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  • Question 1 - A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis....

    Correct

    • A 5-year-old girl presents in a paediatric clinic with symptoms of viral gastroenteritis. You encourage the mother to treat the child at home with oral rehydration therapy (ORT), e.g. dioralyte.

      Out of the following, which statement is FALSE regarding the use of ORT in the management of gastroenteritis?

      Your Answer: ORT is sugar-free

      Explanation:

      One of the major complications of gastroenteritis is dehydration. Choosing the correct fluid replacement therapy is essential according to a patient’s hydration status.

      Oral rehydration therapy (ORT) refers to the restitution of water and electrolyte deficits in dehydrated patients using an oral rehydration salt (ORS) solution. It is a fluid replacement strategy that is less invasive than other strategies for fluid replacement and has successfully lowered the mortality rate of diarrhoea in developing countries.

      Some characteristics of Oral rehydration solutions are:
      – slightly hypo-osmolar (about 250 mmol/litre) to prevent the possible induction of osmotic diarrhoea.
      – contain glucose (e.g. 90 mmol/L in dioralyte). The addition of glucose improves sodium and water absorption in the bowel and prevents hypoglycaemia.
      – also contains essential mineral salts

      Current NICE guidance recommends that 50 ml/kg is given over 4 hours to treat mild dehydration.
      Once rehydrated, a child should continue with their usual daily fluid intake plus 200 ml ORT after each loose stool. In an infant, give ORT at 1-1.5 x the normal feed volume and in an adult, give 200-400 ml after each loose stool.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pharmacology
      307.2
      Seconds

  • Question 2 - Amoxicillin is used first line for all of the following infections EXCEPT for:...

    Correct

    • Amoxicillin is used first line for all of the following infections EXCEPT for:

      Your Answer: Cellulitis

      Explanation:

      Amoxicillin is used first line for low to moderate severity community acquired pneumonia, exacerbations of chronic bronchitis, for acute otitis media, for acute sinusitis, for oral infections/dental abscess, for Listeria meningitis (in combination with another antibiotic), for infective endocarditis (in combination with another antibiotic) and for H. Pylori eradication (in combination with metronidazole/clarithromycin and a PPI). Flucloxacillin is used first line for acute cellulitis.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      23
      Seconds

  • Question 3 - A patient sustains an injury to the proximal median nerve after falling through...

    Correct

    • A patient sustains an injury to the proximal median nerve after falling through a glass door. Which of the following muscles would you not expect to be affected:

      Your Answer: Flexor carpi ulnaris

      Explanation:

      All of the muscles in the anterior forearm are innervated by the median nerve, except for the flexor carpi ulnaris and the medial half of the flexor digitorum profundus which are innervated by the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      143
      Seconds

  • Question 4 - Regarding haemoglobin, which of the following statements is CORRECT: ...

    Correct

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

      Your Answer: In degradation of haemoglobin, the haem group is split from the haemoglobin and converted to biliverdin and ultimately to bilirubin.

      Explanation:

      Haemoglobin is composed of four polypeptide globin chains each with its own iron containing haem molecule. Haem synthesis occurs largely in the mitochondria by a series of biochemical reactions commencing with the condensation of glycine and succinyl coenzyme A under the action of the key rate-limiting enzyme delta-aminolevulinic acid (ALA) synthase. The globin chains are synthesised by ribosomes in the cytosol. Haemoglobin synthesis only occurs in immature red blood cells.
      There are three types of haemoglobin in normal adult blood: haemoglobin A, A2 and F:
      – Normal adult haemoglobin (HbA) makes up about 96 – 98 % of total adult haemoglobin, and consists of two alpha (α) and two beta (β) globin chains. 
      – Haemoglobin A2 (HbA2), a normal variant of adult haemoglobin, makes up about 1.5 – 3.5 % of total adult haemoglobin and consists of two α and two delta (δ) globin chains.
      – Foetal haemoglobin is the main Hb in the later two-thirds of foetal life and in the newborn until approximately 12 weeks of age. Foetal haemoglobin has a higher affinity for oxygen than adult haemoglobin. 
      Red cells are destroyed by macrophages in the liver and spleen after , 120 days. The haem group is split from the haemoglobin and converted to biliverdin and then bilirubin. The iron is conserved and recycled to plasma via transferrin or stored in macrophages as ferritin and haemosiderin. An increased rate of haemoglobin breakdown results in excess bilirubin and jaundice.

