

    Incorrect

    • Funnel plots are typically used to display:

      Your Answer: The survival of a sample cohort

      Correct Answer: The existence of publication bias in meta-analysis

      Explanation:

      Funnel plots are used to demonstrate the existence of publication bias in meta-analysis. Funnel plots are scatter plots of treatment effects estimated from individual studies on the x axis and some measure of study size on the y axis. Each point on the graph represents one of the studies. A symmetrical inverted funnel shape indicates an absence of publication bias. If there is publication bias, there will be asymmetry of the open wide end due to the absence of small negative results.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Study Methodology
      11
      Seconds

  • Question 2 - You're called to a cardiac arrest in your Emergency Department resuscitation area. The...

    Correct

    • You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available. In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines? Ventricular fibrillation

      Your Answer: Lidocaine

      Explanation:

      If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      17.1
      Seconds

  • Question 3 - You see a 30-year-old man who has come to the department with a...

    Correct

    • You see a 30-year-old man who has come to the department with a very tender right elbow. On examination, the elbow is very hot and red, and appears to be acutely inflamed.
      Which SINGLE statement regarding acute inflammation is FALSE?

      Your Answer: Reduced extravascular osmotic pressure leads to oedema

      Explanation:

      Inflammation can be divided intoacute inflammation, which occurs over seconds, minutes, hours, and days, andchronic inflammation, which occurs over longer periods.
      Acute inflammationcommences within seconds or minutes following the injury of tissues. There are numerous potential stimuli for an acute inflammatory response including infections (bacterial, viral, fungal, parasitic), tissue necrosis, foreign bodies, and Immune reactions (hypersensitivity reactions). The chief cell type of acute inflammation is the neutrophil.
      There are three main processesthat occur in the acute inflammatory response:
      Increased blood flow
      Increased capillary permeability
      Neutrophil migration
      1. Increased blood flow:
      Vasoactive mediators are released, such as nitric oxide, histamine, bradykinins, and prostaglandin E2. These mediators cause vasodilatation and increased blood flow to the area (causing redness and heat).
      2. Increased capillary permeability:
      The vasoactive mediators also cause increased capillary permeability by causing endothelial cell contraction that widens the intercellular gaps of venules. This allows an outpouring of protein-rich fluid (exudate) into the extracellular tissues that results in a reduction of intravascular osmotic pressure and an increase in extravascular/interstitial pressure. The increased interstitial osmotic pressure leads to oedema.
      3. Neutrophil migration:
      Neutrophils leave the vasculature through the following sequence of events:
      Margination and rolling: neutrophils flow nearer the vessel wall, rather than in the axial stream, which is referred to as margination. Following margination the neutrophils begin rolling along the surface of the vascular endothelium.
      Activation and adhesion: then as a result of interaction with endothelial cell adhesion molecules (CAMs) that is mediated by selectins, the neutrophils are activated and adhere to the endothelium.
      Transmigration: once bound to the endothelium, neutrophils squeeze through gaps between adjacent endothelial cells into the interstitial fluid, in a process calleddiapedesis.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      35.5
      Seconds

  • Question 4 - The normal range of arterial HCO3- is: ...

    Incorrect

    • The normal range of arterial HCO3- is:

      Your Answer: 20 - 28 mmol/L

      Correct Answer: 24 - 30 mmol/L

      Explanation:

      Normal ranges:
      pH = 7.35 – 7.45
      pO2(on air) = 11 -14 kPa
      pCO2= 4.5 – 6.0 kPa
      HCO3-= 24 – 30 mmol/L
      BE = +/- 2 mmol/L

    • This question is part of the following fields:

      • Physiology
      • Renal
      12.9
      Seconds

  • Question 5 - What is the effect of activated vitamin D on the renal handling of...

    Correct

    • What is the effect of activated vitamin D on the renal handling of calcium:

      Your Answer: Increases calcium reabsorption in the distal tubule

      Explanation:

      Activated vitamin D acts to:
      GUT:increase calcium and phosphate absorption in the small intestine (the main action)
      KIDNEYS:increase renal calcium reabsorption (in the distal tubule via activation of a basolateral Ca2+ATPase pump), increase renal phosphate reabsorption, inhibit 1-alpha-hydroxylase activity in the kidneys (negative feedback)
      PARATHYROID GLANDS:inhibit PTH secretion from the parathyroid glands

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      13.8
      Seconds

  • Question 6 - The hypothalamus produces antidiuretic hormone (ADH), also known as vasopressin, which is a...

    Correct

    • The hypothalamus produces antidiuretic hormone (ADH), also known as vasopressin, which is a peptide hormone. It is important for maintaining water and electrolyte balance, as well helping control arterial pressure.

      To have an effect on blood arteries, ADH binds to which of the following receptors?

