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  • Question 1 - Regarding the human cell, which of the following cell organelles is responsible for...

    Correct

    • Regarding the human cell, which of the following cell organelles is responsible for the production of ATP:

      Your Answer: Mitochondria

      Explanation:

      Mitochondria are membrane-bound organelles that are responsible for the production of the cell’s supply of chemical energy. This is achieved by using molecular oxygen to utilise sugar and small fatty acid molecules to generate adenosine triphosphate (ATP). This process is known as oxidative phosphorylation and requires an enzyme called ATP synthase. ATP acts as an energy-carrying molecule and releases the energy in situations when it is required to fuel cellular processes. Mitochondria are also involved in other cellular processes, including Ca2+homeostasis and signalling. Mitochondria contain a small amount of maternal DNA.
      Mitochondria have two phospholipid bilayers, an outer membrane and an inner membrane. The inner membrane is intricately folded inwards to form numerous layers called cristae. The cristae contain specialised membrane proteins that enable the mitochondria to synthesise ATP. Between the two membranes lies the intermembrane space, which stores large proteins that are required for cellular respiration. Within the inner membrane is the perimitochondrial space, which contains a jelly-like matrix. This matrix contains a large quantity of ATP synthase.
      Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      8.8
      Seconds

  • Question 2 - Identify the type of graph described below:

    This graph has been used to create...

    Incorrect

    • Identify the type of graph described below:

      This graph has been used to create visual representations to communicate the risks and benefits of treatments using 4 face categories.

      Your Answer: Pareto diagram

      Correct Answer: Cates plot

      Explanation:

      Cates Plot, since 1999, has been used to create visual representations to communicate the risks and benefits of treatments. The essence of Cates Plot is the use of 4 face categories to visually indicate the following:

      People not affected by a treatment (green faces for those with a good outcome and red for those with a bad outcome)
      People for which treatment changes their category from a bad outcome to a good outcome (yellow faces)
      People for which treatment causes an adverse event and changes their category from a good outcome to a bad outcome (crossed out green faces)

    • This question is part of the following fields:

      • Evidence Based Medicine
      24.8
      Seconds

  • Question 3 - A patient suffers from an injury and as a consequence, is unable to...

    Incorrect

    • A patient suffers from an injury and as a consequence, is unable to externally rotate his femur when his hip is extended. You suspect a nerve injury to the obturator internus muscle. Which of the following nerves innervate the obturator internus muscle?

      Your Answer: Sciatic nerve

      Correct Answer: Obturator internus nerve

      Explanation:

      The obturator internus is innervated by the obturator internus nerve (L5–S2), a branch of sacral plexus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      33.1
      Seconds

  • Question 4 - Doxycycline is indicated first line for treatment of which of the following infections:...

    Correct

    • Doxycycline is indicated first line for treatment of which of the following infections:

      Your Answer: Chlamydia

      Explanation:

      Doxycycline may be used first line for chlamydia, pelvic inflammatory disease (with metronidazole and ceftriaxone), acute bacterial sinusitis, exacerbation of chronic bronchitis, moderate-severity community acquired pneumonia and high-severity community acquired pneumonia (with benzylpenicillin).

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      13.2
      Seconds

  • Question 5 - An analytical study is conducted to compare the risk of stroke between Ticagrelor...

    Incorrect

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

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

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

      Compute for the absolute risk reduction of a stroke, with Warfarin as the standard of treatment.

      Your Answer: 0.04

      Correct Answer: -0.06

      Explanation:

      Absolute risk reduction (ARR) is computed as the difference between the absolute risk in the control group (ARC) and the absolute risk in the treatment group (ART).

      Since Warfarin is the standard of treatment, Warfarin is considered as the control group.

      ARR = ARC-ART
      ARR = (20/500) – (30/300)
      ARR = -0.06

      This means that there is increased risk of stroke in the treatment group, which is the Ticagrelor group.

    • This question is part of the following fields:

      • Evidence Based Medicine
      25.1
      Seconds

  • Question 6 - What is the direct mechanism of action of digoxin as a positive inotrope:...

    Incorrect

    • What is the direct mechanism of action of digoxin as a positive inotrope:

      Your Answer:

      Correct Answer: Inhibition of Na+/K+ ATPase pump

      Explanation:

      Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 7 - Regarding the lung roots, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the lung roots, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.

      Explanation:

      Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 8 - Which of the following neurotransmitter and receptor combinations is present at the neuromuscular...