    • This question is part of the following fields:

      • Basic Cellular
      • Physiology
      310.9
      Seconds

  • Question 5 - A patient suffered from a chest injury while working out in the gym....

    Incorrect

    • A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.

      Which of the following statements regarding the pectoralis minor muscle is considered correct?

      Your Answer: It flexes the humerus

      Correct Answer: It stabilises the scapula

      Explanation:

      The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.

      Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      137
      Seconds

  • Question 6 - Regarding control of hospital acquired infection (HAI), which of the following statements is...

    Correct

    • Regarding control of hospital acquired infection (HAI), which of the following statements is CORRECT:

      Your Answer: Chlorhexidine is an anti-staphylococcal agent.

      Explanation:

      Chlorhexidine is an anti-staphylococcal agent. Cleaning is the removal of foreign material from areas or objects to a point at which they are visually free from debris.  Disinfection is the reduction in the number of infectious particles. Isopropyl alcohol is not effective against C. difficile spores. Autoclaving is a method of sterilisation.

    • This question is part of the following fields:

      • Microbiology
      • Principles
      547.8
      Seconds

  • Question 7 - A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was...

    Correct

    • A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was rushed to the Emergency Department due to sudden onset crushing chest pain. ECG showed an ST-elevation myocardial infarct in the left anterior descending artery territory. The patient's condition was stabilised and managed with angioplasty, but he sustained significant myocardial damage.

      Which one of the following statements best agrees with the myocardial healing process?

      Your Answer: The left ventricle will likely hypertrophy first to maintain cardiac output

      Explanation:

      Following a myocardial infarction scar tissue formation will take place at the site of the damaged muscle. This places increased load on the rest of the myocardium causing it to hypertrophy. The left ventricle will hypertrophy first as it is pumping blood against a greater afterload as compared to the right ventricle.

      There are three types of cells in the body with regards to the cell cycle: 1. permanent
      2. labile
      3. stable cells

      Permanent cells do not re-enter the cell cycle and remain in G0. If there is a pool of stem cells the stem cells will enter the cell cycle to form more cells. Myocardial cells are a type of permanent cell and there is no pool of stem cells in the heart muscle. The anterior wall will not hypertrophy as it is formed by the right atrium and ventricle and both of these hypertrophy after the left ventricle.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      166.1
      Seconds

  • Question 8 - A suspicious growth on the posterior tongue of a 40-year-old man was discovered...

    Correct

    • A suspicious growth on the posterior tongue of a 40-year-old man was discovered by his dentist and was immediately referred for possible oral cancer.

      The lymph from the posterior tongue will drain to which of the following nodes?

      Your Answer: Deep cervical nodes

      Explanation:

      Lymph from the medial anterior two thirds of the tongue travels to the deep cervical lymph nodes.
      Lymph from the lateral anterior tongue goes to the submandibular nodes.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      449.6
      Seconds

  • Question 9 - Which of the following states that the total pressure exerted by a mixture...

    Correct

    • Which of the following states that the total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the gases in the mixture:

      Your Answer: Dalton's law

      Explanation:

      Dalton’s law states that when two or more gases, which do not react chemically, are present in the same container, the total pressure is the sum of the partial pressures of each gas.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      15.9
      Seconds

  • Question 10 - 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: Neutrophils

      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
      9
      Seconds

  • Question 11 - Vitamin D is a group of secosteroids that play a role in calcium...

    Incorrect

    • Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.

      Which of the following actions of 1,25-dihydroxycholecalciferol is a direct action?

      Your Answer: Stimulates 1-alpha-hydroxylase activity in the kidneys

      Correct Answer: Increases renal phosphate reabsorption

      Explanation:

      The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.

      The following are the primary effects of 1,25-dihydroxycholecalciferol:

      Calcium and phosphate absorption in the small intestine is increased.
      Calcium reabsorption in the kidneys is increased.
      Increases phosphate reabsorption in the kidneys.
      Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)
      Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback)
      Thyroid hormone (parathyroid hormone) Calcium reabsorption in the tubules of the kidneys is increased, but renal phosphate reabsorption is decreased.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      616.4
      Seconds

  • Question 12 - Which of the following acts to inhibit antidiuretic hormone (ADH) release from the...

