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  • Question 1 - A patient suffered from a chest injury while working out in the gym....

    Correct

    • 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: 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
      23.2
      Seconds

  • Question 2 - A 32-year-old female is diagnosed case of bipolar disorder and is on medication....

    Incorrect

    • A 32-year-old female is diagnosed case of bipolar disorder and is on medication. She presents to her psychiatric team with symptoms of severe depression. She is currently taking Lithium.

      Out of the following, which is TRUE regarding lithium?

      Your Answer:

      Correct Answer: It commonly causes a tremor

      Explanation:

      Lithium is the drug of choice for bipolar disorders but is commonly associated with side effects and toxicity.

      Fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy with Lithium. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer. Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremors.

      Option The normal therapeutic range is 2.0-2.5 mmol/l: Lithium should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l. Levels should be checked one week after starting therapy and one week after every change in dosage. (Option Levels should be checked one month after starting therapy)

      Option It can induce hyperthyroidism: Lithium has a known effect on thyroid function. Lithium decreases the production of T4 and T3 and commonly causes hypothyroidism. More rarely, lithium causes hyperthyroidism due to thyroiditis.

      Option It can induce diabetes mellitus: Lithium can induce nephrogenic diabetes insipidus but not diabetes mellitus.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 3 - A patient with pronounced tremor, muscle contractions, muscle spasms, and slowness of movement...

    Incorrect

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

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

      Your Answer:

      Correct Answer: Haloperidol

      Explanation:

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

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

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

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 4 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Incorrect

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer:

      Correct Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.

      For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 5 - What is the mechanism of action of captopril: ...

    Incorrect

    • What is the mechanism of action of captopril:

      Your Answer:

      Correct Answer: Inhibition of the conversion of angiotensin I to angiotensin II

      Explanation:

      Angiotensin-converting enzyme inhibitors (ACE inhibitors) e.g. captopril inhibit the conversion of angiotensin I to angiotensin II, and thus have a vasodilatory effect, lowering both arterial and venous resistance. The cardiac output increases and, because the renovascular resistance falls, there is an increase in renal blood flow. This latter effect, together with reduced aldosterone release, increases Na+ and H2O excretion, contracting the blood volume and reducing venous return to the heart.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 6 - A patient is referred to the Medicine Department for complaints of unilateral hearing...

    Incorrect

    • A patient is referred to the Medicine Department for complaints of unilateral hearing loss, tinnitus and facial numbness. Upon further investigation, an acoustic neuroma is given as the final diagnosis.

      Which of the following nerves is least likely to be affected in acoustic neuroma?

      Your Answer:

      Correct Answer: Trochlear nerve

      Explanation:

      Acoustic neuroma is also called vestibular schwannoma (VS), acoustic neuroma, vestibular neuroma or acoustic neurofibroma. These are tumours that evolve from the Schwann cell sheath and can be either intracranial or extra-axial. They usually occur adjacent to the cochlear and vestibular nerves and most often arise from the inferior division of the latter. Anatomically, acoustic neuroma tends to occupy the cerebellopontine angle. About 5-10% of cerebellopontine angle (CPA) tumours are meningiomas and may occur elsewhere in the brain. Bilateral acoustic neuromas tend to be exclusively found in individuals with type 2 neurofibromatosis.

      The following nerves may be affected due to nerve compression:

      Facial nerve: usually minimal with late presentation except for very large tumours. Depending on the degree of engagement of the nerve, the symptoms may include twitching, increased lacrimation and facial weakness.

      Trigeminal Nerve: paraesthesia in the trigeminal distribution, tingling of the tongue, impairment of the corneal reflex, and less commonly pain which may mimic typical trigeminal neuralgia.

      Glossopharyngeal and Vagus nerves: palatal paresis, hoarseness of voice and dysphagia

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 7 - Which of the following clinical features is most suggestive of a lesion of...