      Your Answer: V 1 receptor

      Explanation:

      ADH, or antidiuretic hormone, is a hormone that regulates water and electrolyte balance. It is released in response to a variety of events, the most important of which are higher plasma osmolality or lower blood pressure. ADH increases plasma volume and blood pressure via acting on the kidneys and peripheral vasculature.

      It causes vasoconstriction by binding to peripheral V1 Receptors on vascular smooth muscle via the IP3 signal transduction and Rho-kinase pathways. The systemic vascular resistance and arterial pressure rise as a result. High levels of ADH appear to be required for this to have a major impact on arterial pressure, such as in hypovolaemic shock.

    • This question is part of the following fields:

      • Physiology
      • Renal Physiology
      16.6
      Seconds

  • Question 7 - Which of the following muscles inserts into the patella? ...

    Correct

    • Which of the following muscles inserts into the patella?

      Your Answer: The quadriceps femoris complex

      Explanation:

      The quadriceps femoris muscle translates to “four-headed muscle” from Latin. It bears this name because it consists of four individual muscles; rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. Out of all four muscles, only the rectus femoris crosses both the hip and knee joints. The others cross only the knee joint. These muscles differ in their origin, but share a common quadriceps femoris tendon which inserts into the patella. The function of the quadriceps femoris muscle is to extend the leg at the knee joint and to flex the thigh at the hip joint.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      7.6
      Seconds

  • Question 8 - Which of the following is true regarding respiration? ...

    Correct

    • Which of the following is true regarding respiration?

      Your Answer: The diaphragm is responsible for abdominal breathing

      Explanation:

      The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.

      Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.

      In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.

      Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      17.4
      Seconds

  • Question 9 - A patient in the Emergency Department had a diagnosis of diabetic ketoacidosis (DKA)...

    Correct

    • A patient in the Emergency Department had a diagnosis of diabetic ketoacidosis (DKA) and you commence an insulin infusion. Which of these statements concerning endogenous insulin is true?

      Your Answer: Insulin has a short half-life of around 5-10 minutes

      Explanation:

      Insulin, a peptide hormone, is produced in the pancreas by the beta-cells of the islets of Langerhans.

      The beta-cells first synthesise an inactive precursor called preproinsulin which is converted to proinsulin by signal peptidases, which remove a signal peptide from the N-terminus.

      Proinsulin is converted to insulin by the removal of the C-peptide.

      Insulin has a short half-life in the circulation of about 5-10 minutes.
      Glucagon and parasympathetic stimulation stimulates insulin release.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      35.7
      Seconds

  • Question 10 - A 44 year old woman is brought to ED having fallen down the...

    Correct

    • A 44 year old woman is brought to ED having fallen down the stairs and injured her right arm. On examination she is unable to abduct her arm normally, and has weakness of lateral rotation. She has sensory loss over the lateral aspect of her upper arm. Which of the following injuries is most likely to produce this pattern of injury:

      Your Answer: Surgical neck of humerus fracture

      Explanation:

      Damage to the axillary nerve will result in loss of abduction past about 15 degrees and weakness of lateral rotation due to paralysis of the deltoid and teres minor and loss of sensation over the regimental badge area on the upper lateral arm. The axillary nerve is most likely injured in fracture of the surgical neck of the humerus due to its course where it winds around this region together with the posterior humeral circumflex vessels.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      10.3
      Seconds

  • Question 11 - Glucagon is contraindicated in which of the following: ...

    Incorrect

    • Glucagon is contraindicated in which of the following:

      Your Answer: Cushing's disease

      Correct Answer: Pheochromocytoma

      Explanation:

      Glucagon is contraindicated in pheochromocytoma.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      33
      Seconds

  • Question 12 - If the ejection fraction increases, there will be a decrease in: ...

    Correct

    • If the ejection fraction increases, there will be a decrease in:

      Your Answer: End-systolic volume

      Explanation:

      An increase in ejection fraction means that a higher fraction of the end-diastolic volume is ejected in the stroke volume (e.g. because of the administration of a positive inotropic agent). When this situation occurs, the volume remaining in the ventricle after systole, the end-systolic volume, will be reduced. Cardiac output, stroke volume, and mean arterial pressure will be increased.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      16.1
      Seconds

  • Question 13 - You have been called to review a patient and his management in the...

    Correct

    • You have been called to review a patient and his management in the resuscitation room. A very sick patient has been started on mannitol in his treatment protocol.

      Out of the following, what is NOT an FDA-recognized indication for the use of mannitol?