    Correct

    • Which of the following acts to inhibit antidiuretic hormone (ADH) release from the posterior pituitary:

      Your Answer: Atrial natriuretic peptide

      Explanation:

      ADH release is inhibited by low plasma osmolality, alcohol, caffeine, glucocorticoids and atrial natriuretic peptide (ANP).

      ADH release is stimulated primarily by raised plasma osmolality detected by osmoreceptors in the anterior hypothalamus. Other factors that increase ADH release include: extracellular fluid volume depletion, angiotensin II, nausea, pain, stress, exercise, emotion, hypoglycaemia.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      23.4
      Seconds

  • Question 13 - A patient with rash is examined. He has some redness of the skin...

    Incorrect

    • A patient with rash is examined. He has some redness of the skin that blanches when finger pressure is applied.

      What is the best description of this rash that you have found on examination?

      Your Answer: Petechiae

      Correct Answer: Erythema

      Explanation:

      Erythema is redness of the skin or mucous membranes caused by hyperaemia of superficial capillaries caused by skin injury, infection or inflammation. Erythema blanches when pressure is applied whereas ecchymosis, purpura and petechiae do not.

      Ecchymosis are discolouration of the skin or mucous membranes caused by extravasation of blood. They are usually red or purple in colour and measure greater than 1 cm in diameter and do not blanch on applying pressure.

      A macule is a flat, well circumscribed area of discoloured skin less than 1 cm in diameter with no changes in the thickness or texture of the skin.

      Petechiae are discolouration of the skin measuring less than 3 mm in diameter

      Purpura are discolouration of the skin measuring between 0.3 cm and 1 cm in diameter.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      26.2
      Seconds

  • Question 14 - Which of the following data types does a pain-scoring system represent? ...

    Incorrect

    • Which of the following data types does a pain-scoring system represent?

      Your Answer: Nominal

      Correct Answer: Ordinal

      Explanation:

      Pain scoring systems are processes for assessing pain and the severity of illnesses that have been scientifically designed and tested. An example of ordinal categorical data is a pain scoring system.

    • This question is part of the following fields:

      • Evidence Based Medicine
      • Statistics
      7.7
      Seconds

  • Question 15 - Regarding antihistamines, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer: Antihistamines act on H2 receptors.

      Correct Answer: Elderly patients and children are more susceptible to side effects.

      Explanation:

      Elderly patients and children are more susceptible to side effects. Antihistamines are competitive inhibitors at the H1-receptor. The newer antihistamines e.g. cetirizine cause less sedation and psychomotor impairment than the older antihistamines because they are much less lipid soluble and penetrate the blood brain barrier only to a slight extent. Antihistamines are used as a second line adjunct to adrenaline in anaphylaxis.

    • This question is part of the following fields:

      • Pharmacology
      • Respiratory
      43.8
      Seconds

  • Question 16 - A 30-year-old woman was involved in a road traffic accident and had a...

    Incorrect

    • A 30-year-old woman was involved in a road traffic accident and had a class I haemorrhage.

      Which physiological parameter is consistent with a diagnosis of class I haemorrhage?

      Your Answer: Pulse rate of 115 bpm

      Correct Answer: Increased pulse pressure

      Explanation:

      There are 4 classes of haemorrhage. Classification is based on clinical signs and physiological parameters.

      In CLASS I:Blood loss (ml) is < or = 750
      Blood loss(% blood volume) < or = 15%
      Pulse rate (bpm) is <100
      Respiratory rate is 14-20
      Urine output (ml/hr) is >30
      Pulse pressure is normal or increased
      Systolic BP is normal
      CNS/mental status patient is slightly anxious

      In CLASS II:
      Blood loss (ml) is 750 – 1500
      Blood loss(% blood volume) is 15 – 30%
      Pulse rate (bpm) is 100 – 120
      Respiratory rate is 20-30
      Urine output (ml/hr) is 20-30
      Pulse pressure is decreased
      Systolic BP is normal
      CNS/mental status patient is mildly anxious