    Incorrect

    • Which of the following clinical features is most suggestive of a lesion of the frontal lobe:

      Your Answer:

      Correct Answer: Conjugate eye deviation towards the side of the lesion

      Explanation:

      Conjugate eye deviation towards the side of the lesion is seen in damage to the frontal eye field of the frontal lobe. Homonymous hemianopia is typically a result of damage to the occipital lobe (or of the optic radiation passing through the parietal and temporal lobes). Auditory agnosia may been seen in a lesion of the temporal lobe. Hemispatial neglect may be seen in a lesion of the parietal lobe. Receptive dysphasia is seen in damage to Wernicke’s area, in the temporal lobe.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 8 - 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:

      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
      0
      Seconds

  • Question 9 - By the third day of wound healing, which sort of inflammatory cell has...

    Incorrect

    • By the third day of wound healing, which sort of inflammatory cell has predominated:

      Your Answer:

      Correct Answer: Macrophages

      Explanation:

      The inflammatory phase of healing is sometimes called the lag phase because wound strength does not begin to return immediately. The inflammatory phase is completed within three days except in the presence of infection or other factors associated with impaired wound healing. Mononuclear leukocytes accumulate and are transformed into macrophages. The maturation of blood-derived monocytes into macrophages is heralded by several events, including secretion of vimentin, which is a structural filament protein involved in wound healing.

    • This question is part of the following fields:

      • Pathology
      • Wound Healing
      0
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  • Question 10 - You examine an elderly man who is experiencing chest pain. He doesn't recall...

    Incorrect

    • You examine an elderly man who is experiencing chest pain. He doesn't recall all of his medications, but he does know that he takes a diuretic.

      The enzyme carbonic anhydrase is inhibited by which of the following diuretics?

      Your Answer:

      Correct Answer: Acetazolamide

      Explanation:

      Acetazolamide is a non-competitive, reversible inhibitor of carbonic anhydrase found in the cytosol of cells and on the brush border of the proximal convoluted tubule. Bicarbonate and hydrogen ions are converted to carbonic acid by carbonic anhydrase, which then converts carbonic acid to carbon dioxide and water. As a result, acetazolamide reduces the availability of hydrogen ions, causing sodium and bicarbonate ions to accumulate in the renal tubule, resulting in diuresis.
      The mechanism of action of the various types of diuretics is summarised below:

      1) Loop diuretics, e.g. furosemide, bumetanide
      Act on the Na.K.2Cl co-transporters in the ascending loop of Henlé to inhibit sodium, chloride and potassium reabsorption.

      2) Thiazide diuretics, e.g. Bendroflumethiazide, hydrochlorothiazide
      Act on the Na.Cl co-transporter in the distal convoluted tubule to inhibit sodium and chloride reabsorption.

      3) Osmotic diuretics, e.g. mannitol
      Increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect.

      4) Aldosterone antagonists, e.g. spironolactone
      Acts in the distal convoluted tubule as a competitive aldosterone antagonist resulting in inhibition of sodium reabsorption and increasing potassium reabsorption.

      5) Carbonic anhydrase inhibitors, e.g. acetazolamide
      Inhibit the enzyme carbonic anhydrase preventing the conversion of bicarbonate and hydrogen ions into carbonic acid.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 11 - Which of the following clinical features is NOT a typical feature of haemolytic...

    Incorrect

    • Which of the following clinical features is NOT a typical feature of haemolytic anaemias:

      Your Answer:

      Correct Answer: Angular cheilitis

      Explanation:

      Features include:
      Anaemia
      Jaundice (caused by unconjugated bilirubin in plasma, bilirubin is absent from urine)
      Pigment gallstones
      Splenomegaly
      Ankle ulcers
      Expansion of marrow with, in children, bone expansion e.g. frontal bossing in beta-thalassaemia major
      Aplastic crisis caused by parvovirus

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 12 - Injury to which nerve can lead to weakness or paralysis of the brachialis...