      Your Answer: Congestive cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      Mannitol has four FDA approved uses clinically:
      1. Reduction of intracranial pressure and brain mass
      2. reduce intraocular pressure if this is not achievable by other means
      3. promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage
      4. promote diuresis to promote the excretion of toxic substances, materials, and metabolites

      It can be used in rhabdomyolysis-induced renal failure, especially in crush injuries. Mannitol reduces osmotic swelling and oedema in the injured muscle cells and helps restore skeletal muscle function.

      It is a low molecular weight compound and can be freely filtered at the glomerulus and not reabsorbed. This way increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).

      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:

      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      24.8
      Seconds

  • Question 14 - Among the following infectious diseases, which is typically considered to have an incubation...

    Correct

    • Among the following infectious diseases, which is typically considered to have an incubation period of 3 weeks and longer?

      Your Answer: Infectious mononucleosis

      Explanation:

      Infectious mononucleosis is caused by Epstein-Barr virus (EBV). The incubation period for EBV varies from 2 weeks to 2 months.

      The usual incubation period for rubella is 14 days; with a range of 12 to 23 days.

      Gonorrhoea has a short incubation period of approximately 2 to 7 days.

      The mumps virus can be isolated from infected saliva and swabs rubbed over the Stensen’s duct from 9 days before onset of symptoms until 8 days after parotitis appears.

      Scarlet fever, which appears within 1 to 2 days after bacterial infection, is characterized by a diffuse red rash that appears on the upper chest and spreads to the trunk and extremities. The rash disappears over the next 5 to
      7 days and is followed by desquamation.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      18.2
      Seconds

  • Question 15 - Which of the following statements regarding the pituitary gland is CORRECT: ...

    Incorrect

    • Which of the following statements regarding the pituitary gland is CORRECT:

      Your Answer: Hypothalamic hormones are transported to the posterior pituitary by hypophyseal portal vessels.

      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
      57.5
      Seconds

  • Question 16 - Following a bee sting, a 8-year old boy was transported to resus with...

    Incorrect

    • Following a bee sting, a 8-year old boy was transported to resus with symptoms and signs of an anaphylactic reaction. You decide to administer adrenaline IM stat. What is the recommended dose of intramuscular adrenaline?

      Your Answer: 0.5 mL of 1:1000

      Correct Answer: 0.3 mL of 1:1000

      Explanation:

      Anaphylaxis is a type I hypersensitivity reaction that is severe and life-threatening. It is marked by the fast onset of life-threatening airway and/or circulatory issues, which are generally accompanied by skin and mucosal abnormalities. When an antigen attaches to specific IgE immunoglobulins on mast cells, degranulation and the release of inflammatory mediators takes place (e.g. histamine, prostaglandins, and leukotrienes).

      The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.

      In anaphylaxis, age-related dosages of IM adrenaline are:
      150 mcg (0.15 mL of 1:1000) for a child under 6 years
      300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years
      500 mcg (0.5 mL of 1:1000) for children aged 12 and above
      500 mcg for adults (0.5 mL of 1:1000)

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory Pharmacology
      12.8
      Seconds

  • Question 17 - A patient with diplopia is found to have eye deviation downwards and outwards....

    Correct

    • A patient with diplopia is found to have eye deviation downwards and outwards. The likely nerves that are affected are:

      Your Answer: Oculomotor nerve

      Explanation:

      The results of an oculomotor (CN III) nerve palsy are a depressed and abducted (down and out) eye, ptosis, diplopia, and a fixed and dilated pupil.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      13.6
      Seconds

  • Question 18 - A 55-year-old woman with history of gastritis and reflux esophagitis tested positive for...

    Correct

    • A 55-year-old woman with history of gastritis and reflux esophagitis tested positive for Helicobacter pylori infection.

      Which of the following statements regarding Helicobacter pylori is considered true?

      Your Answer: It is helix shaped

      Explanation:

      Helicobacter pylori is a curved or helix-shaped, non-spore forming, Gram-negative, microaerophilic bacteria. It is motile, having multiple flagella at one pole. It has a lipopolysaccharide component in its outer membrane.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      15
      Seconds

  • Question 19 - How is filtered K+mainly reabsorbed in the thick ascending limb of the loop...

    Incorrect

    • How is filtered K+mainly reabsorbed in the thick ascending limb of the loop of Henle:

      Your Answer: Primary active transport via Na + /K + ATPase

      Correct Answer: Secondary active transport via Na + /K + /2Cl - cotransporter

      Explanation:

      Around 30% of filtered K+is reabsorbed in the thick ascending limb of the loop of Henle, primarily via the luminal Na+/K+/2Cl-cotransporter, but there is also significant paracellular reabsorption, encouraged by the positive potential in the tubular lumen.

    • This question is part of the following fields:

      • Physiology
      • Renal
      13.2
      Seconds

  • Question 20 - Which of the following statements about sickle cell disease is TRUE: ...