    Incorrect

    • Which of the following neurotransmitter and receptor combinations is present at the neuromuscular junction:

      Your Answer:

      Correct Answer: Acetylcholine acting at nicotinic receptors

      Explanation:

      At the neuromuscular junction, acetylcholine is released from the prejunctional membrane which acts on cholinergic nicotinic receptors on the postjunctional membrane.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      0
      Seconds

  • Question 9 - Regarding antacids, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding antacids, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Antacids are contraindicated in hypophosphataemia.

      Explanation:

      Antacids are contraindicated in hypophosphataemia. Liquid preparations are more effective than tablet preparations. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids tend to be constipating. Antacids are best taken when symptoms occur or are expected, usually between meals and at bedtime. Antacids should preferably not be taken at the same time as other drugs since they may impair absorption.

    • This question is part of the following fields:

      • Gastrointestinal
      • Pharmacology
      0
      Seconds

  • Question 10 - A 68-year-old man has a very fast heartbeat' and is out of breath....

    Incorrect

    • A 68-year-old man has a very fast heartbeat' and is out of breath. He has had a heart transplant in the past. His electrocardiogram reveals supraventricular tachycardia.

      Which of the following is the most appropriate adenosine dose for him to receive as a first dose?

      Your Answer:

      Correct Answer: Adenosine 3 mg IV

      Explanation:

      A rapid IV bolus of adenosine is given, followed by a saline flush. The standard adult dose is 6 mg, followed by 12 mg if necessary, and then another 12 mg bolus every 1-2 minutes until an effect is seen.

      Patients who have had a heart transplant, on the other hand, are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 11 - What is nimodipine used predominantly in the treatment of? ...

    Incorrect

    • What is nimodipine used predominantly in the treatment of?

      Your Answer:

      Correct Answer: Prevention and treatment of vascular spasm following subarachnoid haemorrhage

      Explanation:

      Nimodipine is a smooth muscle relaxant that is related to nifedipine, but the effects preferentially act on cerebral arteries. It is exclusively used for the prevention and treatment of vascular spasm after an aneurysmal subarachnoid haemorrhage.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 12 - Regarding local anaesthetics, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      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
      0
      Seconds

  • Question 13 - A 72 year old man is brought to ED by ambulance with sudden...

    Incorrect

    • A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:

      Your Answer:

      Correct Answer: Synchronised DC cardioversion

      Explanation:

      All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 14 - A young male has presented to the Emergency Department with a sudden onset...

    Incorrect

    • A young male has presented to the Emergency Department with a sudden onset of severe palpitations, shortness of breath, and chest pain. A 12-lead ECG is recorded, and it shows a narrow complex tachycardia that points to a diagnosis of supraventricular tachycardia.

      Vagal manoeuvres are attempted but are unsuccessful in eliminating the arrhythmia. The next action plan is to use a drug to revert to sinus rhythm.

      Out of the following, which is the first-line treatment for supraventricular tachycardia?

      Your Answer:

      Correct Answer: Adenosine

      Explanation:

      Paroxysmal supraventricular tachycardia is an intermittent tachycardia (HR > 100 bpm) and has the following characteristics:
      1. Sudden onset/offset (Contrast with sinus tachycardia)
      2. Electrical activity originates above the ventricle (Contrast with ventricular tachycardia)
      3. Produces narrow QRS complex (<120ms) The most common cause of PSVT is Atrioventricular nodal re-entrant tachycardia (AVNRT), most common in young women with a mean age onset of 32 years old. There are recurrent episodes of palpitations, and most of the episodes spontaneously. Sometimes, some vagal manoeuvres are required:
      1. Valsalva manoeuvre
      2. immersing the face in ice-cold water
      3. carotid sinus massage.

      If PSVT keeps persisting or is causing severe symptoms, the treatment of choice is intravenous adenosine. The patient’s ECG should be continuously monitored throughout the treatment.

      The recommended doses in adults are as follows:
      – Initial dose of adenosine is 6 mg by rapid IV bolus
      – If unsuccessful, give another dose of adenosine 12 mg by rapid IV bolus
      – If unsuccessful, give a further dose of adenosine 12 mg by rapid IV bolus
      The latest ALS guidelines advocate 18 mg for the third dose, whereas the BNF/NICE guidelines advocate 12 mg.

      If adenosine fails or is contraindicated, intravenous verapamil can be used as an alternative, but it should be avoided in patients recently treated with beta-blockers.