      In CLASS III:
      Blood loss (ml) is 1500 – 2000
      Blood loss(% blood volume) is 30- 40%
      Pulse rate (bpm) is 120 – 140
      Respiratory rate is 30-40
      Urine output (ml/hr) is 5-15
      Pulse pressure is decreased
      Systolic BP is decreased
      CNS/mental status patient is anxious, confused

      In CLASS IV:
      Blood loss (ml) is >2000
      Blood loss(% blood volume) is >40%
      Pulse rate (bpm) is >140
      Respiratory rate is >40
      Urine output (ml/hr) is negligible
      Pulse pressure is decreased
      Systolic BP is decreased
      CNS/mental status patient is confused, lethargic

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      41.2
      Seconds

  • Question 17 - You are teaching a group of medical students about cardiovascular examination. You are...

    Incorrect

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

      Your Answer: Atrial systole

      Correct Answer: Isovolumetric relaxation

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      29.3
      Seconds

  • Question 18 - You examine a patient who is experiencing a worsening of his chronic heart...

    Incorrect

    • You examine a patient who is experiencing a worsening of his chronic heart failure. You discuss his care with the on-call cardiology registrar, who recommends switching him from furosemide to bumetanide at an equivalent dose. He's on 80 mg of furosemide once a day right now.

      What is the recommended dose of bumetanide?

      Your Answer: 20 mg

      Correct Answer: 2 mg

      Explanation:

      Bumetanide is 40 times more powerful than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide. This patient is currently taking 80 mg of furosemide and should be switched to a 2 mg bumetanide once daily.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      25
      Seconds

  • Question 19 - One of the following statements about acute lymphoblastic leukaemia(ALL) is true. ...

    Correct

    • One of the following statements about acute lymphoblastic leukaemia(ALL) is true.

      Your Answer: It is classified using the FAB classification

      Explanation:

      ALL affects children predominantly.

      The CNS is commonly involved in ALL.

      The Philadelphia chromosome is present in 25% of adult ALL and 5% of childhood ALL cases.

      The cure rate in children is approximately 80% in children and 50% in adults.

      ALL is classified into 3 groups using the French-American-British (FAB) classification:
      ALL-L1: small uniform cells
      ALL-L2: large varied cells
      ALL-L3: large varied cells with vacuoles.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      23.8
      Seconds

  • Question 20 - You are calculating the anion gap on a patient with an acid-base disturbance...

    Correct

    • You are calculating the anion gap on a patient with an acid-base disturbance and you find the anion gap to be low. Which of the following is the most likely cause for the low anion gap:

      Your Answer: Hypoalbuminaemia

      Explanation:

      A low anion gap is frequently caused by hypoalbuminemia. Albumin is a negatively charged protein and its loss from the serum results in the retention of other negatively charged ions such as chloride and bicarbonate. As bicarbonate and chloride anions are used to calculate the anion gap, there is a subsequent decrease in the gap. The anion gap is sometimes reduced in multiple myeloma, where there is an increase in plasma IgG (paraproteinaemia).

    • This question is part of the following fields:

      • Physiology
      • Renal
      187.8
      Seconds

  • Question 21 - In ventricular myocytes, the plateau phase of the action potential comes about through which...

    Incorrect

    • In ventricular myocytes, the plateau phase of the action potential comes about through which of the following:

      Your Answer: Closing of voltage-gated Na + channels

      Correct Answer: Opening of voltage-gated Ca 2+ channels

      Explanation:

      After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      31.1
      Seconds

  • Question 22 - A 24-year-old man goes to the emergency department with a fever, headache, and...

    Incorrect

    • A 24-year-old man goes to the emergency department with a fever, headache, and swollen parotid glands that are excruciating. You have a suspicion that it is mumps. Which of the following nerves is causing the discomfort the patient is experiencing:

      Your Answer: Zygomaticotemporal nerve

      Correct Answer: Auriculotemporal nerve

      Explanation:

      The auriculotemporal nerve is irritated by mumps, which results in significant discomfort due to inflammation and swelling of the parotid gland, as well as the stretching of its capsule. Compression caused by swallowing or chewing exacerbates pain.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      53
      Seconds

  • Question 23 - A 71-year-old woman is treated with co-amoxiclav for a chest infection but she...

