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  • Question 1 - A 4-year-old child has been convulsing for 20 minutes. She has received two...

    Incorrect

    • A 4-year-old child has been convulsing for 20 minutes. She has received two doses of lorazepam. She takes phenytoin for maintenance therapy, and you draw up a phenobarbitone infusion.
      What dose of phenobarbitone is advised in the treatment of the convulsing child that reaches that stage of the APLS algorithm? Select ONE answer only.

      Your Answer: 5 mg/kg over 30-60 minutes

      Correct Answer: 20 mg/kg over 30-60 minutes

      Explanation:

      If a convulsing child reaches step 3 of the APLS algorithm, then a phenytoin infusion should be set up at 20 mg/kg over 20 minutes. If they are already taken phenytoin as maintenance therapy, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      5.5
      Seconds

  • Question 2 - A 30 year old man stabbed in the upper arm presents to the...

    Incorrect

    • A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination.

      The brachial pulse can be best palpated at ?

      Your Answer: In the anterior arm, medial to the brachialis muscle

      Correct Answer: In the antecubital fossa, medial to the tendon of the biceps brachii

      Explanation:

      The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      13.7
      Seconds

  • Question 3 - Which of the following hormones is dysfunctional in diabetes insipidus: ...

    Correct

    • Which of the following hormones is dysfunctional in diabetes insipidus:

      Your Answer: Antidiuretic hormone

      Explanation:

      Diabetes insipidus (DI) may result from a deficiency of ADH secretion (cranial DI) or from an inappropriate renal response to ADH (nephrogenic DI). As a result, fluid reabsorption at the kidneys is impaired, resulting in large amounts of hypotonic, dilute urine being passed with a profound unquenchable polydipsia.
      The biochemical hallmarks of DI are:
      High plasma osmolality (> 295 mOsm/kg)
      Low urine osmolality (< 300 mOsm/kg)
      Hypernatraemia (> 145 mmol/L)
      High urine volume

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      8.3
      Seconds

  • Question 4 - What is the most common application of Nitrates? ...

    Incorrect

    • What is the most common application of Nitrates?

      Your Answer: Raised intracranial pressure

      Correct Answer: Angina

      Explanation:

      In patients with exertional stable angina, nitrates improve exercise tolerance, time to onset of angina, and ST-segment depression during exercise testing. In combination with beta-blockers or calcium channel blockers, nitrates produce greater anti-anginal and anti-ischemic effects.
      While they act as vasodilators, coronary vasodilators, and modest arteriolar dilators, the primary anti ischemic effect of nitrates is to decrease myocardial oxygen demand by producing systemic vasodilation more than coronary vasodilation. This systemic vasodilation reduces left ventricular systolic wall stress.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      14.5
      Seconds

  • Question 5 - Regarding local anaesthetics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding local anaesthetics, which of the following statements is INCORRECT:

      Your Answer: Lidocaine has class Ib anti-arrhythmic properties.

      Correct Answer: Adrenaline should be used in digital nerve blocks to create a bloodless field.

      Explanation:

      It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in digits or appendages because of the risk of ischaemic necrosis.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      13.1
      Seconds

  • Question 6 - A 34-year-old male is brought into the Emergency Department by the paramedics after...

    Correct

    • A 34-year-old male is brought into the Emergency Department by the paramedics after a road traffic accident. After a quick triage, you establish that he will need to be intubated, and you ask for some ketamine to be prepared.

      Which one of the following options regarding this drug is true?

      Your Answer: It is the only anaesthetic agent available that has analgesic, hypnotic, and amnesic properties

      Explanation:

      Ketamine is a dissociative anaesthetic with analgesic, amnesic, and hypnotic effects. It is the only anaesthetic agent which causes all three of these effects.

      Ketamine exerts its action by non-competitive antagonism at the NMDA (N-methyl-D-aspartate) receptor. Due to its analgesic property, Ketamine is given so that patients do not retain memories of short term procedures. Ketamine is used for the induction and maintenance of anaesthesia in general surgery and for treating burn wounds, battlefield injuries, and children who cannot tolerate other anaesthetic or analgesic agents.

      It can be given by both intravenous and intramuscular routes. Ketamine causes cardiac stimulation by increasing the sympathetic tone. The major side effect is increased intracranial pressure as an increase in the sympathetic tone causes vasoconstriction and an increase in the MAP.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      25.6
      Seconds

  • Question 7 - A 52-year-old man presents to the emergency room with chest pain. He was...