    Incorrect

    • Which of the following statements about sickle cell disease is TRUE:

      Your Answer: Sickle cell is inherited in an autosomal dominant pattern.

      Correct Answer: Hand-foot syndrome is frequently a first presentation of the disease.

      Explanation:

      Hand-foot syndrome in children is typically the first symptom of the disease, produced by infarction of the metaphysis of small bones. The disease is inherited as an autosomal recessive trait. By adulthood, the spleen has usually infarcted. Infection with the B19 parvovirus is usually followed by an aplastic crisis. Thrombocytopenia is caused by splenic sequestration.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      21.3
      Seconds

  • Question 21 - All of the following statements are correct regarding the management of acute asthma...

    Incorrect

    • All of the following statements are correct regarding the management of acute asthma in adults except:

      Your Answer: Continuous salbutamol nebulisation should be considered in patients with severe acute asthma that is poorly responsive to initial bolus dose of salbutamol.

      Correct Answer: Intravenous aminophylline has been shown to result in significant additional bronchodilation compared to standard care.

      Explanation:

      There usually isn’t any additional bronchodilation with intravenous (IV) aminophylline compared to standard care with inhaled bronchodilators and steroids. IV aminophylline may cause side effects such as arrhythmias and vomiting. However, some additional benefit may be gained in patients with near-fatal asthma or life-threatening asthma with a poor response to initial therapy (5 mg/kg loading dose over 20 minutes unless on maintenance oral therapy, then continuous infusion of 0.5 – 0.7 mg/kg/hr).

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      48.6
      Seconds

  • Question 22 - Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antimuscarinic antispasmodics, which of the following statements is CORRECT:

      Your Answer: Hyoscine butylbromide is a very effective antispasmodic.

      Correct Answer: They are contraindicated in paralytic ileus.

      Explanation:

      Antimuscarinics are contraindicated in paralytic ileus. Antimuscarinics reduce intestinal motility by blocking muscarinic acetylcholine receptors and relaxing smooth muscle. Hyoscine butylbromide is advocated as a gastrointestinal antispasmodic, but it is poorly absorbed and thus has limited clinical utility. Antimuscarinics cause a reduction in bronchial secretions (they can be used to this effect in palliative patients). 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.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      34.5
      Seconds

  • Question 23 - For which of the following class of drugs can neostigmine be used as...

    Correct

    • For which of the following class of drugs can neostigmine be used as a reversal agent?

      Your Answer: Non-depolarising muscle relaxants

      Explanation:

      Neostigmine is used specifically for reversal of nondepolarizing (competitive) blockade and is anticholinesterase. It acts within one minute of intravenous injection, and the effects last for 20 to 30 minutes. After this time period, a second dose may then be necessary.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      15.1
      Seconds

  • Question 24 - A 12-year-old boy presents to you with a history of fever. A rash...

    Incorrect

    • A 12-year-old boy presents to you with a history of fever. A rash began as small red dots on the face, scalp, torso, upper arms and legs shortly afterwards and has now progressed to small blisters and pustules. You make a diagnosis of chickenpox.

      The following complications of chickenpox is the LEAST likely.

      Your Answer: Hepatitis

      Correct Answer: Bronchospasm

      Explanation:

      Chickenpox (varicella zoster) is a highly contagious airborne disease and has an incubation period of between 7-21 days. It often has a prodromal phase when there is a fever, aches and headaches, dry cough, and sore throat before onset of rash.

      Some recognized complications of chickenpox are:
      Orchitis
      Hepatitis
      Pneumonia
      Encephalitis
      Infected spots
      Otitis media
      Myocarditis
      Glomerulonephritis
      Appendicitis
      Pancreatitis

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      15.3
      Seconds

  • Question 25 - A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath,...

    Incorrect

    • A 17-year-old male patient diagnosed with cystic fibrosis is experiencing shortness of breath, coughing, and flu-like symptoms. His X-ray results shows atelectasis, or collapsed lung, specifically in his lower right lung. All of the following statements are true regarding collapsed lungs, except for which one.

      Your Answer: Pulmonary capillary blood will have similar PO 2 and PCO 2

      Correct Answer: Atelectasis is an example of a perfusion defect

      Explanation:

      Atelectasis is a complete or partial collapse of the lung. It occurs when the alveoli deflate or are filled with alveolar fluid. It is considered a ventilation defect of the alveoli due to cystic fibrosis. It is not a perfusion defect. A perfusion defect will produce pathological dead space in which the lung alveoli are ventilated adequately but are not perfused, and there is no gas exchange. While with atelectasis, the alveoli remain perfused. However, there is impaired oxygen delivery and intrapulmonary shunting of blood will be present in the collapsed area. Since there is no exchange of gas at the capillary-alveolar interface of the collapsed segments, the pulmonary capillary blood will have similar PO2 and PCO2.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      48
      Seconds

  • Question 26 - You are teaching a group of medical students about cardiovascular examination. You are...