    Incorrect

    • A 71-year-old woman is treated with co-amoxiclav for a chest infection but she returns 1 week later. Her chest infection has resolved but she developed a profuse, offensive smelling diarrhoea and abdominal cramps. You suspect Clostridium difficile associated diarrhoea (CDAD).

      ONE of these statements is true concerning this diagnosis.

      Your Answer: Clostridium difficile is a Gram-negative bacteria

      Correct Answer: The gold standard for the diagnosis of Clostridium difficile colitis is cytotoxin assay

      Explanation:

      Clostridium difficile, a Gram-positive, anaerobic, spore forming bacteria is present in the gut of approximately 3% of healthy adults (2012 UK HPA estimates). Following use of broad spectrum antibiotics, which alter normal gut flora, Clostridium difficile associated diarrhoea (CDAD) occurs.

      Alcohol hand gel is not effective against Clostridium Difficile spores. Hand washing with soap and water is very essential for healthcare workers who come in contact with it.

      Currently, the gold standard for the diagnosis of Clostridium difficile colitis is cytotoxin assay. Stool culture to detect Clostridium difficile is not specific for pathogenic strains, is expensive and therefore not specific for a diagnosis of CDAD

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      5.5
      Seconds

  • Question 24 - How does abciximab mediate its antiplatelet effect: ...

    Correct

    • How does abciximab mediate its antiplatelet effect:

      Your Answer: It is a GPIIb/IIIa inhibitor.

      Explanation:

      Abciximab, eptifibatide and tirofiban are GPIIb/IIIa inhibitors, inhibiting platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor and other adhesive molecules.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      38.9
      Seconds

  • Question 25 - A 7-year-old boy is brought to the emergency room with complaints of a...

    Incorrect

    • A 7-year-old boy is brought to the emergency room with complaints of a red and painful left eye. Upon physical examination, it was noted that there is the presence of conjunctival erythema. A mucopurulent discharge and crusting of the lid was also evident. A diagnosis of bacterial conjunctivitis was made.

      According to the latest NICE guidelines, which of the following should NOT be a part of the management of this patient?

      Your Answer: Give written patient information and explain red flags for an urgent review

      Correct Answer: Topical antibiotics should be prescribed routinely

      Explanation:

      The following are the NICE guidelines on the management of bacterial conjunctivitis:
      – Infective conjunctivitis is a self-limiting illness that usually settles without treatment within 1-2 weeks. If symptoms persist for longer than two weeks they should return for review.
      – Seek medical attention urgently if marked eye pain or photophobia, loss of visual acuity, or marked redness of the eye develop.
      – Remove contact lenses, if worn, until all symptoms and signs of infection have completely resolved and any treatment has been completed for 24 hours.
      – Lubricant eye drops may reduce eye discomfort; these are available over the counter, as well as on prescription.
      – Clean away infected secretions from eyelids and lashes with cotton wool soaked in water.
      – Wash hands regularly, particularly after touching the eyes.
      – Avoid sharing pillows and towels.
      – It is not necessary to exclude a child from school or childcare if they have infective conjunctivitis, as mild infectious illnesses should not interrupt school attendance. An exception would be if there is an outbreak of infective conjunctivitis, when advice should be sought from the Health Protection Agency by the school.
      – Adults who work in close contact with others, or with vulnerable patients, should avoid such contact until the discharge has settled.

    • This question is part of the following fields:

      • Microbiology
      • Specific Pathogen Groups
      9.9
      Seconds

  • Question 26 - Which of the following is NOT a typical side effect of thiopental sodium:...

    Incorrect

    • Which of the following is NOT a typical side effect of thiopental sodium:

      Your Answer: Respiratory depression

      Correct Answer: Seizures

      Explanation:

      Extravasation of thiopental during injection can lead to tissue damage. Accidental intra-arterial injection causes vasospasm and may lead to thrombosis and tissue necrosis. Other side effects include involuntary muscle movements on induction, cough and laryngospasm, arrhythmias, hypotension, headache and hypersensitivity reactions. Thiopental sodium has anticonvulsant properties and does not cause seizures.

    • This question is part of the following fields:

      • Anaesthesia
      • Pharmacology
      82.6
      Seconds

  • Question 27 - A 55-year-old female is urgently rushed into the Emergency Department as she complains...

    Incorrect

    • A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.

      She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.

      Which of the following does heparin activate?