    Incorrect

    • A 52-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.

      Which of the following is NOT a contraindication to abciximab (ReoPro) treatment?

      Your Answer: Active internal bleeding

      Correct Answer: Major surgery within the last 6 months

      Explanation:

      Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.

      The use of abciximab is contraindicated in the following situations:
      Internal bleeding is present.
      Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
      Stroke in the previous two years
      Intracranial tumour
      Aneurysm or arteriovenous malformation
      Haemorrhagic diathesis is a type of haemorrhagic diathesis.
      Vasculitis
      Retinopathy caused by hypertension

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      9.1
      Seconds

  • Question 8 - Regarding bile, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer: The gallbladder concentrates bile mainly by active transport of Na+ into the intercellular spaces of the lining cells.

      Correct Answer: The sphincter of Oddi contracts to force bile from the gallbladder into the duodenum.

      Explanation:

      Bile is secreted by hepatocytes. It is isotonic and resembles plasma ionically. This fraction of bile is called the bile acid-dependent fraction. As it passes along the bile duct, the bile is modified by epithelial cells lining the duct by the addition of water and bicarbonate ions; this fraction is called the bile acid-independent fraction. Overall, the liver can produce 500 – 1000 mL of bile per day. The bile is either discharged directly into the duodenum or stored in the gallbladder. The bile acid-independent fraction is made at the time it is required i.e. during digestion of chyme. The bile acid-dependent fraction is made when the bile salts are returned from the GI tract to the liver, and is then stored in the gallbladder until needed. The gallbladder not only stores bile but concentrates it by removing non-essential solutes and water, leaving bile acids and pigments, mainly by active transport of Na+into the intercellular spaces of the lining cells which, in turn, draws in water, HCO3-and Cl-from the bile and into the extracellular fluid. Within a few minutes of a meal, particularly when fatty foods have been consumed, the gallbladder contracts and releases bile into the bile duct. The sphincter of Oddi is relaxed, allowing the bile to pass into the duodenum through the ampulla of Vater.

    • This question is part of the following fields:

      • Gastrointestinal
      • Physiology
      19
      Seconds

  • Question 9 - A 32-old woman comes for a follow-up visit after being discharged on medications...

    Incorrect

    • A 32-old woman comes for a follow-up visit after being discharged on medications for her newly diagnosed epilepsy. She now complains of a tremor in her arm when she holds a tray in her hand. You examine the patient and notice she has developed postural tremors.

      Which of the following medications for epilepsy is most likely responsible for this tremor?

      Your Answer: Phenytoin

      Correct Answer: Sodium valproate

      Explanation:

      A postural tumour is observed when a person maintains a position against gravity, such as holding the arms outstretched. (The patient holding her tray against gravity)

      Sodium valproate is the most commonly prescribed medication for epilepsy. It is commonly associated with tremors as valproate-induced tremors occur in around 6-45% of patients. The tremors are commonly postural, but a resting tremor may also occur.

      Approximately 25% of patients taking sodium valproate are found to develop a tremor within 3-12 months of initiating therapy.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      8.4
      Seconds

  • Question 10 - A 30-year old male is taken to the emergency room after suffering a...

    Correct

    • A 30-year old male is taken to the emergency room after suffering a blunt trauma to the abdomen. He is complaining of severe abdominal pain, however all his other vital signs remain stable. A FAST scan is performed to assess for hemoperitoneum.

      If hemoperitoneum is present, it is most likely to be observed in which of the following areas?

      Your Answer: Liver

      Explanation:

      The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%.

      The FAST exam evaluates four regions for pathologic fluid: (1) the right upper quadrant, (2) the subxiphoid (or subcostal) view, (3) the left upper quadrant, and (4) the suprapubic region.

      The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The probe is positioned in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The hand is placed against the bed to ensure visualization of the retroperitoneal kidney. The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Recent retrospective evidence suggests the area along the caudal edge of the left lobe of the liver has the highest sensitivity, exceeding 93%.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      21.2
      Seconds

  • Question 11 - A 23 year old student presents to ED with a widespread maculopapular rash....

    Incorrect

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

      Your Answer: Ciprofloxacin

      Correct Answer: Amoxicillin

      Explanation:

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

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      10.8
      Seconds

  • Question 12 - A 56-year-old female visits her cardiologist complaining of a condition that has started...

    Incorrect

    • A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone.

      Which one of the following conditions will this woman NOT have?