    Correct

    • You are teaching a group of medical students about cardiovascular examination. You are discussing heart sounds and the cardiac cycle. Which of the following stages of the cardiac cycle occurs immediately after the aortic valve closes:

      Your Answer: Isovolumetric relaxation

      Explanation:

      Immediately after the closure of the semilunar valves, the ventricles rapidly relax and ventricular pressure decreases rapidly but the AV valves remain closed as initially the ventricular pressure is still greater than atrial pressure. This is isovolumetric relaxation. Atrial pressure continues to rise because of venous return, with the v wave of the JVP waveform peaking during this phase. Rapid flow of blood from the atria into the ventricles during the ventricular filling phase causes thethird heart sound, which is normal in children but, in adults, is associated with disease such as ventricular dilation.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      74.6
      Seconds

  • Question 27 - Regarding the lacrimal apparatus, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the lacrimal apparatus, which of the following statements is CORRECT:

      Your Answer: The nasolacrimal duct empties into the middle nasal meatus.

      Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.

      Explanation:

      Lacrimal fluid is drained from the eyeball through the lacrimal punctum.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      26.4
      Seconds

  • Question 28 - A 45-year-old woman presents with persistent palpitations for the past two days. She...

    Correct

    • A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.

      Which of the drugs listed below is the best fit for this strategy?

      Your Answer: Bisoprolol

      Explanation:

      In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.

      Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      24.9
      Seconds

  • Question 29 - Which of the following statements is incorrect regarding the electron transfer system? ...

    Incorrect

    • Which of the following statements is incorrect regarding the electron transfer system?

      Your Answer: The electron transfer system stage produces most of the energy produced in cellular respiration.

      Correct Answer: The electron transfer system occurs in anaerobic respiration.

      Explanation:

      The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      46.5
      Seconds

  • Question 30 - Which of the following nerves innervates the gastrocnemius muscle? ...

    Correct

    • Which of the following nerves innervates the gastrocnemius muscle?

      Your Answer: Tibial nerve

      Explanation:

      The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      28.7
      Seconds

  • Question 31 - This anatomic part lies at the heart of the tooth. ...

    Correct

    • This anatomic part lies at the heart of the tooth.

      Your Answer: The pulp cavity

      Explanation:

      Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      10.6
      Seconds

  • Question 32 - A patient presents with epistaxis. She tells you that she has a rare...

    Correct

    • A patient presents with epistaxis. She tells you that she has a rare platelet disorder and gives you her haematology outpatient letter that contains information about it. You learn that her disorder is caused by low levels of glycoprotein IIb/IIIa.
      What is the SINGLE most likely diagnosis?

      Your Answer: Glanzamann’s thromboasthenia

      Explanation:

      Glanzmann’s thromboasthenia is a rare platelet disorder in which platelets contain defective or low levels of glycoprotein IIb/IIIa.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      11.4
      Seconds

  • Question 33 - A trauma victim who has been intubated is tachycardic, hypotensive, and has a...

    Correct

    • A trauma victim who has been intubated is tachycardic, hypotensive, and has a poor urine output. You feel she is dehydrated and decide to use a central venous catheter to help you manage her. As part of this, you keep an eye on the waveform of central venous pressure (CVP).

      Which of the following cardiac cycle phases corresponds to the CVP waveform's 'a wave'?

      Your Answer: End diastole

      Explanation:

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

      The structure of the CVP waveform is as follows:
      The CVP’s components are listed in the table below:
      Component of the waveform
      The cardiac cycle phase.
      mechanical event
      mechanical event Diastole 
      Atrial contraction
      a wave 
      C  wave 
      v wave
      Early systole
      The tricuspid valve closes and bulges 
      Late Systole 
      Filling of the atrium with systolic blood 
      x descent
      y descent
      Mid systole
      Relaxation of the atrium 
      Early diastole
      Filling of the ventricles at an early stage

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      36.6
      Seconds

  • Question 34 - One of your patients has been infected by an obligate pathogen and presents...

    Correct

    • One of your patients has been infected by an obligate pathogen and presents with features of this condition.

      Which of these is an example of an obligate pathogen?

      Your Answer: Trepenoma pallidum

      Explanation:

      Treponema pallidum is an obligate pathogen. Obligate pathogens are almost always associated with disease and usually cannot survive outside of the body for long periods of time. Examples include and HIV.

      Staphylococcus aureus and Bacteroides fragilis are conditional pathogens. These are pathogens that usually cause disease only if certain conditions are met.

      Pneumocystis jiroveci and Pseudomonas aeruginosa, are opportunistic pathogens. These are pathogens that can only cause disease in an immunocompromised host or under unusual circumstances.