    Incorrect

    • Injury to which nerve can lead to weakness or paralysis of the brachialis muscle?

      Your Answer:

      Correct Answer: The musculocutaneous nerve

      Explanation:

      The brachialis muscle is a prime flexor of the forearm at the elbow joint. It is fusiform in shape and located in the anterior (flexor) compartment of the arm, deep to the biceps brachii. The brachialis is a broad muscle, with its broadest part located in the middle rather than at either of its extremities. It is sometimes divided into two parts, and may fuse with the fibres of the biceps brachii, coracobrachialis, or pronator teres muscles. It also functions to form part of the floor of the cubital fossa.

      The brachialis is primarily supplied by the musculocutaneous nerve (C5, C6). In addition, a small lateral portion of the muscle is innervated by the radial nerve (C7).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 13 - A 68-year-old female has presented to the Emergency Department with chest pain, palpitations,...

    Incorrect

    • A 68-year-old female has presented to the Emergency Department with chest pain, palpitations, and breathlessness complaints. On ECG, she is diagnosed with ventricular arrhythmia and is administered lidocaine.

      Which of the following is the correct mechanism of action of lidocaine?

      Your Answer:

      Correct Answer: Blocks Na+ channels in the heart

      Explanation:

      Lidocaine is a tertiary amide local anaesthetic and also a class IV antiarrhythmic.

      Like other local anaesthetics, lidocaine works on the voltage-gated sodium ion channel on the nerve cell membranes. It works in the following steps:
      1. diffuses through neural sheaths and the axonal membrane into the axoplasm
      2. binds fast voltage-gated Na+ channels in the neuronal cell membrane and inactivates them
      3. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarise and will be unable to transmit an action potential, thereby preventing the transmission of pain signals

      The same principle applies to Lidocaine’s actions in the heart as it blocks the sodium channels in the conduction system and the myocardium. This raises the threshold for depolarizing, making it less likely for the heart to initiate or conduct any action potential that can cause arrhythmia.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 14 - All of the following typically occurs as part of normal inspiration except: ...

    Incorrect

    • All of the following typically occurs as part of normal inspiration except:

      Your Answer:

      Correct Answer: Contraction of the internal intercostal muscles

      Explanation:

      Passive inspiration is a result of contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs).
      In inspiration, several movements occur. These are:
      1. elevation of the sternal ends of the ribs (‘pump handle’ movement),
      2. elevation of the lateral shafts of the ribs (‘bucket handle’ movement)
      3. depression of the diaphragm.
      These result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. There is an increased intrathoracic volume and decreased intrathoracic pressure and air is drawn into the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 15 - Regarding Escherichia coli, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding Escherichia coli, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: It is a predominant member of the normal flora of the skin.

      Explanation:

      Escherichia coli is a Gram-negative bacilli that is an important member of the intestinal flora. It is the most common cause of UTI in adults (about 70 – 95% of cases), followed by Staphylococcus saprophyticus (about 5 – 10% of cases), and an important cause of neonatal meningitis. E. coli O157 strain is implicated in the development of dysentery associated with haemolytic uraemic syndrome characterised by haemolytic anaemia, thrombocytopenia and acute renal failure.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
      Seconds

  • Question 16 - Funnel plots are typically used to display: ...

    Incorrect

    • Funnel plots are typically used to display:

      Your Answer:

      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
      0
      Seconds

  • Question 17 - Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the...

    Incorrect

    • Cardiac myocytes contract by excitation-contraction coupling, very much like skeletal myocytes. On the other hand, calcium-induced calcium release (CICR) is a mechanism that is unique to Cardiac myocytes. The influx of calcium ions (Ca 2+) into the cell causes a 'calcium spark,' which causes more ions to be released into the cytoplasm.

      In CICR, which membrane protein in the sarcoplasmic reticulum is involved?