      Your Answer: Pulmonary fibrosis

      Correct Answer: Xanthopsia

      Explanation:

      Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias.

      Side effects include:
      1. pulmonary fibrosis
      2. blue discolouration of the skin
      3. phototoxicity
      4. corneal deposits
      5. hepatic necrosis
      6. thyroid dysfunction
      7. sleep disturbances
      8. peripheral neuropathy.

      Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      6.3
      Seconds

  • Question 13 - When a child has chickenpox, how long should he or she be off...

    Incorrect

    • When a child has chickenpox, how long should he or she be off from school?

      Your Answer: 10 days from onset of rash

      Correct Answer: Until all vesicles have crusted over

      Explanation:

      To avoid the spread of infection, infected patients should be isolated. All lesions should be crusted over before children return to nursery or school, even if the standard exclusion time is 5 days.

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      24.4
      Seconds

  • Question 14 - Where on the body is the radial artery pulsation best palpated? ...

    Incorrect

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

      Your Answer: At the wrist just medial to the flexor carpi radialis tendon

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

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      10.3
      Seconds

  • Question 15 - All of the following cause bronchodilation, EXCEPT for: ...

    Incorrect

    • All of the following cause bronchodilation, EXCEPT for:

      Your Answer: Sympathetic stimulation

      Correct Answer: Stimulation of irritant receptors

      Explanation:

      Factors causing bronchodilation: Via beta2-adrenoceptors
      Sympathetic stimulation:
      Adrenaline (epinephrine)
      Beta2-adrenergic agonists e.g. salbutamol
      Anticholinergic and muscarinic antagonists e.g. ipratropium

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      6.4
      Seconds

  • Question 16 - A 65-year-old female presents to the Emergency Department with complaints of chest pain...

    Incorrect

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

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

      Your Answer: Metabolic acidosis

      Correct Answer: Flushing

      Explanation:

      Angina pectoris is the most common symptom of ischemic heart disease and presents with chest pain relieved by rest and nitro-glycerine.

      Nitrates are the first-line treatment to relieve chest pain caused by angina. The commonly used nitrates are:
      1. Glyceryl trinitrate
      2. Isosorbide dinitrate

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

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

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

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      16.7
      Seconds

  • Question 17 - A patient suffers a stab wound to the neck. The entry point of...

    Incorrect

    • A patient suffers a stab wound to the neck. The entry point of the blade is situated within the posterior triangle of the neck.
      Which of the following muscles is LEAST likely to be involved? Select ONE answer only.

      Your Answer: Splenius capitis

      Correct Answer: Sternohyoid

      Explanation:

      The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
      Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
      Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
      Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
      Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
      Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerve

      The posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
      Contents:
      Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
      Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      10.5
      Seconds

  • Question 18 - Which of the following study designs is considered the most appropriate to safely...

    Incorrect

    • Which of the following study designs is considered the most appropriate to safely determine whether an association exists between a well-established, commonly used, anti-hypertensive medication and causing type II diabetes mellitus?

      Your Answer: A double-blind randomised controlled trial

      Correct Answer: A meta-analysis

      Explanation:

      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.

      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.

    • This question is part of the following fields:

      • Evidence Based Medicine
      2.5
      Seconds

  • Question 19 - A patient complains of stomach ache. You see a midline scar in the...

    Incorrect

    • A patient complains of stomach ache. You see a midline scar in the epigastric area when you examine the abdomen. Upon further interrogation, the patient reveals that she had a subtotal gastrectomy for recurring stomach ulcers several years ago. The stomach mucosa secretes a variety of vital compounds, and her ability to secrete some of these molecules has been harmed as a result of his surgery.

      The stomach mucous neck cells secrete which of the following substances?

      Your Answer: Pepsinogen

      Correct Answer: Bicarbonate

      Explanation:

      Foveolar cells, also known as gastric mucous-neck cells, are cells that line the stomach mucosa and are found in the necks of the gastric pits. Mucus and bicarbonate are produced by these cells, which prevent the stomach from digesting itself. At pH 4, the mucous allows the acid to penetrate the lining, while below pH 4, the acid is unable to do so. Viscous fingering is the term for this procedure.