    • This question is part of the following fields:

      • Microbiology
      • Principles Of Microbiology
      14.3
      Seconds

  • Question 35 - A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement...

    Incorrect

    • A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement of her blood glucose level is done and found to be grossly elevated. She is diagnosed with diabetic ketoacidosis. A fixed rate insulin infusion is given as part of her treatment.

      Which of these is an action of insulin?

      Your Answer: Inhibits glycolysis

      Correct Answer: Stimulates lipogenesis

      Explanation:

      Insulin is an anabolic hormone. Its actions can be broadly divided into:
      Lipid metabolism
      Protein metabolism and
      Carbohydrate metabolism

      For lipid metabolism, insulin:
      Stimulates lipogenesis
      Inhibits lipolysis by lipase

      For carbohydrate metabolism, insulin:
      Decreases gluconeogenesis
      Stimulates glycolysis
      Promotes glucose uptake in muscle and adipose tissue
      Promotes glycogen storage
      Increases glycogenesis
      Decreases glycogenolysis

      Protein metabolism:
      Stimulates protein synthesis
      Accelerates net formation of protein
      Stimulates amino acid uptake
      Inhibits protein degradation
      Inhibits amino acid conversion to glucose

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      31.1
      Seconds

  • Question 36 - Antidiuretic hormone (ADH) is synthesised by which of the following: ...

    Correct

    • Antidiuretic hormone (ADH) is synthesised by which of the following:

      Your Answer: Hypothalamus

      Explanation:

      Antidiuretic hormone is synthesised in the hypothalamus and transported to the posterior pituitary within nerve fibres where it is stored in secretory granules. ADH binds V2 receptors on renal principal cells in the late distal tubule and collecting ducts, raising cAMP levels and causing intracellular vesicles to fuse with the apical membrane. In their membrane these vesicles have water channels called aquaporins, which increase the water permeability allowing greater water reabsorption and concentration of urine. Excess levels of ADH results in syndrome of inappropriate ADH secretion (SIADH) characterised by hyponatremia with concomitant hypo-osmolality and high urine osmolality.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      4.3
      Seconds

  • Question 37 - Your consultant decides to use ketamine for a patient requiring procedural sedation in...

    Correct

    • Your consultant decides to use ketamine for a patient requiring procedural sedation in the Emergency Department. At what receptor does ketamine primarily act:

      Your Answer: NMDA receptor

      Explanation:

      In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist (analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast sodium channels (local anaesthetic effect).

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      5.5
      Seconds

  • Question 38 - At the start of the cardiac cycle, towards the end of diastole, all...

    Correct

    • At the start of the cardiac cycle, towards the end of diastole, all of the following statements are true EXCEPT for:

      Your Answer: The semilunar valves are open.

      Explanation:

      At the start of the cardiac cycle, towards the end of diastole, the whole of the heart is relaxed. The atrioventricular (AV) valves are open because the atrial pressure is still slightly greater than the ventricular pressure. The semilunar valves are closed, as the pressure in the pulmonary artery and aorta is greater than the ventricular pressures. The cycle starts when the sinoatrial node (SAN) initiates atrial systole.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      56.1
      Seconds

  • Question 39 - A 60 -year-old man is tested to have low calcium levels . After...

    Correct

    • A 60 -year-old man is tested to have low calcium levels . After additional questioning, it becomes clear that he has a calcium-deficient diet.

      What is the daily calcium intake recommendation for a healthy adult?

      Your Answer: 1300 mg

      Explanation:

      A daily calcium intake of 1,000 to 1,300 mg is advised for adults. Women have a slightly higher calcium need than men and are at a higher risk of developing osteoporosis as they age.

      Calcium-rich foods include the following:
      Milk, cheese, and butter as dairy products.
      Broccoli, spinach, and green beans as green veggies.
      Bread, rice, and cereals as whole grain foods.
      Sardines, salmon, and other bony fish
      Eggs
      Nuts
      The following foods have the least calcium:
      Carrot
      Fruits such as kiwis, raspberries, oranges, and papaya
      Chicken and pork in meats.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      9.7
      Seconds

  • Question 40 - Regarding the partial pressure of gases, which of the following statements is INCORRECT:...

    Incorrect

    • Regarding the partial pressure of gases, which of the following statements is INCORRECT:

      Your Answer: The total pressure exerted by the atmosphere at sea level is 760 mmHg (101 kPa).

      Correct Answer: At high altitude, the oxygen fraction is reduced.

      Explanation:

      At altitude, the oxygen fraction is unaltered but the barometric pressure and thus partial pressure of oxygen is reduced.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      61.6
      Seconds

  • Question 41 - You're evaluating a male patient who's having a lung function test done. In...