      Your Answer:

      Correct Answer: Ryanodine receptor

      Explanation:

      Cardiac myocytes contract by excitation-contraction coupling, just like skeletal myocytes. Heart myocytes, on the other hand, utilise a calcium-induced calcium release mechanism that is unique to cardiac muscle (CICR). The influx of calcium ions (Ca2+) into the cell causes a ‘calcium spark,’ which causes more ions to be released into the cytoplasm.

      An influx of sodium ions induces an initial depolarisation, much as it does in skeletal muscle; however, in cardiac muscle, the inflow of Ca2+ sustains the depolarisation, allowing it to remain longer. Due to potassium ion (K+) inflow, CICR causes a plateau phase in which the cells remain depolarized for a short time before repolarizing. Skeletal muscle, on the other hand, repolarizes almost instantly.

      The release of Ca2+ from the sarcoplasmic reticulum is required for calcium-induced calcium release (CICR). This is mostly accomplished by ryanodine receptors (RyR) on the sarcoplasmic reticulum membrane; Ca2+ binds to RyR, causing additional Ca2+ to be released.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      0
      Seconds

  • Question 18 - Thyroid cancer has spread to the regional lymph nodes of a patient as...

    Incorrect

    • Thyroid cancer has spread to the regional lymph nodes of a patient as seen in a staging CT scan.

      The lymph from the thyroid gland will drain directly to which of the following nodes?

      Your Answer:

      Correct Answer: Deep lateral cervical lymph nodes

      Explanation:

      Lymphatic drainage of the thyroid gland involves the lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes. The paratracheal and lower deep cervical nodes, specifically, receive lymphatic drainage from the isthmus and the inferior lateral lobes. The superior portions of the thyroid gland drain into the superior pretracheal and cervical nodes.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 19 - A newborn baby is referred by the community midwife who is concerned the...

    Incorrect

    • A newborn baby is referred by the community midwife who is concerned the baby is jaundiced because of the yellow appearance of his eyes and skin following a postnatal home visit. The jaundice is visible in the baby’s feet making her worried.

      Jaundice are visible in the extremities of neonates at what approximate threshold bilirubin level?

      Your Answer:

      Correct Answer: 255 μmol/L

      Explanation:

      Newborn babies have a higher concentration of red blood cells with shorter lifespan leading to higher bilirubin levels than in adults. This condition is short-lived and harmless but with potential serious causes that need to be assessed for if present.

      The most obvious physical sign of jaundice is a yellow discolouration of the sclera, skin and mucous membranes. At a bilirubin level of 35 μmol/L or higher, the eye is affected. The bilirubin level will need to be higher than 255 μmol/L for the feet and extremities to be affected.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      0
      Seconds

  • Question 20 - A 15-year-old male is admitted to a rehabilitation centre with a history of...

    Incorrect

    • A 15-year-old male is admitted to a rehabilitation centre with a history of multiple strokes, myopathy and learning disabilities since childhood. He is under the care of a multidisciplinary team, and his genetic testing reports show the presence of a mitochondrial disorder.

      Which one of the following diseases does this patient most likely have?

      Your Answer:

      Correct Answer: MELAS

      Explanation:

      Mitochondrial diseases are a group of disorders caused by dysfunctional mitochondria. Most cases are maternally inherited, as we inherit our mitochondrial DNA from our mothers only, although mutations in nuclear DNA cause some cases.

      Examples of Mitochondrial Diseases include:
      1. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)
      2. Mitochondrial epilepsy with ragged red fibres (MERRF)
      3. Leber’s hereditary optic neuropathy (LHON)
      4. Diabetes mellitus and deafness (DAD)
      5. Neuropathy, ataxia, retinitis pigmentosa, and ptosis (NARP)
      6. Leigh syndrome (subacute sclerosing encephalopathy).

      Red-green colour blindness and G6PD deficiency have an X-linked recessive pattern of inheritance.

      Tay-Sachs Disease and spinal muscular atrophy have an autosomal recessive pattern of inheritance.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
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      Seconds

  • Question 21 - All of the following statements are considered true regarding nominal variables, except: ...