      The table below summarizes the many cell types found in the stomach, as well as the substances secreted by each cell type and the function of the secretion:

      Cell type/ Substance secreted/ Function of secretion
      Parietal cells/ Hydrochloric acid/ Kills microbes and activates pepsinogen
      Parietal cells/ Intrinsic factor/Binds to vitamin B12 and facilitates its absorption
      Chief cells/ Pepsinogen/ Protein digestion
      Chief cells/ Gastric lipase/ Fat digestion
      G-cells/ Gastrin/ Stimulates gastric acid secretion
      Enterochromaffin-like cells (ECL cells) /Histamine/ Stimulates gastric acid secretion
      Mucous-neck cells/ Mucous and bicarbonate/ Protects stomach epithelium from acid
      D-cells/ Somatostatin/ Inhibits gastric acid secretion

    • This question is part of the following fields:

      • Gastrointestinal Physiology
      • Physiology
      1.3
      Seconds

  • Question 20 - 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
      2.1
      Seconds

  • Question 21 - Common causes of exudates are infection, pericarditis, and malignancy.

    Which one statement about exudates...

    Incorrect

    • Common causes of exudates are infection, pericarditis, and malignancy.

      Which one statement about exudates is true?

      Your Answer: They are caused by an imbalance of oncotic and hydrostatic pressures across the walls of the microcirculation

      Correct Answer: LDH levels are usually high

      Explanation:

      An exudate is an inflammatory fluid emanating from the intravascular space due to changes in the permeability of the surrounding microcirculation.

      Exudates are cloudy. It has high LDH levels, serum protein ratio >0.5, protein content >2.9g/dl, specific gravity of >1.020 and a serum-ascites albumin gradient (SAAG) of <1.2g/dl.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      10.6
      Seconds

  • Question 22 - Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the...

    Incorrect

    • Streptococcus viridans has developed subacute bacterial endocarditis in your patient. Which of the following locations is most likely to be the organism's origin?

      Your Answer: Lower respiratory tract

      Correct Answer: Oral cavity

      Explanation:

      Streptococci that are alpha-haemolytic, such as Streptococcus viridans, are major components of the flora in the oral cavity.

    • This question is part of the following fields:

      • Infections
      • Microbiology
      8.6
      Seconds

  • Question 23 - Liquefactive necrosis is most commonly seen in which of the following conditions: ...

    Incorrect

    • Liquefactive necrosis is most commonly seen in which of the following conditions:

      Your Answer: Myocardial infarction

      Correct Answer: Ischaemic stroke

      Explanation:

      Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      16.5
      Seconds

  • Question 24 - Regarding iron handling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding iron handling, which of the following statements is CORRECT:

      Your Answer: Most dietary iron is in the ferrous (Fe 2+ ) state.

      Correct Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).

      Explanation:

      Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      3.8
      Seconds

  • Question 25 - A patient suffers a stab wound to the neck. The entry point of...

    Correct

    • A patient suffers a stab wound to the neck. The entry point of the blade is situated within the posterior triangle of the neck.
      Which of the following muscles is most likely to be involved? Select ONE answer only.

      Your Answer: Anterior scalene

      Explanation:

      The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
      Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
      Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
      Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
      Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
      Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerve

      The posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
      Contents:
      Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
      Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus
      Of the muscles listed in the options, only the anterior scalene is situated within the posterior triangle of the neck.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      2.5
      Seconds

  • Question 26 - You plan to use plain 1% lidocaine for a ring block on a...

    Correct

    • You plan to use plain 1% lidocaine for a ring block on a finger that needs suturing.
      Which SINGLE statement regarding the use of 1% lidocaine, in this case, is true?

      Your Answer: Lidocaine works by blocking fast voltage-gated sodium channels

      Explanation:

      Lidocaine is a tertiary amine that is primarily used as a local anaesthetic but can also be used intravenously in the treatment of ventricular dysrhythmias.
      Lidocaine works as a local anaesthetic by diffusing in its uncharged base form through neural sheaths and the axonal membrane to the internal surface of the cell membrane sodium channels. Here it alters signal conduction by blocking the fast voltage-gated sodium channels. 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.
      Each 1 ml of plain 1% lidocaine solution contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg. When administered with adrenaline 1:200,000, the maximum safe dose is 7 mg/kg. Because of the risk of vasoconstriction and tissue necrosis, lidocaine should not be used in combination with adrenaline in extremities such as fingers, toes, and the nose.
      The half-life of lidocaine is 1.5-2 hours. Its onset of action is rapid within a few minutes, and it has a duration of action of 30-60 minutes when used alone. Its duration of action is prolonged by co-administration with adrenaline (about 90 minutes).
      Lidocaine tends to cause vasodilatation when used locally. This is believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      8
      Seconds

  • Question 27 - A young female was diagnosed with a urinary tract infection and was sent...