      Synchronized electrical cardioversion will be necessary with signs of hemodynamic instability or if drug treatment has failed to restore sinus rhythm.
      Recurrent episodes of paroxysmal supraventricular tachycardia can be treated by catheter ablation or prevented with drugs such as flecainide, sotalol, diltiazem, or verapamil.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 15 - 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 16 - A 25 year old man presents to the emergency room with abdominal pain,...

    Incorrect

    • A 25 year old man presents to the emergency room with abdominal pain, vomiting and constipation. A CT scan is done which is suggestive of Meckel's diverticulum. Where does the blood supply of the Meckel's diverticulum originate?

      Your Answer:

      Correct Answer: Superior mesenteric artery

      Explanation:

      Meckel’s diverticulum has certain classic characteristics.
      1. It lies on the antimesenteric border of the middle-to-distal ileum
      2. It is approximately 2 feet proximal to the ileocaecal junction
      3. It appears as a blind-ended tubular outpouching of bowel
      4. It is about 2 inches long,
      5. It occurs in about 2% of the population,
      6. It may contain two types of ectopic tissue (gastric and pancreatic).
      7. The diverticulum is supplied by the superior mesenteric artery.
      8. Proximal to the major duodenal papilla the duodenum is supplied by the gastroduodenal artery (branch of the coeliac trunk)
      9. Distal to the major duodenal papilla it is supplied by the inferior pancreaticoduodenal artery (branch of superior mesenteric artery).
      10. The arterial supply to the jejunoileum is from the superior mesenteric artery.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 17 - A 36-year-old woman is 22-weeks pregnant and is investigated for a possible thyroid...

    Incorrect

    • A 36-year-old woman is 22-weeks pregnant and is investigated for a possible thyroid disorder. When her total thyroid hormone levels does not correlate with her thyrometabolic status, her thyroid-binding globulin levels are checked.

      What percentage of circulating thyroid hormones is bound to thyroid-binding globulin?

      Your Answer:

      Correct Answer: 70%

      Explanation:

      Only a very small fraction of the thyroid hormones circulating in the blood are free. The majority is bound to transport proteins. Only the free thyroid hormones are biologically active, and measurement of total thyroid hormone levels can be misleading.

      The relative percentages of bound and unbound thyroid hormones are:
      Bound to thyroid-binding globulin -70%
      Bound to albumin -15-20%
      Bound to transthyretin -10-15%
      Free T3 -0.3%
      Free T4 -0.03%

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      0
      Seconds

  • Question 18 - A 32-year-old man is dehydrated as he presents with severe vomiting and diarrhoea....

    Incorrect

    • A 32-year-old man is dehydrated as he presents with severe vomiting and diarrhoea. He urgently requires resuscitation with intravenous fluid administration. He is also administered metoclopramide.

      Which of the following is the true mechanism of action of metoclopramide?

      Your Answer:

      Correct Answer: Dopamine receptor antagonism

      Explanation:

      Metoclopramide is used to treat nausea and vomiting. It works by blocking the central and peripheral D2 (dopamine 2) receptors in the medullary chemoreceptor trigger zone in the vomiting centre (area postrema). It decreases the sensitivity of the visceral sensory nerves that transmit from the GI system to the vomiting centre. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate.

      At high doses, metoclopramide also blocks type-2 serotonin receptors though the effect is much weaker.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      0
      Seconds

  • Question 19 - Which of the following is NOT a pharmacological effect of beta-blockers: ...

    Incorrect

    • Which of the following is NOT a pharmacological effect of beta-blockers:

      Your Answer:

      Correct Answer: Reduced AV conduction time

      Explanation:

      Effects of beta-blockers:
      Cardiovascular system:
      Reduce blood pressure
      Reduce heart rate, contractility and cardiac output
      Increase AV conduction time, refractoriness and suppress automaticity

      Eye:
      Reduce intraocular pressure

      Respiratory system:
      Cause bronchoconstriction

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 20 - Which statement regarding skeletal muscle is true?
    ...

    Incorrect

    • Which statement regarding skeletal muscle is true?

      Your Answer:

      Correct Answer: Myosin is the major constituent of the thick filament

      Explanation:

      Myosin is the major constituent of the thick filament.

      Actin is the major constituent of the THIN filament.

      Thin filaments consist of actin, tropomyosin and troponin in the ratio 7:1:1.

    • This question is part of the following fields:

      • Basic Cellular Physiology
      • Physiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Cellular (1/1) 100%
Physiology (1/1) 100%
Evidence Based Medicine (0/2) 0%
Anatomy (0/1) 0%
Lower Limb (0/1) 0%
Infections (1/1) 100%
Pharmacology (1/1) 100%
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