    Incorrect

    • You're evaluating a male patient who's having a lung function test done. In calculating the patient’s functional residual capacity, what parameters should you add to derive the functional residual capacity volume?

      Your Answer: inspiratory reserve volume + residual volume

      Correct Answer: Expiratory reserve volume + residual volume

      Explanation:

      The volume of air that remains in the lungs after a single breath is known as functional residual capacity (FRC). It is calculated by combining the expiratory reserve volume and residual volume.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
      36
      Seconds

  • Question 42 - A 61-year-old woman returns to get the results of recent blood tests she...

    Incorrect

    • A 61-year-old woman returns to get the results of recent blood tests she had done for non-specific malaise, lethargy, and weight loss.

      The only abnormality discovered during the blood tests was a 580 x 10 9 /l increase in platelets. Her platelets were also elevated on a blood test taken 6 months earlier, according to her previous results. You're aware of the recent emergence of elevated platelet levels as a cancer risk marker and decide to look into it.

      Which of the following cancers is most likely to cause isolated thrombocytosis?

      Your Answer: Multiple myeloma

      Correct Answer: Colorectal cancer

      Explanation:

      Raised platelet levels have emerged as a cancer risk marker, according to a large population-based study published in 2017(link is external). According to the study, 12 percent of men and 6% of women with thrombocytosis were diagnosed with cancer within a year. These figures increased to 18% in men and 10% in women if a second platelet count was taken within 6 months of the first and showed an increased or stable elevated platelet count.

      The researchers discovered that thrombocytosis linked to cancer is most common in colorectal and lung cancers, and it is linked to a worse prognosis. Furthermore, one-third of the cancer patients in the study had no other symptoms that would have prompted an immediate cancer referral.

      The exact mechanism by which these cancers cause thrombocytosis is unknown, but one theory proposes the existence of pathogenic feedback loops between malignant cells and platelets, with a reciprocal interaction between tumour growth and metastasis, as well as thrombocytosis and platelet activation. Another hypothesis is that thrombocytosis occurs independently of cancer but aids in its spread and progression.

      The findings show that routinely testing for thrombocytosis could cut the time it takes to diagnose colorectal and lung cancer by at least two months. In the UK, this could result in around 5500 earlier cancer diagnoses per year.

      Because the positive predictive value of thrombocytosis in middle age for cancer (10%) is higher than the positive predictive value for a woman in her 50s presenting with a new breast lump (8.5%), this is clearly an important research paper that should be used to adjust future clinical practise. The current NICE guidelines predate these new research findings, so we’ll have to wait and see how they affect cancer referral guidelines in the UK.

      Because there are so many possible cancers associated with thrombocytosis, the treating clinician should take a thorough history and perform a thorough clinical examination if a patient is diagnosed with it. Further investigation and the most appropriate referral route should be aided by this information.

      It’s worth noting that the patients in the study had their blood tests done for a medical reason rather than as a random screening test.

      If there are no other symptoms to guide investigation and referral (one-third of the patients in the study had no other symptoms), keep in mind that the two most common cancers encountered were colorectal and lung cancer, so a chest X-ray and a faecal immunochemical test (FIT) for faecal blood may be reasonable initial investigations.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      29.5
      Seconds

  • Question 43 - In relation to ketamine, which of the following statements is TRUE: ...

    Correct

    • In relation to ketamine, which of the following statements is TRUE:

      Your Answer: It is usually associated with tachycardia, increased blood pressure and increased cardiac output.

      Explanation:

      Ketamine has hypnotic, analgesic and local anaesthetic properties. Major adverse effects include Hypertension, Increased cardiac output, Increased ICP, Tachycardia, Tonic-clonic movements, Visual hallucinations and Vivid dreams.
      Ketamine is mostly utilized in paediatric anaesthesia, especially when repeated dosing is necessary (such as for serial burns dressings). Ketamine has little effect on respiratory drive, and protective airway reflexes are unaffected. Ketamine is also a bronchial smooth muscle relaxant, hence it plays a unique function in the treatment of severe asthma.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      21.4
      Seconds

  • Question 44 - All of the following statements are considered true regarding randomized control trials, except:...

    Correct

    • All of the following statements are considered true regarding randomized control trials, except:

      Your Answer: They can eliminate the need for further studies

      Explanation:

      Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis. The examination of variability or heterogeneity in study results is also a critical outcome.
      The benefits of meta-analysis include a consolidated and quantitative review of a large, and often complex, sometimes apparently conflicting, body of literature. The specification of the outcome and hypotheses that are tested is critical to the conduct of meta-analyses, as is a sensitive literature search.