    Incorrect

    • All of the following statements are considered true regarding nominal variables, except:

      Your Answer:

      Correct Answer: The central tendency of a nominal variable is given by its median

      Explanation:

      A nominal variable is a type of variable that is used to name, label or categorize particular attributes that are being measured. It takes qualitative values representing different categories, and there is no intrinsic ordering of these categories.
      A nominal variable is one of the 2 types of categorical variables and is the simplest among all the measurement variables. Some examples of nominal variables include gender, name, phone, etc.

      A nominal variable is qualitative, which means numbers are used here only to categorize or identify objects. They can also take quantitative values. However, these quantitative values do not have numeric properties. That is, arithmetic operations cannot be performed on them. If the variable is nominal, the mode is the only measure of central tendency to use.

    • This question is part of the following fields:

      • Evidence Based Medicine
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  • Question 22 - A patient with a stab wound to the axilla arrives to the emergency...

    Incorrect

    • A patient with a stab wound to the axilla arrives to the emergency department. You notice weakness in elbow flexion and forearm supination during your assessment. Which of these nerves has been affected:

      Your Answer:

      Correct Answer: Musculocutaneous nerve

      Explanation:

      The musculocutaneous nerve is relatively protected in the axilla, hence injury to it is uncommon. A stab wound in the axilla is the most prevalent source of damage. Because of the activities of the pectoralis major and deltoid, the brachioradialis, and the supinator muscles, arm flexion and forearm flexion and supination are diminished but not completely lost. Over the lateral part of the forearm, there is a lack of sensation.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 23 - Which of the following antibiotics is the first line of treatment for a...

    Incorrect

    • Which of the following antibiotics is the first line of treatment for a patient who has been diagnosed with chlamydia infection?

      Your Answer:

      Correct Answer: Azithromycin

      Explanation:

      The Centres for Disease Control and Prevention (CDC) recommends azithromycin, a single 1 g dose, and doxycycline, 100 mg bd for 7 days, as first-line medications for chlamydial infection treatment.

      Second-line medications (such as erythromycin, penicillins, and sulfamethoxazole) are less effective and have more side effects

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      0
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  • 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:

      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
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  • Question 25 - You review a sick patient in resus who has been prescribed mannitol as...

    Incorrect

    • You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
      Which SINGLE statement regarding mannitol is true?

      Your Answer:

      Correct Answer: It is irritant to veins and causes phlebitis

      Explanation:

      Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
      Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
      Decreasing the rate of CSF formation,and;
      Withdrawing extracellular fluid from the brain across the BBB
      Other uses of mannitol include:
      Short-term management of glaucoma
      Treatment of rhabdomyolysis
      Preserve renal function in peri-operative jaundiced patients
      To initiate diuresis in transplanted kidneys
      Bowel preparation prior to colorectal procedures
      The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
      Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
      Anuria
      Intracranial bleeding (except during craniotomy)
      Severe cardiac failure
      Severe dehydration
      Severe pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
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  • Question 26 - Parasympathetic preganglionic neurons originate in which of the following locations: ...

    Incorrect

    • Parasympathetic preganglionic neurons originate in which of the following locations:

      Your Answer:

      Correct Answer: Brainstem and pelvic splanchnic nerves

      Explanation:

      Parasympathetic preganglionic neurones originate in the brainstem from which they run in cranial nerves III, VII, IX and X and also from the second and third sacral segments of the spinal cord. Parasympathetic preganglionic neurones release acetylcholine into the synapse, which acts on cholinergic nicotinic receptors on the postganglionic fibre. Parasympathetic peripheral ganglia are generally found close to or within their target, whereas sympathetic peripheral ganglia are located largely in two sympathetic chains on either side of the vertebral column (paravertebral ganglia), or in diffuse prevertebral ganglia of the visceral plexuses of the abdomen and pelvis. Parasympathetic postganglionic neurones release acetylcholine, which acts on cholinergic muscarinic receptors.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
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  • Question 27 - An ambulance transports a 37-year-old woman who is having a seizure. She is...