      Your Answer: Factor IX

      Correct Answer: Antithrombin III

      Explanation:

      Heparin works by binding to and activating the enzyme inhibitor antithrombin III.

      Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.

      Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
      1. Unfractionated: widely varying polymer chain lengths
      2. Low molecular weight: Smaller polymers only

      Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.

      Heparin is used for:
      1. Prevention and treatment of venous thromboembolism
      2. Treatment of disseminated intravascular coagulation
      3. Treatment of fat embolism
      4. Priming of haemodialysis and cardiopulmonary bypass machines

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      136.4
      Seconds

  • Question 28 - A 78-year-old man develops renal impairment and hearing loss after inpatient management...

    Incorrect

    • A 78-year-old man develops renal impairment and hearing loss after inpatient management for sepsis.

      Which of these antibiotics is most likely to have been used?

      Your Answer: Trimethoprim

      Correct Answer: Gentamicin

      Explanation:

      Gentamicin, an aminoglycoside antibiotic, acts by binding to the 30S subunit of the bacterial ribosome inhibiting the binding of aminoacyl-tRNA, and thus prevents initiation of protein synthesis.

      Two of its most notable side effects are reversible nephrotoxicity(caused by the inhibition of protein synthesis in renal cells, which causes acute tubular necrosis) and hearing loss (caused by damage to the vestibular apparatus of the inner ear).

      Both side effects are dose-related and occur commonly in the elderly.

    • This question is part of the following fields:

      • Infections
      • Pharmacology
      25.3
      Seconds

  • Question 29 - Regarding Clostridium tetani, which of the following statements is CORRECT: ...

    Correct

    • Regarding Clostridium tetani, which of the following statements is CORRECT:

      Your Answer: Metronidazole is usually the antibiotic of choice for tetanus infection.

      Explanation:

      Clostridium tetani infection is predominantly derived from animal faeces and soil.  Clostridium tetani has exotoxin-mediated effects, predominantly by tetanospasmin which inhibits the release of GABA at the presynaptic membrane throughout the central and peripheral nervous system. Metronidazole has overtaken penicillin as the antibiotic of choice for treatment of tetanus (together with surgical debridement, tetanus toxoid immunisation, and human tetanus immunoglobulin).

    • This question is part of the following fields:

      • Microbiology
      • Pathogens
      22.8
      Seconds

  • Question 30 - During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was...

    Incorrect

    • During her pregnancy, a 28-year-old lady was given an antibiotic. The neonate was prematurely born with cyanosis and ashen grey coloured skin as a result of this. Other symptoms were hypotonia, low blood pressure, and poor feeding.

      From the  following antibiotics, which one is most likely to cause this side effect?

      Your Answer:

      Correct Answer: Chloramphenicol

      Explanation:

      Grey baby syndrome is a rare but causes significant adverse effect caused by the build-up of chloramphenicol in neonates (particularly preterm babies).

      The following are the main characteristics of ‘grey baby syndrome’:

      Skin that is ashy grey in colour.
      Feeding problems
      Vomiting
      Cyanosis
      Hypotension
      Hypothermia
      Hypotonia
      Collapse of the cardiovascular system
      Distension of the abdomen
      trouble breathing

    • This question is part of the following fields:

      • Infections
      • Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Fluids & Electrolytes (1/1) 100%
Pharmacology (4/7) 57%
Infections (3/3) 100%
Anatomy (2/4) 50%
Upper Limb (1/2) 50%
Basic Cellular (1/1) 100%
Physiology (5/8) 63%
Microbiology (2/4) 50%
Principles (1/1) 100%
General Pathology (1/2) 50%
Pathology (2/5) 40%
Head And Neck (1/2) 50%
Respiratory (1/1) 100%
Wound Healing (0/1) 0%
Endocrine Physiology (0/1) 0%
Endocrine (1/1) 100%
Evidence Based Medicine (0/1) 0%
Statistics (0/1) 0%
Cardiovascular Physiology (1/1) 100%
Cardiovascular (0/2) 0%
Cardiovascular Pharmacology (0/2) 0%
Haematology (1/2) 50%
Renal (1/1) 100%
Specific Pathogen Groups (1/2) 50%
Anaesthesia (0/1) 0%
Pathogens (0/1) 0%
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