      Important medical questions are typically studied more than once, often by different research teams in different locations. In many instances, the results of these multiple small studies of an issue are diverse and conflicting, which makes the clinical decision-making difficult. The need to arrive at decisions affecting clinical practise fostered the momentum toward evidence-based medicine. Evidence-based medicine may be defined as the systematic, quantitative, preferentially experimental approach to obtaining and using medical information. Therefore, meta-analysis, a statistical procedure that integrates the results of several independent studies, plays a central role in evidence-based medicine.

    • This question is part of the following fields:

      • Evidence Based Medicine
      26.7
      Seconds

  • Question 45 - As a result of a cardiovascular drug she was prescribed, a 67-year-old woman...

    Correct

    • As a result of a cardiovascular drug she was prescribed, a 67-year-old woman develops corneal microdeposits.

      Which of the following drugs is the MOST LIKELY cause?

      Your Answer: Amiodarone

      Explanation:

      Corneal microdeposits are almost universally present (over 90%) in people who have been taking amiodarone for more than six months, especially at doses above 400 mg/day. Although these deposits usually cause no symptoms, about 10% of patients report seeing a ‘bluish halo.’ This goes away once the treatment is stopped, and it rarely causes vision problems.

      Other effects of amiodarone on the eye are much rarer, occurring in only 1-2 percent of patients:
      Optic neuropathy is a condition that affects the eyes.
      Non-arteritic anterior ischaemic optic neuropathy (N-AION)
      Swelling of the optic disc

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      13.4
      Seconds

  • Question 46 - Which of the following statements about neutrophils is TRUE: ...

    Correct

    • Which of the following statements about neutrophils is TRUE:

      Your Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.

      Explanation:

      Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.

      The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      10.6
      Seconds

  • Question 47 - In inserting a nasogastric tube, which area is least likely to be a...

    Incorrect

    • In inserting a nasogastric tube, which area is least likely to be a site of resistance when the tube goes from the nose to the stomach?

      Your Answer: At the oesophageal hiatus in the diaphragm

      Correct Answer: In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk

      Explanation:

      In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk offers the least resistance when nasogastric tube is inserted from the nose to the stomach.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      20.3
      Seconds

  • Question 48 - A 63 year old lady presents to ED with a persistent cough and...

    Correct

    • A 63 year old lady presents to ED with a persistent cough and red currant jelly sputum. She has a history of chronic alcohol abuse and has an X-ray which demonstrates a cavitating pneumonia. The most likely causative pathogen is:

      Your Answer: Klebsiella pneumoniae

      Explanation:

      One of the results of Klebsiella pneumoniae is pneumonia that is usually a very severe infection. It is characterised by thick, bloody sputum (red currant jelly sputum), and is associated with complications like lung abscess, cavitation, necrosis, empyema and pleural effusions.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      14.3
      Seconds

  • Question 49 - Which of the following is NOT a common side effect of antihistamines: ...

    Correct

    • Which of the following is NOT a common side effect of antihistamines:

      Your Answer: Tremor

      Explanation:

      Common side effects of antihistamines may include:
      Anticholinergic effects (blurred vision, dry mouth, urinary retention)
      Headache
      Gastrointestinal disturbances
      Psychomotor impairment (sedation, dizziness and loss of appetite)
      These side effects are significantly reduced with second-generation agents.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      19.7
      Seconds

  • Question 50 - Elevation of the mandible is produced primarily by which of the following muscles:...

    Incorrect

    • Elevation of the mandible is produced primarily by which of the following muscles:

      Your Answer: Temporalis, masseter and lateral pterygoid

      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
      105.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Evidence Based Medicine (1/2) 50%
Study Methodology (0/1) 0%
Cardiovascular Pharmacology (4/4) 100%
Pharmacology (8/12) 67%
General Pathology (1/1) 100%
Pathology (3/5) 60%
Physiology (9/17) 53%
Renal (0/2) 0%
Endocrine (2/4) 50%
Renal Physiology (1/1) 100%
Anatomy (6/9) 67%
Lower Limb (2/2) 100%
Thorax (1/2) 50%
Endocrine Physiology (2/3) 67%
Upper Limb (1/1) 100%
Cardiovascular (3/3) 100%
Microbiology (4/5) 80%
Specific Pathogen Groups (2/3) 67%
Respiratory Pharmacology (0/1) 0%
Cranial Nerve Lesions (1/1) 100%
Haematology (1/3) 33%
Respiratory (1/3) 33%
Gastrointestinal (0/1) 0%
Anaesthesia (3/3) 100%
Respiratory Physiology (0/2) 0%
Head And Neck (1/3) 33%
Basic Cellular (0/1) 0%
Cardiovascular Physiology (1/1) 100%
Principles Of Microbiology (1/1) 100%
Immune Responses (1/1) 100%
Infections (1/1) 100%
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