    Incorrect

    • A young female was diagnosed with a urinary tract infection and was sent home with medications. However, after 48 hours of discharge, she returned to the hospital because there had been no relief from her symptoms. The urine sensitivity test report is still unavailable. Fresh blood tests were sent, and her estimated GFR is calculated to be >60 ml/minute.

      She was prescribed nitrofurantoin 100 mg modified-release orally twice a day for two days.

      Out of the following, which antibiotic is most appropriate to be prescribed to this patient?

      Your Answer: Co-amoxiclav

      Correct Answer: Fosfomycin

      Explanation:

      The NICE guidelines for women with lower UTIs who are not pregnant are:
      1. Consider prescribing a different antibiotic if symptoms do not improve within 48 hours or worsen at any time
      2. If the urine culture and susceptibility test results are available, review the choice of antibiotic according to the results and change the antibiotic accordingly if symptoms are not improving or bacteria is resistant to the prescribed antibiotic

      The first choice of antibiotics for non-pregnant women aged 16 years and over is:
      1. Nitrofurantoin
      100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minute
      2. Trimethoprim
      200 mg PO BD for three days

      The second-choice (no improvement in lower UTI symptoms on first-choice for at least 48 hours, or when first-choice is not suitable) are:
      1. Nitrofurantoin
      100 mg modified-release PO BD for three days – if eGFR >45 ml/minute
      2. Pivmecillinam
      400 mg PO initial dose, then 200 mg PO TDS for three days
      3. Fosfomycin 3 g single sachet dose

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      6.8
      Seconds

  • Question 28 - When treating diabetic ketoacidosis (DKA), glucose should be given together with insulin as...

    Incorrect

    • When treating diabetic ketoacidosis (DKA), glucose should be given together with insulin as soon as the blood glucose concentration falls below 14 mmol/L in the form of:

      Your Answer: 5% glucose intravenous infusion at a rate of 125 mL/hour

      Correct Answer: 10% glucose intravenous infusion at a rate of 125 mL/hour

      Explanation:

      In addition to the sodium chloride 0.9 percent infusion, glucose 10% should be given intravenously (into a large vein with a large-gauge needle) at a rate of 125 mL/hour once blood glucose concentration falls below 14 mmol/litre.

    • This question is part of the following fields:

      • Endocrine
      • Pharmacology
      0.6
      Seconds

  • Question 29 - A 20-year-old with type I diabetes mellitus has an episode of hypoglycaemia following...

    Incorrect

    • A 20-year-old with type I diabetes mellitus has an episode of hypoglycaemia following inadvertent administration of too much insulin.

      The mechanism by which insulin causes glucose to be transported into cells is?

      Your Answer: Co-transport

      Correct Answer: Facilitated diffusion

      Explanation:

      The only mechanism by which insulin facilitates uptake of glucose into cells is by facilitated diffusion through a family of hexose transporters.

      The major transporter used for glucose uptake is GLUT4. GLUT4 is made available in the plasma membrane by the action of insulin.
      When insulin concentrations are low, GLUT4 transporters are present in cytoplasmic vesicles, where they are cannot be used for transporting glucose.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      1
      Seconds

  • Question 30 - A patient who is taking ramipril for high blood pressure complains of a...

    Incorrect

    • A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:

      Your Answer: Increased production of prostaglandin

      Correct Answer: Decreased bradykinin breakdown

      Explanation:

      Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0.7
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

CNS Pharmacology (0/2) 0%
Pharmacology (2/13) 15%
Anatomy (2/5) 40%
Upper Limb (0/2) 0%
Endocrine (1/2) 50%
Physiology (1/5) 20%
Cardiovascular (0/2) 0%
Anaesthesia (2/3) 67%
Cardiovascular Pharmacology (0/3) 0%
Gastrointestinal (0/1) 0%
Abdomen And Pelvis (1/1) 100%
Infections (0/3) 0%
Microbiology (0/2) 0%
Pathogens (0/1) 0%
Respiratory (0/1) 0%
Head And Neck (1/2) 50%
Evidence Based Medicine (1/2) 50%
Gastrointestinal Physiology (0/1) 0%
General Pathology (0/1) 0%
Pathology (0/3) 0%
Inflammatory Responses (0/1) 0%
Haematology (0/1) 0%
Endocrine Physiology (0/1) 0%
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