    Incorrect

    • An ambulance transports a 37-year-old woman who is having a seizure. She is moved to resuscitation and given a benzodiazepine dose, which quickly ends the seizure. You later learn that she has epilepsy and is usually treated with carbamazepine to control her seizures.

      What is carbamazepine's main mechanism of action?

      Your Answer:

      Correct Answer: Sodium channel blocker

      Explanation:

      Carbamazepine is primarily used to treat epilepsy, and it is effective for both focal and generalised seizures. It is not, however, effective in the treatment of absence or myoclonic seizures. It’s also commonly used to treat neuropathic pain, as well as a second-line treatment for bipolar disorder and as a supplement for acute alcohol withdrawal.

      Carbamazepine works as a sodium channel blocker that preferentially binds to voltage-gated sodium channels in their inactive state. This prevents an action potential from firing repeatedly and continuously.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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      Seconds

  • Question 28 - A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness....

    Incorrect

    • A 28-year-old woman in her second trimester is diagnosed with a psychiatric illness. She is started on treatment with a drug. The treatment results in her baby being born with poor tone, feeding problems, hypothyroidism, and a goitre

      Out of the following, which drug is most likely responsible for the baby's condition?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

      In pregnancy and postpartum, lithium is an effective treatment for relapse prevention in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first-trimester lithium exposure and an increased risk of congenital malformations.

      Lithium levels need to be monitored more frequently throughout pregnancy and the postnatal period.

      If given in the 1st-trimester, lithium is associated with a risk of fetal cardiac malformations, such as Ebstein’s anomaly.

      If given in the 2nd and 3rd-trimesters, there is a risk of the following:
      1. hypotonia
      2. lethargy
      3. feeding problems
      4. hypothyroidism
      5. goitre
      6. nephrogenic diabetes insipidus in the neonate

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
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  • Question 29 - Haemophilia B results from a deficiency in: ...

    Incorrect

    • Haemophilia B results from a deficiency in:

      Your Answer:

      Correct Answer: Factor IX

      Explanation:

      Haemophilia B is a bleeding disorder caused by a deficiency of clotting factor IX. It is the second commonest form of haemophilia, and is rarer than haemophilia A. Haemophilia B tends to be similar to haemophilia A but less severe. The two disorders can only be distinguished by specific coagulation factor assays.

      The incidence is one-fifth of that of haemophilia A. Laboratory findings demonstrate prolonged APTT, normal PT and low factor IX.
      Haemophilia B inherited in an X-linked recessive fashion, affecting males born to carrier mothers.
      There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 30 - A 67-year-old man with chronic breathlessness is sent for a lung function test.

    Which...

    Incorrect

    • A 67-year-old man with chronic breathlessness is sent for a lung function test.

      Which statement concerning lung function testing is true?

      Your Answer:

      Correct Answer: In restrictive lung disease, the FEV 1 /FVC ratio is usually >0.7

      Explanation:

      In restrictive lung disease, the FEV1/FVC ratio is usually >0.7%.

      In obstructive lung disease, FEV1 is reduced to <80% of normal and FVC is usually reduced. The FEV1/FVC ratio is reduced to <0.7. Airflow obstruction is defined in the NICE guidelines as:
      Mild airflow obstruction = an FEV 1 of >80% in the presence of symptoms
      Moderate airflow obstruction = FEV 1 of 50-79%
      Severe airflow obstruction = FEV 1 of 30-49%
      Very severe airflow obstruction = FEV1<30%. Spirometry is a poor predictor of quality of life in COPD. However, it can be used as part of the assessment of severity of COPD.

    • This question is part of the following fields:

      • Physiology
      • Respiratory Physiology
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Upper Limb (1/1) 100%
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